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Year : 2019 | Volume : 7 | Issue : 3 | Page : 85 - 90  


Original Articles
Use of sanitary latrines in Rural Health Training Center area of a Medical College

Kokiwar PR 1, Sravya D2, Ramadevi D2, Dharani E2, Farheen Begum 2, Anusha G2, Sushmanjali G2, Gazala Taiseen 2, Harshitha Reddy G. 2

1Professor & HOD, Interns, Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana, India

*Corresponding Author                                                                                                                  

Email: kokiwar@gmail.com                                                                                                         

Abstract:

Background: Improvement in the sanitation is an important aspect from community point of view so that the burden of communicable diseases can be reduced. Use of sanitary latrine in a community is considered as an index for sanitation of that community.

Objective: To study use of sanitary latrines in Rural Health Training Center area of a Medical College

Methods: A community based cross sectional study was carried out in three randomly selected villages from November 2017 to January 2018 in the rural field practice area, Gummadidala under Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram. During the study period we surveyed 447 houses in these three villages. One respondent from each house was interviewed regarding the use of sanitary latrine

Results: More than half of the participants were aware about the Swacch Bharat Mission. The most common source of information on SBM was television in 65.9% of the cases. 80.5% of the household members were using sanitary latrine. The most common reason for not using sanitary latrine was lack of money in 60.9% of the cases. Among 347 households having sanitary latrine at their home and using it, 53 (15.3%) told that they were able to construct sanitary latrine due to aid from Government. 39.6% received 10,000 to 15,000 INR for construction of sanitary latrine. Factors like employment status, and type of family were not found to be associated with not using sanitary latrine. Still 43.7% among them used only water to wash hand and did not use soap. Majority (57.7%) were aware that some diseases were transmitted due to open air defecation. Only 17.4% had correct knowledge of diseases transmitted due to open air defecation among those who were found aware that open air defecation leads to some diseases.

Conclusion: More than half of the participants were aware about the Swacch Bharat Mission. 80.5% of the household members were using sanitary latrine. The most common reason for not using sanitary latrine was lack of money in 60.9%.

Key words: Sanitary latrine, indicator, health

INTRODUCTION:

Improvement in the sanitation is an important aspect from community point of view so that the burden of communicable diseases can be reduced. Use of sanitary latrine in a community is considered as an index for sanitation of that community. 1, 2 There have been many attempts on a large scale to sensitize the public in India to promote the use of sanitary latrine but the acceptance of the concept of use of sanitary latrine was meager among the Indian population. 3 Poor uses of the sanitary latrines can explain to some extent that findings from likewise programs was unable to prevent the diseases like diarrhea and worm infections which are sanitation related diseases. 4 In country like India, it is important that the use of sanitary latrine has to be addressed instead of accessibility and ownership issues of the sanitary latrine. Otherwise it is not likely that we can achieve 100% free of open defecation and other benefits that the sanitation program can give. 3

It is not easy to measure the use of the sanitary latrine at household or individual level as the revelation is different from actual practice. Direct observation method is exposed to the risk of social objections and reaction and moreover it is costly. 5 Household use of the sanitary latrine can be assessed by indicators of the latrine use and spot checks but this method fails to give data on use of the sanitary latrines. 4 Evidence is there about the reaction from society about the spot check method of use of the sanitary latrine. 6 Other available option is use of Sensor-monitored use based on passive latrine use monitors (PLUMs) or similar devices are useful in assessing the reliability of other methods. 5 But present day sensors are not practical for assessment of sanitary latrine use on large scale.

Open defecation leads to pollution of the environment and acts as an important source of infection. There is pollution of the soil, pollution of the water bodies, food contamination, flies propagation and all these factors leads to disease spreads. Diseases spread are cholera, diarrhea, typhoid, worm infections, viral hepatitis, various intestinal infections, dysentery etc. 7

Majority of India population are rural. Hence their health reflects health of India. 60% of population in India does not have access to latrines in India. They are forced to go for open defecation. Thus India is number one country in the practice of open defecation followed by Indonesia. 8

There are 2.4 lakh gram panchayats in India, out of which only 29000 are open defecation free. In 1980s the coverage of sanitation in rural areas in India was only 1%. Central rural sanitation program was launched in 1986 and as a result this coverage went up to 4% in 1988 and then in 2001 rose to 22%. In 1999 it was modified as total sanitation campaign. 540 districts were covered under it. It has been expected that 35% of the population will be covered by the end of the 10th plan. 9

The society practice of hygiene is directly linked with social members practice of hygiene. The society values affect its members practices related to hygiene. 10

Present study was carried out to study the use of sanitary latrines in Rural Health Training Center area of a Medical College 

METHODS: 

A community based cross sectional study was carried out in three randomly selected villages from November 2017 to January 2018 in the rural field practice area, Gummadidala under Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram. During the study period we surveyed 447 houses in these three villages. One respondent from each house was interviewed regarding the use of sanitary latrine.

A house to house survey was carried out among randomly selected houses. There are a total of 12 villages in our field practice area. Out of these 12 villages, three villages were randomly selected. In each selected villages, a house to house survey was carried out. During visits to the house, one respondent who can understand and answer the questions was selected and was interviewed. 118 houses from Anantharam village, 130 houses from Mambapur and 199 houses from Veera Reddy Palli village could be covered. Thus a total of 447 houses were covered during the study period.

The respondent details like age, sex, type of family and employment status were enquired. Additional questions like awareness of Swacch Bharat and source of information regarding Swacch Bharat was asked. Then questions related to the use of sanitary latrine, Place where sanitary latrine was used, Reasons for not using the sanitary, any funds received for construction of the sanitary latrine and the Amount of funds received was asked. They were also interviewed regarding Hand washing practices, Awareness about diseases transmitted and correct knowledge of diseases transmitted among those who were aware about the diseases transmitted due to open air defecation was also enquired.

Data was analyzed using proportions. 

RESULTS: 

Table 1: Age and sex wise distribution of study participants 

Age group (years)

Male

Female

Total

Number

%

Number

%

Number

%

17-25

15

21.7

54

78.3

69

15.4

26-35

50

42.4

68

57.6

118

26.4

36-45

62

58.5

44

41.5

106

23.7

46-55

35

60.3

23

39.7

58

13.0

> 55

46

47.9

50

52.1

96

21.5

Total

208

46.5

239

53.4

447

100

Females were more than males. This may be due to the more presence of females at home during the survey time. Of the total five age groups except for 36-45 years and 46-55 years female participants were more than male participants. 

Table 2: Village wise distribution of study participants 

Village

Number

Percentage

Anantharam

118

26.4

Mambapur

130

29.1

Veera Reddy Palli

199

44.5

Total

447

100

 

Maximum participants were from Veera Reddy Palli village constituting 44.5% of the total sample followed by participants from Mambapur village. 

Table 3: Awareness of Swacch Bharat Mission among participants 

Awareness of Swacch Bharat Mission

Number

Percentage

Yes

261

58.4

No

186

41.6

Total

447

100

More than half of the participants were aware about the Swacch Bharat Mission. 

Table 4: Source of information on SBM (n = 261) 

Source of information

Number

Percentage

Television

172

65.9

Newspaper

53

20.3

TV and newspaper

06

2.3

Friends

28

10.7

Other

02

0.8

Total

261

100

 

The most common source of information on SBM was television in 65.9% of the cases followed by newspaper in 65.3%. Overall television and newspaper contributed to 88.5% in spreading awareness regarding SBM. 

Table 5: Use of sanitary latrine in the study population households 

Use of sanitary latrine

Number

Percentage

Yes

360

80.5

No

087

19.5

Total

447

100

 

Above table depicts that 80.5% of the household members were using sanitary latrine. But still almost one fifth i.e. 19.5% were not using the sanitary latrine. 

Table 6: Village wise use of sanitary latrine 

Village

Use of sanitary latrine

Yes

No

Total

Number

%

Number

%

Number

%

Anantharam

114

96.6

04

3.4

118

26.4

Mambapur

91

70

39

30

130

29.1

Veera Reddy Palli

155

77.9

44

20.1

199

44.5

Highest prevalence of not using the sanitary latrine was in Mambapur village where almost one third houses had no sanitary latrines and they were not using it. In Veera Reddy Palli village almost one fifth of the household members were not using the sanitary latrines. 

Table 7: Place where sanitary latrine was used (N = 360) 

Place

Number

Percentage

Latrine present at home

347

96.4

Community latrine

013

3.6

Total

360

100

Majority users of sanitary latrine were using it at their own home. Only 3.6% of the sanitary latrine users were using it at community latrine. 

Table 8: Reasons for not using the sanitary latrines (N = 87) 

Reasons

Number

Percentage

Lack of money

53

60.9

Lack of space in or around house

21

24.1

Lack of water supply

02

2.3

Lack of money and space

01

1.1

Lack of interest

09

10.3

No response

01

1.1

Total

87

100

 

The most common reason was lack of money in 60.9% of the cases followed by lack of space in 24.1% of the cases. Two houses had problem of water supply. Around 10% had no interest in using sanitary latrines. They preferred open fields. 

Table 9: Distribution as per funds received for construction of sanitary latrine from Government among those having sanitary latrine at home (N = 347) 

Received funds

Number

Percentage

Yes

53

15.3

No

294

84.7

Total

347

100

Among 347 households having sanitary latrine at their home and using it, 53 (15.3%) told that they were able to construct sanitary latrine due to aid from Government others had it on their own. 

Table 10: Amount of funds received for construction of sanitary latrines (N = 53) 

Amount of funds

Number

Percentage

< 1000

03

5.7

1000-3000

19

35.8

4000-9000

06

11.3

10,000-15,000

21

39.6

Material for construction

02

3.8

Rice bag

02

3.8

Total

53

100

39.6% received 10,000 to 15,000 INR for construction of sanitary latrine. Two households received material for construction. But almost 50% did not receive proper benefit as given by Government. 

Table 11: Variables playing role in the use of sanitary latrine 

Variables

Sub group

Use of sanitary latrine

Chi square

 P value

No

Yes

Sex

Male

38

170

0.2256

0.3174

Female

49

190

Employment status

Unemployed

36

134

2.085

0.0744

Employed

51

226

Type of family

Nuclear

63

231

1.766

0.09203

Joint

24

129

Factors like employment status, and type of family were not found to be associated with not using sanitary latrine. 

Table 12: Hand washing practice after defecation and before meals and the method used for hand washing 

Hand washing

Method used for hand washing

Soap and water

Only water

Total

Number

%

Number

%

Number

%

Yes

251

56.3

195

43.7

446

99.8

No

-

-

-

-

001

01.2

Total

251

56.2

195

43.8

447

100

Except one almost everyone told that they washed their hand before taking meals and after defecation. But still 43.7% among them used only water to wash hand and did not use soap. 

Table 13: Awareness about diseases transmitted due to open air defecation 

Awareness

Number

Percentage

Yes

258

57.7

No

189

42.3

Total

447

100

Majority (57.7%) were aware that some diseases were transmitted due to open air defecation. But still more than 40% had no idea that open air defecation can put them to the risk of certain diseases. 

Table 14: Correct knowledge of diseases transmitted among those who were aware about the diseases transmitted due to open air defecation (N = 258) 

Correct knowledge of list of diseases transmitted

Number

Percentage

Yes

45

17.4

No

213

82.6

Total

258

100

Only 17.4% had correct knowledge of diseases transmitted due to open air defecation among those who were found aware that open air defecation leads to some diseases. Only these 17.4% were able to name few diseases like cholera, diarrhea, dysentery etc. But majority 82.6% could not name any correct disease even though they had idea that open air defecation can lead some diseases. Most of them named diseases like malaria, dengue etc. 

Table 15: Correct knowledge of mode of transmission of diseases among those who were aware about the diseases transmitted due to open air defecation (N = 258) 

Correct knowledge of mode of transmission of diseases

Number

Percentage

Yes

169

65.5

No

089

34.5

Total

258

100

Majority i.e. 65.5% had correct knowledge of mode of transmission of diseases. 

DISCUSSION: 

Females were more than males. This may be due to the more presence of females at home during the survey time. Of the total five age groups except for 36-45 years and 46-55 years female participants were more than male participants.

Maximum participants were from Veera Reddy Palli village constituting 44.5% of the total sample followed by participants from Mambapur village. More than half of the participants were aware about the Swacch Bharat Mission. The most common source of information on SBM was television in 65.9% of the cases followed by newspaper in 65.3%. Overall television and newspaper contributed to 88.5% in spreading awareness regarding SBM.

80.5% of the household members were using sanitary latrine. But still almost one fifth i.e. 19.5% were not using the sanitary latrine. Highest prevalence of not using the sanitary latrine was in Mambapur village where almost village almost one fifth of the household members was not using the sanitary latrines. One third houses had no sanitary latrines and they were not using it. In Veera Reddy Palli Majority users of sanitary latrine were using it at their own home. Only 3.6% of the sanitary latrine users were using it at community latrine. The most common reason was lack of money in 60.9% of the cases followed by lack of space in 24.1% of the cases. Two houses had problem of water supply. Around 10% had no interest in using sanitary latrines. They preferred open fields. Among 347 households having sanitary latrine at their home and using it, 53 (15.3%) told that they were able to construct sanitary latrine due to aid from Government Others had it on their own.

39.6% received 10,000 to 15,000 INR for construction of sanitary latrine. Two households received material for construction. But almost 50% did not receive proper benefit as given by Government. Factors like employment status, and type of family were not found to be associated with not using sanitary latrine.

Except one almost everyone told that they washed their hand before taking meals and after defecation. But still 43.7% among them used only water to wash hand and did not use soap. Majority (57.7%) were aware that some diseases were transmitted due to open air defecation. But still more than 40% had no idea that open air defecation can put them to the risk of certain diseases.

Only 17.4% had correct knowledge of diseases transmitted due to open air defecation among those who were found aware that open air defecation leads to some diseases. Only these 17.4% were able to name few diseases like cholera, diarrhea, dysentery etc. But majority 82.6% could not name any correct disease even though they had idea that open air defecation can lead some diseases. Most of them named diseases like malaria, dengue etc. Majority i.e. 65.5% had correct knowledge of mode of transmission of diseases.

Sinha A et al 11 carried out a study in 292 houses of the 25 villages in rural areas of Odisha. They compared the reported use with PLUM recorded daily average. They found that the average reported use was twice as compared to the PLUM recorded daily average.

Veerapu N et al 12 carried out intervention using health education for two years in rural areas of Andhra Pradesh. They found that the level of KAP increased significantly after intervention. Thus they concluded that health education can play a major role in KAP.

Diganth DC et al 13 studied 200 individuals. 59.5% of them had sanitary latrine present at their home. Among these people who had sanitary latrine present at their homes, the use of the sanitary latrine was found out to be 77.3%. Lack of space was the important and leading reason of not having the sanitary latrine at home. It was found that awareness related to Swachh Bharat Abhiyan campaign was 66%. Presence of sanitary latrine was significantly associated with factors like literacy, use of the footwear, social class.

Anuradha R et al 14 surveyed 1175 houses in rural area of Tamil Nadu. Out of these 275 were selected randomly. They found that the use of sanitary latrine was present in 62.5% of the cases and the use of community latrine was seen in 4.3% of the cases. 33.1% of the people were defecating openly and it was significantly associated with low standard of living. 

CONCLUSION: 

More than half of the participants were aware about the Swacch Bharat Mission. 80.5% of the household members were using sanitary latrine. The most common reason for not using sanitary latrine was lack of money in 60.9% of the cases followed by lack of space in 24.1% of the cases. Factors like employment status, and type of family were not found to be associated with not using sanitary latrine. Only 17.4% had correct knowledge of diseases transmitted due to open air defecation among those who were found aware that open air defecation leads to some diseases. Only these 17.4% were able to name few diseases like cholera, diarrhea, dysentery etc. But majority 82.6% could not name any correct disease even though they had idea that open air defecation can lead some diseases. Most of them named diseases like malaria, dengue etc. Majority i.e. 65.5% had correct knowledge of mode of transmission of diseases. 

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