In the research article “Decomposing Rural-Urban Gap in Unsafe Disposal Practice of Child Stool in India”, authors Avijit Roy, Margubur Rahaman, and Pradip Chouhan delve into the significant disparity between rural and urban India in terms of unsafe child stool disposal practices. Utilizing data from the National Family Health Survey (NFHS-5, 2019–21), the study scrutinizes the prevalence and predictors of these unsafe practices, with a focus on the contributing factors to this rural-urban divide.
The research reveals a 22.3 percentage point gap in unsafe disposal practices between rural and urban areas, with a more pronounced disparity among the Scheduled Tribes. The gap is particularly wide in states like Madhya Pradesh, Telangana, Gujarat, and Rajasthan. Key predictors such as mother’s education, mass media exposure, household wealth, and sanitation facilities are significant across both rural and urban areas. However, factors like religion, social group, and water facility on household premises are significant only in rural areas.
The study attributes 67% of the explained gap to the rural-urban difference in household wealth. Other significant contributors include household sanitation facility, mother’s education level, and water facility on household premises. The findings highlight the urgent need for targeted policy interventions, particularly in states with a high prevalence of unsafe disposal practices, to bridge this rural-urban gap.
Here is the summary of the research:
Rural-Urban Disparity in Unsafe Child Stool Disposal Practices in India: NFHS-5 Data Analysis
1. Research Aim and Context:
– The study aims to address the rural-urban disparity in unsafe child stool disposal, using data from NFHS-5, 2019-21.
– Existing research falls short in identifying the contributing factors to this gap.
2. Prevalence of Unsafe Disposal Practices:
– The rural-urban gap in unsafe child stool disposal practices among the study participants was 22.3 percentage points, with a more pronounced gap among the Scheduled Tribes (ST).
– The prevalence of unsafe child stool disposal practices was particularly wide in Madhya Pradesh, Telangana, Gujarat, and Rajasthan.
3. Predictors of Unsafe Disposal Practices:
– Predictors such as mother’s education, mass media exposure, household wealth quintile, and sanitation facilities proved significant irrespective of residence.
– Religion, social group, and water facility on household premises emerged as significant factors in rural areas only.
4. Factors Contributing to the Gap:
– 67% of the explained gap in unsafe child stool disposal practices was attributed to the rural-urban difference in household wealth.
– Other contributors were ‘household sanitation facility’ (21.3%), ‘mother’s education level’ (3.9%), and ‘water facility on household premises’ (3.9%).
5. Implications for Interventions:
– The findings underscore the need for population and area-specific policy interventions, especially for individuals from socio-economically disadvantaged backgrounds and those with lower education levels.
– Such interventions are crucial to mitigating the existing rural-urban gap in unsafe child stool disposal practices.
6. Public Health Concern:
– Despite 61% of households in India using improved toilet facilities, only 36% followed safe disposal practices for their child’s stool.
– The prevalence of unsafe disposal practices for child stool remains high in India, with a recent temporal stagnation at 64% from 2015-16 to 2019-21.
7. Impact on Children’s Health:
– Unsafe disposal of child stool is positively linked with multiple health risks, particularly among children.
– The likelihood of diarrhea was 11% higher among children whose feces were disposed of unsafely compared to those whose feces were disposed of safely in India.
8. Importance of Research Investigation:
– The study aims to contextualize the predictors of unsafe disposal practice of child stool in India, with a focus on rural-urban differences.
– The present study aims to inform the development of targeted, group-based policies and programs to promote the safe disposal of children’s feces and minimize the negative impact of unsafe disposal practices.
9. Sampling Process:
– In NFHS-5, a sample of Census Enumeration Blocks (CEBs) was selected as PSUs based on the scheduled castes and scheduled tribes (SC/ST) population.
– A fixed number of 22 households per cluster were selected with an equal probability of systematic selection from a newly created list of households.
10. Household Selection:
– From the household listing, a systematic random sample of households was selected.
– Within each selected household, specific individuals were identified for various interviews.
11. Survey Instruments:
– NFHS-5 utilizes four survey instruments to encompass a range of health and well-being concerns.
– These instruments comprise various questionnaires linked to general households, male health, female health, along with clinical, anthropometric, and biomedical (CAB) assessments.
12. Participant Interviews:
– A total of 636,699 occupied households were successfully interviewed with a 98% response rate.
– A total of 724,115 eligible women between the ages of 15 and 49 were identified in the interviewed households.
13. Outcome Variable:
– The outcome variable was disposal practice of children’s stools.
– Safe disposal practices involve using a toilet or latrine, placing or rinsing fecal matter in a toilet or latrine, or burying it.
14. Explanatory Variables:
– A set of explanatory variables was selected, including respondent’s age, education level, religion, social group, place of residence, household wealth quintile, and more.
– A bivariate analysis was used to present the prevalence of unsafe disposal practice of children’s stools by selected explanatory variables.
15. Statistical Methods:
– Descriptive statistics and a bivariate analysis were used to analyze the data.
– Multilevel logistic regression analysis was performed to identify the significant predictors of unsafe disposal practice of child stool and geographical variation.
16. Rural-Urban Disparities:
– The rural-urban gap in the prevalence of unsafe disposal of child stool was 22.3 percentage points at the national level.
– The gap varied across different demographic and socioeconomic backgrounds.
17. Rural-Urban Gap in Unsafe Disposal Practices of Child Stool:
– The rural-urban gap in the unsafe disposal practice of child stool was higher among the Hindus (23.9 pp), followed by the Muslims (18.1 pp). ST individuals had a considerably higher unsafe disposal practice of child stool, indicating a higher rural-urban gap (28.5 pp).
– The prevalence of unsafe disposal practice of child stool was more than double in households with the poorest wealth quintile than in the richest counterparts, irrespective of the place of residence.
18. Variation Across Household Wealth Quintiles:
– The rural-urban gap in the unsafe disposal practice of child stool varied across the household wealth quintiles (range: 3.0 pp to 7.1 pp). The prevalence of unsafe disposal practice of child stool was more than double in households with the poorest wealth quintile than in the richest counterparts, irrespective of the place of residence.
19. Factors Contributing to Rural-Urban Gap:
– Household wealth quintile, household sanitation facilities, water availability on household premises, and women’s education were identified as pivotal contributors to the rural-urban gap in unsafe disposal practices of child stool.
20. State-Level Variation:
– The rural-urban gap in unsafe disposal practice of child stool varied substantially across states, with the highest gaps observed in Madhya Pradesh (33.9 pp), Telangana (27.5 pp), Gujarat (26.1 pp), and Rajasthan (25.8 pp). Conversely, Kerala, Mizoram, and Sikkim had less prominent rural-urban gaps.
21. Predictors of Unsafe Disposal Practices of Child Stool:
– Mother’s education, household wealth quintile, mass media exposure, sanitation, and region were identified as significant predictors of unsafe disposal practices of child stool in both rural and urban areas.
22. Impact of Mother’s Education and Household Wealth Quintile:
– Increasing levels of mother’s education and household wealth quintile were associated with a decreased probability of unsafe disposal practice of child stool.
23. Regional Variance in Predictors:
– A significant variation in adjusted odds in unsafe disposal practice of child stool was observed across religious and social groups in rural areas only. In particular, the mothers belonged to other and Muslim religious communities had lower odds of unsafe disposal practice of child stool, while ST and scheduled caste exhibited higher odds.
24. Findings from Decomposition Analysis:
– The rural-urban gap in unsafe disposal practice of child stool was about 21 percentage points, explaining 80% of the overall difference.
25. Rural-Urban Disparities in Child Stool Disposal:
– Notable rural-urban gap exists in child stool disposal across Indian states. Variations observed in prevalence among different regions.
– Household factors like wealth quintile, sanitation, and water facilities influence safe disposal practices.
26. Household-Level Factors and Child Stool Disposal:
– Household wealth and improved sanitation align with safer child stool disposal practices in India.
– Lack of water facilities leads to unsafe disposal, specially in rural settings.
27. Individual-Level Factors and Safe Disposal Practices:
– Mother’s education and media exposure enhance awareness on safe disposal of child stool.
– Teenage mothers in rural areas show higher prevalence of unsafe disposal practices.
28. Religious and Social Affiliations Impact Child Stool Disposal:
– Hindu religious group in rural areas associated with higher likelihood of unsafe disposal.
– Higher incidence of unsafe disposal among SC and ST communities in rural settings.
29. Study Strengths and Limitations:
– Utilized nationally representative NFHS data to minimize sampling errors.
– Challenges in establishing causal relationships due to cross-sectional nature of study.
30. Implications and Recommendations:
– Policies targeting household-level factors can reduce unsafe disposal practices in rural areas.
– Maternal education and state-level interventions pivotal in promoting safe child stool disposal.
31. State-Level Disparities and Policy Implications:
– State-wise analysis crucial for understanding factors influencing rural-urban gaps.
– Targeted strategies required for states like Madhya Pradesh and Rajasthan with wider disparities.
32. Significance of Holistic Policies:
– Need for comprehensive policies addressing rural-urban gap in child stool disposal practices.
– Consideration of household, individual, and societal influences for effective interventions.
33. Disposal of children’s feces and its association with childhood diarrhea in India:
– Research study on disposal of children’s feces and its association with childhood diarrhea in India.
– Association between unhealthy sanitary practices and child health in India.
34. The effect of young children’s faeces disposal practices on child growth:
– Evidence from 34 countries about the effect of young children’s faeces disposal practices on child growth.
– Implications of exposure to fecal bacteria on hygiene behaviors and geophagy among infants and young children.
35. Water, sanitation, hygiene and enteric infections in children:
– Relationship between water, sanitation, hygiene and enteric infections in children.
– Study on unsafe disposal of feces of children< 3 years among households with latrine access in rural Bangladesh and its association with household characteristics, fly presence, and child diarrhea.
36. Children’s behavior and physiology and how it affects exposure to environmental contaminants:
– Investigation of children’s behavior and physiology and its effects on exposure to environmental contaminants.
– Current scenario and future perspectives of diarrheal diseases among children in India.
37. Excreta disposal behavior and latrine ownership in relation to the risk of childhood diarrhoea in Sri Lanka:
– Study on excreta disposal behavior and latrine ownership in relation to the risk of childhood diarrhoea in Sri Lanka.
– Factors associated with diarrhea among children less than 5 years old in Thailand.
38. Unsafe child feces disposal is associated with environmental enteropathy and impaired growth:
– Association of unsafe child feces disposal with environmental enteropathy and impaired growth.
– Analysis of pooled data from four demographic and health surveys on unsafe child feces disposal status in Ethiopia.
39. Data Analysis Using Regression and Multilevel/Hierarchical Models:
– Study utilizing regression and multilevel/hierarchical models for data analysis.
– Multilevel analysis of individual and contextual factors associated with the practice of safe disposal of child feces in sub-Saharan Africa.
40. Addressing path dependence and incorporating sample weights in the nonlinear Blinder-Oaxaca decomposition technique for logit, probit and other nonlinear models:
– Research addressing path dependence and incorporating sample weights in the nonlinear Blinder-Oaxaca decomposition technique.
– Spatial regression and Fairlie decomposition model applied to unveil the spatial divide in open defecation practices across India.
41. Regional Disparities in Education and Health in India:
– Ghosh, M.’s article explores regional disparities in education, health, and human development in India. It provides valuable insights into the factors influencing these disparities.
42. Socio-Cultural and Behavioral Factors Affecting Latrine Adoption in Rural Coastal Odisha:
– Routray, P., Schmidt, W. P., Boisson, S., Clasen, T. & Jenkins, M. W.’s study delves into the socio-cultural and behavioral factors influencing latrine adoption in rural coastal Odisha. The article highlights the constraints in latrine adoption through qualitative analysis.
43. Unhygienic Stool-Disposal Practices Among Mothers of Children Under Five in Cambodia:
– Vong, P., Banchonhattakit, P., Sim, S., Pall, C. & Dewey, R. S.’s study sheds light on the unhygienic stool-disposal practices among mothers of children under five in Cambodia. It presents evidence from a demographic and health survey, emphasizing the need for improved sanitation practices.
44. Factors Associated with Safe Child Feces Disposal in Ethiopia, India, and Zambia:
– Beardsley, R. et al.’s research focuses on identifying factors associated with safe child feces disposal in Ethiopia, India, and Zambia. The study provides valuable insights for promoting better feces disposal practices.
45. Effectiveness of Safe Child Faeces Disposal Interventions:
– Morita, T., Godfrey, S. & George, C. M.’s systematic review examines the effectiveness of safe child feces disposal interventions. The research contributes to understanding and promoting improved sanitary practices.
46. Child Defecation and Feces Disposal Practices in Rural Odisha, India:
– Bauza, V., Reese, H., Routray, P. & Clasen, T.’s study investigates child defecation and feces disposal practices in households following a combined household-level water and sanitation intervention in rural Odisha, India.
47. Maternal Education and Child Health Outcomes in India:
– Vikram, K. & Vanneman, R.’s article highlights the multidimensionality of child health outcomes in India and the impact of maternal education on these outcomes.
48. Educational Inequality of Mothers and Acute Malnutrition in Under-Five Children in Jammu and Kashmir:
– Tariq, I., Khan, J. I. & Malik, M. A.’s study discusses the educational inequality of mothers and its association with acute malnutrition in under-five children in Jammu and Kashmir. It provides critical insights into addressing malnutrition disparities.
49. Factors contributing to disease risk:
– The study explores the various factors that contribute to disease risk.
– It provides insights into new potential risk factors for certain diseases.
NSH Digi Desk