Swachh Barat Mission has played a key role in reducing under-five mortality rates by four points in just a year.
The number of deaths of children under the age of five in India declined to 802,000 in 2017 from around 1 million two years ago. That means close to 200,000 lives have been saved – these are children who would have otherwise been lost to preventable and treatable diseases.
Safe drinking water, an insistence on hand-washing, food safety, and the use of toilets to stop open defecation are all factors that lower diarrhoeal deaths, which account for roughly 8% of the more than 802,000 under-five deaths in India in 2017, said a UN report released Wednesday. Poor sanitation and unsafe water cause 88% of childhood diarrhoea, which also leads to chronic malnutrition, lowered immunity and frequent and potentially fatal infections, such as pneumonia and tuberculosis.
The introduction of six new vaccines, including pneumococcal vaccine against pneumonia and rotavirus vaccine against childhood diarrhoea, in the country’s universal immunisation programme has led to fewer deaths from common childhood infections, but what has helped accelerate the sharpest fall in India’s under-five mortality rate by four points in a single year— from 43 in 2015 to 39 deaths per 1,000 live births in 2016— is Swachh Bharat Mission, which promotes cleanliness and hygiene and aims to make India open-defecation free (ODF) by 2019.
More than 85.2 million toilets have been built in rural India since the launch of Swachh Bharat Mission (Gramin) in 2014, and 459 of the country’s 718 districts have being declared open-defecation free. Now there is evidence to show improving sanitation and hygiene results in fewer illnesses and better health.
Children in districts declared ODF have fewer bouts of diarrhoea than children in non-ODF districts, found a survey across 10 districts in Karnataka, Maharashtra, Rajasthan, Uttar Pradesh and West Bengal.
More loos, less infection
One in 10 children had bouts of diarrhoea within the last two weeks preceding the survey, with the distribution of prevalence being almost the same in the boys (11.8%) and the girls (11.5%), according to the Ministry of Drinking Water and Sanitation which surveyed 4,000 households in 2017.
Children in the ODF districts across all five states were consistently healthier, with diarrhoea affecting 9.3% children in ODF states compared to 13.9% in non-ODF states during the two weeks preceding this survey. Diarrhoea prevalence was the lowest in Karnataka at 4.7%, and the highest in Madhya Pradesh, at 16.1%.
Defecating in the open is a major cause of food and water pollution, confirmed the survey. Bacteria are the most common faecal contaminant, but viruses, protozoa and parasitic worms in the stools of infected people also infect others through contaminated soil, water and food.
The study also found that 62.5% mothers in ODF districts had a healthy bodyweight (62.9%) compared to 57.5% in non-ODF areas. Infection was lower in homes with piped water in non-ODF districts, with 14.7% of cases of diarrhoea in homes that used piped water sources compared to 85.3% in homes that used “other sources” of drinking water, such as hand-pumps, boreholes, wells and springs. “Poor transport and handling of water at the household level, open drains and wastewater in the streets, uncovered garbage, improper stool disposal by mothers, not using soap to wash hands before feeding children also raises the risk of infection,” said Dr Dileep Mavlankar, director, Indian Institute of Public Health (IIPH)Gandhinagar.
The next step
Washing hands with soap and water prevents the transmission of bacteria that cause diarrhoea, show several studies, while using oral rehydration can prevent hospitalisation.
“We need strong monitoring of hygiene practices, including providing soap and water for handwashing and toilets in both aganwadi centres (playschools) and schools, to stop the cycle of infection,” said Dr Sanghita Bhattacharya, senior public health specialist, Public Health Foundation in India.
“India seems to be on track to meet its sanitation infrastructure goals,” said Bhattacharya.
“Building a campaign around sanitation by 2019, but improving coordination between the panchayat and health departments and establishing clear guidelines linked to data on sanitation and behavioural change outcomes will help ODF villages to take the next step to becoming ODF plus, which includes solid and liquid waste management, recycling, clean toilets and public spaces,” said Bhattacharya. Every dollar spent on sanitation leads to about US$ 9 in savings on treatment, health-care costs and gains from more productive days, according to the World Health Organisation, with inadequate sanitation leading to a 6.4% loss of India’s gross domestic product (GDP).
“Poverty and social exclusion are the biggest barriers to preventing infection. Along with building toilets, we need strong social and behaviour change with community involvement for sustainable use of sanitation facilities,” said Dr Mavalankar of IIPH.
“A sick and malnourished child is like a pot with holes, you can never fill it to its full potential. A child cannot reach his or her physical and mental milestones unless they are healthy in the formative years of life,” he said.