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Shared sanitation and the prevalence of diarrhea in young children: evidence from 51 countries, 2001-2011
James A Fuller1, Thomas Clasen2, Marieke Heijnen2
1Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom jafuller@umich.edu.
Insights
Shared sanitation, where multiple households use one toilet, may increase diarrhea risk in young children. Socioeconomic factors play a role, but context matters across diverse countries.
Area of Science:
- Environmental Health
- Global Public Health
- Pediatric Infectious Diseases
Background:
- Shared sanitation facilities are often classified as unimproved due to sanitation concerns.
- This classification is being re-evaluated regarding its impact on public health.
- Understanding the health implications of shared sanitation is crucial for policy development.
Purpose of the Study:
- To investigate the association between using shared toilet facilities and the prevalence of diarrhea in children under five years of age.
- To analyze this association across diverse global settings.
Main Methods:
- Utilized data from Demographic and Health Surveys across 51 countries.
- Estimated crude and adjusted prevalence ratios (PRs) for diarrhea comparing shared versus non-shared facility users.
- Pooled country-specific estimates to derive a global perspective.
Main Results:
- Pooled prevalence ratio (PR) for diarrhea was 1.09, indicating a slight increase with shared sanitation.
- Socioeconomic status differences accounted for roughly half of this increased prevalence (adjusted PR = 1.05).
- Significant heterogeneity across countries was observed, suggesting contextual importance.
Conclusions:
- Shared sanitation appears to be a risk factor for childhood diarrhea, though socioeconomic status is a significant confounding factor.
- The variability in findings across countries highlights the critical role of the social and economic context in shared sanitation's health impact.
Abstract:
Shared sanitation is defined as unimproved because of concerns that it creates unsanitary conditions; this policy is being reconsidered. We assessed whether sharing a toilet facility was associated with an increased prevalence of diarrhea among children < 5 years of age. We use data from Demographic and Health Surveys conducted in 51 countries. Crude and adjusted prevalence ratios (PRs) for diarrhea, comparing children from households that used a shared facility with children from households that used a non-shared facility, were estimated for each country and pooled across countries. Unadjusted PRs varied across countries, ranging from 2.15 to 0.65. The pooled PR was 1.09; differences in socioeconomic status explained approximately half of this increased prevalence (adjusted PR = 1.05). Shared sanitation appears to be a risk factor for diarrhea although differences in socioeconomic status are important. The heterogeneity across countries, however, suggests that the social and economic context is an important factor.
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