What Drives Open-air Defecation and How Widespread Is It? A Mixed Methods Study from a Tribal Predominant Block of...

Sustainable Development Goals (SDG) calls for the elimination of open-air defecation (OAD) by 2030. Despite of many interventions including the recent Swachh Bharat Mission of India, its prevalence is high. Hence, this study was planned to estimate the burden and factors involved in practice of OAD and to explore the perception of people about it.

Explanatory sequential mixed methods design was adopted. (Quan: Community-based cross-sectional survey; qual: Focus Group Discussion (FGD)). Randomly selected adults of any gender residing in the study villages participated. A structured questionnaire was used for the survey, and those who practiced OAD were purposively selected for FGD. Adjusted odds ratio was calculated and reported with its 95% confidence interval. Analysis was done in SPSS software.

A total of 171 adults participated; of them, 56.7% were of the age group of 30-59 years; 69.6% were females. The prevalence of OAD was 58.5% (95% CI: 50.7-65.9). Multivariate binary logistic regression analysis showed that participants who either were illiterate or completed up to primary school, who lived in kutcha house and semi-pucca house, had 15.3 times (95% CI: 1.4-161), 9 (95% CI: 1.5-10.2) and 6.3 (95% CI: 1.8-22.2), higher odds of practicing OAD, respectively. The manual content analysis of the transcript resulted in emergence of two themes, namely, hindering and facilitating factors for OAD.

The prevalence of OAD was higher among the tribal predominant study population. Those who had lower education status and living in kutcha house were at higher risk. Interventions addressing the identified factors remain essential to achieve SDG.