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. 2023 Feb 13;108(4):811-819.
doi: 10.4269/ajtmh.22-0138. Print 2023 Apr 5.

The Association between Anthropometric Failure and Toilet Types: A Cross-Sectional Study from India

Anoop Jain  1 , Helen O Pitchik  2 , Caleb Harrison  3 , Rockli Kim  4 , S V Subramanian  5   6
Affiliations

The Association between Anthropometric Failure and Toilet Types: A Cross-Sectional Study from India

Anoop Jain et al. Am J Trop Med Hyg. .

Abstract

Sustainable Development Goal 6.2 aims to end open defecation by 2030 by ensuring universal access to private household toilets. However, private toilets might not be feasible for poor households. As a result, policy makers and academics have suggested well-managed shared sanitation facilities as an alternative solution. Less is known about the associations between shared sanitation use and health. Using data from the fifth round of the National Family Health Survey from 2019 to 2021, we estimated the association between usual defecation location and child anthropometry outcomes among children under 2 years in India. The primary exposure was usual defecation location at the household level. We compared both shared improved toilet use and open defecation to private, improved toilet use. We used linear regression to estimate the associations between the exposures and linear outcomes: height-for-age Z-score, weight-for-height Z-score, and weight-for-age Z-score. We used Poisson regression with a log link to estimate the prevalence ratios of stunting, wasting, and underweight. After controlling for environmental, maternal, socioeconomic, and child confounders, we found no differences in six child anthropometry outcomes when comparing shared toilet use or open defecation to private toilet use. This finding was consistent across both urban and rural households. Our findings confirm the null associations between private toilet use and child growth found in previous studies, and that this association does not vary if the toilet is being shared. Future research should examine these differences between private and shared toilets in the context of other health outcomes.

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Figures

Figure 1.
Figure 1.
Adjusted and unadjusted prevalence ratios for binary outcomes and mean difference for continuous outcomes for the relationship between toilet-type and anthropometric outcomes. Private toilet use is the reference category for all analysis. “2 sharing”, “3/4 sharing”, and “5+ sharing” are all subgroups of the “any sharing” category and were analyzed in separate models. HAZ = height-for-age Z-score; WAZ = weight-for-age Z-score; WHZ = weight-for-height Z-score.
Figure 2.
Figure 2.
Adjusted prevalence ratios for binary outcomes and mean difference for continuous outcomes for the relationship between toilet-type and anthropometric outcomes within strata of household location (urban versus rural). Private toilet use is the reference category for all analyses. “2 sharing”, “3/4 sharing”, and “5+ sharing” are all subgroups of the “any sharing” category and were analyzed in separate models. HAZ = height-for-age Z-score; WAZ = weight-for-age Z-score; WHZ = weight-for-height Z-score.
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