The report, “ >Increased toilet coverage has little health impact: study ” (Nov.10), needs a critical look so that the public is not misled. The study, done in Puri district of Odisha by Dr. Thomas Clasen and a team from Emory University in the U.S., is not without loopholes. The findings could have far-reaching implications and place a big question mark on the utility of the government spending huge funds on its ‘Total Sanitation Campaign’. Toilet coverage supposedly does not have any impact on the incidence of diarrhoea among children, parasitic infections, child stunting or child mortality.
A positive health impact is not the only justification for constructing toilets. Let us examine the strength of this scientific exercise, for which we need to understand the epidemiology or multifactorial causation of diarrhoea. Basically, there is a successful faeco-oral transmission of pathogens causing diarrhoea from an infected child to a susceptible child. The food and fluids we take often get contaminated by faecal matter. Lack of toilets, indiscriminate open-air defecation and absence of hygiene, especially poor hand washing practices, are responsible for this. Childhood diarrhoea can also result from measles infection and Vitamin A deficiency. Even if the coverage of households with toilets is high, poor hand hygiene practices and levels of personal and food hygiene can lead to high incidence of diarrhoea. When there is a multifactorial causation of diarrhoea, the study should have looked at all these. Just studying the coverage of toilet provision and arriving at misleading conclusions is unscientific.
Similarly, even among children with diarrhoea, the efficiency of the management of dehydration and electrolyte imbalance has a direct relationship with mortality rather than the presence or absence of a toilet at home. It is surprising that a study with methodological flaws was published in The Lancet .
Antony K.R.,
Kochi
