This piece in yesterday's Hindu is also quite interesting in the context of the Total Sanitation Campaign:

www.thehindu.com/news/national/costly-sa...t/article6479587.ece

According to the piece, 40 times the cost of the Mars mission have been spent on TSC but with low levels of uptake. Kamal Kar is quoted as saying:

Indian government should stop counting the latrines it builds and start counting the reduction in hospital visits. “States with the worst outcomes spending the most money is unacceptable.”

In the context of the Lancet study, this is quite an interesting thing to say. Is there evidence to suggest that latrines built as part of a Community Led Total Sanitation initiative have better health outcomes than latrines built by the government? I don't think so.

I thought others might be interested in the following Lancet study, published today.

The title is: Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial

Findings

We randomly assigned 50 villages to the intervention group and 50 villages to the control group. There were 4586 households (24 969 individuals) in intervention villages and 4894 households (25 982 individuals) in control villages. The intervention increased mean village-level latrine coverage from 9% of households to 63%, compared with an increase from 8% to 12% in control villages. Health surveillance data were obtained from 1437 households with children younger than 5 years in the intervention group (1919 children younger than 5 years), and from 1465 households (1916 children younger than 5 years) in the control group. 7-day prevalence of reported diarrhoea in children younger than 5 years was 8·8% in the intervention group and 9·1% in the control group (period prevalence ratio 0·97, 95% CI 0·83—1·12). 162 participants died in the intervention group (11 children younger than 5 years) and 151 died in the control group (13 children younger than 5 years).

Interpretation
Increased latrine coverage is generally believed to be effective for reducing exposure to faecal pathogens and preventing disease; however, our results show that this outcome cannot be assumed. As efforts to improve sanitation are being undertaken worldwide, approaches should not only meet international coverage targets, but should also be implemented in a way that achieves uptake, reduces exposure, and delivers genuine health gains.

The paper, which is open-access, is available here: www.thelancet.com/journals/langlo/articl...4%2970307-9/abstract

The work was funded by the Gates Foundation.

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Note by moderator:

Authors of the study:

Prof Thomas Clasen, PhDcorrespondenceemail, Sophie Boisson, PhD, Parimita Routray, PhD, Belen Torondel, PhD, Melissa Bell, MSc, Oliver Cumming, PhD, Jeroen Ensink, PhD, Matthew Freeman, PhD, Marion Jenkins, PhD, Mitsunori Odagiri, MSc, Subhajyoti Ray, PhD, Antara Sinha, MSc, Mrutyunjay Suar, PhD, Wolf-Peter Schmidt, PhD

The project (grant) is also included here in the project database with links to further documents:
www.susana.org/en/resources/projects?sea...n+Orissa%2C+India%09