Association between water, sanitation and hygiene practices and diarrhea among under 3-year-old children: evidence from a nationally representative sample in India (2019–2021)

Abstract

Globally, 1.7 billion cases of childhood diarrheal disease occur every year. The Government of India initiated the Intensive Diarrhea Control Fortnight (IDCF) program in 2015 aimed to reduce childhood diarrheal deaths to zero. We aimed to ascertain the association between WASH practices and the prevalence of diarrhea in India's children under three years of age. We analyzed the data from the NFHS-5 survey conducted between 2019 and 2021. We extracted data on household and individual levels. The association between WASH practice in the household and diarrheal episodes in children <3 years old were presented by unadjusted and adjusted prevalence ratio (PR) with a 95% confidence interval (CI). We used STATA v 16 for analysis. We included 132,198 children, 8.4% (n = 11,060) had diarrhea in the 2 weeks preceding the survey. The majority of the children were residing in rural areas (79.8%) and using unprotected water (90%) sources. The diarrhea was associated with using shared toilet facilities (adj. PR: 1.28, 95% CI: 1.17, 1.34), improper disposal of child's stools (adj. PR: 1.12, 95% CI: 1.05, 1.20) and having no separate kitchen (adj. PR: 1.16, 95% CI: 1.08, 1.23). Household WASH practices continue to be independent predictors of diarrhea among <3 children.