Decreased Household Travel Time to Road is Associated with Household Use of Improved Sanitation Systems in the Darjeeling Hills, India

Abstract

We sought to better understand the relationship between household-to-road travel time with improved household latrines in villages in the Kalimpong Subdivision of the Darjeeling District. BACKGROUND The absence of improved sanitation facilities is the sixth leading risk factor for death in children under the age of 5 worldwide (Insitute for Health Metrics and Evaluation 2013). There is little published about the health-supporting infrastructure in the Darjeeling District while its mountainous, isolating terrain makes its 1.6 million people (Census of India 2011) vulnerable to health risks (Huddleston, Ataman and d'Ostiani 2003). METHODS This was a secondary data analysis of a cross-sectional household survey of Kalimpong Blocks I and II of the Darjeeling District of West Bengal, India. At both the household and the village level we measured the association of perceived travel time from households to a road with the presence of a household improved latrine. RESULTS After adjusting for a socioeconomic proxy, the person/room index, we found that an increase of one hour in the travel time to road results in a 21% (95% CI: 36%, 7%) increase in the odds of a household having an unimproved sanitation system. CONCLUSION In this study we found that the nearer a household is to the road, the more likely it is to have an improved toilet. This relationship remains significant when we account for crowding, a socio-economic proxy. DISCUSSION Although perceived nearness to road is associated with the increased presence of household sanitation systems, the development of roads as an isolated response to sanitation may be problematic. Due to the introduction of new risk exposures that are coupled with the development of roads it may be necessary to develop roads in conjunction with other infrastructures that support healthy behaviors.