Water, Sanitation and Hygiene (WaSH) practices and morbidity status in rural community: Findings from a cross-sectional study in Odisha, India


WaSH practice
Rural area
Acute illness
Chronic illness



Global evidences indicate an association between improper WaSH practice and poor health outcomes. In rural area this practice is predominantly compromised due to inadequate access to safe drinking water, knowledge gaps and unhygienic socio-behavioural practices. Improper WaSH practice leads to increased vulnerability of various infections, thereby posing a challenge to health system.


A community based cross-sectional study was conducted among 879 participants of two villages in Tigiria block, Cuttack district, Odisha, India. Information pertaining to socio-demography, WaSH practices and self-reported morbidities were captured and analysed using SPSS v 25.0. Bi-variate analysis was done to assess the association between WaSH practices and any acute illnesses. Differences were considered statistically significant if p value was less than 0.05.


Tube well was the main source of drinking water (49.3%) followed by dug well (46.6%). Only 7.1% of participants reported to purify drinking water and around 40% were still practicing open defecation. The prevalence of acute and chronic illnesses was 9.2% and 19.1% respectively. Major acute illnesses were respiratory diseases, diarrhoeal disorders and musculoskeletal problems, while major chronic illnesses were gastro intestinal problems, musculoskeletal problems and hypertension. After adjusting for age, gender and education, a significant odds ratio of 3.79 [CI = (1.23-11.70), p<0.05] was observed between drinking water source (surface water Vs tube well water) for acute illnesses.

Conclusions: Poor WaSH practices among rural people make them vulnerable to acute and chronic morbidities. Health awareness and socio behavioural change pertaining to WaSH practices needs utmost priority to ensure better health.



[1] R. Vishwanath, A. P. Selvabai, and P. Shanmugam, “Detection of bacterial pathogens in the hands of rural school children across different age groups and emphasizing the importance of hand wash,” J. Prev. Med. Hyg., vol. 60, no. 2, pp. E103–E108, Jun. 2019, doi: 10.15167/2421-4248/jpmh2019.60.2.1186.
[2] M. E. Stocks, S. Ogden, D. Haddad, D. G. Addiss, C. McGuire, and M. C. Freeman, “Effect of water, sanitation, and hygiene on the prevention of trachoma: a systematic review and meta-analysis,” PLoS Med., vol. 11, no. 2, p. e1001605, Feb. 2014, doi: 10.1371/journal.pmed.1001605.
[3] D. Berendes et al., “Household sanitation is associated with lower risk of bacterial and protozoal enteric infections, but not viral infections and diarrhoea, in a cohort study in a low-income urban neighbourhood in Vellore, India,” Trop. Med. Int. Health TM IH, vol. 22, no. 9, pp. 1119–1129, 2017, doi: 10.1111/tmi.12915.
[4] S. Pati, S. S. Kadam, and A. S. Chauhan, “Hand hygiene behavior among urban slum children and their care takers in Odisha, India,” J. Prev. Med. Hyg., vol. 55, no. 2, pp. 65–68, Jun. 2014.
[5] F. A. Nizame et al., “Observed practices and perceived advantages of different hand cleansing agents in rural Bangladesh: ash, soil, and soap,” Am. J. Trop. Med. Hyg., vol. 92, no. 6, pp. 1111–1116, Jun. 2015, doi: 10.4269/ajtmh.14-0378.
[6] T. Jordanova, R. Cronk, W. Obando, O. Z. Medina, R. Kinoshita, and J. Bartram, “Water, sanitation, and hygiene in schools in low socio-economic regions in Nicaragua: a cross-sectional survey,” Int. J. Environ. Res. Public. Health, vol. 12, no. 6, pp. 6197–6217, May 2015, doi: 10.3390/ijerph120606197.
[7] A. Chattopadhyay et al., “WASH practices and its association with nutritional status of adolescent girls in poverty pockets of eastern India,” BMC Womens Health, vol. 19, no. 1, p. 89, 05 2019, doi: 10.1186/s12905-019-0787-1.
[8] P. Routray, W.-P. Schmidt, S. Boisson, T. Clasen, and M. W. Jenkins, “Socio-cultural and behavioural factors constraining latrine adoption in rural coastal Odisha: an exploratory qualitative study,” BMC Public Health, vol. 15, p. 880, Sep. 2015, doi: 10.1186/s12889-015-2206-3.
[9] A. K. M. Hayter, R. Jeffery, C. Sharma, A. Prost, and S. Kinra, “Community perceptions of health and chronic disease in South Indian rural transitional communities: a qualitative study,” Glob. Health Action, vol. 8, p. 25946, 2015, doi: 10.3402/gha.v8.25946.
[10] T. Singh et al., “Assessment of Universal Healthcare Coverage in a District of North India: A Rapid Cross-Sectional Survey Using Tablet Computers,” PloS One, vol. 11, no. 6, p. e0157831, 2016, doi: 10.1371/journal.pone.0157831.
[11] P. Mohan, S. B. Mohan, and M. Dutta, “Communicable or noncommunicable diseases? Building strong primary health care systems to address double burden of disease in India,” J. Fam. Med. Prim. Care, vol. 8, no. 2, pp. 326–329, Feb. 2019, doi: 10.4103/jfmpc.jfmpc_67_19.
[12] S. Yadav and P. Arokiasamy, “Understanding epidemiological transition in India,” Glob. Health Action, vol. 7, p. 23248, 2014, doi: 10.3402/gha.v7.23248.
[13] T. Oni and N. Unwin, “Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition,” Int. Health, vol. 7, no. 6, pp. 390–399, Nov. 2015, doi: 10.1093/inthealth/ihv040.
[14] Census 2011, India, “Tigiria Block - Cuttack, Complete details of Population.” .
[15] International Institute for Population Sciences, Mumbai, “National Family Health Survey - 4, 2015-16, State Fact Sheet, Odisha.”
[16] K. K. Baker et al., “From menarche to menopause: A population-based assessment of water, sanitation, and hygiene risk factors for reproductive tract infection symptoms over life stages in rural girls and women in India,” PloS One, vol. 12, no. 12, p. e0188234, 2017, doi: 10.1371/journal.pone.0188234.
[17] S. P. Luby, A. K. Halder, C. Tronchet, S. Akhter, A. Bhuiya, and R. B. Johnston, “Household characteristics associated with handwashing with soap in rural Bangladesh,” Am. J. Trop. Med. Hyg., vol. 81, no. 5, pp. 882–887, 2009, doi: 10.4269/ajtmh.2009.09-0031.
[18] A. Kuberan et al., “Water and sanitation hygiene knowledge, attitude, and practices among household members living in rural setting of India,” J. Nat. Sci. Biol. Med., vol. 6, pp. S69–S74, 2015, doi: 10.4103/0976-9668.166090.
[19] R. Pachori, “Drinking water and sanitation: household survey for knowledge and practice in rural area, Magudanchavadi, Salem district, India,” Int. J. Community Med. Public Health, vol. 3, no. 7, pp. 1820–1828, 2016, doi: 10.18203/2394-6040.ijcmph20162049.
[20] V. Diwan et al., “Understanding Healthcare Workers Self-Reported Practices, Knowledge and Attitude about Hand Hygiene in a Medical Setting in Rural India,” PloS One, vol. 11, no. 10, p. e0163347, 2016, doi: 10.1371/journal.pone.0163347.
[21] K. Y. J., N. K. Naidu, S. D., H. B., and M. V., “Study to assess knowledge, perception and practices regarding Swachh Bharat Abhiyan among rural people of Nalgonda district in Telangana state,” Int. J. Community Med. Public Health, vol. 5, no. 8, p. 3399, 2018, doi: 10.18203/2394-6040.ijcmph20183069.
[22] G. Dandabathula, P. Bhardwaj, M. Burra, P. V. V. P. Rao, and S. S. Rao, “Impact assessment of India’s Swachh Bharat Mission - Clean India Campaign on acute diarrheal disease outbreaks: Yes, there is a positive change,” J. Fam. Med. Prim. Care, vol. 8, no. 3, pp. 1202–1208, Mar. 2019, doi: 10.4103/jfmpc.jfmpc_144_19.
[23] V. Reddy B, Y. S. Kusuma, C. S. Pandav, A. K. Goswami, and A. Krishnan, “Water and Sanitation Hygiene Practices for Under-Five Children among Households of Sugali Tribe of Chittoor District, Andhra Pradesh, India,” J. Environ. Public Health, vol. 2017, p. 7517414, 2017, doi: 10.1155/2017/7517414.
[24] C. Savolainen-Kopra et al., “Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial,” Trials, vol. 13, p. 10, Jan. 2012, doi: 10.1186/1745-6215-13-10.
[25] A. Kundu, W. A. Smith, D. Harvey, and S. Wuertz, “Drinking Water Safety: Role of Hand Hygiene, Sanitation Facility, and Water System in Semi-Urban Areas of India,” Am. J. Trop. Med. Hyg., vol. 99, no. 4, pp. 889–898, 2018, doi: 10.4269/ajtmh.16-0819.
[26] A. Sinha, “Active Engagement of Community Stakeholders and their Capacity Building for Better Hygiene Practices in Tribal Odisha , India : A Case of Balasore District Abstract,” Integr. J. Glob. Health, vol. 1, pp. 1–6, 2017.
[27] G. Rosa, P. Kelly, and T. Clasen, “Consistency of Use and Effectiveness of Household Water Treatment Practices Among Urban and Rural Populations Claiming to Treat Their Drinking Water at Home: A Case Study in Zambia,” Am. J. Trop. Med. Hyg., vol. 94, no. 2, pp. 445–455, Feb. 2016, doi: 10.4269/ajtmh.15-0563.
[28] M. Burton, E. Cobb, P. Donachie, G. Judah, V. Curtis, and W.-P. Schmidt, “The effect of handwashing with water or soap on bacterial contamination of hands,” Int. J. Environ. Res. Public. Health, vol. 8, no. 1, pp. 97–104, 2011, doi: 10.3390/ijerph8010097.
[29] W. R. De Alwis, P. Pakirisamy, L. Wai San, and E. C. Xiaofen, “A Study on Hand Contamination and Hand Washing Practices among Medical Students,” ISRN Public Health, vol. 2012, pp. 1–5, 2012, doi: 10.5402/2012/251483.
[30] N. Garin et al., “Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study,” J. Gerontol. A. Biol. Sci. Med. Sci., vol. 71, no. 2, pp. 205–214, Feb. 2016, doi: 10.1093/gerona/glv128.
[31] J. T. Lee, F. Hamid, S. Pati, R. Atun, and C. Millett, “Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis,” PloS One, vol. 10, no. 7, p. e0127199, 2015, doi: 10.1371/journal.pone.0127199.