New Delhi: Touting the Swachh Bharat Mission (SBM) as one of the largest cleanliness drives in the world, the Economic Survey 2018-19 released on Thursday said the programme has significantly reduced still births, diarrheal and malarial deaths.

The Survey tabled in Parliament by finance minister Nirmala Sitharaman, highlighted that even 67 years after India’s independence, in 2014, around 10 crore rural and about 1 crore urban households in India were without a sanitary toilet; over 56.4 crore, i.e. close to half the population, still practiced open defecation. SBM, one of the largest cleanliness drives in the world, has brought in a remarkable transformation and traceable health benefits.

After becoming Open Defecation Free (ODF), several villages have witnessed a reduction in deaths due to diarrhoea, malaria especially in under-five children, still births and newborns with weight less than 2.5 kg, thereby improved child health and nutrition, the survey report noted.

The report cited that the direct impact of improved sanitation should manifest on the health indicators. Diarrhoea, a leading cause of death among the under-five children in India, accounted for around 11% of deaths in 2013. Diarrhoea cases among children below 5 years in India have reduced significantly over the past 4 years, the report noted. As of March 2014, 50% of the districts in India had Individual Household Latrines (IHHL) Coverage less than 33.5% per cent.

In order to gauge the impact of SBM on health indicators, the surveyors separated districts into two groups- the first group where IHHL coverage was low and the second group where IHHL coverage was high as of 2015.

And compared the diseases figures in between March 2015 and March 2019 when SBM began its implementation. According to the findings, first group i.e. districts with low IHHL coverage suffered more from diarrhoea, malaria, still births and low birth weight than the second group i.e. districts with high IHHL coverage–indicating that sanitation and hygiene is the primary reason for these health problems in the country. The major finding of this analysis was that all these health indicators including diarrhoea and malaria cases improved significantly in both groups after the implementation of SBM, the report highlighted.

According to the survey findings, Diarrhoea cases reduced from around 6,968 and 5,262 in 2015 to 5,683 and 4,550 in 2019 in the first and second group respectively. Malaria cases also dropped from around 761 and 273 in 2015 to 222 and 113 in 2019 in the first and second group respectively. Still births came down from 540 and 403 in 2015 to 456 and 368 in 2019 in the first and second group respectively. Low birth-weight cases declined from 3,890 and 3,230 in 2015 to 3,686 and 3,198 in 2019 in the first and second group respectively.

However, the survey report said that while this study shows that sanitation has an important role to play in reducing diarrhoea and malaria, there may be other factors like distribution of mosquito nets, fogging machines and construction of Gambusia fish hatcheries under the National Vector Borne Disease Control Programme and provision of safe drinking water, Oral rehydration solutions (ORS) and zinc, hand washing and personal hygiene under Integrated Action Plan for Prevention and Control of Pneumonia and Diarrhoea that have also played an important role in reduction of malaria and diarrhoea, but are not in the scope of this study.

With improved sanitation and 100% ODF, diarrhoea cases reduced significantly in many states like Gujarat, Tamil Nadu, West Bengal and Bihar. Going forward, the Economic Survey report said that SBM needs to incorporate environmental and water management issues for sustainable improvements in the long-term.

Findings of a recent study published in Journal of Family Medicine and Primary Care also exhibited a declining rate in acute diarrheal disease (ADD) outbreaks. The researchers analyzed ADD outbreaks from 2010 to 2018. The number of ADD outbreaks per year during the past 2 years (i.e., 2017 and 2018) of SBM regime was found to be lesser than in any year during the investigation period. Seasonal variations during the months of May, June, July, and August account for 55%–60% of ADD outbreaks in any of the years; but for 2018, the total outbreaks were 46%, which is significantly lower than that of regular range of outbreaks in the peak season.

According to the government, through SBM, 99.2% of the rural India has been covered. Since October 2, 2014 over 9.5 crore toilets have been built all over the country and 564,658 villages have been declared ODF. Since October 2, 2014 over 9.5 crore toilets have been built all over the country and 564,658 villages have been declared ODF.

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