Burden of water, sanitation and hygiene related diseases in India: prevalence, health care cost and effect of community level factors

Objectives

To study the disease burden and financial burden of water, sanitation and hygiene (WASH) related-diseases among individuals in India.

Methods

The prevalence and economic burden of WASH-related diseases was estimated using 75th Round National Sample Survey: ‘Household social consumption: Health’. A multilevel logistic regression model was used to assess the effect of community level factors in the prevalence of these diseases.

Results

The prevalence of WASH-related diseases in India was at 5.7% of all outpatient visits and 6.9% of all hospital admissions during in 2017–18.66% of all outpatient malaria visits in rural areas were associated with restrictions in daily activities of ailing individuals. The mean out-of- pocket expenditure across all WASH-related diseases was ₹703 per outpatient visit and ₹9656 per hospital admission. The monthly OOPE on outpatient care for 74% persons with jaundice in rural areas, was greater than their monthly per capita consumption expenditure and 97% persons with malaria in urban areas faced catastrophic OOPE on outpatient care. Each hospital admission for jaundice in urban areas led to an earning loss of ₹2260. The intra-class correlation at community level from the multilevel logistic regression for diseases prevalence were 0.28 and 0.26 for outpatient and inpatient cases, indicating the role of community level factors in the variation in disease prevalence.

Conclusion

There is a high prevalence, financial burden and effect of community level factors on WASH-related diseases in India. Holistic strengthening of WASH facilities is required to mitigate the avoidable burden of these diseases.