Water, Sanitation, and Hygiene Practices in Urban Slums of Eastern India
Open accessAbstract
Background: The Sustainable Development Goals identified universal access to water and sanitation facilities as key components for improving health. We assessed water, sanitation, and hygiene (WASH) practices and associated determinants among residents of urban slums in Kolkata, India. Methods: Information on WASH practices was collected in 2 surveys (2018 and 2019) from participants of a prospective enteric fever surveillance conducted in 2 municipal wards of Kolkata. A composite WASH practice score was computed and a hierarchical stepwise multiple linear regression model constructed to identify key determinants of improved WASH score. Results: Over 90% of households had access to piped water; 6% reported access to continuous supply. Adult women (61% in 2018; 45% in 2019) spent 20 minutes daily to fetch water. Access to improved latrines was almost universal, although 80% used shared facilities. Unhealthy disposal of children’s stools was reported in both rounds. Food hygiene practices were high, with most (>90%) washing uncooked items before eating; frequent consumption of street food items was reported. Conclusions: The study area reported high WASH coverage. Unhygienic behavioral patterns predisposing to food- or water-borne diseases were also noted. Awareness building and sustainable community mobilization for food hygiene needs to be emphasized to ensure community well-being.
AI snapshot
Written from the paper’s full text.
TL;DR
Two surveys in urban slums of Kolkata found high coverage of improved water and sanitation but persistent risky hygiene behaviors, including shared toilets, limited household water treatment, and frequent street-food consumption. A composite WASH score showed little improvement between 2018 and 2019, with only about one-third of households improving.
Key findings
- Over 90% of households had access to piped water, but only 5.97% reported continuous supply in round 2; adult women most commonly fetched water (61.06% in 2018; 45.31% in 2019), with a median of 20 minutes spent daily.
- Access to improved latrines was almost universal, but about 80% used shared facilities (79.87% in 2018; 77.32% in 2019), shared between a median of 6 households. Risky disposal of children’s stools was reported by 14.3% in round 1 and 8.3% in round 2.
- Food hygiene practices were high for washing uncooked food before eating (93.47% in 2018; 97.82% in 2019), but frequent street-food consumption was common: 41% in round 1 and 47% in round 2 reported eating ready-to-eat street food at least once a week.
- In hierarchical linear regression, fewer households sharing a toilet and less time spent fetching water were significantly associated with improved WASH score in model 2 (sharing: β = 0.02, P < .001; fetching time: β = 0.006, P = .01), though overall R² was low (0.054).
Methods
- Community-based prospective enteric fever surveillance in 2 municipal wards of Kolkata, with WASH questionnaires administered to households at baseline (March–September 2018) and 1 year later (March–September 2019).
- Round 1 surveyed 4104 households; round 2 surveyed 3906 households. The surveillance enrolled 5991 children aged 6 months to <15 years, with 258 lost to follow-up.
- A composite WASH score was computed across water, sanitation, and food hygiene domains (maximum possible score 10). Univariable linear regression and hierarchical stepwise multiple linear regression were used to identify factors associated with WASH score.
Limitations
- The paper states possible recall bias, no direct collection of hand hygiene information, self-reported data with social desirability bias, no observational verification of reported practices, inability to demonstrate the knowledge–practice gap, no evaluation of cleanliness or appropriate use of sanitation facilities, post hoc analysis, and inability to ascribe temporality.
- The paper also notes that the composite WASH score’s generalizability may be in doubt, though its internal reliability is assured because all families were measured on the same scale.
- The text makes evident that the regression models explained little variance (R² = 0.054 in model 2), indicating that unobserved factors likely influence WASH scores.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
6 of 15 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured
- Findingown data
In model 2, after adjusting for years of completed education, family size, and public access to family's toilet facilities, fewer households sharing a toilet was significantly associated with higher WASH score.
“After adjusting for the years of completed education, family size, and public access to family’s toilet facilities, model 2 indicated that there was a significant improvement in WASH score when fewer households shared a toilet and less time was spent in collecting water.”
Quote in the paperSubstantial claim - Findingown data
A median of 20 minutes was spent fetching water in both survey rounds.
“A median of 20 minutes was spent in fetching water in both rounds.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Over 41% of respondent households in round 1 and 47% in round 2 reported consuming ready-to-eat street foods at a frequency greater than or equal to once a week.
“Over 41% of respondent households in round 1 and 47% in round 2 reported consuming such foods at a frequency greater than or equal to once a week.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Frequent consumption of street food items was reported.
“frequent consumption of street food items was reported.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Over 95% of households reported having access to some form of improved, flush, or pour-flush latrine.
“Over 95% of the households reported having access to some form of improved, flush, or pour-flush latrine.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
In the second round, less than 6% of households indicated they had continuous access to drinking water.
“In the second round, an additional question was asked about continuous water access; less than 6% of households indicated that they had continuous access to drinking water.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Most families reported having access to intermittent water supply delivered in a time-limited manner, in multiple time intervals each day.
“Most families reported having access to intermittent water supply delivered in a time-limited manner, in multiple time intervals each day.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Fewer women reported fetching water in round 2 (45.31%) than in round 1 (61.06%).
“Although fetching water was the primary responsibility of the adult women in the households, fewer women reported fetching water in round 2 (45.31%) than in round 1 (61.06%).”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
The most common source of safe drinking water supplied by municipal authorities were shared pipes (yard or public taps).
“Around 1 in 10 households had piped water in the dwelling; the most common source of safe drinking water supplied by the municipal authorities were shared pipes, which ran into the residential yard or public taps used by a group of households.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
1 in 10 families reported disposing the stool of their children in open environments.
“This becomes an especial cause of concern because 1 in 10 families have reported disposing the stool of their children in such open environments, amplifying the threat of diseases that are fecal-oral transmitted.”
Quote in the paperSubstantial claim- Rests on an assumption: Safe WASH practices prevent the transmission of water-borne infections in the community.
- Rests on an assumption: Other essential infrastructure has failed to keep pace over the years, leading to poor drainage, waterlogging during monsoon, and fecal contamination of the piped water supply.
- Findingown data
Almost all households in the study area had been using a flush toilet.
“Almost all the households in the study area had been using a flush toilet, which is much higher than what was reported by NFHS-4.”
Quote in the paperNot a substantial claim - Findingown data
Almost all families in the study reported receiving intermittent water supply.
“Notably, almost all families reported receiving intermittent water supply, and often, during scarcity of water—especially during summer months—local municipal authorities also deploy tanker trucks to meet water needs.”
Quote in the paperNot a substantial claim - Findingown data
Food hygiene practices were high, with most (>90%) washing uncooked items before eating.
“Food hygiene practices were high, with most (>90%) washing uncooked items before eating; frequent consumption of street food items was reported.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Almost all respondents reported washing uncooked foods or peeling them before consumption.
“However, over half of the respondents in both the rounds reported rarely or never eating uncooked foods, and almost all respondents reported washing such uncooked foods or peeling them before consumption.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
A majority of sanitation facilities were shared between a median of 6 (IQR 2-10) households.
“A majority of the sanitation facilities were shared between a median of 6 (IQR, 2–10) households.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Shared pipes were the primary source of drinking water for over 80% of households in both rounds.
“These were the primary source of drinking water for over 80% of the households in both the rounds of the survey.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingnone given
Almost all of the study population was living in overcrowded conditions in these urban slums (bustees).
“Almost all of the study population was living in overcrowded conditions in these urban slums (bustees).”
Quote in the paperNot a substantial claim - Findingown data
6% of households reported access to continuous water supply.
“6% reported access to continuous supply.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
A very high proportion of respondents reported consuming ready-to-eat food from street vendors on a regular basis in both rounds.
“A very high proportion of the respondents reported consuming ready-to-eat food from street vendors on a regular basis in both rounds.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Despite almost universal coverage with improved and safe sanitation facilities, 14.3% of households reported risky disposal of children's stools in the community in round 1.
“However, despite the almost universal coverage of the study population with improved and safe sanitation facilities, 14.3% of the households reported risky disposal of children’s stools in the community in round 1.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Increase in family size was significantly associated with unsatisfactory WASH practices in the current study.
“Living in overcrowded households, that is an increase in family size, was significantly associated with unsatisfactory WASH practices in the current study.”
Quote in the paperSubstantial claim - Findingown data
A considerable number of children reported frequent consumption of food, including breakfast, from street vendors.
“Further, the food safety risks of the area are significant, because a considerable number of children of these families reported frequent consumption of food, including breakfast, from street vendors.”
Quote in the paperSubstantial claim - Findingown data
Fetching water was the primary responsibility of adult women in the households.
“Although fetching water was the primary responsibility of the adult women in the households, fewer women reported fetching water in round 2 (45.31%) than in round 1 (61.06%).”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
In round 2, the proportion of households reporting risky disposal of children's stools had reduced to 8.3%.
“In round 2, this proportion had reduced to 8.3%.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
A majority of families believed that the water obtained is safe for drinking.
“A majority of the families believed that the water obtained is safe for drinking, and thus only about one-tenth of the households treated the water in any method before drinking.”
Quote in the paperSubstantial claim - Findingown data
Less than half of the households had a separate kitchen.
“Less than half of the households had a separate kitchen and most cooking activities were conducted inside the house.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
More households reported accessing sanitation facilities that were open to the general public in round 1 (12.04%) than in round 2 (4.84%).
“More households reported accessing sanitation facilities that were open to the general public in round 1 (12.04%) than in round 2 (4.84%).”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
The current analysis finds that despite high coverage of WASH services in the urban slums of Kolkata, there are gaps in WASH practices in the population.
“The current analysis finds that despite a high coverage of WASH services in the urban slums of Kolkata, there are gaps in the WASH practices in the population.”
Quote in the paperSubstantial claim - Findingown data
Lower education level of the head of the household was significantly associated with poor WASH scores.
“The lower education level of the head of the household was significantly associated with poor WASH scores, indicating an improvement in WASH practices with increment in education.”
Quote in the paperSubstantial claim - Findingown data
Over half of the respondents in both rounds reported rarely or never eating uncooked foods.
“However, over half of the respondents in both the rounds reported rarely or never eating uncooked foods, and almost all respondents reported washing such uncooked foods or peeling them before consumption.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
In both rounds, a very high proportion of respondents reported having access to an improved, safe drinking water source.
“In both the rounds, a very high proportion of the respondents reported having access to improved, safe drinking water source, and details are provided in Table 2.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
About 80% of households used shared latrine facilities.
“although 80% used shared facilities.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingnone given
Most WASH facilities are currently shared between multiple families.
“Considering that most of the WASH facilities are currently shared between multiple families, they are unlikely to be used in a safe and sustainable manner unless there is sustainable change in behavioral practices of the community, including contributing to the upkeep, maintenance, and upgrading of such community-owned facilities.”
Quote in the paperNot a substantial claim - Findingown data
Despite high coverage with adequate WASH facilities, most households failed to obtain a high WASH score on the composite summary score.
“Despite the high degree of coverage with adequate WASH facilities, we observe that most of the households failed to obtain a high WASH score on the composite summary score devised for this study.”
Quote in the paperSubstantial claim - Findingown data
Over 90% of households in the study area had access to piped water.
“Over 90% of households had access to piped water”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Similar proportions of the study population reported consuming breakfast or ice creams from street vendors in both rounds.
“Similar proportions of the study population reported consuming breakfast or ice creams from such street vendors in both the rounds.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
In model 2, after adjusting for years of completed education, family size, and public access to family's toilet facilities, less time spent collecting water was significantly associated with higher WASH score.
“After adjusting for the years of completed education, family size, and public access to family’s toilet facilities, model 2 indicated that there was a significant improvement in WASH score when fewer households shared a toilet and less time was spent in collecting water.”
Quote in the paperSubstantial claim - Findingnone given
A large proportion of households had to share their toilet facility with many other local families.
“Again, it is worth mentioning that a large proportion had to share their toilet facility with many other local families.”
Quote in the paperNot a substantial claim - Findingown data
Significant gaps in behavioral patterns have remained in spite of the intense focus on improving WASH through Swachh Bharat Abhiyan.
“Although there are limitations in a self-reported, cross-sectional, observational study design, we have noted significant gaps in behavioral patterns, which have remained in spite of the intense focus on improving WASH through the activities of Swachh Bharat Abhiyan in the country.”
Quote in the paperSubstantial claim- Rests on an assumption: Swachh Bharat Abhiyan has made major strides in coverage of vulnerable areas with appropriate WASH services.
- Findingown data
In both rounds, approximately 1 in 10 families (13.72% in round 1, 9.65% in round 2) reported using any form of home-based water treatment for purification of drinking water.
“In both the rounds, approximately 1 in 10 families (13.72% in round 1, 9.65% in round 2) reported using any form of home-based water treatment for purification of drinking water.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Access to improved latrines was almost universal in the study area.
“Access to improved latrines was almost universal, although 80% used shared facilities.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Most cooking activities were conducted inside the house.
“Less than half of the households had a separate kitchen and most cooking activities were conducted inside the house.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
None of the households reported achieving the lowest possible WASH score of 0 in either of the 2 rounds.
“None of the households reported achieving the lowest possible score of 0 in either of the 2 rounds.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Between November 2017 and December 2019, 5991 children were under active surveillance.
“Between November 2017 and December 2019, 5991 children were under active surveillance; 258 children were lost to follow-up during the study period.”
Quote in the paperNot a substantial claim - Findingown data
In the 2 rounds, a very small proportion reported using open defecation or hanging toilets.
“In the 2 rounds, a very small proportion reported using open defecation or hanging toilets.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingown data
Around 1 in 10 households had piped water in the dwelling.
“Around 1 in 10 households had piped water in the dwelling; the most common source of safe drinking water supplied by the municipal authorities were shared pipes, which ran into the residential yard or public taps used by a group of households.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Findingreasoning
Only about one-tenth of households treated the water in any method before drinking.
“A majority of the families believed that the water obtained is safe for drinking, and thus only about one-tenth of the households treated the water in any method before drinking.”
Quote in the paperSubstantial claim - Findingown data
Unhealthy disposal of children's stools was reported in both survey rounds.
“Unhealthy disposal of children’s stools was reported in both rounds.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Premisecitation
Provision of safe water and adequate sanitation does not always ensure hygienic use or adoption of other sanitary practices.
“However, the provision of safe water and adequate sanitation does not always ensure hygienic use or adoption of other sanitary practices”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] Palit, 2012, In-house contamination of potable water in urban slum of Kolkata, India: a possible transmission route of diarrhea, Water Sci Technol source
- Interpretationreasoning
Shared WASH facilities are unlikely to be used in a safe and sustainable manner unless there is sustainable change in behavioral practices of the community.
“Considering that most of the WASH facilities are currently shared between multiple families, they are unlikely to be used in a safe and sustainable manner unless there is sustainable change in behavioral practices of the community, including contributing to the upkeep, maintenance, and upgrading of such community-owned facilities.”
Quote in the paperSubstantial claim- Rests on an assumption: Safe WASH practices prevent the transmission of water-borne infections in the community.
- Interpretationcitation
A considerable proportion of the burden of disease and ill health could be averted by improvement in the quality of drinking water along with access to improved sanitation and hygiene facilities in underserved locations.
“A considerable proportion of this burden of disease and ill health could be averted by improvement in the quality of drinking water along with access to improved sanitation and hygiene facilities in underserved locations.”
Quote in the paperSubstantial claim- Rests on an assumption: Safe WASH practices prevent the transmission of water-borne infections in the community.
- Interpretationown data
The study area reported high WASH coverage.
“The study area reported high WASH coverage.”
Quote in the paperSubstantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Premisecitation
A larger family incurs a disproportionately higher cost for practicing safe WASH habits like boiling water or adopting any other purification methods.
“As reported in a WHO bulletin, a larger family incurs a disproportionately higher cost for practicing safe WASH habits like boiling water or adopting any other purification methods [28].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] Gilman, 1985, Boiling of drinking-water: can a fuel-scarce community afford it?, Bull World Health Organ
- Interpretationown data
Improvement in WASH practices is associated with increment in education.
“The lower education level of the head of the household was significantly associated with poor WASH scores, indicating an improvement in WASH practices with increment in education.”
Quote in the paperSubstantial claim - Interpretationown data
Unhygienic behavioral patterns predisposing to food- or water-borne diseases were noted in the study area.
“Unhygienic behavioral patterns predisposing to food- or water-borne diseases were also noted.”
Quote in the paperSubstantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
- Study design and conductnone given
Information on hand hygiene was not collected directly in this survey.
“Information on hand hygiene, which is an important part of the WASH practices, was not collected directly in this survey.”
Quote in the paperSubstantial claim - Premisecitation
Despite incremental access to improved WASH amenities, pockets of inequity still remain.
“However, despite incremental access to improved WASH amenities, thanks to the Swachh Bharat Abhiyan, pockets of inequity still remain [11].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] World Health Organization., 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Point-of-use contamination of drinking water obtained from safe municipal sources is a major determinant of diarrheal disease occurrence in children in urban slums of India.
“point-of-use contamination of drinking water, obtained from safe, municipal sources, is a major determinant of diarrheal disease occurrence in children in urban slums of India [9].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] Palit, 2012, In-house contamination of potable water in urban slum of Kolkata, India: a possible transmission route of diarrhea, Water Sci Technol source
- Premisecitation
Water can be contaminated during storage for drinking, cooking, and other domestic use in similar urban slum settings.
“Although drinking water with sufficient residual chlorine is obtained from improved sources by these households, there remains the possibility that the water can be contaminated during storage for drinking, cooking, and other domestic use, as has been previously documented in similar urban slum settings [9].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Palit, 2012, In-house contamination of potable water in urban slum of Kolkata, India: a possible transmission route of diarrhea, Water Sci Technol source
- Interpretationown data
Other explanatory factors not observed in this study could be associated with improved WASH scores in urban slum households in Kolkata, as indicated by the low overall R2 value.
“However, the model characteristics show a low R2 value overall, which indicates that other explanatory factors, which were not observed as part of this study, could be associated with improved WASH scores in the households of urban slums in Kolkata.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Food prepared and sold by local street vendors in slum areas may propagate water-borne infections due to lack of basic hygienic practices of handlers while preparing and storing food.
“It needs to be emphasized that food prepared and sold by the local street vendors, especially in the slum areas, may propagate water-borne infections, owing to the lack of basic hygienic practices of the handlers while preparing and storing food.”
Quote in the paperSubstantial claim- Rests on an assumption: Safe WASH practices prevent the transmission of water-borne infections in the community.
- Study design and conductreasoning
The composite WASH score has internal reliability because all families were measured on the same scale using uniform methods for data elicitation.
“Although the generalizability of such a score may be in doubt, its internal reliability is assured because all families were measured on the same scale, using uniform methods for data elicitation.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 21
- May combine two claims. 14
- The quote only partly states this claim. 1
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationLack of access to safe water, proper sanitation, and inadequate hygiene practices are linked with increased risk of transmitting infectious diseases like cholera, typhoid, hepatitis A, and other water-related diseases.
“Lack of access to safe water, proper sanitation, and inadequate hygiene practices have been linked with the increased risk of transmitting infectious diseases like cholera, typhoid, hepatitis A, and many other water-related diseases [1, 2].”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [1] World Health Organization., 2021
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [2] Stanaway, 2019, The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017, Lancet Infect Dis source
The Introduction (page not provided) links typhoid and paratyphoid infections to poor water supply and sanitation, and the Methods identify unsafe drinking water as a known typhoid risk factor. The paper does not establish the claimed links for inadequate hygiene, cholera, hepatitis A, or other water-related diseases. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn high-income countries, introduction of clean water, well-designed sewerage systems, adoption of hygienic practices, and increased awareness led to a dramatic reduction of morbidity and mortality associated with fecal-oral transmission.
“The introduction of clean water, well-designed sewerage systems, and adoption of hygienic practices, along with increased awareness in high-income countries, has led to a dramatic reduction of morbidity and mortality associated with fecal-oral transmission in these countries [5, 24].”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [5] Prüss-Ustün, 2014, Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries, Trop Med Int Health source
The Discussion reports that diarrhoeal deaths have dropped considerably since 2004, partly because of better access to water and sanitation. It does not establish that the introduction of these measures, hygienic practices, and increased awareness caused a dramatic reduction in both morbidity and mortality specifically in high-income countries; the study focuses on low- and middle-income settings. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [24] Brown, 2013, Water, sanitation, hygiene and enteric infections in children, Arch Dis Child source
The Introduction (page unavailable) says that the Victorian-era introduction of clean water and sewerage led to a dramatic reduction in morbidity and mortality from faecal–oral infections. The paper also describes health benefits of hygiene practices, but does not identify adoption of those practices or increased awareness as causes of that historical reduction across high-income countries. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn urban slums of south Delhi, a majority (75%) did not treat water before drinking because they thought the water was already clean.
“This is similar to a finding from a study conducted in urban slums of south Delhi [17], where a majority (75%) did not treat the water before drinking, as most of them thought the water was already clean and ready to drink.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [17] Joshi, 2014, Water and sanitation hygiene knowledge attitude practice in urban slum settings, Glob J Health Sci source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn Sugali Tribe of Chittoor, Andhra Pradesh, parents' higher levels of education were associated with improved WASH practices.
“Similarly, a study conducted among households with children younger than 5 years of the Sugali Tribe of Chittoor, Andhra Pradesh, stated that parents’ higher levels of education were associated with improved WASH practices [25].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [25] Reddy, 2017, Water and sanitation hygiene practices for under-five children among households of Sugali tribe of Chittoor District, Andhra Pradesh, India, J Environ Public Health source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationEnteric fever imposes a significant public health burden and is a cause for concern in India, with varied geographic heterogeneity across the country.
“Enteric fever is a condition that imposes a significant public health burden and is a cause for concern in India, with varied geographic heterogeneity across the country [12].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [12] John, 2016, The burden of typhoid and paratyphoid in India: systematic review and meta-analysis, PLoS Negl Trop Dis source
May combine two claims.
Findingown dataModel 2 is a better, more parsimonious fit than model 3, as the R2 change from model 2 to model 3 was not statistically significant.
“We then added the variables of location of cooking and family type to construct model 3, but we observed that the change in R2 was not statistically significant, indicating that model 2 is a better, more parsimonious fit than model 3.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataMost families resided in single-room households.
“Most of the families resided in single-room households, as is normal for the area under study.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe median monthly family income was slightly higher in round 2 (INR 9000; IQR 8000-12 000) than in round 1 (INR 8000; IQR 7000-10 000).
“The median monthly family income was slightly higher in round 2 (median Indian rupee [INR] 9000; IQR, INR 8000–12 000) than in round 1 (median INR, 8000; IQR, INR 7000–10 000).”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
May combine two claims.
Findingown dataIn the second round, use of water filters (6.81%) was the commonest home-based water treatment, followed by boiling (1.66%).
“In the second round of the survey, we enquired about the specific strategy being used; use of water filters (6.81%) was the commonest, followed by boiling (1.66%).”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataA very small proportion of households reported backyard poultry rearing or cattle in both rounds.
“A very small proportion reported to have backyard poultry rearing or cattle of any kind in both the rounds.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
May combine two claims.
Findingown dataOnly about a third of the households noted an improvement in the WASH score in round 2, with a third noting a reduction in WASH score, and a third showing no change.
“Only about a third of the households noted an improvement in the WASH score in round 2, with a third noting a reduction in WASH score, and a third showing no change.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataIn both rounds, a large proportion of participating families were nuclear in nature.
“In both rounds, a large proportion of the participating families were nuclear in nature, with a median family size of 5 (interquartile range [IQR], 4–6).”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
May combine two claims.
Findingnone givenMost families lived in rented structures with extended family members in single or double rooms, sharing toilets and other necessary infrastructure.
“Most of these families lived in rented structures with extended family members either in single or double rooms, sharing toilets and other necessary infrastructure.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataNo households reported receiving the highest WASH score in round 1 and only 1 household reported this score in round 2.
“No households reported receiving the highest WASH score in round 1 and only 1 household reported this score in round 2.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
The quote only partly states this claim.
Findingown dataAdult women were the most common persons fetching water, with 61% in 2018 and 45% in 2019.
“Adult women (61% in 2018; 45% in 2019) spent 20 minutes daily to fetch water.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe median family size was 5 (IQR 4-6) in both rounds.
“In both rounds, a large proportion of the participating families were nuclear in nature, with a median family size of 5 (interquartile range [IQR], 4–6).”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
May combine two claims.
Findingown dataUnadjusted simple linear regression indicated that baseline family size, completed years of education, monthly income, housing type, presence of a separate kitchen, location of cooking, cooking methods used, minutes spent fetching water daily, and number of households sharing a toilet were significantly associated with WASH score.
“Unadjusted simple linear regression indicated that the baseline family size, completed years of education, monthly income, housing type, presence of a separate kitchen in the house, location of cooking, cooking methods used, minutes spent fetching water every day, and number of households sharing a toilet were significantly associated with the WASH score (Table 6).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataModel 2 was a better fit than model 1, with a significant R2 change (P = .043).
“The f test for change in R2 indicated that there was a significant change (P = .043) from model 1 and model 2 was a better fit.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataA large proportion of families resided in mixed kutcha-pucca houses.
“A large proportion of the families resided in houses that were mixed kutcha-pucca in construction.”
Quote in the paperNot a substantial claim- Rests on an assumption: The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataA pretested questionnaire was used to collect WASH information.
“A pretested questionnaire was administered to collect information on demography, assets, socioeconomic status, cooking fuel, access to safe water, sanitation, and hygiene practices from the households at the baseline (March to September 2018) and again 1 year later (March to September 2019).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenRigorous checking and verification of collected data, including quality control, were carried out regularly through the central data management team.
“Rigorous checking and verification of the collected data, including quality control of the data, were carried out on a regular basis through the central data management team.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationTyphoid causes an estimated 235 cases per 100,000 persons per year in Kolkata, as reported from cohort studies in urban slum dwellers.
“Typhoid causes an estimated 235 cases per 100 000 persons per year in Kolkata, as reported from cohort studies in urban slum dwellers [13].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Sur, 2006, The malaria and typhoid fever burden in the slums of Kolkata, India: data from a prospective community-based study, Trans R Soc Trop Med Hyg source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThere is a chance of recall bias around the yearly data collection timeline.
“There is a chance of recall bias around the yearly data collection timeline.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningThere were no observational aspects of the study, limiting the possibility of verifying reported practices.
“Further, there were no observational aspects of the study, which limits the possibility of verifying the reported practices.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningThe low WASH score is indicative of vulnerabilities in the area, especially affecting the health of children younger than 5 years.
“This low WASH score is indicative of the vulnerabilities in this area, especially affecting the health of children younger than 5 years.”
Quote in the paperSubstantial claim- Rests on an assumption: Safe WASH practices prevent the transmission of water-borne infections in the community.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataIn the first round of the survey, 4104 households were included and 3906 were surveyed in the second round.
“In the first round of the survey, 4104 households were included and 3906 were surveyed in the second round.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningThe data for the present analysis were collected as part of a large, community-based surveillance for enteric fever, using well-trained data collectors and field staff, making it highly accurate and internally valid.
“However, the data for the present analysis were collected as part of a large, community-based surveillance for enteric fever, using well-trained data collectors and field staff, making it highly accurate and internally valid.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown data258 children were lost to follow-up during the study period.
“258 children were lost to follow-up during the study period.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe data were scrutinized at multiple time points, ensuring high quality and fidelity in data collection.
“The data were also scrutinized at multiple time points, ensuring high quality of the data as well as fidelity in the data collection processes.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataAll data were self-reported, increasing the risk of social desirability bias.
“All data were self-reported, which increases the risk of social desirability bias.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningOvercrowded living situations impose a considerable strain on existing WASH facilities, and with higher usage and fewer maintenance breaks, the infrastructure can weaken over time.
“It is to be noted that overcrowded living situations impose a considerable strain on existing WASH facilities, and with a higher degree of usage and fewer breaks for maintenance, the infrastructure can weaken over time.”
Quote in the paperNot a substantial claim- Rests on an assumption: Overcrowding has historically been associated with the spread of infectious diseases.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn slum-dwellers in Hyderabad, Andhra Pradesh, better caregivers' knowledge was associated with higher odds of improved child hygiene practices.
“Another study conducted among slum-dwellers in Hyderabad, Andhra Pradesh reported that better caregivers’ knowledge was associated with higher odds of improved child hygiene practices [26].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] Peter, 2014, Mothers’ caregiving resources and practices for children under 5 years in the slums of Hyderabad, India: a cross-sectional study, WHO South East Asia J Public Health source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe study followed the Joint Monitoring Program 2017 definitions for improved sources of drinking water and sanitation.
“We followed the Joint Monitoring Program 2017 definitions for improved sources of drinking water and sanitation [15].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] World Health Organization, 2017
Not checked in the free run.
The paper relies on this without support.
The self-reported WASH practices collected by questionnaire accurately reflect the households' actual WASH practices.
“A pretested questionnaire was administered to collect information on demography, assets, socioeconomic status, cooking fuel, access to safe water, sanitation, and hygiene practices from the households at the baseline (March to September 2018) and again 1 year later (March to September 2019).”
The paper relies on this without support.
The two survey rounds are comparable and changes between them reflect real changes in WASH practices rather than differences in sampling or measurement.
“In the first round of the survey, 4104 households were included and 3906 were surveyed in the second round.”
The paper relies on this without support.
Safe WASH practices prevent the transmission of water-borne infections in the community.
“Safe WASH practices prevent the transmission of water-borne infections in the community.”
The paper relies on this without support.
Overcrowding has historically been associated with the spread of infectious diseases.
“Historically, overcrowding has been associated with the spread of infectious diseases.”
The paper relies on this without support.
Swachh Bharat Abhiyan has made major strides in coverage of vulnerable areas with appropriate WASH services.
“It must be noted that as an outcome of the Swachh Bharat Abhiyan, there has been major strides made in coverage of vulnerable areas with appropriate WASH services.”
The paper relies on this without support.
Other essential infrastructure has failed to keep pace over the years, leading to poor drainage, waterlogging during monsoon, and fecal contamination of the piped water supply.
“Ensured access to a sanitary flush toilet has become a reality, although other essential infrastructure has failed to keep pace over the years, leading to poor drainage in the area, resulting in waterlogging during the monsoon months, along with fecal contamination of the piped water supply.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Monthly income is called significant despite its nonsignificant result
MinorThe results narrative includes monthly income among the significantly associated factors, but Table 6 reports P = .231 and a confidence interval that includes zero.
“Unadjusted simple linear regression indicated that the baseline family size, completed years of education, monthly income, housing type, presence of a separate kitchen in the house, location of cooking, cooking methods used, minutes spent fetching water every day, and number of households sharing a toilet were significantly associated with the WASH score (Table 6).”
“| Monthly Income, per 10 000 | −0.046 (−.121 to .029) | .231 |”
Housing type is called significant despite its nonsignificant results
MinorThe results narrative names housing type as significantly associated with the WASH score, but neither housing-type comparison in Table 6 is significant.
“Unadjusted simple linear regression indicated that the baseline family size, completed years of education, monthly income, housing type, presence of a separate kitchen in the house, location of cooking, cooking methods used, minutes spent fetching water every day, and number of households sharing a toilet were significantly associated with the WASH score (Table 6).”
“| House type | | | | Pucca house | Ref | | | Mixed Kutcha-Pucca house | 0.034 (−.052 to .120) | .435 | | Kutcha house | −0.283 (−.626 to .059) | .105 |”
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- Authors
- Kanungo, S., Chatterjee, P., Saha, J., Pan, T., Chakrabarty, N. D., & Dutta, S.
- Affiliations
- National Institute of Cholera and Enteric Diseases (IN)
- Johns Hopkins University (US)
- Corresponding author
- Dutta, Shanta
- Venue
- The Journal of Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-11-15
- Volume
- 224
- Issue
- Supplement_5
- Pages
- S573-S583
- ISSN
- 0022-1899 (ISSN-L)
- 1537-6613
- PMC
- PMC8892530
- OpenAlex
- W3215343326
- Cited by
- 53
- References
- 23
- Citations by year
- 2026: 8 · 2025: 18 · 2024: 15 · 2023: 8 · 2022: 4
- FWCI
- 4.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Journal of Infectious Diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Bill and Melinda Gates Foundation (INV-009497-OPP1159351)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Social Sciences › Urban Studies › Urban and Rural Development Challenges
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Public Health and Environmental Issues
- Keywords
- urban slums, Kolkata, enteric fever, food hygiene, water fetching, piped water access, Sustainable Development Goals, waterborne diseases, community mobilization
- MeSH terms
- Adult, Child, Cross-Sectional Studies, Female, Humans, Hygiene, India, Poverty Areas, Prospective Studies, Sanitation, Water, Water Supply
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