India's Total Sanitation Campaign (TSC), started in 1999, has the primary aim of 'eradicating the practice of open defecation by 2012'. This paper describes a cross-sectional health indicator study of four villages - two 'open-defecation free' (ODF) villages and two non-ODF villages) in Madhya Pradesh in 2006.The study included: (a) an epidemiological investigation based on a study population of 1,245 individuals; (b) microbiological and parasitological examinations of 10 per cent of stool samples from study population; and (c) water quality and sanitary inspection analysis.Results from the study indicate that both diarrhoeal morbidity and overall worm infestations from stool samples reduced in the ODF villages. Results however indicated high levels of microbiological contamination of the water supplies in ODF villages as well as an increased prevalence of hookworm infestation in 16 per cent of the population. These results reflect that, as revealed by interviews, despite improved latrine coverage, many ODF villages are still practising open field defecation resulting in the transmission of hookworms through the human-soil-human contamination route. The study concluded that, to maximize the health benefit of ODF, a choice of alternative sanitation technology options combined with appropriate hygiene promotion must be undertaken.