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.

Alok, K. (2007) ‘Total sanitation campaign: State progress and challenges’, presentation made at UNICEF-Government of India Review Meeting, New Delhi, 20 June 2007.

Department for Drinking Water Supply (DDWS) (2008) ‘Nirmal Gram Puraskar’, Government of India [Online], http://ddws.gov.in/ngp1.htm [accessed 20 May 2008].

Esrey, S, Potash, J., Roberts, L. and Shiff, C. (1990) Health Benefits from Improvements in Water Supply and Sanitation: Survey and Analysis of the Literature on Selected Diseases, WASH Technical Report, No. 66, Water and Sanitation for Health Project, USAID, Washington, DC.

Esrey, S.A., Potash, J.B., Roberts, L. & Shiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis and trachoma’, Bulletin of the World Health Organisation 69(5): 609-21.

Fewtrell, L., Kaufmann, R.B., Kay, D., Ananoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta-analysis’, Lancet Infectious Diseases 5(1): 42-52.

Godfrey, S., Smith, M. and Tino, F. (2005) ‘Relationship between rainfall and microbiological contamination of shallow groundwater in Northern Mozambique’, Water SA 31(4).

Jones, G., Schultink, W. and Babille, M. (2006) ‘Child survival in India’, Indian Journal of Pediatrics 73(6): 479-87.

Lin, J., Biyela, P.T. and Puckree, T. (2002) ‘Antibiotic profiles of environmental isolates from Mthlatuze River, Kwa Zulu Natal, South Africa’, Water SA 30(1): 23-8.

Mackie & McCartneys Practical Medical Microbiology (1996) 14th Edition, Churchill Livingstone, London.

Rameshwar Sarma, K.V. (1998) Nutrition Survey: Methodology, National Institute of Nutrition, Jamai Osmania, Hyderabad.

Regional Medical Research Centre for Tribals (RMRCT) (2004) Annual Report, Jabalpur, India.

Soulsby, E.J.L. (1982) Helminths, Arthropods & Protozoa of Domesticated animals, 7th edition, English Language Book Society, Bailliere Tindall, London.

Vinson, D.C., Reidinger, C. and Wilcosky, T. (2003) ‘Factors affecting the validity of a Timeline Follow-Back interview’, Journal of Studies on Alcohol 64(5): 733-40.

World Health Organization (WHO) (2004) Guidelines for Drinking Water Quality, 3rd edition, WHO, Geneva.

WHO (2007) Water, Sanitation and Hygiene: Quantifying the Health Impact at National and Local Levels in Countries with Incomplete Water Supply and Sanitation Coverage, Environmental Burden of Disease Series, No. 15, WHO, Geneva.

WHO/United Nations Childrens Fund (UNICEF) (2004) Meeting the MDG Drinking-water and SANITATION TARGET: A Mid-term Assessment of Progress, WHO, Geneva.

WHO/UNICEF (2006) Meeting the MDG Drinking Water and Sanitation: The Urban and Rural Challenges of the Decade, WHO/UNICEF, Geneva.

Alok, K. (2007) ‘Total sanitation campaign: State progress and challenges’, presentation made at UNICEF-Government of India Review Meeting, New Delhi, 20 June 2007.

Department for Drinking Water Supply (DDWS) (2008) ‘Nirmal Gram Puraskar’, Government of India [Online], http://ddws.gov.in/ngp1.htm [accessed 20 May 2008].

Esrey, S, Potash, J., Roberts, L. and Shiff, C. (1990) Health Benefits from Improvements in Water Supply and Sanitation: Survey and Analysis of the Literature on Selected Diseases, WASH Technical Report, No. 66, Water and Sanitation for Health Project, USAID, Washington, DC.

Esrey, S.A., Potash, J.B., Roberts, L. & Shiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis and trachoma’, Bulletin of the World Health Organisation 69(5): 609-21.

Fewtrell, L., Kaufmann, R.B., Kay, D., Ananoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta-analysis’, Lancet Infectious Diseases 5(1): 42-52.

Godfrey, S., Smith, M. and Tino, F. (2005) ‘Relationship between rainfall and microbiological contamination of shallow groundwater in Northern Mozambique’, Water SA 31(4).

Jones, G., Schultink, W. and Babille, M. (2006) ‘Child survival in India’, Indian Journal of Pediatrics 73(6): 479-87.

Lin, J., Biyela, P.T. and Puckree, T. (2002) ‘Antibiotic profiles of environmental isolates from Mthlatuze River, Kwa Zulu Natal, South Africa’, Water SA 30(1): 23-8.

Mackie & McCartneys Practical Medical Microbiology (1996) 14th Edition, Churchill Livingstone, London.

Rameshwar Sarma, K.V. (1998) Nutrition Survey: Methodology, National Institute of Nutrition, Jamai Osmania, Hyderabad.

Regional Medical Research Centre for Tribals (RMRCT) (2004) Annual Report, Jabalpur, India.

Soulsby, E.J.L. (1982) Helminths, Arthropods & Protozoa of Domesticated animals, 7th edition, English Language Book Society, Bailliere Tindall, London.

Vinson, D.C., Reidinger, C. and Wilcosky, T. (2003) ‘Factors affecting the validity of a Timeline Follow-Back interview’, Journal of Studies on Alcohol 64(5): 733-40.

World Health Organization (WHO) (2004) Guidelines for Drinking Water Quality, 3rd edition, WHO, Geneva.

WHO (2007) Water, Sanitation and Hygiene: Quantifying the Health Impact at National and Local Levels in Countries with Incomplete Water Supply and Sanitation Coverage, Environmental Burden of Disease Series, No. 15, WHO, Geneva.

WHO/United Nations Childrens Fund (UNICEF) (2004) Meeting the MDG Drinking-water and SANITATION TARGET: A Mid-term Assessment of Progress, WHO, Geneva.

WHO/UNICEF (2006) Meeting the MDG Drinking Water and Sanitation: The Urban and Rural Challenges of the Decade, WHO/UNICEF, Geneva.

Alok, K. (2007) ‘Total sanitation campaign: State progress and challenges’, presentation made at UNICEF-Government of India Review Meeting, New Delhi, 20 June 2007.

Department for Drinking Water Supply (DDWS) (2008) ‘Nirmal Gram Puraskar’, Government of India [Online], http://ddws.gov.in/ngp1.htm [accessed 20 May 2008].

Esrey, S, Potash, J., Roberts, L. and Shiff, C. (1990) Health Benefits from Improvements in Water Supply and Sanitation: Survey and Analysis of the Literature on Selected Diseases, WASH Technical Report, No. 66, Water and Sanitation for Health Project, USAID, Washington, DC.

Esrey, S.A., Potash, J.B., Roberts, L. & Shiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis and trachoma’, Bulletin of the World Health Organisation 69(5): 609-21.

Fewtrell, L., Kaufmann, R.B., Kay, D., Ananoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta-analysis’, Lancet Infectious Diseases 5(1): 42-52.

Godfrey, S., Smith, M. and Tino, F. (2005) ‘Relationship between rainfall and microbiological contamination of shallow groundwater in Northern Mozambique’, Water SA 31(4).

Jones, G., Schultink, W. and Babille, M. (2006) ‘Child survival in India’, Indian Journal of Pediatrics 73(6): 479-87.

Lin, J., Biyela, P.T. and Puckree, T. (2002) ‘Antibiotic profiles of environmental isolates from Mthlatuze River, Kwa Zulu Natal, South Africa’, Water SA 30(1): 23-8.

Mackie & McCartneys Practical Medical Microbiology (1996) 14th Edition, Churchill Livingstone, London.

Rameshwar Sarma, K.V. (1998) Nutrition Survey: Methodology, National Institute of Nutrition, Jamai Osmania, Hyderabad.

Regional Medical Research Centre for Tribals (RMRCT) (2004) Annual Report, Jabalpur, India.

Soulsby, E.J.L. (1982) Helminths, Arthropods & Protozoa of Domesticated animals, 7th edition, English Language Book Society, Bailliere Tindall, London.

Vinson, D.C., Reidinger, C. and Wilcosky, T. (2003) ‘Factors affecting the validity of a Timeline Follow-Back interview’, Journal of Studies on Alcohol 64(5): 733-40.

World Health Organization (WHO) (2004) Guidelines for Drinking Water Quality, 3rd edition, WHO, Geneva.

WHO (2007) Water, Sanitation and Hygiene: Quantifying the Health Impact at National and Local Levels in Countries with Incomplete Water Supply and Sanitation Coverage, Environmental Burden of Disease Series, No. 15, WHO, Geneva.

WHO/United Nations Childrens Fund (UNICEF) (2004) Meeting the MDG Drinking-water and SANITATION TARGET: A Mid-term Assessment of Progress, WHO, Geneva.

WHO/UNICEF (2006) Meeting the MDG Drinking Water and Sanitation: The Urban and Rural Challenges of the Decade, WHO/UNICEF, Geneva.

Alok, K. (2007) ‘Total sanitation campaign: State progress and challenges’, presentation made at UNICEF-Government of India Review Meeting, New Delhi, 20 June 2007.

Department for Drinking Water Supply (DDWS) (2008) ‘Nirmal Gram Puraskar’, Government of India [Online], http://ddws.gov.in/ngp1.htm [accessed 20 May 2008].

Esrey, S, Potash, J., Roberts, L. and Shiff, C. (1990) Health Benefits from Improvements in Water Supply and Sanitation: Survey and Analysis of the Literature on Selected Diseases, WASH Technical Report, No. 66, Water and Sanitation for Health Project, USAID, Washington, DC.

Esrey, S.A., Potash, J.B., Roberts, L. & Shiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis and trachoma’, Bulletin of the World Health Organisation 69(5): 609-21.

Fewtrell, L., Kaufmann, R.B., Kay, D., Ananoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta-analysis’, Lancet Infectious Diseases 5(1): 42-52.

Godfrey, S., Smith, M. and Tino, F. (2005) ‘Relationship between rainfall and microbiological contamination of shallow groundwater in Northern Mozambique’, Water SA 31(4).

Jones, G., Schultink, W. and Babille, M. (2006) ‘Child survival in India’, Indian Journal of Pediatrics 73(6): 479-87.

Lin, J., Biyela, P.T. and Puckree, T. (2002) ‘Antibiotic profiles of environmental isolates from Mthlatuze River, Kwa Zulu Natal, South Africa’, Water SA 30(1): 23-8.

Mackie & McCartneys Practical Medical Microbiology (1996) 14th Edition, Churchill Livingstone, London.

Rameshwar Sarma, K.V. (1998) Nutrition Survey: Methodology, National Institute of Nutrition, Jamai Osmania, Hyderabad.

Regional Medical Research Centre for Tribals (RMRCT) (2004) Annual Report, Jabalpur, India.

Soulsby, E.J.L. (1982) Helminths, Arthropods & Protozoa of Domesticated animals, 7th edition, English Language Book Society, Bailliere Tindall, London.

Vinson, D.C., Reidinger, C. and Wilcosky, T. (2003) ‘Factors affecting the validity of a Timeline Follow-Back interview’, Journal of Studies on Alcohol 64(5): 733-40.

World Health Organization (WHO) (2004) Guidelines for Drinking Water Quality, 3rd edition, WHO, Geneva.

WHO (2007) Water, Sanitation and Hygiene: Quantifying the Health Impact at National and Local Levels in Countries with Incomplete Water Supply and Sanitation Coverage, Environmental Burden of Disease Series, No. 15, WHO, Geneva.

WHO/United Nations Childrens Fund (UNICEF) (2004) Meeting the MDG Drinking-water and SANITATION TARGET: A Mid-term Assessment of Progress, WHO, Geneva.

WHO/UNICEF (2006) Meeting the MDG Drinking Water and Sanitation: The Urban and Rural Challenges of the Decade, WHO/UNICEF, Geneva.