Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 112817

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : IE01 - IE06 Full Version

Assessment of Water, Sanitation, and Hygiene in South-East Asia: A Systematic Review

Published: October 1, 2022 | DOI:
Deepak Kumar Behera, Kalolinid Samant, Ranjit Kumar Dehury

1. Assistant Professor, Department of School of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India; Assistant Professor, Department of Economics, Birla School of Social Sciences and Humanities, Birla Global University, Bhubaneswar, India. 2. Research Assistant, Department of Community Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. 3. Assistant Professor, Department of School of Management Studies, University of Hyderabad, Telangana, India.

Correspondence Address :
Ranjit Kumar Dehury,
School of Management Studies, University of Hyderabad, Telengana, India.


Introduction: Water, Sanitation and Hygiene (WASH) can
be used as an indicator for the assessment of the health of a country. Without WASH facilities, it is very difficult for the sustenance of health and well-being of the people.

Aim: This systematic review tries to bring out various nuances of practices on WASH and their intervention in the South-East Asia Region (SEAR).

Materials and Methods: In the present systematic review, searches were made systematically in scholarly sources like Google Scholar, PubMed and Science Direct to unearth data from January 2005 to February 2020 with a language restriction to English for all the published articles. The literature search was conducted from March to May, 2020. The full-text articles (accessible) were retrieved from each of the searches and a few of the papers which appeared to be relevant were obtained for review. Articles were included from both urban and rural set-ups. Irrelevant topics and headings were excluded. The final review included 15 articles.

Results: The area of SEAR has a different level of practice and outcomes on WASH. The studies show that low-quality WASH practices in Bangladesh, India and Sri Lanka contribute to public health issues. The studies on the health impact of WASH from many countries like Indonesia, Myanmar, Sri Lanka and Timor-Leste are also found to be inadequate in the maintenance of health. The report mentioned about many diseases like gastroenteritis, stunting and helminthes infection among many people in the community. The source of drinking water and drinking water quality needs to be assessed according to the recommendation of studies across the SEAR region. Two infectious diseases recently emerged such as Soil Transmitted Helminths (STH) and Escherichia coli contamination due to inadequate WASH practices.

Conclusion: The diarrhoeal diseases and sanitation related issues are numerous in the entire region. Diverse consumption of sanitary practices and drinking water is seen in India, as reported in one study; whereas open defecation has not been eliminated as reported in another study, where 32% of households are still defecating openly. Health impacts due to the lack of proper WASH practices are still a rising concern. Special attention is required for underprivileged areas like slums and rural areas. The involvement of the government in providing WASH facilities to underprivileged people is very significant.


Drinking water, Hand hygiene, Health outcome, Hand washing, Sanitation

Water, sanitation and Hygiene (WASH) is a parameter to assess the country on health and hygiene (1). Inadequate sanitation and lack of hygiene are considered as factors of grave concern with a bearing on health of common people (2). Lu Z et al., reported that United Nations has set Sustainable Development Goals to provide safe here after WASH practice in low and middle-income countries by 2030 (3). The incremental increase of WASH facilities fails to ensure complete coverage across the world (4). In many countries, diseases of waterborne infections are still found to be a cause of concern, which causes many people to fall ill or even die (5). Diarrhoea-related illnesses account for 4.1 percent of the global disease burden, which claims the lives of 1.8 million people, the majority of whom are children under the age of five (1).

According to a document by World Health Organisation (WHO) the concepts of “safer water, better health” states that with the mere improvement of WASH, almost 10% reduction in the global burden of disease across the world and in South-East Asia Region (SEAR) it could be 8.4% (6). In SEAR, almost 1.1 million children die from diarrhoeal diseases (7). The South-East Asia Region (SEAR) has already met its drinking water target set by the Millennium Development Goals; nonetheless, the safety of drinking water quality remains a concern. Many countries in the region are still trailing behind in terms of sanitation. Therefore, this study has investigated the assessment of WASH practices and their impact on health in SEAR.

Material and Methods

This systematic review performed a literature search in Google Scholar, PubMed and Science Direct databases for journal articles published between January 2005 and February 2020. The titles of the scientific papers, abstracts and keywords were inspected by using relevant terms mentioned in (Table/Fig 1). When performing searches, terms were separated by the Boolean terms OR and AND. First relevant articles were exported to Mendeley reference software. Only peer-reviewed journal articles were included in the study. Searches were limited to English language and location SEAR. The literature search was conducted from March to May 30, 2020.

Inclusion criteria: The articles, reviews and original research with complete text on clearly defined WASH practices and health outcomes, or data about the function and use of the WASH practices of the South-East Asia region, both urban and rural settings, published from the year January 2005 to February 2020 were included in the review with the language restricted to English.

Exclusion criteria: Grey literature and organisational literature or articles on any other region other than SEAR, those on irrevant topic and headings were excluded from the study. The practices and health impact, the specifications included and excluded are shown in (Table/Fig 2).

Selection Procedure of Articles

A three step screening process was developed to identify the studies that show the assessment of WASH practices and their impacts on health outcomes in SEAR. Initially, in the identification, articles considered the relevance of WASH and wash practices. In primary screening, the articles were reviewed as per fulfilling the study objective with all the keywords where only the title was scanned. In the secondary screening, the articles were reviewed as per the inclusion and exclusion criteria where both title and abstract were scanned. In the tertiary screening, the articles finally reviewed were full text and in the final review, the eligible full-text article directly addressed the research questions. All the eligible papers were selected that address the WASH practices and their health impacts.

Data Extraction

Data extraction was created for the 15 identified research studies. Data were extracted from the selected articles employed in the review. The studies were divided and initially extracted as per the objective of the study. Study design, methodology, sample and outcome (see supplementary materials) were extracted. There were no restrictions on the settings whether it’s rural or urban in Southeast Asia. A future direction to improve the health conditions in every study is also described. The data extraction form was revised, refined and capture data concisely.

Risk of Bias Assessment

The risk of bias was assessed using the Cochrane risk of bias assessment tool (8).


The result section is based on a literature search procedure that has been presented through a PRISMA diagram and the literature is extracted based on three themes-nature of wash practices; methodology adopted to assess the WASH practices; evaluation of any health impacts associated with inadequate WASH practices (Table/Fig 3).

The (Table/Fig 4) shows a literature search for a review of WASH practices and health impacts in SEAR published between 2005 and 2020. A total of 15 articles were retrieved from the search as per the eligibility criteria which are included in this review. Five countries (Indonesia, Nepal, India, and Bangladesh) constituting five articles represented access to safe drinking water, toilet usage and hand washing practices in those studies. Two articles from India represented WASH practices and eight of the countries (Indonesia, Vietnam, Thailand, Sri Lanka, Myanmar, India, Laos, and Timor-Leste) constitute 10 articles about the health impacts and risk factors that can contribute to diseases and the disease-associated due to inadequate sanitation, water and hygiene practices of which Laos and Thailand reported one study. The (Table/Fig 4) shows the methodology adopted to assess the WASH practice in SEAR. We have found that most of the study is based on a primary survey using simple random sampling (2),(9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22).

Nature of WASH Practices and Health Outcomes

The (Table/Fig 5) presents the nature of WASH practices and health outcomes of selected studies in SEAR [(2),(9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22).

Indonesia: Hand washing practices were found to be infrequent despite available facilities. Risk factors were associated with diarrhoea due to lack of handwashing stations, minimal presence of septic tank toilets and poor use of toilets (9).

Nepal: It is found that most of the people (96.3%) are using the latrine for defecation. Whereas, many of the respondents (74%) use improvised toilets without sharing. The handwashing with soap is limited to only 71.4% of respondents. The study also confirms that 70.1% of people use to brush their teeth once. Nearly 64.2% of households do not use any sophisticated methods for cleaning portable drinking water (10).

India (West Bengal State): There are various types of water consumption and sanitation practices patterns dominant in the urban slums of Siliguri. According to the concerned study, 733 (92.1%) of the slum dwellers use better drinking water sources; the public tap (71%) plays a big role as the primary source of water. The report also confirms that 54.9% of families use improved and 45.1% of use unimproved portable water resources for food preparation and/or handwashing. There is evidence of two-thirds of the families (65.7%) use sophisticated sanitation facilities, of which the use of a flush facility consists of 47.5% in comparison to 18.2% usingan improved pit latrine (22).

India: The public taps play an important role as a source of drinking water which is closely followed by the dug wells and ponds. The use of latrines was found in relatively low households of around 73.5%. Among all the members of the household only 66.8% use latrines, the rest 33.2% still depend on open defecation. The hand washing practice was done by 86.5% of respondents associated with before and after consumption of food and only 78.3% practiced hand washing in association with feeding the child (16).

Bangladesh: The main source of drinking water found to be tube well among that 96% of platforms were found to be cemented. However, the main crisis was due to problems with iron and arsenic which make the water unsuitable (12).

Overall WASH practices analysis, the authors found four insights. First, accelerating action by the local administration needs to be incorporated to improve water quality. Second, various hygiene awareness programs should be conducted with the direct involvement of the community (10). Third, emphasis should be given to health education to improve people’s behaviour (11). Fourth, awareness through digital media should be strengthened in rural areas (12).

Inadequate WASH Practices and Associated Health Impact

The (Table/Fig 6) shows associated health impacts due to inadequate WASH practices in SEAR. The study has found the most frequently occurring diseases which include gastrointestinal, stunting, waterborne disease and soil helminth infection. A detailed discussion of health impacts (country-specific) has been presented in (Table/Fig 5).

Myanmar: The major risk factors found with diarrhoea is lack of hand washing facilities, lack of access to septic tank toilets and poor use of toilet (13).

Vietnam: The factors like wastewater and excreta in agricultural practices cause diarrhoea among adults. The prevalence of gastrointestinal diseases is associated with the consumption of wastewater irrigated vegetables. Lack of personal hygiene and unsafe food and water causes severe episodes of diarrhoeal diseases among adults (2).

Indonesia: There was close symmetry between the use of sanitation methods and child stunting in parts of Indonesia. The households having lack access to improved latrines were found to be reporting more stunting cases. The WASH interventions into a broader multispectral approach are needed to achieve the results (14).

Indonesia: The use of a towel after hand washing proved to be an effective method to eliminate the bacteria on hands. The maters like improvement of drinking water are required for better results (15).

Kolkata, India: Acute Watery Diarrhoea (AWD) was very much prevalent among the children; around 51% and 72% of other members of the family suffer from AWD. The severity of the diarrhoeal disease can be controlled by 40% by the rotavirus vaccine and most importantly awareness of the waterborne disease plays a major role (16).

Rural India: The evidence of poor sanitation causing more likely of child stunting is found in rural India. Whereas the cases of open defecation are found to be burdensome causing child stunting. Well-targeted nutrition-sensitive interventions are the order of the day to overcome the situation (17).

Laos and Thailand: In suburban Laos, the factors like use of household materials, types of storing water containers and unavailability of toilets are correlated with dangerous organisms like Escherichia coli (E. coli). The high level of E. coli in the two villages in Laos and rural Thailand was found to be a risk factor for diarrhoeal diseases. Massive steps need to be taken for the provision of improvised toilet facilities to reduce the burden of diseases (18).

Myanmar: The prevalence of gastrointestinal disease was found in 83 (22.8%) households and non disease in 281 (77.2%) households. The households focusing on non tube water were 6.5 times more in comparison to others in connection with the occurrence of gastrointestinal diseases than those who use tube water (19).

Timor-Leste: The community-based assessment shows that factors in Timor-Leste are Soil Transmitted Helminths (STH) infections in the area of high STH. High STH is endemic with a poor level of WASH. Improper disposal of human excreta is associated with a major driver of STH transmission which is reported due to poor sanitation infrastructure (20).

Sri Lanka: The flooding period force the ground water sources to be affected heavily and causes diseases. The agents causing the water-borne diseases increase due to improper drainage systems in the coastal areas, which leads to the breeding ground for dengue (21).


Status of Assessment of WASH Practices

The status of WASH in various countries can be defined through the assessment of practices. Water has a profound effect on health. The source of drinking water, and drinking water quality needs to be assessed. The practice of regular handwashing with soap is found to be the most cost-effective in maintaining good health and reducing diseases across the world (5). The Millennium Development Goals (MDGs) are on track in maximum countries of South-east Asia. The diverse pattern of water consumption is seen in the reported study in West Bengal. Still, there is a lack of drinking water treatment in Nepal reported in the study (7). Hand washing was found to be infrequent in a study conducted in Indonesia. Overall handwashing practices were satisfactory (8). Three of the studies have found out public tap was the main source of drinking water whereas two studies reported groundwater was the main source. People still lack basic sanitary services in slums although utilisation of drinking water has been increasing globally in various slums (11). Overall WASH practices are satisfactory although full attainment has not been achieved yet in some regions of South-east Asia.

Infectious Diseases Due to Inadequate WASH

Two infectious diseases recently emerged such as STH and E. Coli contamination due to inadequate WASH practices. Across the globe, the issue of STHs is a concern for people. This may be due to the poor nature of human behaviours in society along with inadequate water sources (21). Evidence found that handwashing with soap is a protective factor for Ascaris and STH generally (23),(24).

Stunting is a risk factor for the death of a child, which again affects cognitive and motor development leading to a low level of performance in study. This can cause overnutrition and noncommunicable diseases along with a low level of productivity. In 2013, Indonesia had the fifth highest burden of stunted children despite being a low-middle-income country (15). The study conducted in Indonesia reports that provincial estimates on household access to improved latrines correlated inversely with the percentage of the stunted child. Many papers report that at a household level in India and Africa, the sanitation facility is found to be associated with the factors like child nutrition (16),(17). The correlation between WASH and nutritional status needs to be investigated in Indonesia with scientific studies.

The diseases of diarrhoeal origin especially protozoan and bacterial infections are very high. To improve the health system, there is a need for improvement of WASH. The focus on addressing public health issues varies across countries. The evidence generated by WASH studies could be incorporated into the regional public health policies. Hence, the governments have to be vigilant according to the inputs of micro-level studies in their countries.

The priorities in rural and urban areas are quite different, so as far as the WASH activities and diseases are concerned, in urban areas the infection is found to be virulent and quickly spreading, especially in the rainy season. Whereas, there is a prevalence of endemic diarrhoeal diseases in rural pockets due to lowlevels of hygiene and sanitation activities. The urban areas having more facilities for healthcare usually combat the situation promptly. The rural areas need sustained effort for awareness and intervention to gain the desired results.

The role of media in the awareness and promotion of WASH plays a very significant role. Intensive education and awareness campaigns need to be done to ensure people understand the need for safe water and sanitation. More investigation on improving WASH and various related infections and proper monitoring and evaluation need to be incorporated.


The SEAR has shown tremendous progress toward WASH activities. Maldives, Singapore, Malaysia, the Philippines and the Democratic People of Korea are in the utmost number in progress toward WASH. Whereas Timor-Leste has shown poor performance of WASH since 2000. Diverse sanitary practices and drinking water is seen in India as open defecation has not been eliminated and 32% of households are still defecating openly. Health impacts due to the lack of proper WASH practices are still a rising concern. Special attention is required for underprivileged areas like slums and rural areas. The involvement of the government in providing WASH facilities to underprivileged people is very significant. Involvement of policies and programmes on adequate Information, Education and Communication (IEC) activities are very much needed for effective WASH strategy implementation.

Authors’ contribution: All the authors have contributed in designing of the study. Authors Deepak Kumar Behera and Kalolini D Samant initiate the process of ideation. Deepak Kumar Behera, Kalolini D Samant and Ranjit Kumar Dehury work on the analysis and findings of the study. Deepak Kumar Behera and Kalolini D Samant make the primary draft with a compilation of the study. Deepak Kumar Behera and Ranjit Kumar Dehury verified the data and make improvements. All the authors approved the manuscript.


UNICEF & WHO. Progress on Drinking Water, Sanitation, and Hygiene-Joint Monitoring Programme 2017 Update and SDG Baselines. 2017 Who, 66. / tmi.12329 (Last accessed on17.07.2022).
Pham-Duc P, Nguyen-Viet H, Hattendorf J, Cam PD, Zurbrügg C, Zinsstag J, et al. Diarrhoeal diseases among adult population in an agricultural community Hanam province, Vietnam, with high wastewater and excreta re-use. BMC Public Health. 2014;14(1):01-04. [crossref] [PubMed]
Lu Z, Bandara JS, Paramati SR. Impact of sanitation, safe drinking water and health expenditure on infant mortality rate in developing economies. Australian Economic Papers. 2020;59(1):13-33. [crossref]
Ngwenya BN, Thakadu OT, Phaladze NA, Bolaane B. Access to water and sanitation facilities in primary schools: A neglected educational crisis in Ngamiland district in Botswana. Physics and Chemistry of the Earth, Parts A/B/C. Elsevier BV; 2018;105:231-38. Available from: pce.2018.03.006(Last accessed on17.07.2022 ). [crossref]
Mubarak MY, Wagner AL, Asami M, Carlson BF, Boulton ML. Hygienic practices and diarrheal illness among persons living in at-risk settings in Kabul, Afghanistan: A cross-sectional study. BMC Infectious Diseases. 2016;16(1):01- 09. [crossref] [PubMed]
World Health Organisation, WHO Global Water, Sanitation and Hygiene Annual report 2020. Retrivated from publications/i/item/9789240033085. accessed on 20, July, 2021. (Last accessed on17.07.2022).
WHO Southeast Asia. No Title. 2018.Retrieved from / outheastasia/news/speeches/detail/world-toilet-day-2018. (Last accessed on17.07.2022).
da Costa BR, Beckett B, Diaz A, Resta NM, Johnston BC, Egger M, et al. Effect of standardised training on the reliability of the Cochrane risk of bias assessment tool: a prospective study. Systematic reviews. 2017;6(1):01-08. [crossref] [PubMed]
Greenland K, Iradati E, Ati A, Maskoen YY, Aunger R. The context and practice of handwashing among new mothers in Serang, Indonesia: A formative research study. BMC public health. 2013;13(1):01-01. [crossref] [PubMed]
Acharya P, Kaphle HP, Thapa SB. Hygiene and sanitation practices among slum dwellers residing in urban slums of Pokhara sub-metropolitan, Nepal. International Journal of Health Sciences and Research. 2015;5(5):298-03.
Tripathy RM, Acharya GC, Karmee N. Assessment of wash practices among women in urban slums of Berhampur, Odisha: A cross sectional study. International Journal of Research in Medical Sciences [Internet]. Medip Academy; 2017;5(11):4846. Available from: accessed on17.07.2022). [crossref]
Shammi M, Morshed M. Assessment of practices of sanitation and hygiene in rural Bangladesh: A comparison of a declared sanitation area to a nondeclared sanitation area of sirajganj district, Bangladesh. Jahangirnagar University Environmental Bulletin [Internet]. Bangladesh Journals Online (JOL). 2013;2:50-60. Available from: (Last accessed on17.07.2022). [crossref]
Weaver ERN, Agius PA, Veale H, Dorning K, Hlang TT, Aung PP, et al. Water, sanitation, and hygiene facilities and hygiene Practices associated with diarrhea and vomiting in monastic schools, Myanmar. The American Journal of Tropical Medicine and Hygiene [Internet]. American Society of Tropical Medicine and Hygiene. 2016;95(2):278-87. Available from: ajtmh.15-0290 (Last accessed on17.07.2022). [crossref] [PubMed]
Torlesse H, Cronin AA, Sebayang SK, Nandy R. Determinants of stunting in Indonesian children: Evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health. Springer Science and Business Media LLC; 2016;16(1). Available from: (Last accessed on17.07.2022). [crossref] [PubMed]
Otsuka Y, Agestika L, Widyarani, Sintawardani N, Yamauchi T. Risk factors for undernutrition and diarrhea prevalence in an urban slum in Indonesia: Focus on water, sanitation, and hygiene. The American Journal of Tropical Medicine and Hygiene [Internet]. American Society of Tropical Medicine and Hygiene. 2019;100(3):727-32. Available from: (Last accessed on17.07.2022). [crossref] [PubMed]
Adhikary M, Pal C. Incidence of water borne disease: A case study of child Diarrhea in Kolkata. Indian Journal of Economics and Development. 2019;7(6):01-02.
Rah JH, Cronin AA, Badgaiyan B, Aguayo VM, Coates S, Ahmed S. Household sanitation and personal hygiene practices are associated with child stunting in rural India: A cross-sectional analysis of surveys. BMJ Open. BMJ; 2015;5(2):e005180-e005180. Available from: bmjopen-2014-005180. [crossref] [PubMed]
Vannavong N, Overgaard HJ, Chareonviriyaphap T, Dada N, Rangsin R, Sibounhom A, et al. Assessing factors of E. coli contamination of household drinking water in suburban and rural Laos and Thailand. Water Supply. IWA Publishing. 2017;18(3):886-900. Available from: ws.2017.133 (Last accessed on17.07.2022). [crossref]
Hlaing ZN, Mongkolchati A, Rattanapan C. A Household level analysis of water sanitation associated with gastrointestinal disease in an urban slum setting of South Okkalapa Township, Myanmar. Environment Asia. 2016;9(2):91- 100.
Campbell SJ, Nery SV, D’Este CA, Gray DJ, McCarthy JS, Traub RJ, et al. Water, sanitation and hygiene related risk factors for soil-transmitted helminth and Giardia duodenalis infections in rural communities in Timor-Leste. International Journal for Parasitology [Internet]. Elsevier BV.2016;46(12):771- 79. Available from: (Last accessed on17.07.2022). [crossref] [PubMed]
Fowsul Ameer ML. Water-borne diseases and the their challenges in the coastal of Ampara District in Sri Lanka. World News of Natural Sciences. 2017;9:07-18.
Bhar D, Bhattacherjee S, Mukherjee A, Sarkar TK, Dasgupta S. Utilization of safe drinking water and sanitary facilities in slum households of Siliguri, West Bengal. Indian Journal of Public Health. 2017;61(4):248. [crossref] [PubMed]
Fung IC, Cairncross S. Ascariasis and handwashing. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009;103(3):215-22. [crossref] [PubMed]
Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC, et al. Water, sanitation, hygiene, and soil-transmitted helminth infection: A systematic review and meta-analysis. PLoS Medicine. 2014;11(3):e1001620. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/55225.17080

Date of Submission: Jan 25, 2022
Date of Peer Review: Mar 12, 2022
Date of Acceptance: Aug 27, 2022
Date of Publishing: Oct 01, 2022

• Financial or Other Competing Interests: Funded by the Institute of Eminence Project, University of
Hyderabad [UoH-IoE by MHRD (F11/9/2019-U3(A)].
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jan 31, 2022
• Manual Googling: Aug 23, 2022
• iThenticate Software: Aug 26, 2022 (9%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)