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Author Notes:

Author to whom correspondence should be addressed; E-Mail: mwjenkins@ucdavis.edu ; Tel.: +1-530-752-0586; Fax: +1-530-752-7872.

Marion W. Jenkins conceived of and designed the study with input from Matthew C. Freeman and Parimita Routray.

Parimita Routray supervised and managed the field work and data collection.

Marion W. Jenkins analyzed the data and prepared the initial manuscript draft and revisions.

Matthew C. Freeman compiled the attitude scores.

Matthew C. Freeman and Parimita Routray critically reviewed manuscript drafts and all authors have reviewed and approved the final manuscript.

The authors thank Tom Clasen and the London School of Hygiene and Tropical Medicine survey and data entry teams in Bhubaneswar, India for their support during the field work

The authors declare no conflict of interest.


Research Funding:

Funding was provided by the Bill and Melinda Gates Foundation under a grant to the London School of Hygiene and Tropical Medicine.

The funder had no role in the study design, data collection and analysis, or preparation of the manuscript.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Environmental Sciences
  • Public, Environmental & Occupational Health
  • Environmental Sciences & Ecology
  • latrine use behavior
  • open defecation behavior
  • child feces disposal
  • gender
  • measurement methods
  • attitudes
  • behavioral determinants
  • India
  • SLUM

Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility


Journal Title:

International Journal of Environmental Research and Public Health


Volume 11, Number 8


, Pages 8319-8346

Type of Work:

Article | Final Publisher PDF


Methods to assess household excreta disposal practices are critical for informing public health outcomes of efforts to improve sanitation in developing countries. We present a new metric, the Safe San Index (SSI), to quantify the hygienic safety of a household's defecation and human feces disposal practices in India, where behavioral outcomes from on-going public expenditures to construct household sanitation facilities and eliminate open defecation are poorly measured. We define hygienic safety of feces disposal as capture in a hygienic sanitation facility. The SSI consists of 15 self-report items and two sub-scales, Latrine Use Frequency and Seven-Day Open Defecation Rate. Households are scored on a standardized scale from 0 (no defecation safely captured) to 100 (all defecation safely captured). We present results of a pilot study in Odisha, India to apply the Index to assess excreta disposal behaviors among rural households and evaluate the reliability and validity of the Index for estimating the rate of correct and consistent sanitation facility usage of household with an improved latrine.

Copyright information:

© 2014 by the authors; licensee MDPI, Basel, Switzerland.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 3.0 Unported License (http://creativecommons.org/licenses/by/3.0/).

Creative Commons License

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