SDGs Goal 6 have committed the international community to expand international cooperation and capacity building on water and sanitation related activities and programmes, and also to support local communities in improving water and sanitation management [1,2]. Among many other health issues environmental sanitation is major public health issue in our country.

India has made rapid progress in ending open defecation across the Country, having huge impact on improving water, sanitation and hygiene. The World Health Organization estimated that Clean India campaign could help prevent the deaths of 300,000 people from diarrhea and protein-energy malnutrition [3] since country launched swachhbharat Mission. In 2015 around 568 million lacked access to toilets Before the Clean India campaign started, only 39% of households had access to a toilet [4], World Bank-supported national survey concluded that 10% of people in rural India defecated in the open -- and 96% of people who had access to a toilet used it [5].

Promotion of community health necessitates providing clean environment helping in breaking the cycle of disease. The levels of morbidity and mortality have led to losses in welfare that in turn cost India’s economy some 5.9 percent of GDP [6].  A 2018 report by the Health Effects Institute projects a rise in annual deaths in India due to air pollution from 1.1 million in 2015 to 1.7 million in 2030 [7], present study was conducted to know the current prevailing situation of kitchen, bathroom & toilet in Shimla city.

Objectives of the Study

To assess prevailing situation of kitchen, bathroom & toilet in Shimla city.

Research Approach

This study used principles of community participation and knowledge-to-action throughout all stages of the research process.

• Study Design: Cross sectional survey 

• Study Area: Shimla city of Himachal Pradesh 

• Study Period: 6 months July 2020 through October 2020)

• Study Population: Population residing in all 34 wards under Municipal corporation area of Shimla City

Sample Size

Sampling unit was households in the Municipal corporation area of Shimla city. Sample size is estimated to be 640 expecting 50% of households has adequate    knowledge   of    WASH    and    solid    waste

management with 95% level of confidence, design effect 1.5 and 5% confidence interval and nonresponse rate of 5%.

Sampling Design

Stratified random Sampling was done for the selection of Households for survey. We equally divided the households in all 34 wards of Shimla city. 18-19 households per municipal ward in Shimla city. First household of the ward was selected randomly and then every 10th household was selected to complete the sample size in the respective ward. An effort was made to have a balance of males and females, as well as to involve some younger persons as respondents, but this was dependent on cultural and other sensitivities when the household members are approached.

Data Collection

Before doing the data collection, the survey team consisting of medical social workers and residents of department of community medicine was given training regarding the testing of water with potables kits and administration of the questionnaire. The data collectors obtained consent from the head of family and pretested standardized questionnaire administered in every selected household, and the respondents (who willing to participate) were asked questions regarding WASH  and solid waste management knowledge, practices etc. Only one adult member per household was selected for data collection.

Table 1: Distribution of the participants according to socio-demographic characteristics

Table 2: Perception about toilet facility

Table 3: Perception about sanitation situation

        The data was collected to obtain information on following parameters:

• Socio demographic profile 

• Knowledge about WASH and solid waste management 

• Attitude about WASH and solid waste management

• Practices about WASH and solid waste management 

• Physical, chemical and biological testing of water

Table 4: Distribution of the participants according to toilet related issues

Table 5: Perception about door-to-door collection of waste

Table 6: Distribution of the participants according to bathing and kitchen Facility in household

Inclusion Criteria

Any adult person (only one per household) in selected household who was willing to participate in the study and had given consent.

Exclusion Criteria

Person who didn’t give consent and decline to answer the questions was excluded in the study.

In the study maximum (71.7%) respondents were females, 97% were Hindus, 93.1% were literate and37.7% were employed or working. 77.7% respondents were considered toilet facility as very important. 63.59% respondents were comfortable with sanitation situation of Shimla city. 97.2% of respondents had toilet facility, 2.5% use community toilets while 0.8% went for open defecation.58.4% used sitting type of toilet, 79.37% have toilet inside their home, 95.94 had all toilets functional, 4.7% had toilet related problems like flooding of toilets,17.19% share toilets with other households,98.59 % use water after toilet while only0.31 % use toilet 92.8% had bathing facility at their homes, among them 98.4% had drainage system in the bathroom. 96.3% had separate kitchen in their household, among them 94.8% had smoke outlet in their kitchen. 94.1% respondent used cooking gas as fuel. Paper, 89.1% had hand washing station at toilet, 72.19% had water basin as water station, 87.66% had soap at hand washing station, 75% had solid soap. 92.8% had bathing facility at their homes, among them 98.4% had drainage system in the bathroom. 96.3% had separate kitchen in their household, among them 94.8% had smoke outlet in their kitchen. 94.1% respondent used cooking gas as fuel.

In our study maximum (71.7%) respondents were females, 97% were Hindus, 93.1 were literate and 37.7 were employed or working. 63.59% respondents were comfortable with sanitation situation of Shimla city. 77.7 respondents were of the opinion that toilet facility is very important,19.4% considered it important and 3% considered it slightly important. 97.2 of respondents had toilet facility, 2.5 use community toilets while 0.8% went for open defecation. 58.4 used sitting type of toilet, 79.37 have toilet inside their home, 95.94 had all toilets functional, 4.7 had toilet related problems like flooding of toilets,17.19 share toilets with other households, 98.59 use water after toilet while only 0.31 use toilet paper, 89.1 had hand washing station at toilet,72.19 had water basin as water station, 87.66 had soap at hand washing station, 75% had solid soap. 92.8 had bathing facility at their homes, among them 98.4% had drainage system in the bathroom. 96.3 had separate kitchen in their household, among them 94.8 % had smoke outlet in their kitchen.  94.1%   respondent  used   cooking  gas as fuel.

According to NFHS4 in urban area of Himachal Pradesh practice of open defecation is 4%, whereas in our study 0.8% practice open defecation (99.2% never went for open defecation), In a study done by Saroj et al found 7% open defecation in Urban areas of Himachal Pradesh. Improved parameters may be due to implementation of Swachh Bharat Abhiyan (ODF mission) and better awareness in capital city. According NFHS-4 84% households have separate kitchen, 88% of households use a clean fuel for cooking in urban areas, in our study 96.3% had separate kitchen in their household, among them 94.8 had smoke outlet in their kitchen. 94.1 respondent used cooking gas as fuel, 4.2 using electricity, 0.8 and 0.3% firewood and kerosene respectively. Study done by Saroj Rana found that 84 used LPG for cooking, 12 used Firewood and chips, Charcoal/kerosene 3 were main source of fuel in urban households 8% of clean fuel use was higher in our study, as with time progress is being done (Swacchsurvekshan Rank for Shimla was 128th in 2019 and 65th in 2020 being cleanest in H.P) 92.8 had bathing facility at their homes, among them 98.4% had drainage system in the bathroom. 

WASH practices & facilities has improved over the time and is related to Households quality of life. Improved Kitchen, toilet & bathroom facilities improve health and hygiene, clean cooking fuel and smokeless cooking can reduce load of NCD. Efforts to achieve 100% targets for above mentioned basic amenities should continue & equal importance to be given to maintaining already constructed structures under WASH services, utmost important is IEC activity regarding WASH practices

1. World Health Organization. "Water, Sanitation, and Health: Burden of Disease and Risks." World Health Organization, https://www.who.int/water_sanitation_health/diseases-risks/ burden/en/.

2. United Nations India. "Sustainable Development Goals: SDG 6 – Clean Water and Sanitation." United Nations India, https://in.one.un.org/page/sustainable-development-goals/sdg-6/#:~.

3. World Health Organization. "India’s Commitment to Accelerated Sanitation Coverage." World Health Organization, http://origin.searo.who.int/mediacentre/ features/2018/indias-commitment-accelerated-sanitati on-coverage/en/.

4. "Air Pollution in India: The Role of Policy, Finance, and Communities." Observer Research Foundation, https://w ww.orfonline.org/research/finding-solutions-to-air-pollu tion-in-india-the-role-of-policy-finance-and-communities-74311/.World Bank. National Annual Rural Sanitation Survey (NARSS), 17 May 2019.

5. "A Mixed-Methods Evaluation of Swachh Bharat Abhiyan’s Sanitation Interventions." BMJ Global Health, vol. 4, no. 5, 2019, https://gh.bmj.com/content/4/5/e001892

6. National Center for Biotechnology Information. "Water, Sanitation, and Hygiene in India: Overview and Challenges." NCBI, https://www.ncbi.nlm.nih.gov/pmc /articles/PMC3299104/."Role of Government and Policy in Addressing Sanitation Challenges in India." ResearchGate, https://www.researchgate.net/publication /336496382.