Geography, sanitation and diarrhea

I've been involved as a research assistant for a study on sanitation project in rural East Java. One of the tasks was supervising the data collection from more than 2,000 households in 160 villages in 8 districts (kabupaten) in East Java, between August and December 2008.

The most important information we'd want to collect is whether the household has access to 'improved sanitation.' Improved sanitation is based on an international definition. Basically, if the sanitation facility is just an open pit, open area or riverside, then it is 'unimproved.'

When I did the calculation of the percentage of households^* with improved sanitation by district, I found a quite obvious geographical pattern. People in the Western part of East Java has higher rate of improved sanitation compared with those in the Eastern part. This could be due to different climate and soil type. But what is interesting for me is the geographical boundary also coincides with cultural boundary. The Western East Java are of 'Mataraman' sub-culture - with closer proximity to the Central Javanese. The Eastern side are predominantly Madurese, they don't even speak Javanese in that part.

Could culture explain the variation in sanitation behavior? Too early to conclude, since so many variables may interact with each other. But this could be a starting point to look further.

What is clear is there is a correlation between improved sanitation and diarrhea incidence among children under five. This suggests that an intervention aims to improve sanitation quality could be an effective measure to reduce diarrhea prevalence for children, among other illness.

The question is: how. The project in which I involved specifically deals with creating demand for improved sanitation through community-based promotion. It is not a subsidy or supply-side intervention. Is it effective? Ask me again by the end of the year when we are (supposedly) done with the study.

^*Due to copy right issue I can not share the numbers here. Sorry.