Effect of access to sanitation on Urinary Tract Infections in urban women, Maharashtra, India

Background: Women and girls have restricted access to sanitation in India. This leads to various health issues, especially for women and girls living in slums/settlements. This study aims assessment of urinary tract infections among women and girls who have restricted access to sanitation and compares the prevalence after the installation of household toilets. Along with the prevalence this study also examines the alterations in behaviors associated with access to sanitation. Materials and Methods: A pre and post-intervention study was conducted among women (n=1711) residing in slums across four cities in Maharashtra.The intervention included the installation of household toilets. Data on the individual characteristics of women, housing area/conditions, access to sanitation facilities, behaviors adopted by the women/girls that could be associated with UTI symptoms, and reported symptomatic UTI in the previous one month were gathered through a structured tool using the mobile application. Results: The prevalence of UTI among women and adolescent girls living in slums was 12.8% pre-intervention and 2.9% post-intervention. In the unavailability of the individual toilets, women and girls have altered their routine habits related to taking dinner, toilet use after dark (24.9%) and avoiding drinking water and liquid intakes (12.15%) to avoid frequent toilet visits. All these behavioral adaptations were found significantly associated with the presence of UTI. Conclusion: The study demonstrates that the installation of toilets in households improve sanitation-related behavior and menstrual and vaginal hygiene.