Mapping spatial inequality: unsafe child feces disposal practices across 707 districts in India

BACKGROUND: Unsafe child feces disposal is a recognized public health concern linked to adverse child health outcomes. While previous studies have examined its impact, the spatial heterogeneity and determinants of unsafe child feces disposal in India remain underexplored. This study addresses this research gap by investigating the spatial distribution and key factors influencing unsafe disposal practices across Indian districts. METHOD: This study utilized data from the National Family Health Survey-5 (2019-2021) to conduct a comprehensive spatial analysis. Univariate and Bivariate Local Indicators of Spatial Association (LISA) clustering were employed to identify spatial patterns of unsafe child feces disposal. To examine the determinants, a Spatial Error Model (SEM) was applied, while Fairlie decomposition was used to quantify the contribution of various factors to regional disparities. RESULTS: The Univariate LISA analysis identified 170 hotspot districts characterized by high levels of unsafe child feces disposal, primarily located in Odisha, Jharkhand, Bihar, Assam, and Tamil Nadu. The SEM analysis revealed that maternal education, household wealth, sanitation access, and religious affiliation are significant determinants. Hotspot districts demonstrated a 22% higher likelihood of unsafe disposal compared to cold spots. Decomposition results indicated that household wealth accounted for 65.3% of the observed disparity, followed by sanitation (17.1%), religion (7.4%), media exposure (4.5%), and education (3.2%). CONCLUSION: This study underscores the pronounced spatial disparities in unsafe child feces disposal across Indian districts. Addressing these disparities requires targeted interventions focusing on improving sanitation, enhancing maternal education, and leveraging media outreach to promote safe disposal practices.