Neighbour-shared versus communal latrines in urban slums: a cross-sectional study in Orissa, India exploring household demographics, accessibility, privacy, use and cleanliness.

A growing proportion of the global population rely on shared sanitation facilities, despite their association with adverse health outcomes. We sought to explore differences between neighbour-shared and communal latrines in terms household demographics, accessibility, facilities and use.We conducted surveys among 295 households relying on shared sanitation in 30 slums in Orissa, India, 60.3% (178) of which relied on neighbour-shared latrines while the balance relied on communal latrines. We collected household demographic data, conducted latrine spot-checks and collected data on indicators of use, accessibility, privacy and cleanliness.Compared to neighbour-shared facilities, households relying on communal facilities were poorer, larger, less educated, less likely to have access to piped water and more likely to have a member practicing open defecation. Communal latrines were also less accessible, less likely to have water or a hand washing station on site and cleaned less frequently; they were more likely to have visible faeces and flies present.We found significant differences between neighbour-shared and communal facilities in terms of user demographics, access, facilities and cleanliness that could potentially explain differences in health. These findings highlight the need for a shared sanitation policy that focuses not just on the number of users, but also on maintenance, accessibility, cleanliness and provision of water and hand washing facilities.