Impact assessment of India's Swachh Bharat Mission – Clean India Campaign on acute diarrheal disease outbreaks: Yes, there is a positive change

BACKGROUND: Enough evidence exists to attribute the occurrence of diarrheal disease outbreaks due to open defecation practice and unsafe sanitation methods. Open defecation enables pathogens such as virus, bacteria, and protozoa to infect humans by means of fecal–oral transmission methods through contaminated fluids, water, and fomites. To curb the malefic effects of open defecation, the Indian government had initiated pro sanitation program namely Swachh Bharat Mission (SBM) in 2014. SBM became the world's largest toilet-building initiative. More than 95 million toilets have been built across rural and urban India since the launch of this mission. This articulation summarizes the trend analysis of acute diarrheal disease (ADD) outbreaks over a 9-year period with emphasis on changes due to the building of toilets under the clean India campaign. METHODS: Weekly ADD outbreaks data from national-level Integrated Disease Surveillance Program between 2010 and 2018 were used for trend analysis along with the number of toilets constructed in rural areas under SBM from the year 2014. RESULTS: ADD outbreaks were analyzed from 2010 to 2018. The number of ADD outbreaks per year during the past 2 years (i.e., 2017 and 2018) of SBM regime was lesser than in any year during the investigation period. Seasonal variations during the months of May, June, July, and August account for 55%–60% of ADD outbreaks in any of the years; but for 2018, the total outbreaks were 46%, which is significantly lower than that of regular range of outbreaks in the peak season. CONCLUSION: The recent pattern of ADD outbreaks exhibits a declining rate.