Diarrhoeal disease is one of the major causes of morbidity and mortality in children and is usually measured at individual level. Shared household attributes, such as improved water supply and sanitation, expose those living in the same household to these same risk factors for diarrhoea. The occurrence of diarrhoea in two or more children in the same household is termed ‘diarrhoea clustering’. The aim of this study was to examine the role of improved water supply and sanitation in the occurrence of diarrhoea, and the clustering of diarrhoea in households, among under-five children in India. Data were taken from the fourth round of the National Family and Health Survey (NFHS-4), a nationally representative survey which interviewed 699,686 women from 601,509 households in the country. If any child was reported to have diarrhoea in a household in the 2 weeks preceding the survey, the household was designated a diarrhoeal household. Household clustering of diarrhoea was defined the occurrence of diarrhoea in more than one child in households with two or more children. The analysis was done at the household level separately for diarrhoeal households and clustering of diarrhoea in households. The presence of clustering was tested using a chi-squared test. The overall prevalences of diarrhoea and clustering of diarrhoea were examined using exogenous variables. Odds ratios, standardized to allow comparison across categories, were computed. The household prevalence of diarrhoea was 12% and that of clustering of diarrhoea was 2.4%. About 6.5% of households contributed 12.6% of the total diarrhoeal cases. Access to safe water and sanitation was shown to have a great impact on reducing diarrhoeal prevalence and clustering across different household groups. Safe water alone had a greater impact on reducing the prevalence in the absence of improved sanitation when compared with the presence of improved sanitation. It may be possible to reduce the prevalence of diarrhoea in households by targeting those households with more than one child in the under-five age group with the provision of safe water and improved sanitation.

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印度家庭中腹泻的患病率和聚集性：来自 NFHS-4, 2015-16 的一些证据

腹泻病是儿童发病和死亡的主要原因之一，通常在个体水平上进行测量。共同的家庭属性，例如改善供水和卫生设施，使生活在同一家庭中的人面临同样的腹泻风险因素。同一家庭中两个或多个儿童发生腹泻被称为“腹泻聚集性”。本研究的目的是检查改善供水和卫生设施在印度 5 岁以下儿童腹泻发生中的作用，以及家庭中腹泻的聚集性。数据取自第四轮全国家庭与健康调查 (NFHS-4)，这是一项具有全国代表性的调查，采访了该国 601,509 个家庭的 699,686 名妇女。如果在调查前 2 周内有任何儿童被报告在家庭中出现腹泻，则该家庭被指定为腹泻家庭。家庭聚集性腹泻被定义为在有两个或更多孩子的家庭中发生不止一个孩子的腹泻。分析是在家庭层面分别针对腹泻家庭和家庭中的腹泻集群进行的。使用卡方检验测试聚类的存在。使用外源变量检查了腹泻的总体患病率和腹泻聚集性。计算了标准化以允许跨类别比较的优势比。腹泻的家庭患病率为12%，聚集性腹泻的患病率为2.4%。大约 6.5% 的家庭贡献了总腹泻病例的 12.6%。事实证明，获得安全的水和卫生设施对降低不同家庭群体的腹泻患病率和聚集性具有重大影响。与改善卫生条件相比，在没有改善卫生条件的情况下，仅安全水对降低流行率的影响更大。通过针对 5 岁以下儿童的家庭提供安全饮用水和改善卫生条件，可能会降低家庭中腹泻的流行率。