Rationale: A great wealth of studies expound on the impact of water and sanitation facilities on sustainable human development. But even though water-sanitation nexus is acknowledged in WaSH (Water-Sanitation-Hygiene) literature, they are seldom assessed collectively. In rural India, open defecation is still a major threat to human health, as much as potable water quality. Unfortunately, no study yet exists that attempts to assess the WaSH sector in a holistic sense. Objective: Present study was aimed to integrate multiple WaSH parameters into a composite WaSH Quality Index (WaSHQI) for rural India, within a geospatial framework, and understand potential effects of different sociodemographic factors that are likely to influece WaSH profile development. Methods: District-wise data for (i) within-premises latrine facility, (ii) water source type (safe/treated tap), (iii) water source location (near home/away from home), and (iv) wastewater drainage (closed/open) were mapped at nationwide scale. Gini Coefficients were computed for each parameter to elucidate spatial inequality. The parameters were integrated in various combinations to compute a composite index for each district called, WaSHQI. In the process, four hypothetical scenarios were generated (grading from most conservative to most liberal). The WaSHQI was later (a) merged with spatial algorithms (Moran’s I and LISA) ) to identify WaSH-hotspots and (b) correlated with a range of sociodemographic factors (e.g., literacy, household density, caste). Results: Under a conservative aproach (presumably the most hygienic WaSH scenario), a vast expanse through central India were significantly (p < 0.001) lagging in multiple WaSH facilities and appeared as major hotspots that deserve urgent management actions. On the other hand, northwestern states (Punjab and Haryana) registered a better WaSH profile owing to a number of progressive social reforms. Significant (p < 0.01) correlations between the WaSHQI and literacy levels, especially that of female, in the hotspots called for more in-depth region-specific investigations in future. Rural WaSH sector in India is marked by intense spatial inequality/heterogeneity, calling for spatially-optimized interventions. Using multiple geospatial alrorithms and statistical analyses the study demonstrated the spatially interconnected nature of the WaSH and argued that policy decisions have to address the parameters collectively. Future Implications: WaSHQI can offer the decision-makers a semi-quantitative approximation of overall WaSH infrastructural inadequacy at any level of administrative hierarchy anywhere in the world. However, some efforts to exapand/diversify the potentials WaSHQI (accounting for additional socioeconomic parameters) could be pursued on the premise of developing a WaSH informatics system to track regional progress/lag over time.

中文翻译：

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使用综合指数、空间算法和印度农村社会人口统计学相关性评估 WaSH（水-卫生-卫生）基础设施

理由：大量研究阐述了水和卫生设施对人类可持续发展的影响。但是，尽管水与卫生的关系在 WaSH（水-卫生-卫生）文献中得到承认，但很少对它们进行集体评估。在印度农村，露天排便与饮用水质量一样，仍然是对人类健康的主要威胁。不幸的是，目前还没有任何研究试图从整体上评估 WaSH 部门。目标：本研究旨在在地理空间框架内将多个 WaSH 参数整合到印度农村的综合 WaSH 质量指数 (WaSHQI) 中，并了解可能影响 WaSH 概况发展的不同社会人口因素的潜在影响。方法： (i) 室内厕所设施的地区数据，(ii) 水源类型（安全/处理过的水龙头）、（iii）水源位置（离家附近/离家）和（iv）废水排放（封闭/开放）在全国范围内绘制。计算每个参数的基尼系数以阐明空间不平等。这些参数以各种组合进行整合，以计算每个称为 WaSHQI 的地区的综合指数。在这个过程中，产生了四个假设情景（从最保守到最自由的等级）。WaSHQI 后来 (a) 与空间算法（Moran's I 和 LISA）合并）以识别 WaSH 热点，并且 (b) 与一系列社会人口因素（例如识字率、家庭密度、种姓）相关联。结果：在保守的方法下（大概是最卫生的 WaSH 方案），印度中部的广阔区域是显着的（p < 0. 001) 在多个 WaSH 设施中滞后，并成为值得采取紧急管理行动的主要热点。另一方面，由于一些渐进的社会改革，西北部各州（旁遮普邦和哈里亚纳邦）记录了更好的 WaSH 形象。在热点地区，WaSHQI 与识字水平，尤其是女性识字水平之间存在显着 (p < 0.01) 相关性，需要在未来进行更深入的区域特定调查。印度农村水电行业的特点是空间不平等/异质性严重，需要空间优化干预。该研究使用多个地理空间算法和统计分析证明了 WaSH 在空间上相互关联的性质，并认为政策决策必须共同解决这些参数。未来的影响：WaSHQI 可以为决策者提供世界上任何行政层级的整体 WaSH 基础设施不足的半定量近似值。然而，在开发 WaSH 信息学系统以跟踪区域进展/滞后的前提下，可以采取一些努力来扩大/多样化 WaSHQI（考虑额外的社会经济参数）。