WASH Practices and Their Association with Morbidity among Households Enrolled in the Scheduled Caste Sub-Plan (SCSP) Mobile Healthcare Programme in Five Villages of Navi Mumbai: A Community-Based Cross-Sectional Study

Abstract

Background: Unsafe water, inadequate sanitation, and poor hygiene (WASH) remain leading modifiable causes of
infectious morbidity in low-income communities. Evidence from marginalised rural and peri-urban populations in
Maharashtra is limited.
Objective: To describe household WASH practices and to estimate their association with recent morbidity among
households enrolled in the Scheduled Caste Sub-Plan (SCSP) mobile healthcare programme in five villages of Navi
Mumbai.
Methods: A community-based cross-sectional study was conducted among 228 households (one respondent per
household) enrolled in the SCSP mobile healthcare programme in five villages (Scheduled Tribe 50.4%, Scheduled
Caste 32.0%, OBC/other 17.5%), 2024–2026. A structured questionnaire captured water source, distance to source,
storage, drinking-water treatment, drainage, stagnant water, sanitation facility, and handwashing with soap. The
outcome was self-reported morbidity (diarrhoea, enteric fever, skin infection, vector-borne fever, or jaundice) in the
preceding three months. Analyses used chi-square and Fisher’s exact tests, the Cochran–Armitage trend test, the
Mann–Whitney U test, Spearman correlation, and multivariable logistic regression, with model fit assessed by the
likelihood-ratio test, Hosmer–Lemeshow test, Nagelkerke R2

, and area under the ROC curve.

Results: Three-month morbidity prevalence was 42.5% (97/228; 95% CI 36.2–49.1). Illness was significantly associated
with stagnant water around the home (56.6% vs 31.8%, p < .001), unsafe sanitation (p < .001), no handwashing with
soap (51.5% vs 30.6%, p = .002), and uncovered storage (p = .009). In the adjusted model, uncovered storage (aOR
3.99; 95% CI 1.77–8.97), stagnant water (aOR 3.59; 1.86–6.91), open defecation (aOR 4.52; 1.78–11.45), shared toilets
(aOR 2.90; 1.31–6.46), non-piped water (aOR 3.48; 1.55–7.81), and no handwashing with soap (aOR 3.33; 1.70–6.54)
remained independently associated with morbidity. A composite WASH-deficit score showed a strong dose–response
trend (19.2%, 44.6%, and 76.7% across tertile-style bands; trend χ

2 = 36.83, p < .001).

Conclusion: In this illustrative dataset, household-level hygiene behaviour and environmental sanitation, rather than
distance to water, tracked most closely with morbidity. Programmes should pair infrastructure with point-of-use
safeguards and behaviour change.