Household Economics of Diarrhea Illness

Estimates suggest that Indian infants make up 25% of global diarrhea deaths in that age group.  Studies of urban slums in Kenya, Bangladesh, Pakistan, and India have all found diarrheal illness to be one of the top two most common causes of mortality for children under the age of five.1-4Diarrheal illness also exacts a major economic toll: a recent World Bank study estimated that diseases related to inadequate sanitation cost India 2.4 trillion rupees every year, or 6.4% of the country’s GDP.5

The following is a map of the world from worldmapper.org that distorts the size of countries based on their contribution to global diarrhea deaths.  The map makes it clear that India and sub-Saharan Africa are the major bastions of diarrhea deaths in the world:

This study will investigate the economic toll of diarrheal illness at the household level inKaula Bandar by collecting large-scale data on the incidence of diarrhea in the community during the monsoon season. For each diarrheal episode, we will assess what this illness costs these households in terms of lost days of work, the cost of medications, the cost of a doctor’s visit, etc. Using these data, we can then advocate for cost-effective solutions for diarrheal disease that may save slum residents and the public health system substantial money in the long run.

The PUKAR team completed five weeks of household-level data collection in July 2011. At that time, the PUKAR Barefoot Researchers also engaged in extensive door-to-door education regarding diarrheal diseases at every household in the community. Using colorful pictorial diagrams, women in Kaula Bandar were taught to recognize the warning signs of severe diarrhea so that they will know when to seek further care from a physician.  Women were also educated regarding the benefits of oral rehydration solution (ORS) for treatment of diarrhea, and households with cases of diarrheal illness were provided with ORS packets.  This is an example of how PUKAR integrates research (that can eventually be used for local advocacy) with direct community engagement and education.

This research project is a partnership with Harvard Medical School physician-researchers Dr. Ronak Patel and Dr. Hanni Stoklosa, as well as with Dr. Alison Ridpath, an emergency medicine physician working in Winchester, MA.


1. Kyobutungi C, Ziraba AK, Ezeh A, and Ye Y. The burden of disease profile of residents of Nairobi’s slums: Results from a Demographic Surveillance System. Popul Health Metr, 2008.6:1.

2. Hussain A, Ali SM, and Kvale G. Determinants of mortality among children in the urban slums of Dhaka city, Bangladesh. Trop Med Int Health, 1999. 4(11):758-64.

3. Marsh D, Husein K, Lobo M, Shah MA, and Luby S. Verbal autopsy in Karachi slums: comparing single and multiple cause of child deaths. Health Policy Plan, 1995. 10(4):395-403.

4. Choudhary SR and Jayaswal ON. Infant and early childhood mortality in urban slums under ICDS scheme–a prospective study.Indian Pediatr, 1989. 26(6):544-9.

5. World Bank. The economic impacts of inadequate sanitation in India. World Bank Water and Sanitation Program: New Delhi, India. 2010.


***An abstract from this research project was accepted for presentation by HMS researcher Hanni Stoklosa at the 2011 International Conference on Urban Health in Belo Horizonte, Brazil:  View Abstract and View Poster**