Exploring the Burden of Diarrheal Disease and Associated Hygiene Practices in Rural West Bengal,India: An Explanatory Sequential Mixed-Method Approach

Background Diarrheal diseases are a significant public health issue, disproportionately affecting under-five children residing in low- and middle-income countries. Inadequate WASH practices exacerbate this burden, especially in rural areas. This study used a mixed-method approach to evaluate the association between WASH practices and the prevalence of diarrheal diseases in the rural communities of West Bengal, India. Method The study was conducted in the Bishnupur-II block of South 24 Parganas district, West Bengal. A census survey covering approximately 10,000 families was conducted over nine weeks. Data on hygiene-related knowledge, attitudes, practices, and diarrheal episodes in the previous six months were collected using a semi-structured questionnaire administered by trained community health workers. Bivariable and multivariable logistic regression analyses were performed to assess associations between hygiene indicators and diarrhea prevalence. Ten in-depth interviews with mothers of under-five children and six key informant interviews with Auxiliary Nurse Midwives were conducted. Thematic analysis was used to explore contextual barriers and facilitators related to hygiene and disease prevention. Results The study found that 16.9% of families reported diarrheal episodes in the past six months, with 75.9% of affected children receiving treatment at government health facilities. Open defecation near homes increased the likelihood of diarrhea by 1.15 times (COR: 1.15; 95% CI: 1.05–2.24). Households relying on vendor-supplied drinking water faced nearly three times the risk (AOR: 2.71; 95% CI: 1.84–4.01), while those using only water for handwashing had a 3.14 times higher risk compared to those using soap (AOR: 3.14; 95% CI: 2.51–3.93). Notably, 80% of participants did not disinfect drinking water. Qualitative analysis identified five themes—awareness gaps, cultural beliefs, financial constraints, inadequate infrastructure, and community engagement—highlighting key barriers to hygiene and diarrhea prevention. Conclusion The study emphasizes the persistent burden of diarrhea in rural West Bengal, which is linked to inadequate hygiene practices and unsafe water consumption. It emphasizes the need for targeted public health interventions that combine community education, behavior change communication, and improved access to safe water and sanitation. Integrating proven tools like oral cholera vaccination with existing WASH strategies may further enhance disease prevention in high-burden rural settings.