Globally, approximately 2.4 billion people do not have access to improved sanitation facilities, while 1.1 billion of those people practice open defecation (WHO 2012a; JMP 2012). Open defecation contributes substantially to the insanitary environment in which too many children grow up. About 2 million people die every year due to diarrheal diseases; most of them are children less than 5 years of age. Indeed, diarrhea is the second leading cause of death globally among children under 5, killing more young children than HIV/AIDS, malaria and measles combined. As a result, the sanitary disposal of excreta, and introduction of sound hygiene behaviors are seen to be ?of capital importance to reduce the burden of disease.? (WHO 2012a)
In Nepal, diarrhea and other morbidity conditions related to poor sanitation and hygiene continue to be major causes of childhood illness and death. The 2006 NDHS reported that 12% of children under 5 suffer from diarrhea (with 5% dying), while the 2011 NDHS suggested that conditions have not substantially improved, with 14% of children having had diarrhea in the 2 weeks preceding the survey (MOHP 2011). Indeed, as of 2010, roughly 40% of Nepal?s rural households use a bush or open fields for defecation?down from 50% half a decade ago, but still a huge problem (MOHP 2011).