Environmental risk scoring of household solid waste practices and its association with infectious morbidity: a community-based mixed-methods study in urban and rural Odisha, India

Background Inadequate household solid waste management remains a critical environmental health challenge in low- and middle- income countries, contributing to infectious disease transmission through vector breeding, water contamination, and unsafe disposal practices. Evidence linking quantified environmental risk practices to household morbidity remains limited, particularly in urban–rural comparative settings. Methods A community- based mixed- methods descriptive study was conducted among 219 households across urban slums and rural villages in Odisha, India. Quantitative data were collected using interviewer- administered questionnaires, observational checklists, and waste quantification through colour- coded bag weighing. Eight waste categories were assessed for segregation and disposal practices. An environmental risk score (0–8) was developed based on the appropriateness of disposal. Infectious morbidity (gastrointestinal, respiratory, dermatological, and vector- borne diseases) reported within the preceding 3 months was recorded. Qualitative insights were obtained through focus group discussions and in- depth stakeholder interviews. Associations were analysed using chi- square tests, odds ratios, and thematic analysis. Results A total of 219 households participated (urban = 110; rural = 109). Appropriate waste segregation practices were significantly higher in urban households. Dustbin use for kitchen waste was reported by 75% (95% CI: 66.1–82.3) in urban areas compared to 65% (95% CI: 55.5–73.4) in rural areas ( p < 0.001), while indiscriminate disposal was observed only in rural households (20%; 95% CI: 13.3–28.5). Safe thin- plastic collection was higher in urban settings (78%; 95% CI: 69.5–84.7) than rural (64%; 95% CI: 1.54.5–72.6) ( p < 0.001). Mean daily kitchen waste generation was greater in rural households (2.38 ± 0.60 kg) than in urban households (1.38 ± 0.50 kg; p < 0.001). Skin infections were significantly higher in rural households (46%; 95% CI: 36.7–55.6) than in urban households (18%; 95% CI: 11.7–26.4), whereas vector- borne diseases were more prevalent in urban areas (21%; 95% CI: 14.2–29.7). Higher environmental risk scores were positively associated with increased reporting of infectious morbidity. Conclusion Environmental risk scoring provides an actionable household- level metric linking waste practices to infectious morbidity. Strengthening segregation behaviour, decentralised waste systems, and risk communication strategies is essential for infection prevention and environmental health equity.