New Delhi, Oct. 15: India is at the top of an unenviable heap that may invite involuntary sniggers but carries with it the seeds of an inexcusable tragedy.

A global report has put the number of Indians who defaecate in the open at 665 million — more than half of the 1.2 billion people estimated to have followed the practice worldwide in 2006.

A related piece of statistics brings out the magnitude of the fallout: India also accounts for the highest number of child deaths from diarrhoea. Over 386,000 children — out of the 1.5 million worldwide — who die annually from the infection are from the country, according to a report released by Unicef and the WHO on Wednesday.

Up to eight in 10 diarrhoea deaths are said to be caused by unsafe drinking water and poor sanitation as well as unhygienic practices such as inadequate washing of hands.

The figures also provide a pointer to how daunting one of India’s unfinished tasks is — a government pledge to eliminate open defaecation by 2012.

In April 2007, the rural development ministry had announced it would work to achieve total sanitation by ensuring that every household had access to a toilet by 2012, but experts have cautioned that the deadline appears unrealistic.

“Even where new toilets have been built, there’s resistance among people to using them,” said a water specialist with an international organisation in New Delhi. “This is not surprising at all — at some sites, there is not enough water, some toilets may be badly designed, and others are so badly maintained that people prefer to use the open fields.”

The scale of the problem isn’t linked to India’s large population alone. China, with a higher population, has only 37 million people who practise open defaecation. At 40,000, the number of child deaths from diarrhoea in China shows a corresponding decline compared with that in India.

The Indian government has helped build 58 million household toilets, 900,000 toilets in schools, and more than 45,000 community toilets over the past eight years under the total sanitation campaign led by the rural development ministry.

In some districts, local authorities are using community workers to run sanitation campaigns. One such worker, from Haryana’s Kurukshetra, who had attended a seminar on sanitation in Delhi this year, recalled an innovative method she and her colleague used to stress the need to use toilets.

“We would pick a blade of grass, place it for a few seconds on faeces that we would find in village fields, then dip the grass blade in a tumbler of water, and ask people whether they would drink that water,” the worker said. “We did this to tell them how flies carry disease from open defaecation.”

Indian officials said the number of child deaths from diarrhoea in the country had halved over the past 15 years. “There has been more progress against childhood diarrhoea than against childhood pneumonia,” said M.K. Bhan, a paediatrician who is now India’s biotechnology secretary. “But we also have to address malnutrition — which is an underlying cause of most of the deaths from diarrhoea and pneumonia,” Bhan said.

The Unicef-WHO report has prescribed preventive actions to improve hygiene and sanitation focused on hand-washing with soap, improving water quality and quantity, and promoting community-wide sanitation.

It has also prescribed promotion of exclusive breast-feeding and the use of fluid replacement to prevent dehydration, and zinc therapy to decrease the severity and duration of diarrhoea symptoms.

“It is a tragedy that diarrhoea, which is little more than an inconvenience in the developed world kills an estimated 1.5 million children each year,” Anne Veneman, executive director of Unicef, said in a statement released with the report.