1
|
Kouassi HAA, Andrianisa HA, Sossou SK, Traoré MB, Nguematio RM. Sustainability of facilities built under the Community-Led Total Sanitation (CLTS) implementation: Moving from basic to safe facilities on the sanitation ladder. PLoS One 2023; 18:e0293395. [PMID: 37972150 PMCID: PMC10653469 DOI: 10.1371/journal.pone.0293395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
In the context of monitoring progress towards SDG target 6.2, a household is counted to have access to sanitation if it uses at least basic sanitation services. Several approaches have been employed to help rural communities to climb up the sanitation ladder such as Community-led Total Sanitation (CLTS), whose primary target is to end open defecation through behavior change. CLTS does not subsidize sanitation facilities, but let households build their own facilities. The types and sustainability of facilities when construction is entrusted to households without guidelines remain understudied. The contribution of CLTS in achieving SDG6.2 also have not been studied. This paper addresses these gaps. Conducted in the province of Sissili in Burkina Faso, our study involved interviewing CLTS implementers, government officials, and community stakeholders. Coupled with household surveys, the data was analyzed using SPSS and Excel software. Findings indicate that CLTS succeeded in motivating households to build latrines hence escalating latrine coverage from 29.51% in 2016 (pre-CLTS) to 90.44% in 2020 (post-CLTS) in the province. However, 97.53% of latrines built were unimproved pit latrines with superstructures and without/with wooden or clay slabs and no roof, of which 19.76% collapsed during the rainy season. During this period, sanitation access rate rose from 11.9% to 17.00%. The study has therefore revealed that CLTS significantly elevates latrine coverage, yet it does not guarantee a proportional rise in sanitation access. This discrepancy results from the type of technologies generated by CLTS, which are not considered in calculating the sanitation access rate due to their unimproved nature. Consequently, further exploration of social approaches is essential, amalgamating technical and engineering aspects. Beyond socio-economic considerations, the sustainability of CLTS and the achievement of access to adequate and safe sanitation also rely on the robustness and resilience of the implemented facilities.
Collapse
Affiliation(s)
- Hemez Ange Aurélien Kouassi
- Laboratoire Eaux, Hydro-Systèmes et Agriculture (LEHSA), Institut International d’Ingénierie de l’Eau et de l’Environnement (2iE), Ouagadougou, Burkina Faso
| | - Harinaivo Anderson Andrianisa
- Laboratoire Eaux, Hydro-Systèmes et Agriculture (LEHSA), Institut International d’Ingénierie de l’Eau et de l’Environnement (2iE), Ouagadougou, Burkina Faso
| | - Seyram Kossi Sossou
- Laboratoire Eaux, Hydro-Systèmes et Agriculture (LEHSA), Institut International d’Ingénierie de l’Eau et de l’Environnement (2iE), Ouagadougou, Burkina Faso
| | - Maïmouna Bologo Traoré
- Laboratoire Eaux, Hydro-Systèmes et Agriculture (LEHSA), Institut International d’Ingénierie de l’Eau et de l’Environnement (2iE), Ouagadougou, Burkina Faso
| | - Rikyelle Momo Nguematio
- Laboratoire Eaux, Hydro-Systèmes et Agriculture (LEHSA), Institut International d’Ingénierie de l’Eau et de l’Environnement (2iE), Ouagadougou, Burkina Faso
| |
Collapse
|
2
|
Takele H, Alemayehu M, Geberu DM. Outcome evaluation of WASH intervention in rural households at Jawi district, Northwest Ethiopia: Mixed method design, goal based evaluation. EVALUATION AND PROGRAM PLANNING 2023; 98:102283. [PMID: 37084492 DOI: 10.1016/j.evalprogplan.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The government of Ethiopia revealed that GTP II and SDG were achieved through one Water Sanitation and Hygiene (WASH) program. According to the 2016 Ethiopian Demographic and Health survey, the rural population was more affected by poor sanitation and hygiene. To address this Ethiopian government ratified Rural WASH sanitation and hygiene promotion through a community-centered approach, and to improve WASH service evidence on the effectiveness of an intervention at the household level is needed in developing countries. However, in our country one WASH in rural areas called community centered approach intervention was planned and delivered for 3 years (2018-2020) Nevertheless, as to our review and researchers knowledge, the outcome of this intervention is not evaluated yet in our country as well as in this evaluation study area. METHOD The evaluation was conducted in rural households of Jawi district by a Quasi-experimental design supplemented with a qualitative in-depth interview, from 01/14/2021-3/28/2021 and 4/22/2021-5/25/2021 for quanitative and qualitative study, respectively. Intervention groups were households that took WASH intervention while the controls did not. The evaluation approach was summative and counterfactual plus participatory and focuses on program outcome. A total of 1280 households were selected using two stage sampling with lottery method simple random sampling. We collected quantitative data through survey and structured observational checklist, while qualitative data through key informant interviews using a semi-structured questionnaire. We assessed program effectiveness and also the analytical study was conducted through propensity score matching to assess program effect through Stata 14.1. Qualitative data were transcribed and translated to English and thematic analysis was done using Atlas.ti.9. RESULT The overall program effectiveness was very good but the effectiveness in handwashing before eating using soap and water was poor. Also, this intervention increased water treatment utilization in 41.7% point (ATT=0.417, 95% CI= 0.356, 0.478), 24.3% point (ATT =0.243, 95%CI=0.180, 0.300) in exclusive latrine utilization, 41.9% point (ATT=0.419, 95%CI = 0.376, 0.470) in handwashing using water and soap before eating, 50.2% point(ATT=0.502, 95%CI=0.450, 0.550) in handwashing after defecation by using water and soap in intervention households. Our qualitative finding revealed that unable to afford soap and their working place far away from their home were the most frequent reason reported by the respondent for not using soap for hand washing and latrine utilization respectively CONCLUSIONS: This intervention should be scale-up and pay greater attention and deliver innovative strategies to the improvement of handwashing practice and exclusive latrine utilization. AVAILABILITY OF DATA AND MATERIALS The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Collapse
Affiliation(s)
- Habtamu Takele
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Mekuriaw Alemayehu
- Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Demiss Mulatu Geberu
- Department of Health Systems and Policy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
3
|
Kouassi HAA, Andrianisa HA, Traoré MB, Sossou SK, Momo Nguematio R, Ymélé SSS, Ahossouhe MS. Review of the slippage factors from open defecation-free (ODF) status towards open defecation (OD) after the Community-Led Total Sanitation (CLTS) approach implementation. Int J Hyg Environ Health 2023; 250:114160. [PMID: 36958189 DOI: 10.1016/j.ijheh.2023.114160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
Open-defecation (OD) is one of the most widespread sanitation practices in low-income countries. This practice often causes diarrheal diseases and 760,000 deaths per year. To eradicate OD, several approaches have been developed, including Community-Led-Total Sanitation (CLTS) which is a participatory and community approach. The specificity of CLTS is that it is managed by the community itself, as its name implies, and that no subsidies or financial contributions from outside the community are used in the construction of the facilities. Although, the CLTS is effective in the short-term for eradicating OD, the long-term results are not encouraging: Open-Defecation-Free (ODF) communities revert to OD or partially use latrines. The present research is based on literature review and authors investigation in Burkina Faso. It was conducted to provide a comprehensive understanding of the factors that affect the sustainability of ODF-status leading to slippage in communities. It was found that these factors can be grouped into five categories: behavioral and social, technological, organizational, and vulnerability factors. The last one, socio-political factors, is a contribution from the authors as it was not reported in the literature yet. The authors have proposed graphical synthesis of all the slippage factors and their associated categories in the ODF-communities. Finally, authors have suggested that to sustain ODF-status of communities: include all stages of the sanitation value chain (SVC) in the CLTS, the follow-up activities after achieving ODF-status must be planned well in advance, sanitation marketing should be developed and the sanctions against the practice of OD have to be reinforced. Governments and donors should pay particular attention to the following options: raising awareness and regular monitoring after ODF certification, encouraging research on sustainable and pro-poor sanitation technologies, and building the capacity of implementing actors including facilitators. While obtaining ODF status is materialized by a sign with the status on it, this paper drew the attention of CLTS implementers to the lack of materialization of slippage when it occurs, and the absence of studies on the evolution of the community sanitation scale after ODF-status.
Collapse
Affiliation(s)
- Hemez Ange Aurélien Kouassi
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso.
| | - Harinaivo Anderson Andrianisa
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Maïmouna Bologo Traoré
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Seyram Kossi Sossou
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Rikyelle Momo Nguematio
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Sidesse Sonia Saapi Ymélé
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Mahugnon Samuel Ahossouhe
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| |
Collapse
|
4
|
Pinchoff J, Dougherty L, Dadi C. Water and Handwashing in a Drought-Prone Region of Southern Niger: How Environment, Household Infrastructure, and Exposure to Social and Behavior Change Messages Interact. Am J Trop Med Hyg 2023; 108:536-542. [PMID: 36746660 PMCID: PMC9978540 DOI: 10.4269/ajtmh.22-0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/22/2022] [Indexed: 02/08/2023] Open
Abstract
This study aims to inform multisectoral development programs by exploring the extent to which social and behavior change (SBC) messages, environment, and household infrastructure are associated with knowledge and practice of handwashing behaviors. A cross-sectional survey of 2,708 households in the Maradi and Zinder districts of Niger was collected in April 2021. Household data were integrated with two local environmental measures: 1) water level at the nearest waterhole point, and 2) anomalous rainfall for the previous rainy season derived from climate hazards infrared precipitation with station rainfall (CHIRPS) data. Logistic regression models were constructed to explore how environment, household infrastructure, and exposure to SBC messages were associated with two hygiene-related outcomes: 1) observed water and soap available at household handwashing stations, a behavior, and 2) knowledge of critical moments for handwashing, a behavioral determinant. We find that in households near a water point with higher water depth, households were statistically significantly more likely (odds ratio [OR] = 1.25); (confidence interval [CI] = 1.12-1.49) to have water and soap observed at the handwashing station. Women in households near a water point with increased water depth (more water) were more likely to know three or more critical handwashing moments (OR = 1.07; CI = 1.03-1.11). Exposure to messages about the importance of handwashing was significantly associated with knowledge of critical handwashing moments and having water and soap observed at a handwashing station. Multisectoral programming should consider layering efforts so that development projects that increase access to water sources are complemented with SBC approaches focused on hygiene.
Collapse
Affiliation(s)
- Jessie Pinchoff
- Population Council, New York, New York
- Address correspondence to Jessie Pinchoff, Population Council, One Dag Hammarskjold Plaza, New York, NY 10017. E-mail:
| | | | - Chaibou Dadi
- Conception Etudes Suivi Evaluation Appuis Formation, Niamey, Niger
| |
Collapse
|
5
|
Challenges of sanitation in developing counties - Evidenced from a study of fourteen towns, Ethiopia. Heliyon 2023; 9:e12932. [PMID: 36747957 PMCID: PMC9898597 DOI: 10.1016/j.heliyon.2023.e12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/25/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
Rapid urbanization and population growth in the past few decades has been worsening the water supply and sanitation problems in Ethiopia putting the current water supply deficit of the country at a staggering 41%. Using Ethiopia as a case of rapidly growing countries in the Global South and struggling with water supply and sanitation management, the objective of this study was to examine the challenges of sanitation in Ethiopia by selecting 14 towns located under different climatic conditions and administrative regions with diversified culture, ethnicity, and religion. Data from these towns were collected through household survey, Focus Group Discussion (FGD), Key Informant Interview (KII) and site visits. The field observation was conducted with representatives from the municipality who have knowledge on the existing sanitation and associated problems. Analysis of the collected data shows that poor water supply, inadequate toilet facilities, poor toilet facility emptying practices, poor community perceptions on sanitation management and inadequate emptying services were major challenges associated with sanitation. Moreover, absence of wastewater dumping site, lack of integration among the different components of sanitation, insufficient collaboration among potential stakeholders and gaps between the existing population and sanitation services were the other key challenges of sanitation exacerbated by inadequate financial resources. From the 14 studied towns the average water deficit was found 35%, and the average households with no toilet facilities were 17%. Only about 20% households have flushed toilets and about 5% practiced open defecation. While 42% of the households use vacuum trucks for emptying wastewaters and about 37% of the households dump wastewater outside of their premises. Among the studied 14 towns, only four towns have their own vacuum trucks, no town possesses wastewater dumping site. The different components of sanitation were managed separately without integration. Moreover, the collaboration among the potential stakeholders of sanitation management was found poor and fragmented. Also, sanitation services have not developed along with the population growth as the finance allocated to sanitation management is much lower compared to other municipal services. Thus, sanitation in the studied towns is poor, though there are progresses when compared with previous decades. To improve the sanitation condition in these towns the water supply should be improved together with raising the perception of the local community. The present study recommends further studies to be conducted on the feasibility of sustainable sanitation and "country-wide comprehensive" study on water supply, sanitation and open defecation in Ethiopian in particular and in developing countries as a whole.
Collapse
|
6
|
Sakas Z, Uwah EA, Bhattrai RK, Garn JV, Gc KH, Mutta A, Ndlovu K, Nyaboro F, Singh RP, Rinzin U, Snyder JS, Wangdi K, Freeman MC. Assessing Sustainability Factors for Rural Household Sanitation Coverage in Bhutan, Kenya, Nepal, and Zambia: A Qualitative Analysis. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00724. [PMID: 36951284 PMCID: PMC9771455 DOI: 10.9745/ghsp-d-21-00724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few countries are likely to achieve universal sanitation within the next decade as sustaining household sanitation coverage remains a critical challenge. This study aimed to investigate factors that may have supported or hindered sustainability of sanitation coverage 1-2 years after the completion of an integrated, area-wide sanitation program in 4 countries. METHODS We conducted qualitative analyses to identify factors related to the sustainability of sanitation coverage in Bhutan, Kenya, Nepal, and Zambia, 2 years after completion of the Sustainable Sanitation and Hygiene for All program. From November 2019 to March 2020, we conducted focus group discussions and key informant interviews with community members, project implementers, and decision makers. We triangulated the qualitative findings with data from household surveys to characterize subnational sanitation coverage throughout implementation and 1-2 years after. RESULTS Our data revealed behavioral, contextual, and service delivery factors that were related to the sustainability of sanitation improvements. Service delivery factors included follow-up hygiene promotion, access to construction materials, local government commitment postimplementation, functioning monitoring systems, private sector uptake of supply chain improvements, and capacity for innovation. Contextual and behavioral factors included poverty, soil type, road networks, social cohesion, desire for improved latrines, maintenance and cleaning, and knowledge of sanitation benefits. CONCLUSION The presence or absence of sustainability factors identified through this research may have implications on where certain programmatic approaches will work and where adaptations may be required. By comparing sustainability factors with subnational slippage rates, we were able to illustrate how local service delivery systems may respond to barriers and enablers. Understanding the programmatic and contextual factors that either drive or hinder long-term sanitation coverage may allow for greater program impact through adapting implementation based on existing challenges in service delivery and context.
Collapse
Affiliation(s)
- Zoe Sakas
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eberechukwu A Uwah
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Joshua V Garn
- Division of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | | | - Anna Mutta
- SNV Netherlands Development Organisation, The Hague, The Netherlands
| | | | | | | | | | - Jedidiah S Snyder
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| |
Collapse
|
7
|
Kanda A, Ncube EJ, Voyi K. Frameworks for selecting appropriate rural sanitation technology options in low- and middle-income countries: a critical review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:2324-2336. [PMID: 34420432 DOI: 10.1080/09603123.2021.1963685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
Several rural technology options exist on the sanitation market with different characteristics, yet project failures in some developing countries were attributable to inappropriate technology choices. Frameworks that are used to select sanitation technology options (hard copy, computer programmes) were developed by researchers and project implementers. They vary in design and application as there is no standard format. This appears to create a gap between science and practice. Frameworks should have some key elements needed to select appropriate sanitation technologies. We evaluated 12 available frameworks (2000-2019) used to select sanitation technologies in rural communities of low- and middle-income countries against 22 assessment criteria derived from literature. Criteria that were not fully addressed by some of the reviewed frameworks (scores of 8-50%) included equity, sanitation demand, sanitation behaviour change, ongoing contact, replicability, framework limitations, personnel selection and flexibility. Addressing such limitations may assist in future framework development.
Collapse
Affiliation(s)
- Artwell Kanda
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Esper Jacobeth Ncube
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kuku Voyi
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
8
|
Apanga PA, Freeman MC, Sakas Z, Garn JV. Assessing the Sustainability of an Integrated Rural Sanitation and Hygiene Approach: A Repeated Cross-Sectional Evaluation in 10 Countries. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00564. [PMID: 36041842 PMCID: PMC9426995 DOI: 10.9745/ghsp-d-21-00564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Abstract
An evaluation of area-wide sanitation interventions in 10 countries found that 6 of the 12 program areas had sustained similar levels of basic sanitation 1–2 years post-implementation, with varying levels of slippage in the other program areas. Introduction: While many studies have implemented programs to increase sanitation coverage throughout the world, there are limited rigorous studies on the sustainability of these sanitation programs. Methods: Between 2014 and 2018, the rural Sustainable Sanitation and Hygiene for All (SSH4A) approach was implemented by SNV in sub-Saharan Africa and Asia. Repeated cross-sectional household surveys were administered annually throughout program implementation and 1 to 2 years following completion of program activities. We characterize to what extent sanitation coverage was sustained 1 to 2 years after implementation of this SSH4A intervention. Results: Surveys were conducted in 12 program areas in 10 countries, with 22,666 households receiving a post-implementation survey. Six of 12 program areas (Bhutan, Ghana, Kenya, both Nepal sites, Tanzania) had similar coverage levels of basic sanitation 1–2 years post-implementation, whereas there were varying levels of slippage in the other program areas (both Ethiopia sites, Indonesia, Mozambique, Uganda, Zambia), ranging from a drop of 63 percentage points in coverage in Ethiopia to a drop of only 4 percentage points in Indonesia. In countries that experienced losses in the coverage of household sanitation, sanitation sharing among neighbors generally did not increase, whereas open defecation did increase. In each of the areas where slippage occurred, the sanitation coverage levels at the final time point were all still higher than the initial time point before SNV started working in these areas. We found several factors to be associated with the sustainability of sanitation coverage, including household socioeconomic status, having household members with disabilities, baseline sanitation coverage levels of the program areas, and rate of change of coverage during program activities. Conclusions: Data revealed sustained gains in sanitation coverage in some program areas, yet slippage in other areas. This work may serve to benchmark the sustainability of sanitation interventions in sub-Saharan Africa and Asia.
Collapse
|
9
|
Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana. PLoS One 2022; 17:e0261674. [PMID: 34995310 PMCID: PMC8740968 DOI: 10.1371/journal.pone.0261674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/30/2021] [Indexed: 01/01/2023] Open
Abstract
Community-led total sanitation (CLTS) is a widely used approach to reduce open defecation in rural areas of low-income countries. Following CLTS programs, communities are designated as open defecation free (ODF) when household-level toilet coverage reaches the threshold specified by national guidelines (e.g., 80% in Ghana). However, because sanitation conditions are rarely monitored after communities are declared ODF, the ability of CLTS to generate lasting reductions in open defecation is poorly understood. In this study, we examined the extent to which levels of toilet ownership and use were sustained in 109 communities in rural Northern Ghana up to two and a half years after they had obtained ODF status. We found that the majority of communities (75%) did not meet Ghana’s ODF requirements. Over a third of households had either never owned (16%) or no longer owned (24%) a functional toilet, and 25% reported practicing open defecation regularly. Toilet pit and superstructure collapse were the primary causes of reversion to open defecation. Multivariate regression analysis indicated that communities had higher toilet coverage when they were located further from major roads, were not located on rocky soil, reported having a system of fines to punish open defecation, and when less time had elapsed since ODF status achievement. Households were more likely to own a functional toilet if they were larger, wealthier, had a male household head who had not completed primary education, had no children under the age of five, and benefitted from the national Livelihood Empowerment Against Poverty (LEAP) program. Wealthier households were also more likely to use a toilet for defecation and to rebuild their toilet when it collapsed. Our findings suggest that interventions that address toilet collapse and the difficulty of rebuilding, particularly among the poorest and most vulnerable households, will improve the longevity of CLTS-driven sanitation improvements in rural Ghana.
Collapse
|
10
|
Freeman MC, Delea MG, Snyder JS, Garn JV, Belew M, Caruso BA, Clasen TF, Sclar GD, Tesfaye Y, Woreta M, Zewudie K, Gobezayehu AG. The impact of a demand-side sanitation and hygiene promotion intervention on sustained behavior change and health in Amhara, Ethiopia: A cluster-randomized trial. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000056. [PMID: 36962125 PMCID: PMC10021625 DOI: 10.1371/journal.pgph.0000056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/07/2021] [Indexed: 04/19/2023]
Abstract
Behaviors related to water, sanitation, and hygiene (WASH) are key drivers of infectious disease transmission, and experiences of WASH are potential influencers of mental well-being. Important knowledge gaps exist related to the content and delivery of effective WASH programs and their associated health impacts, particularly within the contexts of government programs implemented at scale. We developed and tested a demand-side intervention called Andilaye, which aimed to change behaviors related to sanitation, personal hygiene, and household environmental sanitation. This theory-informed intervention was delivered through the existing Ethiopian Health Extension Programme (HEP). It was a multilevel intervention with a catalyzing event at the community level and behavior change activities at group and household levels. We randomly selected and assigned 50 kebeles (sub-districts) from three woredas (districts), half to receive the Andilaye intervention, and half the standard of care sanitation and hygiene programming (i.e., community-led total sanitation and hygiene [CLTSH]). We collected data on WASH access, behavioral outcomes, and mental well-being. A total of 1,589 households were enrolled into the study at baseline; 1,472 households (94%) participated in an endline assessment two years after baseline, and approximately 14 months after the initiation of a multi-level intervention. The intervention did not improve construction of latrines (prevalence ratio [PR]: 0.99; 95% CI: 0.82, 1.21) or handwashing stations with water (PR: 0.96; 95% CI: 0.72, 1.26), or the removal of animal feces from the compound (PR: 1.10; 95% CI: 0.95, 1.28). Nor did it impact anxiety (PR: 0.90; 95% CI: 0.72, 1.11), depression (PR: 0.83; 95% CI: 0.64, 1.07), emotional distress (PR: 0.86; 95% CI: 0.67, 1.09) or well-being (PR: 0.90; 95% CI: 0.74, 1.10) scores. We report limited impact of the intervention, as delivered, on changes in behavior and mental well-being. The effectiveness of the intervention was limited by poor intervention fidelity. While sanitation and hygiene improvements have been documented in Ethiopia, behavioral slippage, or regression to unimproved practices, in communities previously declared open defecation free is widespread. Evidence from this trial may help address knowledge gaps related to challenges associated with scalable alternatives to CLTSH and inform sanitation and hygiene programming and policy in Ethiopia and beyond. Trial registration: This trial was registered with clinicaltrials.gov (NCT03075436) on March 9, 2017.
Collapse
Affiliation(s)
- Matthew C. Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Maryann G. Delea
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Jedidiah S. Snyder
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Joshua V. Garn
- School of Community Health Sciences, University of Nevada, Reno, Nevada, United States of America
| | | | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Gloria D. Sclar
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Yihenew Tesfaye
- Department of Social Anthropology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulat Woreta
- Emory Ethiopia, Bahir Dar and Addis Ababa, Ethiopia
| | | | - Abebe Gebremariam Gobezayehu
- Emory Ethiopia, Bahir Dar and Addis Ababa, Ethiopia
- School of Nursing, Emory University, Atlanta, Georgia, United States of America
| |
Collapse
|
11
|
Khare K, Suresh L. Justice and sanitation well-being: an analysis of frameworks in the context of slippage, based on findings from Shravasti, Uttar Pradesh, India. JOURNAL OF WATER AND HEALTH 2021; 19:823-835. [PMID: 34665774 DOI: 10.2166/wh.2021.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Access to safe drinking water and adequate sanitation is considered as a basic human right. Swachh Bharat Mission - Gramin (Rural), launched by the Government of India in 2014, is hailed as an attempt towards that direction. On 2nd October 2019, India was declared free from open defecation, with rural households having full toilet coverage. However, despite Government claims, the existing literature indicates the presence of slippage: where households practice open defecation despite having access to toilets. Equating progress in sanitation interventions with mere toilet provision presents a partial assessment of sanitation. To address the gap, the 'Sanitation Well-being' framework, based on Amartya Sen's concept of justice, has been proposed. It identifies slippage as an outcome of various underlying factors across the sanitation life-cycle. The framework provides a lens to analyse existing frameworks and secondary data sets and finds that they do not capture the dynamism inherent in the sector. The efficacy of the framework has been tested in the rural district of Shravasti, Uttar Pradesh, India, through the rapid rural appraisal method. Through our investigation, we found that slippage exists in the field, and that the framework is a feasible instrument to assess sanitation as a comprehensive phenomenon.
Collapse
Affiliation(s)
- Kopal Khare
- Department of Humanities and Social Sciences, Birla Institute of Technology and Science Pilani, Hyderabad Campus, Shamirpet-Keesara Road, Jawahar Nagar, Shamirpet, Hyderabad, Telangana 500078, India E-mail:
| | - Lavanya Suresh
- Department of Humanities and Social Sciences, Birla Institute of Technology and Science Pilani, Hyderabad Campus, Shamirpet-Keesara Road, Jawahar Nagar, Shamirpet, Hyderabad, Telangana 500078, India E-mail:
| |
Collapse
|
12
|
Sunkari ED, Korboe HM, Abu M, Kizildeniz T. Sources and routes of SARS-CoV-2 transmission in water systems in Africa: Are there any sustainable remedies? THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 753:142298. [PMID: 33207460 PMCID: PMC7480675 DOI: 10.1016/j.scitotenv.2020.142298] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 05/20/2023]
Abstract
Governments across the globe are currently besieged with the novel coronavirus (COVID-19) pandemic caused by SARS-CoV-2. Although some countries have been largely affected by this pandemic, others are only slightly affected. In this regard, every government is taking precautionary measures to mitigate the adverse effects of COVID-19. SARS-CoV-2 has been detected in wastewater raising an alarm for Africa due to the poor water, sanitation, and hygiene (WASH) facilities. Also, most countries in Africa do not have resilient policies governing sanitation and water management systems, which expose them to higher risk levels for the transmission of SARS-CoV-2. Therefore, this study unearthed the likely sources and routes of SARS-CoV-2 transmission in water systems (mainly wastewater) in Africa through a holistic review of published works. This provided the opportunity to propose sustainable remedial measures, which can be extrapolated to most developing countries in the world. The principal sources and routes of potential transmission of SARS-CoV-2 in water systems are hospital sewage, waste from isolation and quarantine centres, faecal-oral transmission, contaminated surface and groundwater sources, and contaminated sewage. The envisioned overwhelming impact of these sources on the transmission of SARS-CoV-2 through water systems in Africa suggests that governments need to put stringent and sustainable measures to curtail the scourge. Hence, it is proposed that governments in Africa must put measures like improved WASH facilities and public awareness campaigns, suburbanization of wastewater treatment facilities, utilizing low-cost point-of-use water treatment systems, legally backed policy interventions, and Community-Led Total Sanitation (CLTS). SARS-CoV-2 in water systems can be inactivated and destroyed by integrating ozonation, chlorination, UV irradiation, and sodium hypochlorite in low-cost point-of-use treatment systems. These proposed sustainable remedial measures can help policymakers in Africa to effectively monitor and manage the untoward impact of SARS-CoV-2 on water systems and consequently, on the health of the general public.
Collapse
Affiliation(s)
- Emmanuel Daanoba Sunkari
- Department of Geological Engineering, Faculty of Engineering, Niğde Ömer Halisdemir University, Main Campus, 51240, Niğde, Turkey.
| | - Harriet Mateko Korboe
- Department of Agricultural Genetic Engineering, Faculty of Agricultural Sciences and Technologies, Niğde Ömer Halisdemir University, Main Campus, 51240, Niğde, Turkey
| | - Mahamuda Abu
- Department of Earth Science, Faculty of Earth and Environmental Sciences, CK Tedam University of Technology and Applied Sciences, P.O. Box 24, Navrongo, Upper East Region, Ghana
| | - Tefide Kizildeniz
- Department of Biosystem Engineering, Faculty of Agricultural Sciences and Technologies, Niğde Ömer Halisdemir University, Main Campus, 51240, Niğde, Turkey
| |
Collapse
|