Abstract
BackgroundThe practice of sharing sanitation facilities does not meet the current World Health Organization/UNICEF definition for what is considered improved sanitation. Recommendations have been made to categorize shared sanitation as improved sanitation if security, user access, and other conditions can be assured, yet limited data exist on user preferences with respect to shared facilities.ObjectiveThis study analyzed user perceptions of shared sanitation facilities in rural households in East Java, Indonesia, and Bangladesh.MethodsCross-sectional studies of 2,087 households in East Java and 3,000 households in Bangladesh were conducted using questionnaires and observational methods. Relative risks were calculated to analyze associations between sanitation access and user perceptions of satisfaction, cleanliness, and safety.ResultsIn East Java, 82.4% of households with private improved sanitation facilities reported feeling satisfied with their place of defecation compared to 68.3% of households with shared improved facilities [RR 1.19, 95% CI 1.09, 1.31]. In Bangladesh, 87.7% of households with private improved facilities reported feeling satisfied compared to 74.5% of households with shared improved facilities [RR 1.15, 95% CI 1.10, 1.20]. In East Java, 79.5% of households who reported a clean latrine also reported feeling satisfied with their place of defecation; only 38.9% of households who reported a dirty latrine also reported feeling satisfied [RR 1.74, 95% CI 1.45, 2.08].ConclusionSimple distinctions between improved and unimproved sanitation facilities tend to misrepresent the variability observed among households sharing sanitation facilities. Our results suggest that private improved sanitation is consistently preferred over any other sanitation option. An increased number of users appeared to negatively affect toilet cleanliness, and lower levels of cleanliness were associated with lower levels of satisfaction. However, when sanitation facilities were clean and shared by a limited number of households, users of shared facilities often reported feeling both satisfied and safe.
Highlights
The practice of sharing sanitation facilities does not meet the current World Health Organization/UNICEF definition for what is considered improved sanitation
UNICEF and the World Health Organization’s Joint Monitoring Programme (JMP), the official body in charge of monitoring Millennium Development Goals (MDG) development in the water and sanitation sector, define improved sanitation by the following types of facilities: toilets connected to sewers or septic systems, water-based toilets that flush into pits, simple pit latrines with slabs, and ventilated improved pit latrines [2]
68% of all surveyed households reported feeling satisfied with their sanitation facility. (Table 1)
Summary
The practice of sharing sanitation facilities does not meet the current World Health Organization/UNICEF definition for what is considered improved sanitation. The goal of improved sanitation is to hygienically separate human excreta from human contact and reduce exposure to fecal contamination [2]. UNICEF and the World Health Organization’s Joint Monitoring Programme (JMP), the official body in charge of monitoring MDG development in the water and sanitation sector, define improved sanitation by the following types of facilities: toilets connected to sewers or septic systems, water-based toilets that flush into pits, simple pit latrines with slabs, and ventilated improved pit latrines [2]. Unimproved facilities include any otherwise improved facility that is shared by more than one household as well as infrastructure that does not properly separate human excreta from potential human contact [3].
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