Toilet Construction Research Articles

Sanitation ladder in rural and urban India: can subsidy from the Swachh Bharat Mission ensure transition to safely managed toilets?

ABSTRACT The Swachh Bharat Mission, globally the biggest public programme to support sanitation, has focused on subsidised construction of household toilets in rural areas, while aiming for solid waste disposal and behavioural changes in urban areas. In spite of that, India witnesses a huge gap from the SDGs related to usage of safely managed sanitation associated with more environment- responsive technology and hygiene management. The hierarchical sanitation ladder identifies fivecategories of toilets, namely, safely managed, basic, limited, unimproved, and open defecation. This study attempts to contribute to the existing literature by locating the empirical estimation of the sanitation ladder in India across both rural and urban settings, using nationally representative unit-level National Sample Survey data. Results find that only 38% of urban and 6% of rural households in India use safely managed toilets. Also, using logistic regression, the study posits that receiving subsidy for toilet construction can significantly improve usage of safely managed toilets along the ladder only among the poorest urbanclass and the factor is generally more potent in rural areas. The findings identify that there is hardly any benefit in subsidizing the middle-income class and hence highlight a need to redesign the subsidy-driven sanitation policy.

Toilet construction under the Swachh Bharat Mission and infant mortality in India

Improvement of water and sanitation conditions may reduce infant mortality, particularly in countries like India where open defecation is highly prevalent. We conducted a quasi-experimental study to investigate the association between the Swachh Bharat Mission (SBM)—a national sanitation program initiated in 2014—and infant (IMR) and under five mortality rates (U5MR) in India. We analyzed data from thirty-five Indian states and 640 districts spanning 10 years (2011–2020), with IMR and U5MR per thousand live births as the outcomes. Our main exposure was the district-level annual percentage of households that received a constructed toilet under SBM. We mapped changes in IMR and U5MR and toilet access at the district level over time. We fit two-way fixed effects regression models controlling for sociodemographic, wealth, and healthcare-related confounders at the district-level to estimate the association between toilets constructed and child mortality. Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM in 2014. Results from panel data regression models show that districts with > 30% toilets constructed under SBM corresponds with 5.3 lower IMR (p < 0.05), and 6.8 lower U5MR (p < 0.05). Placebo, falsification tests and robustness checks support our main findings. The post-SBM period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years. Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000–70,000 infant deaths annually. Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries.

Evaluation of Sanitation/Hygiene Behaviours and Sanitary Conditions Among Households in Jos Metropolis, Plateau State, Nigeria

Access to sustainable sanitation and hygiene facilities is one of the biggest challenges faced by developing countries because of the increasing population of these regions. This study assessed the environmental sanitation and hygiene behaviours and facilities among households of Jos metropolis, Nigeria. The data used for the research were obtained through observations, field surveys and the use of questionnaire while secondary data sources included information from the internet, books and databases. The study employed random and purposive sampling techniques in the selection of sampled wards of Jos metropolis and elicited information from 383 respondents in the area. The data was analysed through the use of simple descriptive statistics like frequency tables, bar graphs and pie charts. The study revealed that sanitation and hygiene facilities like flush and pour toilets, pit latrines, sink and showers are predominant in most residential houses and majority of people take their bath once in a day because of work pressure and just very few don’t take their baths at all in a day. It therefore recommends among other things that in order to improve the hygiene and the sanitary condition in the area, government and other stakeholders should intensify efforts towards ensuring the success of the monthly environmental sanitation, NGOSs and health facilities should regularly hold health education sessions for households. Also, individuals and other stakeholders should embark on construction of decent public toilets in strategic locations in the metropolis in order to discourage people from defecating in the bush or open spaces.

Compliance of private ventilated improved pit latrines to odour and fly control guidelines: A technical audit in selected regions of Ghana

The ventilated improved pit (VIP) latrine offers a promising route to safely managed sanitation to many households in developing countries. However, some technical guidelines must be followed in order to realise the technology's advantage of odour and fly nuisance control. This study sought to audit private VIP latrines in selected regions of Ghana to assess their compliance to conventional technical guidelines and to understand the major factors that influence the latrine designs. An inspection checklist was developed to assess 296 private VIP latrines in the Central, Ashanti and Northern Regions of Ghana while semi-structured interviews were conducted among the latrine owners to enquire the factors that influenced the designs of their latrines. The results show that provision of a window in the superstructure (86 %), and the avoidance of an insect screen in the window(s) (77 %) were the most complied guidelines. The use of 150 mm diameter vent pipe was the least satisfied guideline (5 %). On the average, a latrine satisfied about half (3.6) of the technical guidelines that were assessed. The decision or advice of local artisans is the most influential factor in the design of the latrines. Cost was the least mentioned factor cited by the latrine owners. There is the need to establish information desks at the various Metropolitan, Municipal and District Assemblies (MMDAs) to guide prospective owners on the proper design and construction of the VIP latrine. In addition, toilet construction should be incorporated in the curriculum for the basic training of building and construction students in Technical and Vocational Education and Training (TVET) institutions in Ghana. Further research is required to ascertain the basis of the decisions of local artisans and the potential impact of the use of accessories that are ‘borrowed’ from the WC toilet on odour and fly control in the latrine.

Challenges faced by adolescent girls on menstrual hygiene management: School-based study, Siha, Kilimanjaro, Tanzania.

Menstrual hygiene management (MHM) has received increasing attention as a public health issue globally. Governments and stakeholders have started to engage communities to address barriers and challenges faced by adolescents in and out of school. This study, conducted in Siha District, northern Tanzania, responds to the call for evidence sensitive to local barriers and challenges to inform successful strategies in MHM. Institutional-based cross-sectional study which involved 400 school girls aged 10 to 19 years old who attained menarche were randomly selected in four secondary and advanced level government schools from September 2019 to January 2020. Bivariate and multivariable logistic regression analysis were employed. A P-value less than 0.05 was used to declare statistical significance. Among all the girls who participated in the study 30% reported missing school due to menstruation while 56% of the girls reported using toilets as changing places at school. The use of reusable sanitary material was 52% compared with non-reusable materials which was 48%. In urban areas, 34.5% of students reported missing school due to menstruation compared to 25% who reported in rural areas. The findings show that school absenteeism among adolescent girls during menstruation is significantly associated with a headache (Adjusted odds ratio (AOR) = 3.3 (95% CI:1.32-8.23)) and abdominal waist pain (AOR = 8.50 (95% CI: 6.27-15.56)), lack of changing rooms in school (AOR = 5.85 (95% CI: 4.82-7.93)). In addition, the high cost of sanitary pads was mentioned as one of the main reasons for students not using sanitary pads. This study calls for promoting MHM-friendly practices in schools to create a supportive and conducive learning environment for adolescent girls. Ongoing infrastructure improvements such as the construction of classrooms and toilets in schools should include the construction of proper changing places to reduce the number of adolescent girls who miss school due to menstruation.

Optimized strategy for schistosomiasis elimination: results from marginal benefit modeling

BackgroundPoverty contributes to the transmission of schistosomiasis via multiple pathways, with the insufficiency of appropriate interventions being a crucial factor. The aim of this article is to provide more economical and feasible intervention measures for endemic areas with varying levels of poverty.MethodsWe collected and analyzed the prevalence patterns along with the cost of control measures in 11 counties over the last 20 years in China. Seven machine learning models, including XGBoost, support vector machine, generalized linear model, regression tree, random forest, gradient boosting machine and neural network, were used for developing model and calculate marginal benefits.ResultsThe XGBoost model had the highest prediction accuracy with an R2 of 0.7308. Results showed that risk surveillance, snail control with molluscicides and treatment were the most effective interventions in controlling schistosomiasis prevalence. The best combination of interventions was interlacing seven interventions, including risk surveillance, treatment, toilet construction, health education, snail control with molluscicides, cattle slaughter and animal chemotherapy. The marginal benefit of risk surveillance is the most effective intervention among nine interventions, which was influenced by the prevalence of schistosomiasis and cost.ConclusionsIn the elimination phase of the national schistosomiasis program, emphasizing risk surveillance holds significant importance in terms of cost-saving.Graphical

Barriers of household toilet utilization among toilet owners in a rural area of Northern India: An analytical cross-sectional study.

Open defecation continues to prevail among toilet owners despite effective implementation of the Swachh Bharat Mission (Gramin). We conducted this study to determine toilet utilization rates and learn about the barriers to toilet use in the rural areas. By understanding the barriers, physicians can provide targeted education and become better equipped to manage their patients' conditions and advocate for their demands. We conducted a cross-sectional study on the households of the rural field practice areas of the department in central Uttar Pradesh by the census method. House listing was procured from the departmental records. The questionnaire was directed at both the household level and individual level. The proportion of households with access to a toilet was found to be 91.1% of which 504 households were included in the study. Among the toilet owners, 115 (22.8%) households were not using toilets exclusively by all the members. At the individual level, age groups (of 20-59 years, and ≥60 years) and female gender were found to be significantly associated with open defecation. At the household level, government assistance for toilet construction and livestock keeping was found to be associated with open defecation. Major barriers to toilet use were childhood habits, dearth of toilets in the farming grounds/workplace, women during menstruation and having a non-functional toilet. This study indicates that merely installing a household toilet does not ensure exclusive utilization of toilet and the practice of open defecation might continue to be prevalent if corrective measures are not undertaken.

Immigration, ethnic diversity and public goods provisioning: Evidence from rural communities in Uganda

A considerable body of literature suggests that immigration undermines voluntary contributions to public goods because it leads to ethnic diversity, which erodes social trust. This article posits that the effect of immigration outweighs that of ethnic diversity, so that immigration may explain why ethnic diversity is negatively associated with social trust and public goods provisioning. I also highlight a need to emphasize the moderating influence of transaction costs when analyzing provisioning problems associated with immigration and ethnic diversity. To examine my hypotheses, I use a mixed-method research design to study public goods management in randomly selected communities in rural Uganda whose rates of immigration and levels of ethnic diversity vary. I analyze community-level attempts at collective action that involve substantially different costs; that is, contributing to toilet construction and participating in litter pickup programs. The findings suggest that socio-political barriers to collective action for public goods provisioning may have less to do with the stock of demographic diversity than the flow rate of demographic change. The same findings suggest a more micro-level explanation that transcends the erosive effects (of immigration and ethnic diversity) on social trust to emphasize the moderating influence of transaction costs.

Public toilets have reduced enteric pathogen hazards in San Francisco

Uncontained fecal wastes in cities may present exposure risks to the public. We collected discarded feces from public spaces in San Francisco, CA for analysis by RT-qPCR for a range of enteric pathogens. Out of 59 samples, we found 12 (20%) were of human origin and 47 (80%) were non-human; 30 of 59 stools were positive for ≥1 of the 35 pathogens assessed, including pathogenic E. coli, Shigella, norovirus, Cryptosporidium, and Trichuris. Using quantitative enteric pathogen estimates and data on observed fecal waste from a public reporting system, we modeled pathogens removed from the environment attributable to a recently implemented program of public toilet construction. We estimated that each new public toilet reduced the annual number of enteric pathogens released into the immediate environment (within 500 m walking distance), including 6.3 x 1012 enteropathogenic E. coli (95% CI: 4.0 x 1012–7.9 x 1012), 3.2 x 1011 enteroaggregative E. coli (95% CI: 1.3 x 1011–6.3 x 1011), and 3.2 x 108 Shigella (6.3 x 107–2.5 x 109). Improving access to public sanitation can reduce enteric pathogen hazards in cities. Interventions must also consider the hygienic disposal of animal waste to reduce microbial hazards with zoonotic infection potential.

Analysis on the Current Energy Consumption of Heating In Rural Toilets in Tibet

In order to grasp the basic sanitation facilities, toilet renovation planning and progress, residents' toilet habits and willingness to renovate, and the maintenance status of renovated toilets in townships and rural areas of Tibet, and to understand the basic situation and toilet renovation planning of public toilets in townships and rural areas. This article selects independent public toilets in agricultural and pastoral areas of Tibet as the research object. In response to the problems of low indoor temperature and high heat consumption in township toilets, the construction and heating status of township toilets were obtained through on-site research. The heating characteristics of township toilet buildings were summarized, and typical buildings were selected for load characteristics analysis, providing a preliminary basis for the design of solar heating schemes in the future.

The Political-Economy of Rural Development Through Corporate Social Responsibility: An Assessment of the INs and OUTs

The shift of rural development from the government’s agenda to the CSR units’ agenda is a recent political development. The Companies Act 2013 has made it mandatory for the corporate to play a significant role, sometimes as a supplement to or as a substitution for the State under the neo-liberal economy. In this context, the present study has tried to explore the role of two major industries, i.e., HAL and NALCO, in rural development in the backward district of Koraput, Odisha. The seminal contributions of these two industries in four major areas, i.e., construction of toilets, construction and repair of roads, installation of solar lights and construction and repair of water service infrastructure, have been analysed in this article. The study has relied on both quantitative and qualitative data drawing them from secondary and primary sources. The study concludes that no clear-cut financial investment on different heads is projected by the company’s CSR units, there is overlapping in the company’s inclusion of the heads of rural development, people’s felt needs are hardly reflected in the designing of rural development programmes by the CSR units, and follow-up impact assessments are rarely undertaken. So, the investments are made without a real spirit, and the dividends do not commensurate with the hefty investment. Rural development programmes floated by the CSR units are less people-centric, not sustainable and economically viable, and are more politically motivated and just done to comply with the policy mandates.

Socialization and Evaluation of the BLM Program for Penataban Giri Banyuwangi Village

A good and healthy environment is very important in supporting human survival. Settlement drainage is a facility or infrastructure in settlements to drain rainwater from one place to another. The wastewater distribution system is a series of water structures that function to reduce or dispose of wastewater from an area or land, both households and industrial areas. The KOTAKU Program (City Without Slums) BLM Program for Penataban Giri Banyuwangi Village has been completed, namely the construction of drainage facilities, toilets, and beautification. The hope is that after the construction of some of these facilities can help the level of cleanliness and quality of a healthy environment for the community. Hopefully in the future the community can maintain the local wisdom values ​​of environmental preservation in the Penataban Village, namely the value of environmental adaptation, the value of responsibility, the value of environmental awareness, and the value of cooperation. The values ​​of local wisdom as an effort to maintain the environment in Penataban Village are reflected in the activities of residents in maintaining drainage channels for waste water management, maintaining environmental cleanliness and the spirit of community cooperation to beautify and preserve the surrounding.

Pembuatan Jamban Keluarga untuk Rumah Tangga dengan Kasus Stunting di Wilayah Kerja Puskesmas Wani

The working area of the Wani Community Health Center has 193 cases of stunting in toddlers. One of the risk factors for stunting in toddlers is the use of family toilets. In Central Sulawesi, low birth weight, lack of handwashing behavior, and not having a toilet are risk factors for stunting in infants. Family toilets are an important sanitation facility for housing. The goal of this activity is to provide adequate sanitation facilities for defecation for one household that has a stunted toddler and for the household members to be able to use it. The method of community service is by practicing the construction of healthy toilets and providing education and discussion on healthy toilets to the community who have stunting cases. The target of the education is 20 mothers of stunted toddlers in the working area of the Wani Community Health Center, and after that, the utilization will be evaluated by household members. The results of this community service are the construction of one toilet facility and education to the community on the importance of toilets. The conclusion is that all household members should not dispose of waste in any place such as in rivers and behind houses as before. It is recommended that every household have a healthy toilet to break the chain of environmentally-based disease transmission.

Elevated levels of anthropogenic antibiotic resistance gene marker, sul1, linked with extreme fecal contamination and poor water quality in wastewater-receiving ponds.

In several low- and middle-income countries, such as India, the rapid construction of toilets to combat open defecation has not been matched with adequate wastewater treatment, resulting in extreme fecal contamination of the receiving environments. The sewage-receiving surface water bodies, typically close to the residences, are a potential hotspot for disease transmission and antibiotic resistance. Water, soil, and sediment samples from seven wastewater-receiving ponds (WRPs) were analyzed for water quality, chlorophyll-a, fecal contamination (yccT for Escherichia coli), 16S rRNA gene copies, and anthropogenic antibiotic resistance gene markers-sul1 and intI1. These WRPs were contrasted with two ponds that did not directly receive sewage. The water quality in the WRPs was comparable to raw sewage (BOD: 210-380mg/L; COD: 350-630mg/L; total-N: 100-190mg/L; and total-P: 6-21mg/L), and the relative levels of the DNA marker of E. coli were very high (yccT: 0.1% to ∼100% of total bacterial count) indicating extreme fecal contamination. The relative levels of sul1 and intI1 were 1-3 orders of magnitude higher in WRPs (sul1: 0.32%-10% of total bacterial count; and intI1: 0.2%-5% of total bacterial count) compared to the ponds that did not receive sewage directly. The relative levels of sul1 correlated with the DNA marker for the fecal indicator, E. coli (p-value<0.05; r=0.50; Spearman's rank correlation), and poor water quality.

Exploring the Applicability of the PPP in Tourist Toilets: Reflections on the Laoshan Case in China

Although public–private partnerships (PPPs) for tourism have received extensive attention, there has been limited research on their application to tourist toilets. The purpose of this study was to systematically explore the applicability of PPPs with respect to the construction and operation of tourist toilets. The study conducted field investigations and semi-structured interviews in the Qingdao Laoshan Scenic Area (LSA), where purposive sampling techniques were used to manage participant selection and expand sample sizes. It finds that first, the use of PPPs to build tourist toilets is new and has shown both development potential and challenges. Second, the use of PPPs to provide tourist toilets is not yet mature owing to management and supply inefficiencies. Third, the DBTO model in the Laoshan case offers a significant methodological value for similar PPP projects, which could be replicated and promoted more widely when certain conditions are met. This study has filled a research gap in the global toilet revolution and shows a different path from the investment guarantee system in developed Western countries and the Guilin model in China. This application of a PPP in provision of tourist toilets also broadens the knowledge base of researchers studying PPPs in the field of tourism and could lead to the development of a policy approach with respect to PPPs’ application in the toilet revolution and regional tourism development.

Sanitation citizenship: state expectations and community practices of shared toilet use and maintenance in urban India

Although India declared itself “open defecation free” in 2019, critics charge that its national urban sanitation campaign, Swachh Bharat Mission–Urban (SBM-U), has failed. SBM-U provided community toilets in informal settlements where household latrines were unviable, delegating their upkeep to local governments and users. Initially, these community toilets were used. However, the failure to maintain and repair them resulted in a reversion to open defecation, forcing the state to reconsider its decision to withdraw after construction. We use the SBM-U to develop a framework of “sanitation citizenship”, which emerges through sanitation infrastructure’s use and disuse, and emerges over its life course. We trace how mutual expectations and everyday practices of citizenship by the state and users aligned and fractured during the construction, maintenance and repair phases of community toilets. We argue that the changing material condition of infrastructure is critical to negotiations over mutual obligations and definitions of the citizenship contract.

The obstacles to China’s rural toilet revolution discussed on social media: A content analysis of Weibo posts and Zhihu answers data

The Chinese government has been promoting a “rural toilet revolution” (RTR) since 2015 to popularize sanitary toilets in rural areas, but the objective obstacles to RTR are impeding the revolution. Understanding public opinions on the obstacles can improve the effectiveness of RTR. To identify and detail the obstacles reflected by the public, we collected the opinion data from two representative social media platforms in China (i.e., Weibo and Zhihu), and analyzed the data by employing a blend of inductive content analysis and frequency analysis. The results showed five main obstacles to China’s RTR. The most often mentioned obstacle was toilet design problems (61.54 % of 390 Weibo posts and Zhihu answers), followed by local government incompetence problems (39.74 %), toilet cleaning & maintenance problems (27.44 %), toilet construction quality problems (15.13 %), and habits & technology problems (12.05 %). Our study revealed that (1) many superficial “glitter” toilets were accompanied by poor design of sewage treatment, flushing water, location, and building time; (2) the local governments were accused of much corrupt and coercion behavior; (3) many toilets were difficult to maintain and clean. It is imperative for the government to pay more attention to the design problems, be more open, transparent, and decentralized, broaden financing channels for RTR, and enhance health publicity and education of toilet knowledge. Our study can provide reference for policymakers and decision-makers to identify and satisfy the demands of stakeholders, better promoting the RTR in China.

Can Immigration Explain Why Ethnic Diversity is Negatively Associated with Common Property Management?

A persistent question for social scientists is the extent to which societal levels of ethnic diversity, and rates of immigration, make collective action difficult to achieve (or maintain). Here I examine whether immigration can explain why ethnic diversity is negatively associated with collective action. The focus is on two aspects of collective action for common property management (that is, voluntary contributions to toilet construction and voluntary compliance with forestry regulations) among Ugandan communities whose levels of ethnic diversity and rates of immigration vary. Preliminary evidence suggests that communities with lower rates of immigration are more supportive of common property management, irrespective of their levels of ethnic diversity. By implication, socio-political impediments to collective action may have less to do with the stock of demographic diversity than the flow rate of demographic change.

Water, hygiene and sanitation practices are associated with stunting among children of age 24-59 months in Lemo district, South Ethiopia, in 2021: community based cross sectional study

BackgroundStunting among children of ages 24-59 months is a major public health challenge in developing countries. It has been linked with poor water quality, water accessibility, a lack of environmental sanitation, and personal hygiene (WASH) practices, particularly in food-insecure areas. Stunting occurs during certain seasons in food-insecure settings. Therefore, a complete understanding of risk factors is the first step in the development of a preventive strategy. However, information is scarce about the prevalence and factors associated with stunting among children of ages 24-59 months in these settings.ObjectiveThis study aimed to assess the prevalence of and factors associated with stunting among children aged 24–59 months in Lemo district, south Ethiopia, in 2021.MethodsA community based cross-sectional study was conducted from January 1-30/2021. Data were collected from a total of 415 randomly selected children and mother /guardian/. Logistic regression analysis was done to identify factors associated with childhood stunting. In binary logistic regression analysis, independent variables with p-value < 0.25 were fitted into multivariable logistic regression analysis to explore final predictors of stunting/ thinness/. Independent variables with AOR and 95% CI and P-value < 0.05 was computed and reported as predictors of stunting among children in this study.ResultsFrom a total of 450 children, only 415 were included in the final analysis, making a response rate of 92.2%. The prevalence of stunting among children was 33.5% (95% CI: 30.4 and 36.6%) in this study. Children ages 48-59 months (AOR = 2.8, 95% CI: 2.1, 12.1), children ages 36-47 months (AOR = 1.6, 95% CI: 1.1, 7.1), children of uneducated women (AOR = 1.8, 95% CI: 1.5, 4.2), children who lived near unimproved toilets (AOR = 1.7, 95% CI: 1.2, 2.6), children whose feces was disposed of unsafely (AOR = 2.8, 95% CI: 1.57, 5.31), and children whose mothers did not wash their hands before feeding their children (AOR = 6.2, 95% CI: 2.0, 19.1) were factors positively associated with stunting among children aged 24 months to 59 months.ConclusionThe prevalence of stunting is high compared with the national prevalence of stunting in food insecure areas. Policy makers, local leaders, and community health extension workers should enhance environmental sanitation and create awareness about personal hygiene. Furthermore, improved toilet construction and appropriate utilization should be encouraged. Furthermore, the local government should work to improve the socio-economic status of poor households.

The effect of sanitation risk on toddler stunting incident with geographically weighted regression approach in Malang Regency, Indonesia

Stunting is a fundamental problem in Indonesia's human development. The risk factors for stunting are very complex, including inadequate environmental sanitation. This study aims to analyze and map the influence of spatially correlated sanitation risk on the incidence of stunting toddlers in Malang Regency, Indonesia. Data collection was carried out by interviewing respondents using questionnaires, counting stunting toddlers, and observing environmental sanitation objects. Determination of respondents was done purposively with the following stages. First, at the village level, 75 sites were selected based on the following criteria: population density; poverty level; the presence of streams, drainage or irrigation canals; and flood vulnerability. Furthermore, in each village, 40 respondents were selected based on the following criteria: women aged between 18 to 65 years, came from poor families and had a child (or children). When the number of respondents who were willing to participate is less than 40 people in each village, they were replaced by other respondents based on recommendations from village officials. A total of 3000 respondents have participated in this study. The selected respondents include wives, dependent married women or widows. The spatial analysis approach was carried out using the Geographically Weighted Regression (GWR) method. Based on the results of the analysis of the spatial effect of the GWR model, the Sanitation Risk Factors that significantly affected the incidence of stunting in Malang Regency were; Environmental Drainage (greywater), Solid Waste, and Domestic Wastewater (black water). Clean and Healthy Lifestyles and Water Sources have less effect on sanitation risk. This study recommends government and public interventions to improve environmental sanitation including integrated waste management, improvement of drainage infrastructure, construction of standardized toilets, and carrying out health promotion efforts with education to increase public awareness.