Practice Open Defecation Research Articles

The sanitation arc: an alternative examination of WASH behavior change

Abstract A primary goal of the WASH sector is to facilitate transitions from open defecation to improved sanitation. Many residents of low-income countries desire improved sanitation but lack the resources to obtain or maintain access to toilets. For such persons, describing the goal as ‘behavior change’ implies a deficiency in mindset, failing to capture contextual factors affecting sanitation access. Furthermore, household circumstances affect movement both up and down the sanitation ladder, a phenomenon that the sector tends to overlook. This study, based on interviews with 308 former subscribers to Haitian container-based-sanitation service EkoLakay, tracks household sanitation access at four points in time: prior to subscribing, during the subscription period, immediately upon unsubscribing, and at the time of interview. We describe this movement through time as the ‘sanitation arc’. Prior to subscribing, households were more likely to practice open defecation or rely on non-household sanitation, and less likely to have private improved sanitation than the average urban Haitian. This distribution is reversed among former subscribers. Nearly half of former subscribers, however, could not afford continuous access to EkoLakay; 80% of involuntary terminations resulted in loss of access to private improved sanitation, and over one-third of these households reverted to open defecation.

The proof-of-concept of a novel feces destroyer latrine

Improving water and sanitation safeties is part of the global agenda aiming at equitable sanitation, hygiene for all, and the end of open defecation. Nevertheless, despite the efforts made in recent years, the use of unimproved facilities and the practice of open defecation are still generating around 70 wt% of the worldwide fecal matter. The purpose of this work is to present a concept of a new laboratory-scale latrine, the FeD-Latrine, that destroys fresh feces through out-of-bed combustion. We performed experimental runs simulating real defecation scenarios to destroy fresh feces with an average dropping rate of 120 g/h. The FeD-Latrine recovered valuable soil components from feces (Ca, K, P, Si, Fe, Cr, S, Zn, Mn, Sr) and emitted controlled gaseous emissions of 475 g of CO2−eq per hour. Although the FeD-Latrine used electric inputs, it generated enough thermal energy to cover up to three times the electric inputs.

Determinants of stunting and wasting in street children in Northwest Ethiopia: A community-based study

ObjectiveThis study aimed to identify determinant factors of stunting and wasting in street children ages 5 to 18 y in Northwest Ethiopia. Materials and methodsA community-based cross-sectional study design was employed. An interviewer-administered, structured, and pretested questionnaire was used to collect the data. A convenience sampling technique was used to recruit participants. Stunting and wasting were defined as having a height-for-age and weight-for-height Z score of less than –2 SDs, respectively. Both bivariable and multivariable logistic regression analyses were fitted to identify factors associated with stunting and wasting. A 95% confidence interval (CI) and P < 0.05 were used to declare statistical significance. ResultsThe overall prevalence of stunting and wasting was 46.4% (95% CI: 41.6–51.5%) and 15.3 % (95% CI: 11.7–19.0%), respectively. Age (adjusted odds ratio [AOR] = 0.18, 95% CI: 0.08, 0.47), substance use (AOR = 2.07, 95% CI: 1.33, 3.21), and loss of appetite (AOR = 2.00, 95% CI: 1.31, 3.04) were independently associated with stunting. Whereas age (AOR = 0.49, 95% CI: 0.27, 0.89), illness (AOR = 2.38, 95% CI: 1.27, 4.48), and open defecation (AOR = 2.27, 95% CI: 1.14, 4.51) were factors associated with wasting. ConclusionStunting and wasting were found to be critical problems in street children. Age, loss of appetite, and substance use were significantly associated with stunting, whereas child age, illness, and open defecation practice were significantly associated with wasting. Thus, tailored nutritional interventions are urgently required in this population to improve their nutritional status.

A Holistic Study on Demographic, Sociocultural and Healthcare Seeking Pattern of Irular Community at Pichavaram, Cuddalore District, Tamilnadu.

Background: The tribal communities remain at the lowest stratum of society – Though accorded special status under Indian Constitution their health remains unsatisfactory due to isolation, illiteracy and the environment in which they live. This study was conducted to present a holistic view of the socioeconomic status, living conditions, general customs, beliefs and practices and health seeking behaviour of the Irular community, at Pichavaram in Cuddalore district, Tamil Nadu. Methods: A - Mixed method study was performed using Focus Group Discussion, in-depth interviews, participatory observations (triangulation of methods) and a pre- tested semi structured questionnaire among the people of Irular community aged 13 to 70 years residing at Kalaignarnagar and Grid colony, Killai, Pichavaram during the month of October 2020. Results: The study was done among 250 participants with the mean age of 30.66±12.48. 11.6% of them have acquired education upto high school level, 7% upto higher secondary and 2.2% upto degree level. 55.6% of the families use LPG for cooking,69.1% boil water for drinking. 25.2% practice open air defecation. Association between menstrual hygiene and literacy of female participants is statistically significant. 55.6% utilize Government Hospital and 44.4% utilize Primary Health Centre services for healthcare. Conclusion: Our results identified a notable transition in the sociocultural patterns and a progress in the economic status of these Irulars due to fishing profession, self-help groups, literacy among younger generation and efforts of a private foundation. There is improved awareness related to menstrual hygiene and Maternal and child health practices. But the elder generation requires further motivation for increased health seeking behaviour.

EVALUASI PROGRAM GERAKAN SANITASI TOTAL BERBASIS MASYARAKAT (STBM) DI WILAYAH KERJA DINAS KESEHATAN KABUPATEN BOMBANA

The total population is 287.70 million people, people who practice open defecation are 30, 31 million people. Access to sanitation nationally reached 81% with 30,636 ODF villages/Kelurahan. In Southeast Sulawesi, the realization of the number of villages/kelurahan that implemented STBM only reached 46.60%, not yet reaching the national average of 60.99%. The purpose of the study was to evaluate the Community-Based Total Sanitation Program (STBM) in Controlling the Community Environment in the Work Area of ​​the Bombana District Health Office, Southeast Sulawesi Province in 2021. This type of research was a qualitative research with a qualitative descriptive design. Informants in this study included: Head of Public Health Division and Head of Environmental Health Section and sanitarian Puskesmas and STBM managers, village officials. Human resources include community elements (local Village Government) as coordinators and community mobilizers; The Bombana Health Office through the public health sector, the environmental health section, acts as a verifier and mentoring staff from the Public Health Center in the Public Health sector as mentoring staff for triggering the STBM program. The availability of infrastructure that triggers the STBM program is still lacking. The policy from the Health Office is to increase the achievement of the STBM program through budget allocations from DAK and DAU which are given to village work areas that declare STOP open defecation (ODF). The planning process involves community elements as program targets through internal village meetings and Musrenbang level. Monitoring and monitoring activities are carried out by the Health Office as a verifier and sanitarian officer of the Puskesmas. The achievement of STBM indicators has not met the target, which is still reaching 40% of the National target of 75% of all STBM indicators. It is necessary to set a definite time target for the STBM program to be able to run according to the target set and it is hoped that there will be assistance and participation of the community and the Health Office in sending STBM reports.

Water and Sanitation Situation in Selected Villages in Ifedore Local Government Area of Ondo State, Nigeria

Water is essential for life, while sanitation is for dignity. Worldwide, Nigeria is second to India in term of open defecation, with an estimated population of 109 million open defecators. The rural areas currently lagged behind the urban areas in term of water and sanitation. A survey of two villages in the Ifedore Local Government of Ondo State, Nigeria was conducted, using 88 respondents selected through purposive sampling technique from Ikota and Aaye village cluster. Findings from the study revealed that sources of water are boreholes, wells and streams. On the other hand, most of the indigenes still practice open defecation, though some of them use water closet, pour flush toilet and variances of pit latrine as toilet. Most of them still expect the government to install and maintain facilities provided. It is suggested that demand driven and the bottom-top approach where the people first believe that water and sanitation prevent diseases and provide longevity be explored. It is believed that reinventing the services of sanitary officers (Wole Wole), will help in disseminating and enforcing proper hygienic practices.

Assessment of Social Demographic Characteristics Influencing the Uptake Community Led Total Sanitation Strategy in Embu County, Kenya

The open defecation(OD) status of Mbeere North Sub-county as at 2019 stood at 138 villages against the required 254 villages triggered. Though conceived to end open defecation practice, Community Led Total Sanitation(CLTS) has not achieved this goal in Mbeere north sub county since some people still use forests and available hideouts. It is not clear why CLTS, which is a key component of primary healthcare, has not yielded the intended results, hence the current study investigated the influencers of community led total sanitation strategy among households in Mbeere north sub county, Embu County, Kenya. Specifically, the study aimed to assess social demographic characteristic influencing uptake of CLTS strategy in Mbeere north Sub-county, Embu county. The study employed Socio-Ecological Model as a theoretical guideline. Descriptive cross-sectional study design adopted targeting households and health workers tasked with implementing CLTS strategy. 388 respondents were sampled through fisher et al and applied stratified sampling technique for villages and systematic random sampling technique for household. Questionnaires and interview guide were used to collect data, then analyzed with the aid of SPSS. Both descriptive and inferential statistics were employed based on applicability. The study found that income (p 0.044), education, (p 0.043), age (p 0.006) and religion (p 0.004) had a significant influence on CLTS strategy in Mbeere North Sub County. Construction of latrines was found to be crucial for addressing open defecation The study recommends that County Health department in conjunction with health stakeholders accelerate the CLTS strategy in order to achieve 100% ODF status. Keywords: Community, Defecation, Social demographic, Sanitation DOI: 10.7176/PPAR/11-8-02 Publication date: October 31 st 2021

Having a latrine facility is not a guarantee for eliminating open defecation owing to socio-demographic and environmental factors: The case of Machakel district in Ethiopia

BackgroundOpen defecation practice problem is rampant in most rural areas of developing countries, including Ethiopia. To combat this problem, the Ethiopian government implemented different sanitation interventions including Community-Led Total Sanitation and Hygiene (CLTSH). The CLTSH approach is mainly aimed to eradicate open defecation practice through mobilizing the community to construct a latrine facility and utilize it. Although this intervention has significantly improved households’ access to a latrine facility, its impact on bringing behavioral change such as avoiding open defecation is not well studied.ObjectiveOur study aimed to assess the prevalence of open defecation among households having their latrine and its determinant factors in rural settings in Northwest Ethiopia.MethodsA community-based cross-sectional study was conducted in Machakal district from September 1 to 30, 2019. A total of 472 household heads who had a latrine facility and systematically selected from six rural Kebeles of the district, were involved in the study. The data were collected using a structured questionnaire and observational checklist tools through face-to-face interviews and observation methods. Bivariate and multivariable logistic regression models were run to identify the factors that influence open defecation practice. During the multivariable analysis, statistical significance was declared at the p-value of <0.05 with 95% CI.ResultsThe prevalence of open defecation practice among household heads who had latrine facility was 27.8% (95% CI, [23.1–32.8]). Female gender (AOR = 2.94, 95% CI [1.13–7.68]), not attending of formal education (AOR = 3.10, CI 95% [1.34–7.13]), having >5 family members (AOR = 1.72, CI 95% [1.05–2.80]), presence of under-five child (AOR = 3.64 CI 95% [2.14–6.21]), preferring leaf as anal cleaning material (AOR = 3.18, CI 95% [1.67–6.08]), having unclean latrine (AOR = 2.15, CI 95% [1.34–3.44]), and having latrine that needs maintenance (AOR = 2.50 CI 95% [1.52–4.11]) variables were associated with open defecation practice.ConclusionsAmong the total respondents, finding more than a quarter of open defecators is concerning for a district that achieved greatly in terms of latrine coverage. This indicates the above-mentioned factors contributed to influence household heads to defecate openly despite having latrines. Therefore, the government and partners need to focus on designing strategies that effectively address determinant factors of open defecation.

Justice and sanitation well-being: an analysis of frameworks in the context of slippage, based on findings from Shravasti, Uttar Pradesh, India.

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.

Comparing Reproductive Health Awareness, Nutrition, and Hygiene among Early and Late Adolescents from Marginalized Populations of India: A Community-Based Cross-Sectional Survey.

Adolescence (10–19 years) is marked by many physiological changes and is vulnerable to health and nutritional problems. Adolescence, particularly, early adolescence is inadequately addressed in our national surveys. The present study aimed to assess the reproductive health awareness, nutrition, and hygiene of marginalized adolescent girls and boys and compare them among early and late adolescents. Our cross-sectional study was a part of a community-based project across India’s five zones, namely North, East, West, Central, and South. Unadjusted and adjusted logistic regression was performed to compare awareness about HIV/AIDS, or Sexually Transmitted Infections (STI), consumption of Iron Folic Acid (IFA) tablets and three meals in a day, safe menstrual hygiene practices, history of anemia, and open defecation practice among early and late adolescents. Data were reported as unadjusted and adjusted odds ratio (aOR) with a 95% confidence interval (95% CI). Among early adolescents, around 58% of girls and boys did not consume IFA tablets, and 28% of girls and 24% of boys defecated in the open. Compared to late adolescents, early adolescent girls had lower odds of awareness about HIV/AIDS (aOR (95% CI): 0.50 (0.47–0.54)) and open defecation (aOR (95% CI): 0.90 (0.83–0.98)) and higher odds of hand hygiene after defecation (aOR (95% CI): 1.52 (1.37–1.68)) and safe menstrual practices (aOR (95% CI): 1.42 (1.23–1.64)). There is a dire need to start public health interventions from early adolescence for long-term benefits throughout adolescence.

Whether COVID-19 has waterborne transmission too?

SARS CoV-2 and COVID-19 have hogged the headlines for almost 18 months and over the last 2 months, it has occupied the mind space of entire India. Its second wave has not only sent shock waves across the nation but has created ripples across oceans too. There has been intense debate over how it went spiralling up in such a manner that India is is reporting large number of cases daily as well as deaths. One of most hotly debated topics is “Whether it is being transmitted through contaminated water too?” There is enough evidence that the virus sheds in feces and that the virus sheds in feces, sewage, sewer lines, waste water, and sewage treatment plants as well as effluents of plants. The important factor is that about two-third of sewer is not treated. On top of that, countries such as India do not have universal access to safe drinking water and practice of open defecation is still prevalent. In such a scenario, likelihood of waterborne transmission cannot be ruled out.

Child Undernutrition following the Introduction of a Large-Scale Toilet Construction Campaign in India.

Lack of toilets and the widespread practice of open defecation may contribute to India's large burden of child undernutrition. We examine whether a large national sanitation campaign launched in 2014, the Swachh Bharat Mission (SBM), precedes a reduction in stunting and wasting among under 5-y-old (u5) children in India. In this observational study, we used district-level data from before (2013-2014) and after (2015-2016) SBM from 3 national surveys to derive, as our outcomes, the percentage of u5 children per district who are stunted and wasted. We defined our exposures as 1) binary indicator of SBM and 2) percentage of households with toilets per district. Our analytic sample comprised nearly all 640 Indian districts (with ∼1200 rural/urban divisions per district per time point). Linear regression analyses controlled for baseline differences in districts, linear time trends by state, and relevant covariates. Relative to pre-SBM, u5 stunting declines by 0.06% (95% CI: -0.10, -0.01; P=0.009) with every percentage increase in households with toilets post-SBM. Rural regions and districts with higher pre-SBM toilet availability show greater decline in u5 stunting post-SBM. An increase in toilet availability on a national scale, precipitated by the SBM sanitation campaign, is associated with a reduction in undernutrition among u5 children in India over the early phase of the campaign.

Japanese Encephalitis and Other Acute Encephalitis Syndrome in the Khurda, Odisha, India

Background: Japanese Encephalitis (JE) is caused by Japanese encephalitis virus (JEV), a mosquito-borne flavivirus (family Flaviviridae, genus Flavivirus). In India a large number (10-15%) of cases of Acute Encephalitis Syndrome (AES) is due to Japanese encephalitis with a case fatality rate of 18%. In Odisha, sporadic cases of JE/AES cases have been reported since 2011. A case-control study was conducted in Khurda district of Odisha to assess the burden of Japanese encephalitis and the associated risk factors. Methods: A probable case of AES/JE is defined as any child of 0-15 year age with onset of illness between September 1-December 31, 2017, residing in the Khurda district of Odisha, presenting with an “acute onset of fever, change in mental status (such as confusion, disorientation, delirium or coma) and/ or new onset of seizures”.. A 1to 2 age matched case-control study was conducted. Data was analysed using SPSS version 15.0.Results: We enrolled 13 cases and 26 controls between September 1-December 31, 2017. People living in close proximity to the agricultural fields(OR:15.63) rearing livestock at their house and having animal shed at proximity (OR:3.02 and 6.57 respectively) are at higher risk of getting the disease. Presence of waterbodies within 200-meter distance of the household (OR: 9.05) and stagnant water in the surrounding of the houses (OR: 12.38) were at higher risk of getting AES/JE.People using peri-domestic space for toilet (OR: 3.6) and having Practice of open air defecation (OR: 12.38) were are at higher risk of getting the disease.Conclusion: Improvement of water and sanitation practices among the community by empowering the village water hygiene and sanitation committee and village gram panchayat. That will also involve building of toilets in the houses. Vector control activities like insecticide fogging, IRS spraying and distribution of long lasting insecticide treated nets are to be taken into consideration, especially in the rural parts of the district where it is not done regularly. Vaccination coverage of Japanese Encephalitis vaccine is to be increased.

Impact of poverty reduction on access to water and sanitation in low- and lower-middle-income countries: country-specific Bayesian projections to 2030.

In 2017, 785 million people globally lacked access to basic services of drinking water and 2 billion people lived without basic sanitation services. Most of these people live in low- and lower-middle-income countries in South Asia, Southeast Asia and sub-Saharan Africa. To monitor the progress towards universal access to water and sanitation, this study aimed to predict the coverage of access to basic drinking water supply and sanitation (WSS) services as well as the reduction in the practice of open defecation by 2030, under two assumptions: following the current trends and accelerated poverty reduction. Households reporting access to basic WSS services and those practising open defecation were extracted from 210 nationally representative Demographic Health Surveys and Multiple Cluster Indicator Surveys (1994-2016) from 51 countries. A Bayesian hierarchical mixed effect linear regression model was developed to predict the indicators in 2030 at national, urban-rural and wealth-specific levels. A Bayesian regression model with accelerated reduction in poverty by 2030 was applied to assess the impact of poverty reduction on these indicators. Out of 51 countries, only nine (Bangladesh, Bhutan, Ghana, India, Nepal, Pakistan, The Philippines, Togo and Vietnam) were predicted to reach over 90% coverage in access to basic services of drinking water by 2030. However, none of the countries were projected to achieve equivalent coverage for access to basic sanitation services. By 2030, 21 countries were projected to achieve the target of less than 10% households practising open defecation. Urban-rural and wealth-derived disparities in access to basic WSS services, especially sanitation, were more pronounced in sub-Saharan Africa than South Asia and Southeast Asia. Access to basic sanitation services was projected to benefit more from poverty reduction than access to basic drinking water services. Households residing in rural settings were predicted to receive greater benefit from poverty reduction than urban populations in access to both basic WSS services. Achieving poverty eradication targets may have a substantial positive impact on access to basic water supply and sanitation services. However, many low- and lower-middle-income countries will struggle to achieve the goal of universal access to basic services, especially in the sanitation sector.

SARS-CoV-2: fate in water environments and sewage surveillance as an early warning system

Abstract Coronavirus disease has emerged as one of the greatest threats to human well-being. Currently, the whole world is fighting against this pandemic that is transmitted either through exposure to virus laden respiratory or water droplets or by touching the virus contaminated surfaces. The viral load in feces of an infected patient varies according to the severity of the disease. Subsequent detection of viral genome (SARS-CoV-2) in human feces and sewage systems is an emerging concern for public health. This also dictates to reinforce the existing sewage/wastewater treatment facilities. Rapid monitoring is the key to prevent and control the current mass transmission. Wastewater-based epidemiology (WBE) is a potential epidemiology tool that can act as a complementary approach for current infectious disease surveillance systems and an early warning system for disease outbreaks. In a developing country like India, inadequate wastewater treatment systems, low-operational facility and relaxed surface water quality criteria even in terms of fecal coliform bacteria are the major challenges for WBE. Herein, we review the occurrence, transmission, and survival of SARS-CoV-2, and disinfection and potential of sewage surveillance as an early warning system for COVID-19 spread. We also discuss the challenges of open-defecation practices affecting sewage-surveillance in real-time in densely populated developing countries like India.

Open Defecation Free Zone and Practice in Jorayal Gaunpalika

The study is based on Open Defecation Free Zone and Their Practice in Jorayal Gaunpalika -4, Doti District. The main objective of the study is to analyze the practice of open defecation free zone. Out of 310 total households, only 150 households were selected for the study. The cluster sampling method was applied to collect necessary information. The study area was divided into 6 clusters and from each cluster 25 households were selected randomly. According to the study, hand wash practice is very high that is 85.3 percent wash their hands with soap and water and 14.7 percent use soil and water. The high majority of the respondents (88.7 percent) said that they maintained the garden and the toilet, 7.3 percent said that they kept the courtyard of the house plain. Most of the respondents (82.7 percent) cleaned the toilet every day. Most of the respondents (70.7) expressed that they defecated in the field, and 28.7 percent respondents said that they defecated along the riverside and remaining others used the road. In this study, the researcher gives suggestions to the concerned department and to possible future researchers. The government and non-government sectors should support such open defecation free zone area ensuring adequate environmental sanitation. The municipality should be made aware of the importance of a good environmental hygiene. Furthermore, such studies should be conducted at the national level.

Impact of cyclone Amphan on the water, sanitation, hygiene, and health (WASH2) facilities of coastal Bangladesh

Abstract The vulnerability of the underfunded water, sanitation, hygiene, and health (WASH2) facilities, particularly in the developing nations, is exacerbated by natural disasters. This study assessed the impacts of Amphan on the WASH2 facilities of the affected coastal areas of Bangladesh via a structured questionnaire survey, key informant interviews, and direct observation. The study reported that Amphan destroyed WASH2 facilities, where only 20% of the respondents were receiving WASH2 services afterwards. Many respondents had to rely on unsafe water sources after the cyclone hit. While the respondents used different kinds of water treatment methods, three-quarters of the respondents reported issues related to odor, taste, color, and/or others. The majority had to practice open defecation due to damage done to sanitation facilities. Amphan has also resulted in an onslaught of several WASH2 diseases in the study area, primarily skin disease and diarrhea. The study has exhibited how intense natural disasters can completely render WASH2 facilities useless, causing the communities affected to switch to unsafe practices to meet their needs. The affected communities are in urgent need of adequate and sustainable WASH2 facilities.

Patterns and Determinants of Open Defecation among Urban People

At the present time, an estimated of 673 million people defecate in the open space, not in private. Indonesia is a densely populated country with a lot of open defecation (OD) both in urban (37%) and rural areas (43%). Tanjung Karang Pusat Subdistrict is an area in Bandar Lampung City with the highest percentage of OD practice (45%). This study aimed to explore and explain the patterns and determinants of OD among urban people in the Tanjung Karang Pusat Subdistrict in- volving 377 respondents for quantitative analysis. Quantitative data were analyzed using the chi square and regression analysis. After controlling the economic status and education level variables, the data revealed that urban communities were still practicing OD (23.3%) with land ownership, latrine ownership, conative attitude, and occupation as influential factors. Statistical test results showed that the most influential factor in the behavior of OD in the community was latrine ownership (p-value &amp;lt;0.001, OR adj = 58.2). These findings suggested that stakeholders must take action on landowners who do not allow sanitation facilities to be built on their land.

Improving Uptake and Sustainability of Sanitation Interventions in Timor-Leste: A Case Study.

Open defecation (OD) is still a significant public health challenge worldwide. In Timor-Leste, where an estimated 20% of the population practiced OD in 2017, increasing access and use of improved sanitation facilities is a government priority. Community-led total sanitation (CLTS) has become a popular strategy to end OD since its inception in 2000, but evidence on the uptake of CLTS and related interventions and the long-term sustainability of OD-free (ODF) communities is limited. This study utilized a mixed-methods approach, encompassing quantitative monitoring and evaluation data from water, sanitation, and hygiene (WASH) agencies, and semi-structured interviews with staff working for these organizations and the government Department of Environmental Health, to examine sanitation interventions in Timor-Leste. Recommendations from WASH practitioners on how sanitation strategies can be optimized to ensure ODF sustainability are presented. Whilst uptake of interventions is generally good in Timor-Leste, lack of consistent monitoring and evaluation following intervention delivery may contribute to the observed slippage back to OD practices. Stakeholder views suggest that long-term support and monitoring after ODF certification are needed to sustain ODF communities.

Application of the positive deviance model for Sustainable reduction of open defecation (OD) practice in rural, Ethiopia

Application of the positive deviance model for Sustainable reduction of open defecation (OD) practice in rural, Ethiopia