Total Sanitation Research Articles

Awareness of community-led total sanitation and its impact on sanitation among residents of Kilifi and Marsabit Counties, Kenya

Background: Community-based strategy known as community-led total sanitation (CLTS) is frequently employed to address open defecation and the health issues it causes. Inadequate sanitation is one of the biggest health and environmental problems in the world, contributing to approximately 775,000 deaths per year. This study aimed to assess the level of awareness of community-led total sanitation (CLTS) and its impact on sanitation among communities in Kilifi and Marsabit Counties in Kenya. Methods: The study adopted a comparative study design. Purposive and multistage sampling were used to recruit study respondents in this study. Fischer's formula was used to determine the sample size for this investigation where 811 study participants were enlisted for the research. Propensity score matching (PSM) was used to estimate the impact of CLTS intervention on sanitation status. A significance level of 0.05 was employed as the threshold for all tests conducted in this study. Results: From this study, Among those fully conversant with CLTS, 98% resided in Kilifi County; 77% in Marsabit were fully aware of CLTS. The majority(87.7%) of the study respondents were fully aware of CLTS. Despite CLTS intervention resulting in a 42% increase in households owning a sanitation facility, There was no significant statistical association between CLTS intervention and sanitation status (t=0.42, p=0.0835). Conclusion: The study established that the level of awareness of CLTS in both counties was high. The results from this study demonstrated that CLTS intervention programs had an impact on sanitation levels in Kilifi and Marsabit counties.

Knowledge Levels of Community-Based Health Workers on the Community-Led Total Sanitation Approach in Turkana County, Kenya

Knowledge Levels of Community-Based Health Workers on the Community-Led Total Sanitation Approach in Turkana County, Kenya

Is community-led total sanitation programme ending open defecation? A sustainability perspective from stakeholders in Ghana

Community-led total sanitation (CLTS) is an intervention widely employed by developing countries to end open defecation (OD) in line with SDG Target 6.2. Following its adoption in Ghana, many communities have been declared open defecation-free (ODF), but little is known about their sustainability. This study sought to determine the sustainability of the ODF status of communities after 2 to 10 years of certification across eight regions in Ghana. Qualitative data were collected using semi-structured interviews with 26 practitioners and implementers, focus group discussions and direct observations in 22 communities. The data were manually transcribed and thematically analysed. The results revealed four major sustainability factors: motivational, behavioural change, leadership and financial. While motivational factors included improved health, pride, comfort and convenience, leadership factors involved supportive traditional and active natural leaders, and behavioural change entailed understanding the consequences of OD and latrine rebuilding. Financial factors encompassed access to sanitation funds. Regional and district league tables were found to be influencing the sustainability factors of the programme. Based on the findings, policymakers and implementers of the CLTS programme should intensify persuasive education focusing on sustainable behavioural change towards OD and post-ODF follow-ups alongside league tables to motivate sustained ODF communities while providing a friendly loan schedule for communities willing to pay.

Influence of Social and Cultural Factors on Adoption of Community-Led Total Sanitation in Laisamis Sub-County, Marsabit County, Kenya

Influence of Social and Cultural Factors on Adoption of Community-Led Total Sanitation in Laisamis Sub-County, Marsabit County, Kenya

Impact of Community-Based Health Workers on Community-Led Total Sanitation Implementation on Latrine Ownership and Practice of Open Defecation among Household Members in Turkana County, Kenya

Impact of Community-Based Health Workers on Community-Led Total Sanitation Implementation on Latrine Ownership and Practice of Open Defecation among Household Members in Turkana County, Kenya

Major factors influencing the effectiveness of community-led total sanitation among communities in Kilifi and Marsabit Counties in Kenya

Background: Poor sanitation contributes to about 775,000 deaths annually and is one of the world's most significant health and environmental challenges, especially in developing nations. This study examined factors influencing the effectiveness of CLTS as an approach to delivering open defecation-free communities in Kilifi and Marsabit Counties in Kenya. Methods: The study methodology included a comparative cross-sectional study of the two diverse study populations. The researchers recruited 811 participants after a multistage sampling procedure was used to sample the villages and the households. Quantitative data was analysed using SPSS tool version 26.0. Descriptive and inferential statistics and propensity score matching (PSM) were used to analyse the data. All tests were done at p≤0.05. Results: Open defecation dropped from 30% to 13.45% after CLTS interventions. There was a significant statistical association between household heads having a college-level education (A.O.R=10.273, p=0.013), being above 61 years (A.O.R=4.046, p=0.009), having a higher monthly income (A.O.R=6.461, p=0.091), and being female (A.O.R=1.792, p=0.03), and owning a sanitation facility. Also, households with heads with good handwashing and CLTS awareness (A.O.R=2.459, p=0.002) and (A.O.R=4.317, p=0.022) were statistically associated with owning sanitation facilities. PSM analysis found that CLTS programs impacted sanitation status, resulting in a 42% increase in facility ownership. Conclusions: The study established a statistical significance of CLTS and ownership of sanitation facilities in both counties. The results show that the CLTS program is effective and has positively impacted sanitation status by reducing open defecation levels in Kilifi and Marsabit.

Influence of Perceived Health Risk Factors on Adoption of Community-Led Total Sanitation: A Case of Turkana Central Sub-County, Turkana County, Kenya

The primary objective of Sustainable Development Goal 6 target 2 is to achieve widespread accessibility to sufficient sanitation and hygiene facilities, therefore eliminating the practice of open defecation by the year 2030. One strategy for achieving this objective involves the implementation of Community-Led Total Sanitation (CLTS), a participatory method that allows communities to take on accountability for their sanitation behaviors. However, sustaining favorable changes after the implementation of the intervention continues to be a significant obstacle. The objective of this study was to investigate the influence of perceived health risk factors on adoption of Community-Led Total Sanitation. The study was carried out on the household members of Lodwar township and Kalokol ward, targeting a sample size of 382 respondents The research utilized a convergent design methodology, which combined quantitative and qualitative data collection methods, enabling the simultaneous gathering of both types of data. Quantitative data were collected using structured questionnaires and observation checklist, while qualitative data were collected from Focus Group Discussions. A stratified sampling technique was applied to group the village units into strata and simple random sampling used in selection of household heads. Qualitative results were structured into themes and direct quotes. The study determined that an increase in perceived knowledge regarding health risks was associated with a higher likelihood of latrine presence (p-value< 0.05). Findings from multiple regression analysis also showed that education level was a significant predictor for awareness, understanding, and knowledge (p=0.000<0.05), while gender demonstrated a significant negative relationship with awareness and understanding p= -0.2573, suggested males score lower in these areas compared to females. Age correlated positively with awareness and was marginally significant for understanding (p=0.043), indicating that older individuals had higher scores. The study concluded that increased knowledge regarding health risk in terms of vulnerability and susceptibility influenced latrine presence at the households and thus the adoption of community-led total sanitation programs in Turkana Central Sub-County. The study highlighted the critical role of knowledge in achieving open defecation-free status in the area. The study recommended that CLTS interventions by the Ministry of Health and sanitation implementers place a particular focus on knowledge enhancement, to ensure that communities are better informed, which could lead to a higher likelihood of adopting improved sanitation practices, thereby reducing the prevalence of open defecation and related health issues.

Knowledge, Attitudes and Practices (KAP) Towards Community-Led Total Sanitation (CLTS) Behaviours Among Communities in Northern Ghana

Community-Led Total Sanitation (CLTS) programs have been implemented extensively to eradicate open defecation and enhance sanitation practices. However, concerns about the sustainability of CLTS outcomes persist, necessitating a nuanced examination of the phenomenon. This study assessed the knowledge, attitudes and practices (KAP) of people in the Northern region of Ghana towards behaviors associated with the community-led total sanitation (CLTS) programme. The study design was a descriptive cross-sectional one and the approach for the study was quantitative. It involved the use of questionnaire to collect data from respondents. Data were gathered through survey among respondents in 12 communities across 3 districts. Socio-demographic characteristics were analyzed for their associations with knowledge, attitude, and practice. Results revealed significant associations between district, age, religion, occupation, and monthly income level with knowledge, attitude, and practice. Specifically, respondents from Saboba demonstrated higher odds of knowledge compared to Mion and Kpandai districts, while Muslims exhibited higher odds of knowledge compared to Christians. Monthly income levels of 200-500 and 501-1500 Ghanaian cedis were associated with improved knowledge and practice compared to incomes less than 200 cedis. Notably, good knowledge was positively correlated with good attitude. These findings underscore the importance of considering socio-demographic factors in designing and implementing sanitation interventions. Tailored strategies addressing specific factors identified in this study may enhance the effectiveness and sustainability of CLTS programs in the Northern Region of Ghana and similar contexts. Further research and targeted interventions are warranted to address the complex interplay between socio-demographic characteristics and sanitation behaviors.

Relationship Between Community-Based Total Sanitation and Stunting Incidence in Medan City

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Stunting remains a significant public health issue in Indonesia, particularly in Medan City. Poor sanitation has been identified as one of the key contributing factors to stunting. This study aims to analyze the relationship between community-based total sanitation and stunting incidence in Medan City. The research is a comparative study with a case-control design. It was conducted in five sub-districts with high stunting rates among the fourteen sub-districts in Medan City that have received community-based total sanitation interventions. The study was carried out from November 2023 to February 2024. The study population included all mothers with children age 0-59 months living in sub-districts that received community-based total sanitation interventions. There were 165 participants in the stunting and 49,676 in the not stunting. The sample size was calculated using the Lemeshow formula, resulting in 50 mothers for the stunting group. The not stunting group was matched to the case group in a 1:1 ratio, making the total sample size 100 mothers. Purposive sampling was used to select participants who met the inclusion and exclusion criteria.</em><em> </em><em>Data analysis was performed using SPSS software version 27, employing the chi-square test with a 95% confidence level (α = 0.05). The results showed that three pillars of community-based total sanitation were significantly related to stunting incidence: relationship between handwashing with soap and stunting incidence was significant (p=0.005; OR=4.125), relationship between household Latrine and stunting incidence was significant (p=0.001; OR=7.211), and relationship between household solid waste management and stunting incidence was significant (p=0.027; OR=2.681). The overall relationship between community-based total sanitation and stunting incidence was significant (p=0.015; OR=6.769). Recommendations for the Health Department and Community Health Centers in Medan City include enhancing the achievement of the five STBM pillars within the community through health promotion activities.</em></p><p><em> </em></p></td></tr></tbody></table></div><p><strong><em>Keyword: Child, Hygiene, Mother, Sanitation, Stunting</em></strong></p>

Community Knowledge and Attitude on Community Led Total Sanitation after Open Defecation-Free Certification of Balaka District in Malawi

Community Knowledge and Attitude on Community Led Total Sanitation after Open Defecation-Free Certification of Balaka District in Malawi

Islamic Religious Education in Building Insight Multicultural

Islamic religious education (PAI) taught in madrasas and public schools is felt has not been one hundred percent successful in making students be tolerant and open towards other communities outside himself. This type of research is a systematic literature review which is carried out by collecting and accumulating research related to community-based total sanitation evaluation. The keywords used for literature searches; "Islamic Education" and "Islamic Education in Multicultural Society". The literature sources used in the research come from online databases, namely Google Scholar and Garuda. the results of this research Multicultural Education is a development process that seeks to improve something that has existed from the beginning or previously existed, developing all human potential, education that respects plurality and heterogeneity, and education that respects and upholds cultural, ethnic, tribal and religious diversity. Multicultural religious learning can instill Islamic values multicultural to participants. So anti-multicultural values such as discrimination and violence can be avoided. Therefore, the learning process of Religious Education Multicultural Islam is recommended to be implemented because it can make things easier achieve the goals of Islamic religious education in forming knowledge, attitudes and students' skills in a unified and balanced manner

Upaya Peningkatan Perilaku Hidup Sehat melalui Program Community-Led Total Sanitation kepada Masyarakat Desa Tumpang, Malang

The practice of open defecation remains prevalent in Ledoksari Hamlet, Tumpang Village, Malang Regency. This behavior persists because open defecation has become a normalized culture or habit among the local community. Therefore, a change effort is needed through the implementation of the Community-Led Total Sanitation Approach by the Community Service Team of Universitas Negeri Malang. This program aims to educate the community about the impacts of open defecation. The method used in this program employs a triggering approach that directly involves the community, with stages including pre-triggering, triggering, and post-triggering activities. The outcomes of this initiative reveal an increase in participants knowledge regarding environmental health. Interactive discussions were also conducted by the service team to allow participants to voice their aspirations, which were then communicated to stakeholders. The service team further recommended the implementation of the "Arisan Jamban" program. This program encourages community members to organize activities that promote clean and healthy living behaviors within their environment. Aligned with the first pillar of the Community-Based Total Sanitation (STBM) initiative, which is to stop open defecation, the "Arisan Jamban" program can be utilized as a viable solution to reduce water source contamination.

Effect of a Community-Led Total Sanitation Intervention on the Incidence and Prevalence of Diarrhea in Children in Rural Ethiopia: A Cluster-Randomized Controlled Trial

Effect of a Community-Led Total Sanitation Intervention on the Incidence and Prevalence of Diarrhea in Children in Rural Ethiopia: A Cluster-Randomized Controlled Trial

Demographic factors and open defecation practices: A cross-sectional study in Gunungtua Jae Village, Padang Lawas Utara

Open defecation (OD) remains a significant public health concern, particularly in rural areas of developing countries. This study aimed to investigate the association between demographic factors and OD practices in Gunungtua Jae Village, Padang Lawas Utara, Indonesia. A cross-sectional study was conducted involving 82 households. Data were collected using structured questionnaires and analyzed using Chi-square test and logistic regression. The findings revealed a significant association between several demographic factors and OD practices. These factors included household head knowledge (p = 0.000), occupation (p = 0.002), attitude (p = 0.000), education level (p = 0.000), and income level (p = 0.000). The study highlights the importance of considering demographic factors when addressing OD practices in public health interventions. Comprehensive efforts are needed to enhance community knowledge, particularly among household heads, regarding the significance of adequate sanitation and the detrimental impacts of OD practices. Collaboration between community health centers (puskesmas) and various stakeholders is essential for the sustainable implementation of the Total Sanitation Based on Community Approach (STBM) program. This program can effectively raise awareness and promote positive behavioral changes towards environmental hygiene and personal health, with a primary focus on encouraging proper sanitation practices and preventing environmental pollution.

Performance of Pit Latrines and Their Herd Protection Against Diarrhea: A Longitudinal Cohort Study in Rural Ethiopia.

In sanitation policies, "improved sanitation" is often broadly described as a goal with little rationale for the minimum standard required. We conducted a secondary analysis of data collected as part of a cluster randomized controlled trial in rural Ethiopia. We compared the performance of well-constructed and poorly constructed pit latrines in reducing child diarrhea. In addition, we explored whether having a well-constructed household latrine provides indirect protection to neighbors if cluster-level coverage reaches a certain threshold. We followed up children aged younger than 5 years (U5C) of 906 households in rural areas of the Gurage zone, Ethiopia, for 10 months after community-led total sanitation interventions. A study-improved latrine was defined as having all the following: pit of ≥2 m depth, slab of any material, drop-hole cover, wall, roof, door, and handwashing facilities (water and soap observed). U5C in households with a study-improved latrine had 54% lower odds of contracting diarrhea than those living in households with a latrine missing 1 or more of the characteristics (adjusted odds ratio [aOR]=0.46; 95% confidence interval [CI]=0.27, 0.81; P=.006). Analyses were adjusted for child age and sex, presence of improved water for drinking, and self-reported handwashing at 4 critical times. The odds of having diarrhea among those with an improved latrine based on the World Health Organization/UNICEF Joint Monitoring Program (JMP) definition (i.e., pit latrines with slabs) were not substantially different from those with a JMP-unimproved latrine (aOR=0.99; 95% CI=0.56, 1.79; P=.99). Of U5C living in households without a latrine or with a study-unimproved latrine, those in the high-coverage villages were less likely to contract diarrhea than those in low-coverage villages (aOR=0.55; 95% CI=0.35, 0.86; P=.008). We recommend that academic studies and routine program monitoring and evaluation should measure more latrine characteristics and evaluate multiple latrine categories instead of making binary comparisons only.

Pelatihan Peningkatan PHBS dan Pengelolaan Air Siap Konsumsi pada Masyarakat Wilayah RW 006, Kelurahan Tanjung Duren Selatan

Water is crucial for human survival, serving both consumption needs and daily activities. However, water contamination often occurs when it is not managed and stored properly. Contaminated drinking water can pose health risks, causing various digestive diseases and even death, especially in children. Therefore, the management and storage of water require special attention. Indonesian communities, especially those in the RW 006, Tanjung Duren Selatan, are still limited in gathering clean water without proper water management for it to be made suitable for consumption. In response to this concern, a program was implemented to enhance awareness and empower the residents of RW 006, Tanjung Duren Selatan, focusing on improving environmental sanitation and the effective management of safe drinking water. The activities took place at the secretariat office of RW 006, Tanjung Duren Selatan, on Friday, November 10, 2023, from 08:30 to 10:15 AM. A total of 25 participants filled out attendance and completed pre-test questionnaires. Participants were then provided with education and training by the team on environmental sanitation, Community-Based Total Sanitation (STMB), proper management of household waste, and the handling of water intended for consumption. The post-test results showed an improvement in participants' knowledge and understanding regarding the enhancement of environmental sanitation and the management of water ready for consumption in households. It is hoped that participants will serve as links in communication and educators within the local community, ultimately contributing to improved sanitation and an enhanced quality of life.

Community-led total sanitation (CLTS) implementation in West Mamprusi Municipal Assembly in Ghana. What do communities think eleven years on?

ObjectiveAccess to improved sanitation is a fundamental human right and an important aspect of Public Health. However, an estimated thousands of people in Ghana especially, the West Mamprusi Municipal Assembly (WMMA) still have no access to adequate toilet facilities. This has brought untold health repercussions to the inhabitants, the community, and the environment at large. To address this menace, the community-led total sanitation (CLTS) was implemented. This study aimed to assess communities’ perspectives on the implementation of CLTS and to understand the factors influencing its success and failures. MethodsA mixed-method approach involving sequential qualitative and quantitative methods was employed in this study. Participants for the quantitative study were randomly selected and surveyed using questionnaires. The qualitative study employed focus group discussion involving purposively sampled participants including assembly members, opinion leaders, and assembly staff. ResultsThe CLTS program in WMMA realized an apparent use of construction and proper use of household latrines leading to a reduction of open defecation free (ODF) and two communities achieving sanitized status in the history of the study area, enabling the training of latrine artisans and natural leaders to facilitate the CLTS expansion and sustainability, improved sanitation and hygiene, strengthened the enforcement of community rules and regulations and many others. ConclusionThe CLTS program has received more widespread acceptance in the study area than the previous government policy of constructing public toilets, which was greeted with massive failures due to poor implementation. To ensure that gains achieved through CLTS implementation are sustained longer, it is recommended that chiefs and opinion leaders should be involved in the CLTS programs to ensure checks and enforcement. The entrenchment of bylaws and more education to address enduring myths and misconceptions will sustain the program. Subsidies in the form of sanitation loans for latrine construction materials by the government and supporting non-governmental organizations (NGOs) will be paramount in sustaining ODF.

Evaluation of internship program Kampus Merdeka in the community-based total sanitation facilitator field at community health center Dr. Soetomo

The MSIB Kampus Merdeka program is a program that plays a role in bridging and securing the availability of quality talent for national industries that need alternative solutions to obtain talent that meets the qualifications and fits the culture of the organization so that they can make a real contribution over a long period. However, in the implementation of the internship program by the Surabaya City Health Office partners in the field of Community-Based Total Sanitation facilitators, there are still discrepancies in several components. The purpose of this study is to evaluate the Merdeka Campus Internship program at the Surabaya City Health Office for the Community-Based Total Sanitation Facilitator field. This research is a type of evaluative research with a qualitative descriptive approach using the CIPP Model (Context, Input, Process, Product). Data was obtained through interviews and observations. Data analysis techniques by presenting data in the form of descriptions and verified by concluding. The results of the evaluation based on 4 components show that the content component is not yet appropriate in terms of background and program objectives, the input component is still lacking in human resources and the use of facilities and infrastructure, the process component is in accordance with the specified operating hours and the evaluation of activities carried out is not optimal, the product component is still largely developed due to the limited role of student interns. This study concludes that there are still elements in several components that are evaluated that are still not in accordance with the program plan.

Jumping up the sanitation ladder in rural Cambodia: The role of remittances and peer-to-peer pressure in adopting high-quality latrines

Over the last 50 years, a combination of factors has driven sanitation improvements in rural areas of low-income and emerging economies in Asia. While open defecation remains an important challenge in many countries, Cambodia has rapidly increased rural sanitation coverage in the last 20 years. Using data collected via 92 interviews and seven focus group discussions, this qualitative study analysed the macro-level, community, and individual factors that motivated rural households to invest in high-quality latrines in seven villages in Cambodia that achieved and sustained open defecation free status with at least 85% latrine coverage. Local demand for adoption of high quality latrine was stimulated by a number of factors which include: a) NGO-led interventions that included behaviour change communication, sanitation marketing, and community-led total sanitation, all magnified by the strong support of local leaders at the village and commune levels; b) an increased proportion of rural households engaging in factory work, with access to raising wages, higher disposable incomes, and remittances; and c) subsidies and microcredit. Furthermore, migrants not only transferred financial resources to their home villages, but also transferred a set of ideas, norms, expectations, information, and behaviors back to their communities that reflect the migrants’ new ways of life, and economic possibilities. We provide evidence that new habits among factory workers, and ownership and display of new technologies and consumer commodities as symbols of modern success and social status facilitated high-quality latrine adoption. Peer-to-peer pressure at the village level, and among adult children commuting to factories or visiting their rural hometown ensured widespread adoption.

Implementation Total Sanitation Based on First Community-Based Pillar at Public

Defecation in Indonesia is quite a lot to be found and one of the regions of Indonesia that still performs open defecation is in one of Aceh Regency, namely Southwest Aceh Regency which applies latrines to the people of Tangan-Tangan Cut Village, Regency, Southwest Aceh which is still small. The purpose of this study is to determine the application of latrines in the people of Tangan-Tangan Cut Village related to income, community work and education of the people of Hand-Cut Village, Setia District, Regency, Southwest Aceh. The method carried out is quantitative research using. Rendom sampling type . The number of informants in the form of respondents in this study was 40 respondents from 356 populations in hand-cut villages. The sampling technique is to use the slovin formula. The results of this study found that the application of latrines in village communities with cut, sub-district, faithful has no relationship between education (P = 0.635), income (P = 0.071) work (P = 0.337) people with latrine ownership, the number of respondents who have implemented latrines is 17 respondents with a percentage of 42.5%, while there are 23 respondents with a percentage of 57.5% who do not have latrines. The results of this research are that most villagers do not apply latrines / do not have latrines in their homes.