Open Defecation Practice and Its Determinants Among Households Owned Toilet Facilities in Gambela Town, South West Ethiopia.

The use of toilet facilities is a major sanitation intervention, as it reduces the spread of diarrheal diseases. In areas where toilets are misused, human excreta may be disposed of in open fields, bushes, and other open places. However, information about the level of utilization of toilet facilities in developing regions of Ethiopia is limited. Therefore, this study aimed to identify open defecation (OD) levels and determinants of OD among household-owned toilets in Gambella town, Ethiopia. A cross-sectional survey was conducted among 561 households in Gambela Town, using systematic random sampling and questionnaires. The level of OD was analyzed using frequency and percentage. The determinants of OD were assessed using binary logistic regression. Variables with a P-value less than .25 in univariable logistic regression were entered into the multivariable logistic regression model, and statistical significance was declared at a P-value less than .05. The model's fit was tested using Hosmer and Lemeshow's goodness of fit. The study found that OD was 47.2% [95% CI: 43.2%-51.4%] among those who owned toilet facilities. The determinants of OD were: occupation of household head [AOR: 5.27, 95% CI: 3.08-9.00], toilet facilities lacking a superstructure [AOR: 2.0, 95% CI: 1.16-3.43], toilet facilities lacking doors [AOR: 3.23, 95% CI: 1.97-5.27], large family size [AOR: 2.16, 95% CI: 1.29-3.60], knowledge of the respondents [AOR: 2.40, 95% CI: 1.50-3.99], and respondents with negative attitude [AOR: 1.76, 95% CI: 1.12-2.74]. Therefore, key stakeholders should focus on improving toilet utilization, considering those factors in their interventions.

Promotion of market-based sanitation in Ethiopia: a case study from Wolaita zone.

Ethiopia increased the availability of latrines notably, but the sanitation facilities rarely meet hygienic standards. Therefore, the market-based sanitation (MBS) programme has been implemented across the country for nearly a decade to expand the market and boost the demand for hygienic sanitation products and services. While it does not seem that the MBS would bring any notable change in sanitation conditions so far, its implementation challenges are not adequately understood. To address this gap, this article delves into the grassroots-level implementation of MBS in the Wolaita zone. The study relies on qualitative data gathered through interviews with various stakeholders, examining both demand- and supply-side challenges. Some issues identified were external to MBS implementation, such as high inflation and an unstable political and security situation in Ethiopia. Additionally, the study reveals that more general deficiencies of the Ethiopian health extension program, including the stress and discouragement of local change agents (health extension workers, health development army members) due to workloads and low remuneration, have adversely impacted MBS delivery. The implementation of MBS has also not effectively addressed the affordability of hygienic sanitation products. On the supply side, economic constraints and organizational inefficiencies have hindered the development of the sanitation market, preventing it from reaching a critical mass. Our research suggests that MBS alone will not suffice to improve sanitation in Ethiopia.

Wastewater-based epidemiology as a public health resource in low- and middle-income settings.

In the face of emerging and re-emerging diseases, novel and innovative approaches to population scale surveillance are necessary for the early detection and quantification of pathogens. The last decade has seen the rapid development of wastewater and environmental surveillance (WES) to address public health challenges, which has led to establishment of wastewater-based epidemiology (WBE) approaches being deployed to monitor a range of health hazards. WBE exploits the fact that excretions and secretions from urine, and from the gut are discharged in wastewater, particularly sewage, such that sampling sewage systems provides an early warning system for disease outbreaks by providing an early indication of pathogen circulation. While WBE has been mainly used in locations with networked wastewater systems, here we consider its value for less connected populations typical of lower-income settings, and in assess the opportunity afforded by pit latrines to sample communities and localities. We propose that where populations struggle to access health and diagnostic facilities, and despite several additional challenges, sampling unconnected wastewater systems remains an important means to monitor the health of large populations in a relatively cost-effective manner.

Improved Child Feces Management Mediates Reductions in Childhood Diarrhea from an On-Site Sanitation Intervention: Causal Mediation Analysis of a Cluster-Randomized Trial in Rural Bangladesh.

BACKGROUND: The WASH benefits Bangladesh trial multi-component sanitation intervention reduced diarrheal disease among children < 5 years. Intervention components included latrine upgrades, child feces management tools, and behavioral promotion. It remains unclear which components most impacted diarrhea. METHODS: We conducted mediation analysis within a subset of households (n = 720) from the sanitation and control arms. Potential mediators were categorized into indicators of latrine quality, latrine use practices, and feces management practices. We estimated average causal mediation effects (ACME) as prevalence differences (PD), defined as the intervention's effect on diarrhea through its effect on the mediator. RESULTS: The intervention improved all indicators compared to controls. We found significant mediation through multiple latrine use and feces management practice indicators. The strongest mediators during monsoon seasons were reduced open defecation among children aged < 3 and 3-8 years, and increased disposal of child feces into latrines. The strongest mediators during dry seasons were access to a flush/pour-flush latrine, reduced open defecation among children aged 3-8 years, and increased disposal of child feces into latrines. Individual mediation effects were small (PD = 0.5-2 percentage points) compared to the overall intervention effect but collectively describe significant mediation pathways. DISCUSSION: The effect of the WASH Benefits Bangladesh sanitation intervention on diarrheal disease was mediated through improved child feces management and reduced child open defecation. Although the intervention significantly improved latrine quality, relatively high latrine quality at baseline may have limited benefits from additional improvements. Targeting safe child feces management may increase the health benefits of rural sanitation interventions.

Analysis of latrine fecal odor release pattern and the deodorization with composited microbial agent.

As an important source of malodor, the odor gases emitted from public toilet significantly interfered the air quality of living surroundings, resulting in environmental problem which received little attention before. Thus, this paper explored the odor release pattern of latrine feces and deodorization effect with composited microbial agent in Chengdu, China. The odor release rules were investigated in sealed installations with a working volume of 9 L for 20 days. The odor units (OU), ammonia (NH3), hydrogen sulfide (H2S) and total volatile organic compounds (TVOC) were selected to assess the release of malodorous gases under different temperature and humidity, while the highest malodor release was observed under 45℃, with OU and TVOC concentration was 643.91 ± 2.49 and 7767.33 ± 33.50 mg/m3, respectively. Microbes with deodorization ability were screened and mixed into an agent, which composited of Bacillus amyloliquefaciens, Lactobacillus plantarum, Enterococcus faecalis and Pichia fermentans. The addition of microbial deodorant could significantly suppress the release of malodor gas during a 20-day trial, and the removal efficiency of NH3, H2S, TVOC and OU was 81.50 %, 38.31 %, 64.38 %, and 76.86 %, respectively. The analysis of microbial community structure showed that temperature was the main environmental factor driving the microbial variations in latrine feces, while Firmicutes, Actinobacteria, Proteobacteria and Bacteroidetes were the main bacteria phyla involved in the formation and emission of malodorous gases. However, after adding the deodorant, the abundance of Bacteroidetes, Proteobacteria and Actinobacteria were decreased, while the abundance of Firmicutes was increased. Furthermore, P. fermentans successfully colonized in fecal substrates and became the dominant fungus after deodorization. These results expanded the understanding of the odor release from latrine feces, and the composited microbial deodorant provided a valuable basis to the management of odor pollution.

Understanding Households' Willingness to Pay for Improved Sanitation Services in Benin: A Study Protocol.

Nowadays, in Benin, latrine construction by households highly depends on their financial contributions. However, empirical evidence shows that many households are unwilling to invest in adequate sanitation services. The study aims to determine the household's willingness to pay for improved sanitation services and the associated factors. The study population will include households lacking unimproved sanitation facilities. The household heads will be eligible for survey participation. We will perform a contingent valuation to determine households' willingness to pay for a Ventilated Improved Pit (VIP) latrine. Following a description of the surveyed population, we will assess willingness to pay using the 'doubleb' command in Stata. Subsequently, we will conduct multivariate logistic regression to determine the factors associated with willingness to pay. The expected results will be: a description of the basic characteristics of households without improved sanitation services, an estimation of household willingness to pay for VIP latrines using the contingent valuation, and factors associated with household willingness to pay for VIP latrines. This study will contribute to the literature on household demand for improved sanitation services in Benin.

Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling.

Improved sanitation provides many benefits to human health and well-being and is integral to achieving Sustainable Development Goal Six. However, many nations, including most of sub-Saharan Africa, are not on track to meeting sanitation targets. Recognizing the inherent complexity of environmental health, we used systems thinking to study sanitation sustainability in Uganda. Our study participants, 37 sanitation actors in three rural districts, were engaged in interviews, group model building workshops, and a survey. The resulting model was parametrized and calibrated using publicly available data and data collected through the Uganda Sanitation for Health Activity. Our simulations revealed slippage from improved sanitation in all study districts, a behavior reflected in real interventions. This implies that systemic changes-changes to the rules and relationships in the system-may be required to improve sanitation outcomes in this context. Adding reinforcing feedback targeting households' perceived value of sanitation yielded promising simulation results. We conclude with the following general recommendations for those designing sanitation policies or interventions: (1) conceptualize sanitation systems in terms of reinforcing and balancing feedback, (2) consider using participatory and simulation modeling to build confidence in these conceptual models, and (3) design many experiments (e.g., simulation scenarios) to test and improve understanding.

Evaluation of SaTo pans as a new latrine technology in Kisumu County healthcare facilities, Kenya.

OBJECTIVES: Innovations to improve public sanitation facilities, especially in healthcare facilities (HCFs) in low-income countries, are limited. SaTo pans represent novel, largely untested, modifications to reduce odour and flies and improve acceptability of HCF sanitation facilities. We conducted a pilot project to evaluate acceptability, cleanliness, flies and odour within latrines in 37 HCFs in Kisumu, Kenya, randomised into intervention (SaTo pan modifications) and control arms by sub-county and HCF level. METHODS: At baseline (pre-intervention) and endline (>3 months after completion of SaTo pan installations in latrines in intervention HCFs), we surveyed users, cleaners and in-charges, observed odour and cleanliness, and assessed flies using fly tape. Unadjusted difference-in-difference analysis compared changes from baseline to endline in patient-reported acceptability and observed latrine conditions between intervention and control HCFs. A secondary assessment compared patient-reported acceptability following use of SaTo pan versus non-SaTo pan latrines within intervention HCFs. RESULTS: Patient-reported acceptability of latrines was higher following the intervention (baseline: 87%, endline: 96%, p = 0.05). However, patient-reported acceptability was also high in the control arm (79%, 86%, p = 0.34), and the between-arm difference-in-difference was not significant. Enumerator-observed odour declined in intervention latrines (32%-14%) compared with controls (36%-51%, difference-in-difference ratio: 0.32, 95% confidence interval: 0.12-0.84), but changes in flies, puddling of urine and visible faeces did not differ between arms. In the secondary assessment, fewer intervention than control latrines had patient-reported flies (0% vs. 26%) and odour (18% vs. 50%), and reported satisfaction was greater. Most cleaners reported dropholes and floors were easier to clean in intervention versus controls; limited challenges with water for flushing were reported. CONCLUSIONS: Our results suggest SaTo pans may be acceptable by cleaners and users and reduce odour in HCF sanitation facilities, though challenges exist and further evaluation with larger sample sizes is needed.

Development of a behaviour change intervention to promote sanitation and latrine use in rural India.

BACKGROUND: Across developing countries poor sanitation is associated with disease often found widespread in rural populations. OBJECTIVES: This objective of this study was to conduct a formative research and feasibility evaluation of the behavioural intervention designed to improve latrine use in rural India. METHODS: Study conducted in four villages of Rajasthan, where latrine use is low and open defecation may spread disease. To identify the intervention a literature review was conducted, a survey of 497 households, and focus groups in village households (8-10 women and children). Seven focus groups with 63 women were conducted. Based on the survey results, the behaviour change intervention is developed utilising the Capability-Opportunity-Motivation-behaviour model and MINDSPACE framework. One intervention component involves psychological aspects that engage villagers through a pledge; the other component is provision of small incentives to facilitate latrine use. Feasibility and acceptability of the intervention was examined in the study population. The 30-day intervention was delivered to women in 38 randomly selected households who despite having a functional latrine did not use it. Thematic analysis, binary logistic regression analysis and feasibility evaluation of the intervention conducted. Post-intervention feedback from 22 participating households was obtained. RESULTS: The piloted intervention was feasible and so a revised design is offered. Results driving this evaluation include barriers identified, and used to improved intervention design in the current study. Village authority figures influenced behaviours across the villages and so did factors of convenience (ß = 5.28, p < 0.01), relief (ß = 5.49, p < 0.01), comfort (ß = 2.36, p < 0.01), Construction cost (ß=-1.98, p < 0.01) and safety (ß = 2.93, p < 0.01) were significant concerns associated with latrine use in the context of prevalent OD in the region. The logistic regression baseline model for the dependant variables indicated a significant increase in latrine use. Based on the feasibility study, the intervention is refined in several ways. CONCLUSIONS: Our theory-driven approach improves latrine use in Rajasthan and offers a useful tool to facilitate hygiene behaviour.

Latrine Utilization and its Associated Factors in Urban Slums Dwellers of Gondar City, Northwest Ethiopia: A Community-Based Cross-Sectional Study.

Background: Sanitation facilities are critical for interrupting the transmission of feco-oral disease through proper use, not simply their physical presence. Latrine utilization is the actual behavior in a practice of regularly using existing latrines for the safe disposal of excreta. In slum regions of developing nations, such as Ethiopia, poor latrine use is a prevalent concern. As a result, the purpose of this study was to examine the state of latrine utilization and its determinant factors in the urban slums of Gondar City, Northwest Ethiopia. Methods: A cross-sectional survey was done in slum regions of Gondar City from March 1 to April 30, 2021, with a total of 422 systematically chosen households. A structured pre-tested questionnaire and on-the-spot observational checklists were used to collect the data from each household. Result: Latrine utilization was observed among 31.5% of households. Latrine utilization was also significantly associated with the age of the latrine (age ⩽10 years) (AOR: 2.31; 95% CI (1.15, 4.63)), cleanliness of the latrine (AOR: 3.70; 95% CI (1.16, 11.78)), pit being lined (AOR: 6.33; 95% CI (2.09, 19.15)), depth of latrine (⩽3 m) (AOR: 0.43; 95% CI (0.24, 0.77)), and cleaning materials for handwashing (AOR: 0.33; 95% CI (0.15, 0.75)). Conclusion: Based on the present finding, most households didn't have proper latrine utilization practices. The age of the latrine, cleanliness of the latrine, pit being lined, depth of the pit, and cleaning materials for handwashing were associated factors of latrine utilization. As a result, sanitation interventions such as health education about improving the cleanliness and sanitary condition of existing latrine facilities and constructing lined and deep new latrines as the goal's standard should be implemented.

Exploration of appropriate media to influence sustainable on-site sanitation choices in Sri Lanka- visualization with still images or a video.

Pit latrines are the most common form of improved sanitation in many rapidly developing countries. However, they cause the highest amount of groundwater pollution among on-site sanitation (OSS) facilities. Many households in developing countries use groundwater as their main or sub-source, and pit latrines are not a sustainable solution. Thus, the conversion from pit latrines to septic tanks is required. We created two types of media, still images and a video, to illustrate the differences in functions and hygiene risks between pit latrines and septic tanks. Moreover, a survey was conducted in Sri Lanka to determine the media choice that would increase the people's preference for septic tanks as their next OSS, even weeks after the information is presented. The choice of the next OSS participants selected before they were presented with the images was the same as that currently in use, reflecting the belief that the problem of pit latrines was not currently apparent and need not be changed. However, a video presentation of the information made it possible for a larger group of people to choose the usage of septic tanks in the future, especially in suburban areas where the problems were likely to occur.

Do Sanitation Marketing Activities Increase Households' Likelihoods of Reaching Improved Sanitation or Involving Women in Decision Making?

Poor sanitation causes 30% of diarrheal deaths globally, and much of the world has struggled to finance top-down interventions. Sanitation marketing is a demand-led approach that uses a mixture of social and commercial marketing methods and direct sales to households. However, little is known about its impacts on household decision making. This mixed-methods study uses data from eight focus groups and 86,666 household surveys from participants in a five-year sanitation marketing program in Uganda. Logistic regression models identified 10 variables predicting attainment of improved (limited or basic) sanitation and four variables predicting female involvement in decision making. Triggering session attendance increased chances of reaching improved sanitation by 15-28%, depending on who attended, and by 19% if the household found the session motivational. Although women were engaged in decision-making conversations, they were not viewed as primary decision makers, even in female-headed households. Women were more likely to become involved in decision making if they had attended triggering sessions with men (+70%) or engaged with sales promoters alone (+74%) or with men (+78%). For both outcomes, joint activity engagement was more effective than male or female engagement alone. This work highlights two sanitation marketing activities as pathways to improving latrine coverage and women's decision-making agency.

Urban Sanitation: New Terminology for Globally Relevant Solutions?

Progress toward Sustainable Development Goals for global access to safe sanitation is lagging significantly. In this Feature, we propose that misleading terminology leads to errors of categorization and hinders progress toward sanitation service provision in urban areas. Binary classifications such as "offsite/onsite" and "sewered/nonsewered" do not capture the need for "transport to treatment" or the complexity of urban sanitation and should be discarded. "Fecal sludge management" is used only in the development context of low- or middle-income countries, implying separate solutions for "poor" or "southern" contexts, which is unhelpful. Terminology alone does not solve problems, but rather than using outdated or "special" terminology, we argue that a robust terminology that is globally relevant across low-, middle-, and upper-income contexts is required to overcome increasingly unhelpful assumptions and stereotypes. The use of accurate, technically robust vocabulary and definitions can improve decisions about management and selection of treatment, promote a circular economy, provide a basis for evidence-based science and technology research, and lead to critical shifts and transformations to set policy goals around truly safely managed sanitation. In this Feature, the three current modes of sanitation are defined, examples of misconceptions based on existing terminology are presented, and a new terminology for collection and conveyance is proposed: (I) fully road transported, (II) source-separated mixed transport, (III) mixed transport, and (IV) fully pipe transported.

Effects of Community-Led Total Sanitation (CLTS) Boosting and Household Factors on Latrine Ownership in Siaya County, Kenya.

Community-led total sanitation (CLTS) is a widely used approach for enhancing sanitation practices. However, the impact of boosted CLTS on household latrine ownership has not been adequately evaluated. This study aims to investigate the factors associated with latrine possession among households, with a specific focus on single and CLTS-boosting implementation. A community-based repeated cross-sectional study was conducted in Siaya County, Kenya, involving 512 households at the baseline and 423 households at the follow-up. Data were analyzed using the mixed-effects logistic regression model. At the baseline, latrine possession was significantly associated with CLTS implementation (adjusted OR [aOR]: 3.01; 95% confidence interval [CI]: 1.41-6.44), literacy among households (aOR: 1.83; 95% CI: 1.12-2.98) and higher socioeconomic status (SES) (second level: aOR: 2.48; 95% CI:1.41-4.36, third level: aOR: 3.11; 95% CI: 1.76-5.50, fourth level: aOR: 10.20; 95% CI: 5.07-20.54). At follow-up, CLTS boosting (aOR: 7.92; 95% CI: 1.77-35.45) and a higher SES were associated with increased latrine ownership (second level: aOR: 2.04; 95% CI: 0.97-4.26, third level: aOR: 7.73; 95% CI: 2.98-20.03, fourth level: aOR: 9.93; 95% CI: 3.14-28.35). These findings highlight the significant role played by both single and CLST boosting in promoting universal latrine ownership and empowering vulnerable households to understand the importance of sanitation and open defecation-free practices.

A review of latrine front-end characteristics associated with microbial infection risk; reveals a lack of pathogen density data.

Unsafe sanitation accounts for an estimated 898,000 global deaths annually. The faecal pathogen transmission pathway is complex with several possible routes. Latrine front-end characteristics and usage behaviours are one key transmission pathway for microbial pathogens, however, there has not yet been a synthesis of the available research. This review aims to compare the microbial infection risks with latrine front-end components including any quantified microbial densities within the household latrines. This review was conducted with no restriction on the geographical location of the research. Of 118 studies reviewed, only ten (8%) have quantified the microbial density inside the household latrines compared to 109 (92%) measuring the infection risks. The reported risks were most frequent for specific bacterial (n = 34), and helminths infections (n = 32) compared to diarrhoea (n = 23), combined (n = 15), protozoan (n = 4), and viral (n = 4) infections. The infections risk decreased for using latrines lying at a higher position on the sanitation ladder (for example flush latrines) compared to those lying lower (for example pit latrines). The trend was similar for using floor materials that were easier to clean and less favourable for pathogen survival inside the latrines (for example, concrete as opposed to earth). Faecal coliforms were reported highest on the surface of the squat pan (743 CFU/cm2) of pour-flush latrines and helminths on earth floors of pit latrines (1.5 eggs and larvae per gram of soil). Irrespective of latrine type and its position on the sanitation ladder, a dirty latrine, evidenced by a visible lack of cleanliness, significantly increased the risk for all infections. This study recommends that effective microbial infection risk reduction in latrines can be gained efficiently by ensuring washable surfaces and consistent cleaning practices. Future studies should include more rigorous measurements of microbial densities in various latrine types incorporating the different front-end components and usage behaviours.

The effect of a health extension program on improving water, sanitation, and hygiene practices in rural Ethiopia.

BACKGROUND: To make basic primary health care services accessible, especially to the rural community, the government of Ethiopia launched the Health Extension Program (HEP) in 2004. Most of components of HEP are dedicated to hygiene and sanitation. Few studies have assessed the role of the Health Extension Program in improving water, hygiene, and sanitation (WASH) practices in Ethiopia. This study explored the role of health extension workers (HEWs) in influencing household water treatment practices, latrine ownership, latrine use and ownership, and the use of hand-washing facilities on the incidence of diarrheal diseases among the children under five years of age in rural Ethiopia. METHODS: Using a cross sectional design, we conducted a national assessment that covered all nine regions of Ethiopia. We conducted face-to-face interviews among a sample of 6430 rural households using a structured questionnaire and an observation checklist to collect data from March 2018 to May 2019. Multilevel logistic regressions models were used to determine the relationships between the exposure of households to HEWs and WASH practice outcomes such as the use of water from an improved water source, household water treatment practices, availability of hand-washing and hand-washing with soap and water, availability of latrines, and use of latrines as well as the incidence of diarrheal diseases among children age 5 and younger. Our models were adjusted for covariates and confounders and P-values less than 5% were set to determine statistical significance. RESULTS: We found that 72.7% of rural households had some type of latrine and 27.3% reported practicing open defecation. A total of 71.5% of rural households had access to drinking water from improved water sources, but only 9.4% reported practicing household water treatment. Exposure to HEWs was positively associated with household water treatment practices (AOR: 1.46; 95% CI = 1.01-2.10) and latrine availability (AOR: 1.44; 95% CI = 1.15-1.80). Among the households who were either visited by HEWs at their home or the that visited health posts to meet with the HEWs, being exposed to WASH health education by HEWs was significantly associated with the availability of a hand-washing facility (AOR: 5.14; 95% CI = 4.11-6.42) and latrine availability (AOR: 1.48; 95% CI = 1.10-2.01). However, we did not find a relationship between the incidence of diarrhea among children age 5 and under and exposure to HEWs (AOR: 2.09; 95% CI = 0.73- 6.62). CONCLUSION: Our results show a significant association between exposure to the Health Extension Program/ HEWs and improved household water treatment practices, latrine construction, and the availability of hand-washing facilities in rural Ethiopia, suggesting the need to strengthen efforts to change WASH behavior through the Heath Extension Program. On the other hand, further investigation is needed regarding the spillover effect of latrine use practices and the reduction of the incidence of diarrheal diseases.

Improved latrine coverage may reduce porcine cysticercosis: a comparative cross-sectional study, Busia County, Kenya 2021.

Introduction: Smallholder pig farming is an important economic activity for many poor, rural communities in developing countries. Porcine cysticercosis is a growing public health risk in countries where pig rearing is popular. A sanitation-based intervention to reduce the prevalence of open defecation was completed in Busia County, Kenya in 2016. We capitalized on this third party intervention to evaluate its impact on porcine cysticercosis prevalence. Methods: We conducted a comparative cross-sectional survey from August through to September 2021. Household selection was done using multistage sampling. Household questionnaire data on pig production, transmission, risk factors and awareness of porcine cysticercosis were collected from 251 households. Lingual palpation was used to test for cysticerci in 370 pigs while serum was tested for circulating antigen using Ag-ELISA. We compared results of our survey to an effective baseline, which was a near equivalent cross sectional survey conducted in 2012 before the third party sanitary intervention was established. The difference in prevalence was measured using Chi-square tests. Multivariable logistic regression analysis was used to identify risk factors for lingual cysts in pigs. Results: The prevalence of palpable lingual cysts was estimated to be 3.8% (95% CI 2.3-6.3%) (14/370). This was 6% (95% CI 0.8-13.9%; p-value 0.0178) lower than the prevalence reported in the pre-implementation period of 9.7% (95% CI: 4.5-17.6%). Circulating antigen was detected in 2 samples (0.54%, 95% CI: 0.2-1.9). Latrine coverage was 86% (95% CI: 81-90%), which was 11% (95% CI: 4.8-16.8%; p < 0.001) higher than the pre-implementation period coverage of 75% (95% CI: 71-79%). There was reduced prevalence of lingual cysts in pigs from households that had a latrine (OR = 0.14; 95% CI: 0.05-0.43; p < 0.001) and where pigs were confined or tethered (OR = 0.27; 95% CI: 0.07-1.02; p = 0.053). Conclusion: There was a reduction in the prevalence of porcine cysticercosis in Busia County over the study period from 2012 to 2021. This was not a trial design so we are unable to directly link the decline to a specific cause, but the data are consistent with previous research indicating that improved sanitation reduces porcine cysticercosis. Programs for controlling porcine cysticercosis should include a focus on sanitation in addition to other integrated One Health approaches.

Influence of latrine coverage and usage on diarrhoea incidence among children under 5 living in slum areas of Douala 5th sub-division, Cameroon.

Introduction: lack of adequate sanitation facilities remain a major concern in developing countries. While around 41% of Cameroonians lack access to improved sanitation facilities, the 2011 National Survey revealed a diarrhoea incidence rate of 21% in children under five years, two weeks before interview. This study aimed at evaluating the influence of latrine coverage and usage on diarrhoeic disease outcomes among children under 5. Methods: a cross-sectional study was carried out in March 2016 in pre-selected slums areas of Douala 5th district. A structured questionnaire was used to collect data from one consenting adult per household. Data analysis was carried out using Epi Info version 7.1.4.0. Pearson's chi-square and Fisher exact test were used to estimate the influence of latrine coverage on the incidence of diarrhoea. Statistical significance was set at p < 0.05. Results: of the 384 households enrolled, 69.01% had latrine facilities, while 30.99% shared latrines with neighbouring households. Sixty point sixteen percent (60.16%) (231/384) of all households used pit latrines. Although consistent use of latrines by all adults was reported, 20.05% of children under 5 practiced open-air defecation. The incidence of diarrhoea among children under 5 years 2 weeks before interview was 29.25%, of which 26.35% were bloody stools. Diarrhoea outcome was significantly associated with use of pit latrines (p < 0.01); lack of cover on latrines hole (p < 0.0001) and proximity of latrines to household (p=0.01). Conclusion: poor faecal waste management and lack of improved sanitation facilities contribute significantly to diarrhoeal episodes among children under 5. A structured strategy to improve community-based sanitation considering urban planning and sanitation campaigns would promote safer environment and reduce outcome of water-borne and diarrhoeic diseases.

A Community-Based Cross-Sectional Study on Latrine Utilization and Associated Factors Among Rural Community of East Meskan District, Gurage Zone, Southern Ethiopia.

Background: Using sanitary facilities is proven to enhance health and halt the spread of fecal-to-oral disease. Despite efforts to improve the availability of latrine facilities in developing countries like Ethiopia, finding a village that is entirely free of open defecation remains difficult. To determine the need for intervention programs and promote regular latrine usage, local data is essential. Objectives: This study aimed to assess latrine utilization and associated factors among households in East Meskan District, Southern Ethiopia. Methods: A community-based cross-sectional study was conducted among 630 households from April 15 to May 30, 2022. A simple random sampling technique was used to select the study households. Data were collected using an interviewer-administered structured questionnaire and an observational checklist. The collected data were then entered into Epi-Info version 7.1 and analyzed using SPSS version 21. In binary logistic regression analysis, independent variables with a P-value < .25 were considered candidates for multiple logistic regression analysis. The association was expressed in odds ratio with a 95% confidence interval (CI), and significance was declared at P-value < .05 in the final model. Results: The magnitude of latrine utilization was 73.3% (95% CI: 69.7, 76.8) in the study district. Husband being family head (adjusted odds ratio [AOR] = 12.9; 95% CI: 5.78 ,28.90), being female (AOR = 16.4; 95% CI: 6.52, 41.27), family size less than 5 (AOR = 24.2; 95% CI: 11.49, 51.09), absence of school children (AOR = 0.3; 95% CI: 0.13, 0.51), and greater than 2 years since latrine was constructed (AOR = 14; 95% CI: 7.18, 27.41) had a significant association with latrine utilization. Conclusion: In this study, utilization of latrines was low compared to the national target plan. Family head, sex, family size, presence of school children, and length of years in which the latrine was constructed were factors associated with latrine utilization. Thus, regular supervision of early latrine construction and utilization in communities is essential.

Latrine Utilization and Associated Factors Among Rural Households in Southwest Ethiopia: Risk, Attitude, Norms, Ability, and Self-Regulation Behavioral Model.

Background: Consistent latrine utilization remains a challenge in most rural areas of poor and middle-income countries including Ethiopia. Therefore; the objective of this study was to determine the magnitude of latrine utilization and its associated factors among rural households in open defecation-free declared (ODF) and non-ODF kebeles, Southwest Ethiopia, 2022. Methods: A community-based comparative cross sectional study design was employed from May 16 to June 14, 2022 among 682 (341 ODF and 341 non-ODF) rural households which were selected by multistage systematic random sampling technique. Data were collected by face to face using a pretested structured questionnaire and an observational checklist through Open data kit. SPSS version 26 was used to analysis the data and separate logistic regression models; ODF and non-ODF were run to identify the associated factors. P-values <.05 with 95% CI were set as statistical significant. Result: The overall magnitude of latrine utilization in the study area was 67.1% (95% CI: 63.71, 70.49). Latrine utilization was higher in ODF declared households (71.6%) than in non-ODF households (62.5%). In ODF; Graduated as model households [AOR = 5.1, 95% CI: 2.14, 12.84], visited by health extension works (HEWs) [AOR = 3.5, 95% CI: 1.67, 7.25], and latrine with privacy [AOR = 3.0, 95% CI: 1.37, 6.65] and also in non-ODF; households visited by HEWs [AOR = 2.9, 95% CI: 1.34, 6.06], latrine with privacy [AOR = 2.5, 95% CI: 1.24, 5.07], positive attitude [AOR = 3.2, 95% CI: 1.52, 6.59], and descriptive norm [AOR = 2.7, 95% CI: 1.27, 5.53] were significantly associated with latrine utilization. Conclusion: This study found that rural households declared as ODF utilize their latrine higher than non-ODF. Constructing latrine without privacy, lack of follow up, Attitude and societal norms were factors that limited the utilization of latrine and the sustainability of ODF. Therefore, health extension follow-up, latrine construction with privacy, normative and persuasive behavior change approach should be encouraged.