Role of sanitation-hygiene practices and social norms on open defecation free status in households of Suna-west sub-county, Migori county

Abstract

The government of Kenya adopted Community-led total sanitation as a national strategy to elicit sanitation-related behaviour change and eliminate open defecation. Since then, several villages have achieved open defecation free status, increased access to sanitation and reduced sanitation-related morbidities. Suna West Sub-County particularly recorded increased access to sanitation and achieved partial ODF status since the adoption of CLTS within the county. However, research shows that close to 70% of villages in Kenya that received partial or full open defecation free status have reverted back to non-ODF status after a while. This study aimed at determining the role of sanitation hygiene practices and social norms on open defecation free status in households of Suna West Sub-County. Specifically, to determine ODF status in households, determine association between sanitation and hygiene practices and ODF status and to determine the association between social norms and ODF status. The study employed a cross-sectional study design targeting 384 household heads, administered questionnaire, used observation checklist and also conducted 6 key informant interviews for 2 public health professionals and 4 community leaders. Informed consent was sought from the participants and ethical considerations ascertained as reviewed by the University’s ethics review committee. Results revealed 33.9% of households had sustained ODF status and 66.1% had partially reverted back to non-ODF status. The odds of being ODF for households that carried out sanitation-hygiene practices includes: treated water (OR=3.17; CI=1.20-8.40; P=0.020), used elevated racks (OR=2.17; CI=1.08-4.37; P=0.030), regularly cleaned their latrines (OR=4.88; CI=1.12-21.37; P=0.035), poured ash over the pit of the latrine (OR=4.25; CI=4.20-8.87; P<0.001) and used dug out pits for waste disposal (OR=4.51; CI=2.09-9.78; P<0.001). On social norms, the study found significant association between; laws/penalties (OR=0.31; CI=0.21-0.48; P<0.001), need to improve things in the family (OR=0.50; CI=0.28-0.92; P=0.025), rewards/incentives (OR=0.21; CI=0.13-0.33; P<0.001) whose odds of being ODF were less likely. The odds of being ODF was less likely for households with perception that; construction/maintenance materials were expensive (OR=0.52; CI=0.33-0.80; P=0.003), most people don’t have a latrine (OR=0.40; CI=0.25-0.64; P<0.001) and it is okay to defecate in bushes/rivers/dams (OR=0.31; CI=0.19-0.51; P<0.001). There was partial reversion to non-ODF status in households one year after certification of Suna West Sub County mainly attributed to 3 major indicators; provision of hand washing facility, squat hole cover and privacy. Secondly, there was significant association between sanitation-hygiene practices and open defecation free status and that there were higher odds of sustained ODF status in households that carried out sanitation hygiene practices in Suna West Sub-County. Finally, even though there was association between social norms and ODF status, the odds of being ODF were significantly lower due to the weakly embedded social norms that failed to influence the perceptions on benefits and/or risks on sanitation-related awareness positively.