Effects of community Led Total Sanitation Program in Pallisa District, Uganda: Seven years of Implementation (2011-2017)

Abstract

Introduction: Globally 2.4 billion people are still without access to improved sanitation and 946 million people still practice open defecation and as result approximately 1.5 million children under the age of five die each year from sanitation related diseases which can be prevented (WHO/UNICEF, 2015). It is believed that implementation of Community-Led Total Sanitation will significantly lead to better sanitation and hygiene outcomes in households in Pallisa district. Objective: The main objective of this study was to establish the effects of Community Led Total Sanitation program on sanitation and hygiene outcomes in the intervention areas in Pallisa district. Methods. Comparative cross-sectional study design was carried out where the study subjects were selected by multi stage sampling procedure. A total of 400 households were included in the study. Data entry and cleaning was undertaken by using Epi-data and analyzed using STATA version 13. Chi square test was used to compare proportions between two study sites with level of significance set at α=0.05. Two sample t-test was used to compare means of diarrhea cases between two study sites. Bivariate and multivariate analysis was used to examine the relationship between the primary outcome variable (ODF status) and its predictors. Results: Overall, knowledge on sanitation and hygiene was significantly higher 64.5% (129/200) among households in CLTS implementing than non-implementing sub-counties 54.0 % (108/200) (P=0.033). The latrine quality was rated as fair in a majority 73.3% (143/195) of CLTS households compared to 50.8% (93/183) for non-CLTS households (p=0.000). The latrine cleanliness was rated as good in more than a half 51.3 % (100/195) of households in intervention area while only 13.7 % (25/183) for non-intervention area (p=0.000). In this study 35.0% (70/200) of the households in intervention sub-county had attained ODF status compared to only 6.0% (12/200) in non-intervention sub-county (p=0.000). Level of knowledge on sanitation and hygiene [AOR 2.23, 95% CI (1.24-4.03)] and CLTS status [AOR 8.89, 95% CI (4.26-18.56)] were significantly associated with achievement of ODF status in multivariate analysis. The mean cases of diarrhea were significantly lower in CLTS implementing sub-county than the non CLTs implementing sub-county (t = - 4.6, p=0.000). Conclusions and recommendations: sanitation and hygiene outcomes were better in the CLTS sub-county compared to the non-CLTS sub-county. This study recommends, equipping communities with knowledge on sanitation and hygiene as a key priority.