Assessing patterns and determinants of latrine use in rural settings: A longitudinal study in Odisha, India

Abstract

IntroductionMonitoring of sanitation programs is often limited to sanitation access and coverage, with little emphasis on use of the facilities despite increasing evidence of widespread non-use.ObjectivesWe assessed patterns and determinants of individual latrine use over 12 months in a low- income rural study population that had recently received latrines as part of the Government of India’s Total Sanitation Campaign (TSC) in coastal Puri district in Odisha, India.Materials and methodsWe surveyed 1938 individuals (>3 years) in 310 rural households with latrines from 25 villages over 12 months. Data collection rounds were timed to correspond with the seasons. The primary outcome was reported use by each member of the household over the prior 48 h. We classified use into three categories—“never”, “sometimes” and “always/usually”. We also assessed consistency of use over six days across the three seasons (dry cold, dry hot, rainy). We explored the association between individual and household-level variables and latrine use in any given season and longitudinally using multinomial logistic regression. We also inquired about reasons for non-use.ResultsOverall, latrine use was poor and inconsistent. The average response probability at any given round of never use was 43.5% (95% CI = 37.9, 49.1), sometimes use was 4.6% (95% CI = 3.8, 5.5), and always/usual use was 51.9% (95% CI = 46.2, 57.5). Only two-thirds of those who reported always/usually using a latrine in round one reported the same for all three rounds. Across all three rounds, the study population was about equally divided among those who reported never using the latrine (30.1%, 95% CI = 23.0, 37.2), sometimes using the latrine (33.2%, 95% CI = 28.3, 38.1) and always/usually using the latrine (36.8%, 95% CI = 31.8, 41.8). The reported likelihood of always/usually versus never using the latrine was significantly greater in the dry cold season (OR = 1.50, 95% CI = 1.18, 1.89, p = 0.001) and in the rainy season (OR = 1.34, 95% CI = 1.07, 1.69, p = 0.012), than in the dry hot season.Across all three seasons, there was increased likelihood of always/usually and sometimes using the latrine versus never using it among females and where latrines had a door and roof. Older age groups, including those aged 41–59 years and 60+ years, and increase in household size were associated with a decreased likelihood of always/usually using the latrine versus never using it. The leading reason for non-use was a preference for open defecation.ConclusionResults highlight the low and inconsistent use of subsidized latrines built under the TSC in rural Odisha. This study identifies individual and household levels factors that may be used to target behavior change campaigns to drive consistent use of sanitation facilities by all.

An Approach Incorporating User Preferences in the Design of Sanitation Systems and Its Application in the Rural Communities of Chiapas, Mexico

“…Unfortunately, only a handful of researchers have undertaken the task of analyzing and understanding user preferences, so the task remains large. In addition, most of the current approaches focus on one or two aspects of sanitation, such as usage or ownership, and cost or technical features [8], whereas some have a significant number of variables [6]. Moreover, researchers such as Simiyu [18] and Conradin [50] have evaluated technologies where they were already implemented, and as Nawab et al [13] suggested, it is possible and probably better to conduct the evaluation before the design and implementation based on user preferences, to improve and maybe ensure the acceptance of such systems.…”

“…Likewise, direct user and stakeholder participation, as well as empowerment by intermediate-level organizations, can provide an avenue to identify the needs of the community [57,64]. This implies that current and future interventions in the design, selection, development, and monitoring of technologies and the subsequent provision of sanitation services should involve community decision-makers who understand people's culture and behavior, to develop strategies with users as part of the process and to implement feasible, affordable, and user-accepted sanitation systems [6,7,9,14,15].…”

Evaluation of Sanitation Strategies and Initiatives Implemented in Mexico from Community Capitals Point of View

“…The correlation between the reduction of mortality with sewage coverage and water supply coverage is 0.98 and 0.99, respectively, which denotes that they are intimately related ( Figure 2). As it has been inferred in other countries [30], the construction of water and sanitation supply systems supports the control and eradication of epidemic outbreaks; but in Mexico, implementers seem to be incentivized to prioritize the construction of sanitation or water supply systems over ensuring a sustainable behavior change and ensuring the use of the systems. If communities continue growing with this lag, the possibilities for development are scarce [27,31].…”

“…Access to sanitation is necessary to ensure water quality, but the provision of this service is more complicated, since it depends on many authority levels and it has a great impact on health and the environment [8]. It is important to mention that a sustainable sanitation system protects and promotes human health, is people-centered, responds to demand, does not contribute to environmental degradation or depletion of the resource base, is technically and institutionally appropriate, economically viable and socially acceptable, and it should have a high degree of As it has been inferred in other countries [30], the construction of water and sanitation supply systems supports the control and eradication of epidemic outbreaks; but in Mexico, implementers seem to be incentivized to prioritize the construction of sanitation or water supply systems over ensuring a sustainable behavior change and ensuring the use of the systems. If communities continue growing with this lag, the possibilities for development are scarce [27,31].…”

The Sustainable Development Goals for Water: The Need to Consider Perception, Preference, and Safety

“…8 Recent evidence examining latrine use has found that access to a latrine may not imply usage, especially when something else is preferred over the latrine. 9 Nevertheless, to take advantage of the greatest health benefits of these water and sanitation interventions, consistent and continued use is necessary for the largest impact on health. 8,10 …”