Household-level sanitation in Ethiopia and its influencing factors: a systematic review

Abstract

Background Within the past two decades, Ethiopia has achieved one of the fastest reductions of open defecation worldwide. This change can be attributed to the implementation of a national sanitation strategy that focused on facilitating community demand for latrine adoption and use of basic self-constructed latrines but less on other preconditions of hygienic sanitation. Recognition of sanitation by policymakers also catalyzed primary research in this area. As such, the synthesis of the available evidence is both warranted and possible. In this article, we thus decided to assess available primary evidence on the household-level sanitation in Ethiopia and its influencing factors. Methods We searched primary studies that present findings on the role of factors influencing household-level sanitation outcomes in Ethiopia. We typologically classified sanitation outcomes analyzed in identified literature and computed pooled estimates for the most prevalent ones (measures of latrine availability and use). We characterized thematic types (themes and sub-themes) of influential sanitation drivers and used network analysis to examine the relational patterns between sanitation outcomes and their influencing factors. Findings We identified 37 studies that met our inclusion criteria—all but one published after 2009. The general latrine coverage pooled across 23 studies was 70% (95% CI: 62–77%), the share of improved latrines pooled across 15 studies was 55% (95% CI: 41–68%), and latrine use pooled across 22 studies was 72% (95% CI: 64–79%). Between-study heterogeneity was high, and no time trends were identified. The identified sanitation outcomes were classified into eight types and factors reported to influence these outcomes were classified into 11 broader themes and 43 more specific sub-themes. Factors around the quality of latrines represented the most frequent sub-theme of consequential drivers. We found that the available research focused predominantly on outcomes concerning the initial adoption and use of basic latrines, emulating the main focus of national sanitation strategy. By contrast, research on drivers of the sustainability of sanitation change and, in particular, on the upgrading of latrines, has been rare despite its urgency. There is a high need to redirect the focus of sanitation research in Ethiopia towards understanding these factors on both the demand and supply side.

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

“…In addition to the results obtained in this study, the lower latrine coverage among lower SES households has been shown in previous studies [ 30 , 40 ]. The low latrine coverage among people with low incomes could be explained in terms of the cost of latrine construction.…”

“…More so, the cost of constructing a public latrine in a community can be funded by external or co-financing, whereas self-financing is generally required for the individual latrines of households based on CLTS policy [ 13 ]. Thus, whereas several studies have indicated that individual beliefs about cost and benefit are predictors of latrine ownership [ 25 , 30 ], the issue of motivation plays an important role. It can be assumed that there are differences in motivation between households depending on their SES, in as much as CLTS tries to motivate the community.…”

“…The second issue pertains to the effectiveness of CLTS interventions in promoting household latrine ownership. While some communities have shown success, the overall progress toward universal latrine ownership remains slow [ 29 , 30 ]. In rural areas of Kenya where this study was undertaken, many communities still face sanitation challenges.…”

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

“…A prominent approach within this strategy was the Ethiopian adaptation of Community-Led Total Sanitation and Hygiene, building upon the Community-Led Total Sanitation (CLTS) approach ( Crocker et al ., 2017 ; Novotný et al, 2018a ). However, the increased latrine coverage often compromised quality, using low-cost, locally available materials, resulting in sustainability issues, collapses, and a resurgence of open defecation ( Abebe and Tucho, 2020 ; UNICEF, 2020 ; Novotný and Mamo, 2022 ; Kouassi et al ., 2023 ). Research indicates that relying solely on the CLTS approach may not be sufficient for achieving hygienic sanitation ( Cavill et al , 2015 ; Crocker et al ., 2017 ; Novotný et al, 2018b ; Ficek and Novotný, 2019 ).…”

Demographic, social and economic factors affecting the adoption of green toilets among rural households in India

“…Novotný and Mamo ( 2022 ) reviewed the factors affecting household-level sanitation in Ethiopia, highlighting that key focus has been on understanding the adoption of basic latrines; and studies on identifying the drivers of the sustainability of sanitation such as upgrading of latrines, has been rare despite its urgency. Rashid and Pandit ( 2019 ) analyzed the issue of lack of disposal systems among household toilets and found that the households are willing to pay for better service quality and improvement in attributes of toilets and hygiene.…”