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Background Despite evidence showing that access to and use of improved sanitation is associated with healthier households and communities, barriers influencing the adoption and sustainablity of sanitation facilities remain unclear. We conducted a qualitative case study to explore barriers influencing the adoption, sustainablity and consistent use of sanitation facilities in rural Ethiopia. Methods A qualitative study was conducted in the rural district of Becho, in central Ethiopia, from June to August 2016. A socio-ecological model and Integrated Behavioural Model (IBM) for a Water Hygiene and Sanitation (WASH) framework were employed to design the study and analyse data. A total of 10 in-depth interviews (IDI) were conducted with latrine adopters ( n  = 3), latrine non-adopters (n = 3), health extension workers (n = 3) and the district WASH coordinator ( n  = 1). Eight Focus Group Discussions (FGD) were undertaken with 75 participants, of which 31 were women. The FGDs and IDIs were tape-recorded, transcribed verbatim and translated into English. The analysis was supported using Nvivo version 10 software. Results Barriers to sustained adoption and use of sanitation facilities were categorized into 1) individual level factors (e.g., past latrine experience, lack of demand and perceived high cost to improved latrines), 2) household level factors (e.g., unaffordability, lack of space and absence of a physically strong family member), 3) community level factors (e.g., lack of access to public latrines, lack of shared rules against open defecation, lack of financial access for the poor), and 4) societal level factors (e.g., lack of strong local leadership, flooding, soil conditions, lack of appropriate sanitation technology, lack of promotion and demand creation for improved latrines). Conclusion The use of the socio-ecological model and IBM-WASH framework helped to achieve a better understanding of multi-level and multi-dimensional barriers to sustained latrine adoption. The results indicate that there is a need to consider interventions that address multi-level factors concurrently.

Despite the quick urban population growth increased volume of wastes, including human excreta, which demands an expanded need of infrastructure, solid institutional setup and communities' engagement for management of safe disposal of excreta, arrangement of such basic social services has not developed as per the rate of population growth. Mostly, communal latrines are inclined towards an absence of cleanliness, as they accommodate many people beyond their capacity, filling up septic tanks quickly. A community-based cross-sectional study conducted in 817 randomly selected communal latrine user households, five focus group discussions and four key informant interviews were analysed. Bivariate and multivariate logistic regression analysis was performed to discover the impact of different factors on the use of communal latrines. The findings revealed that the rate of communal latrine use in Addis Ababa was about 79.8%. Unhygienic conditions, latrine emptying challenges, extreme smell, number of family units sharing the same squats, and latrine designs for the aged and children were identified as barriers to latrine utilization. This study suggests that, in parallel with the continued investments to increase access to sanitary facilities in the city, the management and behavioural change part has likewise to be stressed for better use and sustainability.

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 (β = 5.28, p  < 0.01), relief (β = 5.49, p  < 0.01), comfort (β = 2.36, p  < 0.01), Construction cost (β=-1.98, p  < 0.01) and safety (β = 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.

Background Inadequate sanitation is one of the leading causes of disease in poor and middle-income countries. Objective The objective of the study was to identify the psychological factors that predict latrine ownership and consistent latrine use in the rural Becho district of central Ethiopia. Method A quantitative, cross-sectional, community based study was conducted. A total of 1047 heads of household were interviewed using a structured questionnaire. Ownership of latrine and consistent latrine use constituted the outcome variable of the study. Data were entered using Epi Info version 3.5.4 and were analyzed using SPSS version 20. Results Of the 1047 households, 73% owned a traditional pit latrine. Among the psychological factors, attitude (AOR 1.70; 95% CI 1.21–2.37) and injunctive norm (AOR 6.18; 95% CI 4.46–10.44) were positively and significantly associated with latrine ownership. Among the demographic factors , having a family size of more than six (AOR = 1.43; 95% CI 1.01–1.97, having a child attending school (AOR = 1.88; 95% CI 1.17–3.02), and having a high school education (AOR = 1.98; 95% CI 1.34–2.87) were significantly associated with latrine ownership. With respect to exposure to communication about sanitation (the cues to action), households that had a family member who took part in Community Led Total Sanitation and Hygiene (CLTSH) triggering were three times more likely to be latrine owners than those who did not participate in CLTSH triggering (95% CI 1.92–4.78.) Results from adjusted logistic regression analysis of potential predictors of consistent latrine use showed that having a positive attitude (AOR 7.00; 95% CI 4.55–10.55), owning of a latrine that had superstructure (AOR 2.3 95% CI 1.47–3.48), having a clean latrine (AOR 1.69 95% CI 1.00–3.00), and having a latrine with a protected door (AOR 1.94; 95% CI 1.10–3.48) were significantly associated with consistent latrine use. Conclusion The study findings showed that attitude and injunctive norm are the psychological predictors of latrine ownership, and consistent latrine use was associated with attitude, cleanliness of the latrine, and its privacy. Hence, sanitation intervention needs to focus on changing societal norms, attitudes, and the promotion of latrine quality.

Open defecation is still a major health problem in developing countries. While enormous empirical research exists on latrine coverage, little is known about households’ latrine construction and usage behaviours. Using field observation and survey data collected from 1523 households in 132 communities in northern Ghana after 16 months of implementation of Community Led Total Sanitation (CLTS), this paper assessed the factors associated with latrine completion and latrine use. The survey tool was structured to conform to the Risk, Attitude, Norms, Ability and Self-regulation (RANAS) model. In the analysis, we classified households into three based on their latrine completion level, and conducted descriptive statistics for statistical correlation in level of latrine construction and latrine use behaviour. The findings suggest that open defecation among households reduces as latrine construction approaches completion. Although the study did not find socio-demographic differences of household to be significantly associated with level of latrine completion, we found that social context is a significant determinant of households’ latrine completion decisions. The study therefore emphasises the need for continuous sensitisation and social marketing to ensure latrine completion by households at lower levels of construction, and the sustained use of latrines by households.

European badgers, Meles meles, are group-living in the UK, and demarcate their ranges with shared latrines. As carnivores, badgers possess paired anal glands, but olfactory information on the content of badger anal gland secretion (AGS) is largely uninvestigated. Here, we examined the volatile organic compounds (VOCs) of AGS samples from 57 free-living badgers using solid-phase microextraction (SPME) and gas chromatography—mass spectrometry. AGS was rich in alkanes (C7–C15, 14.3% of identified compounds), aldehydes (C5–C14, 9.7%), phenols (C6–C15, 9.5%), alcohols (C5–C10, 7.3%), aromatic hydrocarbons (C6–C13, 6.8%), ketones (C6–C13, 6.3%) and carboxylic acids (C3–C12, 5.6%) and contained a variety of esters, sulfurous and nitrogenous compounds, and ethers. The number of VOCs per profile ranged from 20 to 111 (mean = 65.4; ± 22.7 SD), but no compound was unique for any of the biological categories. After normalization of the raw data using Probabilistic Quotient Normalization, we produced a resemblance matrix by calculating the Euclidian distances between all sample pairs. PERMANOVA revealed that AGS composition differs between social groups, and concentration and complexity in terms of number of measurable VOCs varies between seasons and years. AGS VOC profiles encode individual identity, sex and vary with female reproductive state, indicating an important function in intraspecific communication. Because AGS is excreted together with fecal deposits, we conclude that chemical complexity of AGS enables particularly latrine-using species, such as badgers, to advertise more complex individual-specific information than in feces alone.

Community Approaches to Total Sanitation (CATS) programmes, like the Sanitasi Total Berbasis Masyarakat (STBM) programme of the Government of Indonesia, have played a significant role in reducing open defecation though still little is known about the sustainability of the outcomes. We assessed the sustainability of verified Open Defecation Free (ODF) villages and explored the association between slippage occurrence and the strength of social norms through a government conducted cross-sectional data collection in rural Indonesia. The study surveyed 587 households and held focus group discussions (FGDs) in six ODF villages two years after the government’s ODF verification. Overall, the slippage rate (i.e., a combination of sub-optimal use of a latrine and open defecation at respondent level) was estimated to be 14.5% (95% CI 11.6–17.3). Results of multivariate logistic regression analyses indicated that (1) weaker social norms, as measured by respondents’ perceptions around latrine ownership coverage in their community, (2) a lack of all-year round water access, and (3) wealth levels (i.e., not being in the richest quintile), were found to be significantly associated with slippage occurrence. These findings, together with qualitative analysis, concluded that CATS programmes, including a combination of demand creation, removal of perceived constraints through community support mechanisms, and continued encouragement to pursue higher levels of services with post-ODF follow-up, could stabilize social norms and help to sustain longer-term latrine usage in study communities. Further investigation and at a larger scale, would be important to strengthen these findings.

Background While the sanitation ladder is useful in analysing progressive improvements in sanitation, studies in Uganda have not indicated the sanitation barriers faced by the urban poor. There are various challenges in shared latrine use, cleaning and maintenance. Results from Kampala city indicate that, failure to clean and maintain sanitation infrastructure can lead to a reversal of the potential benefits that come with various sanitation facilities. Methods A cross sectional qualitative study was conducted between March and May 2013. Data were collected through 18 focus group discussions (FGDs) held separately; one with women, men and youth respectively. We also used pictorial methods; in addition, 16 key informant interviews were conducted. Data were analysed using content thematic approach. Relevant quotations per thematic area were identified and have been used in the presentation of the results. Results Whether a shared sanitation facility was improved or not, it was abandoned once it was not properly used and cleaned. The problem of using shared latrines began with the lack of proper latrine training when people do not know how to squat on the latrine hole. The constrained access and security concerns, obscure paths that were filthy especially at night, lack of light in the latrine cubicle, raised latrines sometimes up to two metres above the ground, coupled with lack of cleaning and emptying the shared facilities only made a bad situation worse. In this way, open defecation gradually substituted use of the available sanitation facilities. This paper argues that, filthy latrines have the same net effect as crude open defection. Conclusion Whereas most sanitation campaigns are geared towards provision of improved sanitation infrastructure, these findings show that mere provision of infrastructure (improved or not) without adequate emphasis on proper use, cleaning and maintenance triggers an involuntary descent off the sanitation ladder. Understanding this reversal movement is critical in sustainable sanitation services and should be a concern for all actors.

While latrine coverage is increasing in India, not all household members use their latrines. Cost-effective, culturally appropriate, and theory-informed behavior change interventions are necessary to encourage sustained latrine use by all household members. We qualitatively examined community perceptions of sanitation interventions broadly, along with specific impressions and spillover of community-level activities of the Sundara Grama latrine use behavior change intervention in rural Odisha, India. We conducted sixteen sex-segregated focus group discussions (n = 152) in three intervention and three nonintervention villages and thematically analyzed the data. We found Sundara Grama was well-received by community members and considered educative, but perceptions of impact on latrine use were mixed and varied by activity. Intervention recruitment challenges prevented some, such as women and households belonging to lower castes, from attending activities. Spillover occurred in one of two nonintervention villages, potentially due to positive relations within and between the nonintervention village and nearby intervention village. Community-level sanitation initiatives can be hindered by community divisions, prioritization of household sanitation over community cleanliness, and perceptions of latrine use as a household and individual issue, rather than common good. Community-centered sanitation interventions should assess underlying social divisions, norms, and perceptions of collective efficacy to adapt intervention delivery and activities.

The purpose of this study was to quantify how school sanitation conditions are associated with pupils’ use of sanitation facilities. We conducted a longitudinal assessment in 60 primary schools in Nyanza Province, Kenya, using structured observations to measure facility conditions and pupils’ use at specific facilities. We used multivariable mixed regression models to characterize how pupil to toilet ratio was associated with toilet use at the school-level and also how facility conditions were associated with pupils’ use at specific facilities. We found a piecewise linear relationship between decreasing pupil to toilet ratio and increasing pupil toilet use (p < 0.01). Our data also revealed significant associations between toilet use and newer facility age (p < 0.01), facility type (p < 0.01), and the number of toilets in a facility (p < 0.01). We found some evidence suggesting facility dirtiness may deter girls from use (p = 0.06), but not boys (p = 0.98). Our study is the first to rigorously quantify many of these relationships, and provides insight into the complexity of factors affecting pupil toilet use patterns, potentially leading to a better allocation of resources for school sanitation, and to improved health and educational outcomes for children.