Chiengi District, Zambia Open Defecation Free After 1 Year of Community-Led Total Sanitation

Zimba, Rabson; Ngulube, Vernon; Lukama, Chinyama; Manangi, Abel; Tiwari, Amy; Osbert, Nicolas; Hoehne, Alexandra; Muleya, Sarah; Mukosha, Leonard; Crooks, Philippa; Chikobo, Cade; Winters, Benjamin; Larsen, David A.

doi:10.4269/ajtmh.16-0210

Cited by 15 publications

(40 citation statements)

References 8 publications

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“…Over the past decade, CLTS as a means to prevent diarrhoeal diseases has gained traction and is being applied at large scale in various low-and middle-income countries [22,35]. Yet, there is relatively little scientific inquiry about the specific effects of CLTS alone or in combination with other interventions against neglected tropical diseases [13,[36][37][38][39], and hence, the public health impact of CLTS [40]. We discuss the effect of an integrated package of interventions, placing emphasis on latrine construction by the community, levels of helminth and intestinal protozoa infections, infection patterns at follow-up and people's behaviour and attitudes (e.g.…”

Section: Discussionmentioning

confidence: 99%

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d’Ivoire

et al. 2018

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Background: Preventive chemotherapy with donated anthelminthic drugs is the cornerstone for the control of helminthiases. However, reinfection can occur rapidly in the absence of clean water and sanitation coupled with unhygienic behaviour. The purpose of this study was to assess the effect of an integrated package of interventions, consisting of preventive chemotherapy, community-led total sanitation (CLTS) and health education, on the prevalence of helminth and intestinal protozoa infections and on participants' knowledge, attitude, practice and beliefs (KAPB) towards these diseases including water, sanitation and hygiene (WASH).

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Section: Discussionmentioning

confidence: 99%

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d’Ivoire

et al. 2018

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“…19 By giving chiefs knowledge, a voice in CLTS and control over CLTS progress in their chiefdom, we leveraged the positive aspects of traditional society in rural Zambia and have seen the first district in Zambia achieve universal coverage of access to adequate sanitation. 20 The influence that chiefs have on culture and village-level behavior change may in part be tied to the communal model of land ownership, 21 which in some parts of sub-Saharan Africa is actually seen as an obstacle to economic development. 22,23 Traditional leadership throughout sub-Saharan Africa has come under scrutiny since colonial rule when colonial powers manipulated the traditional leadership structure to maintain control over colonies.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Impact of Leveraging Traditional Leadership on Access to Sanitation in Rural Zambia

Tiwari¹,

Russpatrick²,

Hoehne³

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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Open defecation is practiced by more than one billion people throughout the world and leads to significant public health issues including infectious disease transmission and stunted growth in children. Zambia implemented community-led total sanitation (CLTS) as an intervention to eliminate open defecation in rural areas. To support CLTS and the attainment of open defecation free communities, chiefs were considered key agents of change and were empowered to drive CLTS and improve sanitation for their chiefdom. Chiefs were provided with data on access to sanitation in the chiefdom during chiefdom orientations prior to the initiation of CLTS within each community and encouraged to make goals of universal sanitation access within the community. Using a survival regression, we found that where chiefs were orientated and mobilized in CLTS, the probability that a village would achieve 100% coverage of adequate sanitation increased by 23% (hazard ratio = 1.263, 95% confidence interval = 1.080-1.478, = 0.003). Using an interrupted time series, we found a 30% increase in the number of individuals with access to adequate sanitation following chiefdom orientations (95% confidence interval = 28.8-32.0%). The mobilization and support of chiefs greatly improved the uptake of CLTS, and empowering them with increased CLTS knowledge and authority of the program in their chiefdom allowed chiefs to closely monitor village sanitation progress and follow-up with their headmen/headwomen. These key agents of change are important facilitators of public health goals such as the elimination of open defecation in Zambia by 2020.

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“…In Zambia, for a chiefdom to be declared ODF, it must be verified and certified that all the villages have households with an adequate toilet (Zimba, et al, 2016). The four parameters governing adequacy are (1) smooth cleanable floor, (2) toilet orifice lid (or fly trap for VIP's), (3) super structure providing privacy and (4) a hand washing station with soap.…”

Section: Source Of Datamentioning

confidence: 99%

Development and external validation of a logistic regression derived algorithm to estimate a 12-month post open defecation free slippage risk

Simangolwa

2019

JHE

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Appropriate open defecation free (ODF) sustainability interventions are key to further mobilise communities to consume sanitation and hygiene products and services that enhance household’s quality of life and embed household behavioural change for heathier communities. This study aims to develop a logistic regression derived risk algorithm to estimate a 12-month ODF slippage risk and externally validate the model in an independent data set. ODF slippage occurs when one or more toilet adequacy parameters are no longer present for one or more toilets in a community. Data in the Zambia district health information software for water sanitation and hygiene management information system for Chungu and Chabula chiefdoms was used for the study. The data was retrieved from the date of chief Chungu and Chabula chiefdoms' attainment of ODF status in October 2016 for 12 months until September 2017 for the development and validation data sets respectively. Data was assumed to be missing completely at random and the complete case analysis approach was used. The events per variables were satisfactory for both the development and validation data sets. Multivariable regression with a backwards selection procedure was used to decide candidate predictor variables with p < 0.05 meriting inclusion. To correct for optimism, the study compared amount of heuristic shrinkage by comparing the model’s apparent C-statistic to the C- statistic computed by nonparametric bootstrap resampling. In the resulting model, an increase in the covariates ‘months after ODF attainment’, ‘village population’ and ‘latrine built after CLTS’, were all associated with a higher probability of ODF slippage. Conversely, an increase in the covariate ‘presence of a handwashing station with soap’, was associated with reduced probability of ODF slippage. The predictive performance of the model was improved by the heuristic shrinkage factor of 0.988. The external validation confirmed good prediction performance with an area under the receiver operating characteristic curve of 0.85 and no significant lack of fit (Hosmer-Lemeshow test: p = 0.246). The results must be interpreted with caution in regions where the ODF definitions, culture and other factors are different from those asserted in the study.

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Chiengi District, Zambia Open Defecation Free After 1 Year of Community-Led Total Sanitation

Cited by 15 publications

References 8 publications

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d’Ivoire

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d’Ivoire

Assessing the Impact of Leveraging Traditional Leadership on Access to Sanitation in Rural Zambia

Development and external validation of a logistic regression derived algorithm to estimate a 12-month post open defecation free slippage risk

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