Contextual factors and motivations affecting rural community sanitation in low- and middle-income countries: A systematic review

Novotný, Josef; Hasman, Jiří; Lepič, Martin

doi:10.1016/j.ijheh.2017.10.018

Cited by 53 publications

(65 citation statements)

References 54 publications

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“…Whereas, our study shows that only four out of five households have a fixed place for handwashing. Studies show that the unavailability of water facilities at toilets motivates people for open defecation and disuse of toilets [20]. Similarly, use of unprotected water for drinking is considered a major factor for diarrheal disease (21).…”

Section: Discussionmentioning

confidence: 99%

Open defecation free: where do we need to focus ?

Adhikari

Ghimire

2020

Health Prospect

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BackgroundDespite major national and international efforts, many households in Nepal (as in other low-income and middle-income countries) still lack toilets. This paper assesses various determinants that act as main contributing factors because of which households in Nepal still do not have toilets. MethodsData from the Nepal Demographic and Health Survey (NDHS) 2016 was used for this study. Bivariate analysis was done to assess the association between dependent variables (toilet status- having and not having toilets in the household) and independent variables (demographic, socio-economic and geographical characteristics) using Chi-square test. Then, a multi variate logistic regression model was used to assess significant predictors for a household not having a toilet after controlling other variables. ResultsOut of the total number of sampled households (11040), nearly a fifth (18%) belonged to province no. 2, where nearly half of the households (49%) did not have toilet facilities. Similarly, households in rural areas were found to be less likely to have toilets than households in urban areas (aOR=1.56, CI1.35-1.80). In the Terai, households were almost ten times as likely not to have toilets (aOR=9.65, CI6.56-14.19) as compared to households in the mountain region. Furthermore, there is a strong positive association between households with toilets and their economic status. Poorest (aOR=15.19, CI11.26-20.47), poorer (aOR=8.75, CI6.89-11.11) and middle income (aOR=5.12, CI4.15-6.32) households were less likely to have a toilet than richer or richest households. ConclusionsDespite some real achievements and progress in Open Defecation Free (ODF) status, Nepal still has a large number of residences without a toilet. Thus, it is crucial to address all the multifaceted factors such as geographical, provincial and economic when considering sustainable ODF programming.

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Section: Discussionmentioning

confidence: 99%

Open defecation free: where do we need to focus ?

Adhikari

Ghimire

2020

Health Prospect

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“…Sanitation involves complex human-environment interactions. Therefore, various adaptations of interventions to local conditions are typically necessary (Coffey et al, 2014;Novotn y et al, 2018). Modifications to fit local context are also encouraged in the CLTS guidelines (Chambers and Kar, 2008) and elsewhere (Kariuki et al, 2012).…”

Section: The Clts Approach and Debates So Farmentioning

confidence: 99%

“…Sanitation targets in global strategic frameworks have catalysed sanitation programs across the world. A recent meta-analysis nevertheless documented only modest impacts of sanitation interventions on latrine access and use (Garn et al, 2016), though it was argued that a high dependence of sanitation on contextual conditions makes the aggregate inferences difficult (Novotn y et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Comprehending practitioners’ assessments of community-led total sanitation

Ficek

Novotný

2018

Health Promotion International

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Around 2.3 billion people in developing countries still lack access to improved sanitation facilities and almost one billion practice open defecation (OD). The Community-Led Total Sanitation (CLTS) has recently become a particularly popular approach used in more than 60 countries. CLTS is a behavior-change approach that aims to ignite community action and make OD socially unacceptable without providing any external financial or material support to individual households. CLTS is sometimes perceived as a revolutionary approach that has proven to be highly cost-effective in abolishing OD. However, it has been criticized for its use of unethical practices and questioned with respect to the sustainability of its outcomes and the limited health benefits it can generate. Based on semi-structured interviews with development workers experienced in the implementation of CLTS in 14 different countries, this paper seeks to examine practical views on the issues surrounding this approach. We found that despite acknowledging some of the controversies and the possibly limited sustainability of results, CLTS is generally considered an effective and satisfactory tool for improving sanitation conditions. Practitioners first of all accentuate the normative importance of the elimination of OD attained through CLTS without weighting on (the absence of) evidence on the longer term effects or impacts on health. However, a need for various modifications of CLTS according to local social and natural environments was strongly expressed, including changes that go against the core principles of CLTS like no subsidies and no technical assistance principles.

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“…General model of sanitation logic Before discussing how specifically CLTS might work a logic model of sanitation is outlined in Figure 1 which was adapted from Novotný et al (2018). It provides a general framework according to which information extracted from particular primary studies will be organised.…”

Section: How the Intervention Might Workmentioning

confidence: 99%

“…Third, we will assess which factors influence which sanitation outcomes and how. In addition to a descriptive characterisation of the relationships between different types of factors and outcomes, we will also attempt for a graphical representation of the patterns in these relationships, for example using a network visualisation of 'sanitation nexus' as in Novotný et al (2018). The procedure is applicable to both quantitative and qualitative evidence.…”

Section: Statistical and Other Procedures And Conventions (Including mentioning

confidence: 99%