Effectiveness of community and school-based sanitation interventions in improving latrine coverage: a systematic review and meta-analysis of randomized controlled interventions

Abstract

Introduction Approximately 1000 children die each year due to preventable water and sanitation-related diarrheal diseases. Six in 10 people lacked access to safely managed sanitation facilities in 2015. Numerous community- and school-based approaches have been implemented to eradicate open defecation practices, promote latrine ownership, improve situation sanitation, and reduce waterborne disease. Objective Given that current evidence for sanitation interventions seem promising, the aim of this study was to systematically summarize existing research on the effectiveness of community- and school-based randomized controlled sanitation intervention in improving (1) free open defecation (safe feces disposal), (2) latrine usage, (3) latrine coverage or access, and (4) improved latrine coverage or access. Methods Eight electronic databases were searched: PubMed, Scopus, WHO Global Health Library (GHL), Virtual Health Library (VHL), POPLINE, Web of Science, Cochrane, and Google Scholar up to 26 April 2019. Original randomized clinical trials addressing community-based or school-based intervention that reported feces disposal and latrine coverage were deemed eligible. More than two researchers independently contributed to screening of papers, data extraction, and bias assessment. We conducted a meta-analysis by random-effects model. The risk of bias was assessed by the Cochrane risk of bias tool. Results Eighteen papers that matched all criteria and 16 studies were included in the final meta-analysis. Compared to the control, the sanitation intervention significantly increased safe feces disposal (OR 2.19, 95% CI 1.51–3.19, p < 0.05, I2 = 97.28), latrine usage (OR 3.72, 95% CI 1.71–8.11, p < 0.05, I2 = 91.52), latrine coverage or access (OR 3.95, 95% CI 2.08–7.50, p < 0.05, I2 = 99.07), and improved latrine coverage or access (OR 3.68, 95% CI 1.52–8.91, p < 0.05, I2 = 99.11). A combination of education and latrine construction was more effective compared to educational intervention alone. Conclusion Our study showed strong evidence for both community- and school-based sanitation interventions as effective for the safe disposal of human excreta. The finding suggests major implications for health policy and design of future intervention in developing countries.

The Impact of Pro-Poor Sanitation Subsidies in Open Defecation-Free Communities: A Randomized, Controlled Trial in Rural Ghana

“…It is important to note the risk of reporting bias when relying on surveys with reported sanitation outcomes. 50 , 51 We included cross-validation questions and direct toilet observations to minimize bias, but we do see indications toward reports of better sanitation conditions at baseline and worse conditions at endline, which would have made the deterioration in sanitation conditions appear larger than it truly was. For example, 15% of households at baseline reported that they had never owned a toilet, whereas 28% reported the same at endline ( Table 4 ).…”

Sosialisasi Peningkatan Kesadaran Sanitasi Dan Kesehatan Lingkungan Bagi Pelajar Sekolah Dasar Di Ternate

“…Praktik sanitasi dan prilaku sehat adalah dua hal yang tidak dapat dipisahkan, peningkatan kualitas kesehatan bagi siswa berkorelasi dengan sanitasi yang lebih baik pula. Perbaikan sanitasi lingkungan sekolah berdampak positif pada kesehatan siswa dan hasil belajarnya (Igaki et al, 2021). Intervensi seperti program pendidikan kesehatan, dan meningkatkan kebiasaan mencuci tangan telah terbukti mampu mengurangi malnutrisi dan gejala dehidrasi di kalangan siswa (Sangalang et al, 2022).…”

Interventions to address unsafe child feces disposal practices in the Asia-Pacific region: a systematic review

“…For example, Bawankule et al (2017) assessed associations of unsafe CFD with childhood diarrhea in India but did not describe an intervention to address those factors, and this study was therefore excluded. Majorin et al (2019) and Igaki et al (2021) both conducted systematic reviews of interventions that included improving CFD practices among other factors, but reviews were not an included reference type, so these studies were excluded. Gimaiyo et al (2019) and Ellis et al (2020) assessed CFD practices in Kenya, which is not in the Asia-Pacific region.…”