Effects of Community-led Total Sanitation and Hygiene Implementation on Diarrheal Diseases Prevention in children less than five years of age in South Western Ethiopia: A Quasi- Experimental study

Abstract

Background: Diarrheal disease is one of the main causes of morbidity and mortality in children under five years of age in low and middle-income countries. Lack of improved sanitation is the most important contributing factor to diarrheal disease. Promotion of water, sanitation, and hygiene technologies combined with hygiene promotion is a key strategy for reducing diarrheal diseases in resource poor settings. Few studies have been conducted in rural areas of low-income countries where Community-Led Total Sanitation and Hygiene intervention is implemented. To our knowledge, no study was conducted in the study area to evaluate the effect of this intervention. This study was designed with the aim of finding the effects of Community-led Total Sanitation and Hygiene implementation for preventing diarrhea among under-five children.Methods: A community-based Quasi-Experimental study was conducted from March 01- April 10, 2019 in Kersa and Manna districts. Community-led Total Sanitation and Hygiene intervention is being implemented in Kersa district since 2005 Ethiopian calendar. Sample of 846 households were selected from intervention and comparison districts using four-stage random cluster-sampling method. Semi-structured questionnaire was used to collect data. Data was collected by 8 data collectors who attended secondary school. Data was cleaned, coded and entered into Epi data entry version 3.1 and exported to SPSS version 20 for analysis. Difference-in Difference method with McNemar’s tests was used to compare the prevalence of diarrhea between the intervention and comparison districts, and significance of change between the pre-test and post-test was declared at p-value of less than 0.05 with 95% confidence interval.Results: The intervention led to decreased diarrhea prevalence [pp = -8.2, 95% CI: -15.9, -0.5], increased latrine ownership [pp = 5.6, 95% CI: 0.5, 10.8], and increased latrine utilization [pp = 10.7, 95% CI: 4.7, 16.6] in intervention district at post-test compared to the baseline; while presence of hand washing facility near latrine, home based water treatment, and proper water storage and handling practice were decreased at post-test compared to the baseline.Conclusion: Implementation of Community-Led Total Sanitation improved sanitation and hygiene status of community that resulted in reduction of diarrhea prevalence in children less than five years of age. Further implementation, evaluation, and scale-up of the intervention is needed to reduce diarrheal disease in children less than five years of age.