Poor awareness and attitudes to sanitation servicing can impede China's Rural Toilet Revolution: Evidence from Western China

Abstract

The ongoing Toilet Revolution in China offers an opportunity to improve sanitation in rural areas by introducing new approaches, such as urine source separation, that can contribute to achieving SDG6. However, few studies have systematically assessed the social acceptability of managing human excreta collected in new sanitation systems. Therefore, in this study we performed face-to-face interviews with 414 local residents from 13 villages across three provinces in western China, to analyze the current situation and attitudes to possible changes in the rural sanitation service chain. We found that the sanitation chain was predominantly pit latrine-based, with 86.2% of households surveyed collecting their excreta in a simple pit, 82% manually emptying their pits, and 80.2% reusing excreta in agriculture without adequate pre-treatment. A majority (72%) of the households had a generally positive attitude to production of human excreta-derived fertilizer, but only 24% agreed that urine and feces should be collected separately. Multivariate logistic regression indicated that three factors (level of education, number of permanent household residents, perceived social acceptability) significantly influenced respondents' attitudes to reuse of excreta, although only perceived social acceptability had a high strength of association. Overall, our survey revealed that rural households often misuse toilet systems, fail to comply with government-specified sanitation guidelines, have low awareness of alternative solutions, and are over-reliant on the government to fix problems in the service chain. Thus while new sanitation technologies should be developed and implemented, information campaigns that encourage rural households to manage their excreta safely are also important.

A Marked Decline in Taenia solium Taeniasis and Cysticercosis Infections in China: Possible Reasons from the Ecological Determinants Perspective

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Understanding on-site sanitation in rural Fiji: where definitions of sanitation back-ends differ

“…Lack of sanitation awareness and health and environmental risk perception for unsafe faecal sludge management practices are common in developing countries. [55][56][57] Findings from this study showed user risk perception of sanitation practices can be a risk factor in achieving safe sanitation practices. Therefore, in addition to sanitation infrastructure interventions, there is a need for educational interventions for rural communities with clearly defined examples and explanations of adequate sanitation infrastructure and safe faecal sludge management.…”

Flush toilet use and its impact on health and non‐health expenditures

“…A lack of financial wherewithal and awareness of the benefits of using flush toilets has led to a stagnation in adopting flush toilets in rural China. The adoption rate in the rural areas of the nation's less developed region, western China, is only 15% (Guo et al, 2021). Given the scale of the problem of increasing health expenditure and sanitation in rural China and the steps the government is taking to resolve it, China presents a critical case study.…”