Why Latrines Are Not Used: Communities’ Perceptions and Practices Regarding Latrines in a Taenia solium Endemic Rural Area in Eastern Zambia

Abstract

Taenia solium cysticercosis is a neglected parasitic zoonosis occurring in many developing countries. Socio-cultural determinants related to its control remain unclear. Studies in Africa have shown that the underuse of sanitary facilities and the widespread occurrence of free-roaming pigs are the major risk factors for porcine cysticercosis. The study objective was to assess the communities’ perceptions, practices and knowledge regarding latrines in a T. solium endemic rural area in Eastern Zambia inhabited by the Nsenga ethno-linguistic group, and to identify possible barriers to their construction and use. A total of 21 focus group discussions on latrine use were organized separately with men, women and children, in seven villages of the Petauke district. The themes covered were related to perceived latrine availability (absence-presence, building obstacles) and perceived latrine use (defecation practices, latrine management, socio-cultural constraints).The findings reveal that latrines were not constructed in every household because of the convenient use of existing latrines in the neighborhood. Latrines were perceived to contribute to good hygiene mainly because they prevent pigs from eating human feces. Men expressed reluctance to abandon the open-air defecation practice mainly because of toilet-associated taboos with in-laws and grown-up children of the opposite gender. When reviewing conceptual frameworks of people’s approach to sanitation, we found that seeking privacy and taboos hindering latrine use and construction were mainly explained in our study area by the fact that the Nsenga observe a traditionally matrilineal descent. These findings indicate that in this local context latrine promotion messages should not only focus on health benefits in general. Since only men were responsible for building latrines and mostly men preferred open defecation, sanitation programs should also be directed to men and address related sanitary taboos in order to be effective.

Risk factors, perceptions and practices associated with Taenia solium cysticercosis and its control in the smallholder pig production systems in Uganda: a cross-sectional survey

“…Such factors include: poor hygiene and sanitation practices in humans, free-range pig rearing and tethering, lack of awareness about the disease and its transmission, poor or non-inspection of pigs before or following slaughter, use of contaminated water for pigs and people, and, eating under-cooked pork [11, 12]. …”

“…Poor sanitation practices, such as open air defecation and latrines in poor conditions can allow pigs access to human feces [14]. Feces deposited in the open environment can be washed into unprotected springs and wells posing a risk to both pigs and humans [12, 15]. …”

“…Lack of knowledge about the pork tapeworm transmission cycle by farmers, consumers and non-consumers of pork, medical and veterinary personnel, policy makers and implementers in developing countries has made control of the potentially eradicable condition difficult [21]. Limited knowledge has been linked to increasing incidence among rural poor pig-keeping communities [12, 22–24]. …”

“…Stakeholders in endemic areas may know about tapeworm infections in humans but may not relate it to porcine cysticercosis and neuro-cysticercosis [12]. In Uganda, misleading reports by the media which allege that “ eating pork directly causes epilepsy ” could complicate the control of T. solium infection [25].…”

“…In Uganda, misleading reports by the media which allege that “ eating pork directly causes epilepsy ” could complicate the control of T. solium infection [25]. Although change of behavior in communities is not automatic after acquisition of knowledge, it could be a key step in prevention of T. solium cysticercosis [12, 15, 23, 24]. …”