Factors influencing promotion of latrine utilization in Laisamis Sub County, Marsabit, Kenya

Abstract

Community-Led Total Sanitation (CLTS) is a behavior change approach aimed at promoting sustainable and equitable access to sanitation and hygiene for all. The approach focuses on empowering communities to take collective action to eliminate open defecation and improve sanitation practices. Although CLTS has been implemented in Kenya for more than a decade now, open defecation is still rampant particularly in low-income communities including the pastoral areas. The influence of social and cultural factors on the adoption of Community-Led Total Sanitation in pastoral areas is less understood which was the focus of this study. The study was conducted in Laisamis Sub-County, Marsabit County, Kenya. A descriptive study design and a mixed methods approach was used. The sample targeted was 275 randomly selected household heads from the five Wards in the Sub-County which were treated as clusters. The data was analysed in descriptive and inferential statistics. Focus group discussion data was analysed in themes and presented as narratives. The role of natural leaders in mobilizing communities to construct toilets after CLTS was appreciated due to its ability to promote toilet adoption (Unadjusted OR 1.576 95% CI: 1.245-3.476, p=0.042). Findings showed that although CLTS had promoted knowledge on dangers of open defecation as reported by 63.3% of participants, open defecation practice was still rampant despite adoption of household toilets. Open defecation practices were associated with the participants’ livelihoods of herding in grazelands where there were no toilets (Unadjusted OR 4.094 95% CI: 0.145-2.856, p=0.000). Taboos and beliefs that surrounded toilet sharing between children and adults affected toilet utilization (OR 0.67 95% CI: 0.345-4.567, P=0.002). Although CLTS had promoted construction of toilets, the facilities were described as poor and non-durable as they were constructed using locally available weak materials like sacks and tree branches or leaves. Floors of most toilets were not easily cleanable which was associated with negative impact on utilization of the available latrines (Unadjusted OR 0.73 95% CI: 0.256-4.5689, p<0.0001). The impact of CLTS was thought to be minimal for a community which often interacted with animal faeces, which made over 90% of the participants believe that human faecal matter was not dangerous just like animal faecal matter. Since women mostly stayed at their households while men went to look after cattle, the role of toilet construction was bestowed on them. However, herdsmen’s concerns regarding the essence of investing in improved latrines were minimal as most of their time was spent in the fields, and convincing them on the need for better toilets could have been impossible. The study concluded that CLTS was an effective strategy in triggering behaviour change among communities. However, the manner of its execution needed to be context-specific to accommodate the needs of the communities targeted. Involvement of both women and men in CLTS triggering and behaviour change communication campaigns to reinforce the importance of ending open defecation in whether in bushes or at home could be necessary.