Household-level sanitation in Ethiopia and its influencing factors: a systematic review

Barriers to transition to resource-oriented sanitation in rural Ethiopia

Recycling excreta resources through resource-oriented toilet systems (ROTS) holds transformative potential, yet adoption remains limited, especially where benefits could be high. This study aims to understand constraints hindering the adoption of ROTS in one such area in Ethiopia. Based on a survey among 476 households comprising 2393 individuals, we examine the plans to use ROTS and willingness to pay for ROTS and apply structural equation modelling to analyze the drivers of these two outcomes while comparing the explanative power of the extended technology acceptance model, extended theory of planned behaviour, and their combined model. While 40% of households expressed a plan to use ROTS and 20% reported willingness to pay for a subsidized ROTS with a biogas unit, merely 7% revealed both the plan to use and sufficient willingness to pay, highlighting the need to target both these complementary outcomes concurrently. The theory of planned behaviour showed the best explanative power, also revealing that these two outcomes are influenced by partly distinct sets of factors. Findings imply that common efforts to ease objective constraints through subsidies, which incentivize willingness to pay, are necessary but not sufficient for facilitating the adoption of ROTS. To simultaneously enhance intentions to use, it is also recommended to target psychosocial drivers, such as perceived behavioural control and perceived community support, through awareness creation, behaviour change activities, and community engagement techniques.

Household Sanitation and Crowding Status in Addis Health and Demographic Surveillance System (Addis-HDSS) in Addis Ababa, Ethiopia

Background

Access to sanitation and healthy housing conditions are essential for public health, reducing the spread of diseases and improving overall well-being. However, millions of people, particularly in low-income countries, still lack access to basic sanitation and housing facilities. This study assessed household sanitation and crowding status in a rapidly developing urban area of Addis Ababa.

Methods

Data were extracted from the household census conducted from December 2022 to January 2023 at the Addis-HDSS site. Availability of basic sanitation facilities was defined as the presence of privately owned sanitation facilities within the household. Household crowding was measured by the number of occupants per bedroom. Multivariable logistic regression was used to identify factors associated with access to sanitation facilities (STATA/SE 14.2). A p-value of <0.05 was considered statistically significant.

Results

The study included 30,533 households. Overall, 76.37% (95% CI: 74.86-77.2) lacked access to basic sanitation facilities. Most households (67.42%) lived in overcrowded housing. Educational status of the household head and household size were significantly associated with sanitation access. Households with college-educated heads were more likely to have access to basic sanitation (AOR 2.52, 95% CI: 2.27-2.79), while overcrowded households were less likely to have such access (AOR 0.06, 95% CI: 0.040-0.063).

Conclusions

A large proportion of households lacked basic sanitation facilities and lived in overcrowded housing, which increases the risk of infectious disease transmission. Improving sanitation and housing conditions is crucial for reducing health risks and improving public health outcomes.

Fecal Sludge Management and Sanitation Safety: An Assessment in Addis Ababa, Ethiopia

Background

Sanitation safety practices and risks associated with fecal sludge management are crucial for public health and the environment. This study assessed sanitation safety practices and risks in Addis Ababa, Ethiopia, at different stages of fecal sludge management. The research aimed to understand the current state of sanitation facilities, practices, and associated risks and identify areas for improvement.

Materials and Methods

A mixed methods/approach was employed, utilizing household surveys, risk assessments, and sanitary inspections. A total of 384 study subjects were interviewed using face-to-face interviews and observations.

Results

The findings revealed that the majority of households (97.7%) had consistent access to toilets, with flush/pour flush toilets being the most common type (47.4%). Factors such as odors in toilets or septic tanks, open defecation by children, and the use of untreated wastewater for food production were significantly associated with sociodemographic factors. Risk assessments indicated that 67% of households fell into the low-risk category, while 33% were classified as intermediate risk. The study identified non-compliance issues during sanitary inspections at transfer stations (45%), a wastewater treatment and disposal facility (61.5%), and in the management of wastewater and sludge in the sewer line (64%). These findings call for urgent actions to address improper feces disposal, inadequate maintenance of sanitation facilities, and unsafe practices in fecal sludge management.

Conclusion

This study identified concerning issues in fecal sludge management, including improper feces disposal, inadequate facility maintenance, and non-compliance with safety standards during emptying, transport, treatment, and disposal. Urgent action is needed to address these risks. Promoting proper disposal techniques, improving facility maintenance, education programs, strengthening regulations, providing training and protective equipment, and investing in enhanced sanitation facilities and wastewater treatment methods are essential for improving sanitation safety practices.

Promotion of market-based sanitation in Ethiopia: a case study from Wolaita zone

Ethiopia increased the availability of latrines notably, but the sanitation facilities rarely meet hygienic standards. Therefore, the market-based sanitation (MBS) programme has been implemented across the country for nearly a decade to expand the market and boost the demand for hygienic sanitation products and services. While it does not seem that the MBS would bring any notable change in sanitation conditions so far, its implementation challenges are not adequately understood. To address this gap, this article delves into the grassroots-level implementation of MBS in the Wolaita zone. The study relies on qualitative data gathered through interviews with various stakeholders, examining both demand- and supply-side challenges. Some issues identified were external to MBS implementation, such as high inflation and an unstable political and security situation in Ethiopia. Additionally, the study reveals that more general deficiencies of the Ethiopian health extension program, including the stress and discouragement of local change agents (health extension workers, health development army members) due to workloads and low remuneration, have adversely impacted MBS delivery. The implementation of MBS has also not effectively addressed the affordability of hygienic sanitation products. On the supply side, economic constraints and organizational inefficiencies have hindered the development of the sanitation market, preventing it from reaching a critical mass. Our research suggests that MBS alone will not suffice to improve sanitation in Ethiopia.

Sustainability of facilities built under the Community-Led Total Sanitation (CLTS) implementation: Moving from basic to safe facilities on the sanitation ladder

In the context of monitoring progress towards SDG target 6.2, a household is counted to have access to sanitation if it uses at least basic sanitation services. Several approaches have been employed to help rural communities to climb up the sanitation ladder such as Community-led Total Sanitation (CLTS), whose primary target is to end open defecation through behavior change. CLTS does not subsidize sanitation facilities, but let households build their own facilities. The types and sustainability of facilities when construction is entrusted to households without guidelines remain understudied. The contribution of CLTS in achieving SDG6.2 also have not been studied. This paper addresses these gaps. Conducted in the province of Sissili in Burkina Faso, our study involved interviewing CLTS implementers, government officials, and community stakeholders. Coupled with household surveys, the data was analyzed using SPSS and Excel software. Findings indicate that CLTS succeeded in motivating households to build latrines hence escalating latrine coverage from 29.51% in 2016 (pre-CLTS) to 90.44% in 2020 (post-CLTS) in the province. However, 97.53% of latrines built were unimproved pit latrines with superstructures and without/with wooden or clay slabs and no roof, of which 19.76% collapsed during the rainy season. During this period, sanitation access rate rose from 11.9% to 17.00%. The study has therefore revealed that CLTS significantly elevates latrine coverage, yet it does not guarantee a proportional rise in sanitation access. This discrepancy results from the type of technologies generated by CLTS, which are not considered in calculating the sanitation access rate due to their unimproved nature. Consequently, further exploration of social approaches is essential, amalgamating technical and engineering aspects. Beyond socio-economic considerations, the sustainability of CLTS and the achievement of access to adequate and safe sanitation also rely on the robustness and resilience of the implemented facilities.

Effects of Community-Led Total Sanitation (CLTS) Boosting and Household Factors on Latrine Ownership in Siaya County, Kenya

Community-led total sanitation (CLTS) is a widely used approach for enhancing sanitation practices. However, the impact of boosted CLTS on household latrine ownership has not been adequately evaluated. This study aims to investigate the factors associated with latrine possession among households, with a specific focus on single and CLTS-boosting implementation. A community-based repeated cross-sectional study was conducted in Siaya County, Kenya, involving 512 households at the baseline and 423 households at the follow-up. Data were analyzed using the mixed-effects logistic regression model. At the baseline, latrine possession was significantly associated with CLTS implementation (adjusted OR [aOR]: 3.01; 95% confidence interval [CI]: 1.41-6.44), literacy among households (aOR: 1.83; 95% CI: 1.12-2.98) and higher socioeconomic status (SES) (second level: aOR: 2.48; 95% CI:1.41-4.36, third level: aOR: 3.11; 95% CI: 1.76-5.50, fourth level: aOR: 10.20; 95% CI: 5.07-20.54). At follow-up, CLTS boosting (aOR: 7.92; 95% CI: 1.77-35.45) and a higher SES were associated with increased latrine ownership (second level: aOR: 2.04; 95% CI: 0.97-4.26, third level: aOR: 7.73; 95% CI: 2.98-20.03, fourth level: aOR: 9.93; 95% CI: 3.14-28.35). These findings highlight the significant role played by both single and CLST boosting in promoting universal latrine ownership and empowering vulnerable households to understand the importance of sanitation and open defecation-free practices.

Demographic, social and economic factors affecting the adoption of green toilets among rural households in India

This study investigates the demographic, social and economic factors as key determinants of green toilet adoption among rural households in India. The Rural Impact Survey data of the World Bank have been used for this study, covering 2731 rural households from Bihar, Madhya Pradesh, and Uttar Pradesh. The chi-square test and regression analysis with marginal estimate have been used to analyze the data. Result of the analysis indicates that about 36.2 percent surveyed rural households have reported access to green toilets having proper effluent discharge systems as per the environmental norms. Further, there is a significant association between the adoption of green toilets and demographic, social and economic characteristics of rural households. Finally, the regression analysis indicates that a number of demographic, social and economic factors i.e., age, education, income, social category, access to information, access to drinking water, and asset ownership have a significant marginal effect on the adoption of green toilets in rural India. Considering the importance of ensuring total sanitation and commitment under the Sustainable Development Goals (SDGs) of the United Nations for eradicating open defecation for all by 2030 in the country, the results of the study provide useful policy directions for enhancing the adoption of green toilets among the rural households in India.