Assessing the Community-led Total Sanitation Approach in achieving Open Defecation Free Status among residents of Katikamu Sub-county, Luweero District
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Background: Open defecation can lead to public health problems most especially in areas where people defecate openly in bushes, gardens, rivers and other water bodies. Nonetheless, even with the availability of toilets, people still need to be convinced to desist from open defecation and use toilets. Therefore, the need for behavior change is critical in addition to the provision of toilets; this has been attempted through the use of programs like the Community-Led Total Sanitation (CLTS). Objective: The purpose of this study was to assess the contribution of the community led total sanitation approach in achieving open defecation free status among residents of Katikamu Sub County - Luwero district Methods: This was a mixed methods cross sectional study. Both qualitative and quantitative data was collected for this study. Simple random sampling was used to sample out seven of the nine present parishes. In each of the sampled parishes cluster sampling was used to map out the parishes; in this procedure the parishes were clustered into rural parishes and urban parishes. Systematic sampling was used to select households with the eligible respondent who was a household head. Structured interviews were conducted to collect quantitative data from the respondents. Focus group discussions were conducted in this study in order to triangulate it (have more than one method and therefore type of data to rely on) in order to achieve higher reliability of the results. The quantified data was then transferred to Statistical Package of Social sciences (SPSS) computer package for data analysis. Qualitative data was analyzed using content analysis Results: When asked whether the household of or any of his house hold members with the exemption of infants had eased themselves in a place other than a latrine or toilet, more than three quarters of them denied this occurrence 327(85.2%). More than half of the respondents 245(63%) reported that a member of the CLTS program team had come around their area to check on the condition of latrines before the CLTS sessions started. Majority of the respondents noted that their household members were involved in the CLTS programme (72.1%), that the CLTS facilitation had helped them in realizing the importance of having a latrine 334 (87%). The importance of CLTS in having an ODF household was shown by the CLTS facilitators to the respondents according to 325 (84.6%) of them and lastly, it was also reported that the local authorities in Katikamu had been supportive all through the CLTS process (88.3%). Local resources for construction of latrines were possessed by the majority of the respondents (n = 226, 58.9%). For the respondents who owned latrines, resources for the maintenance of those latrines were owned by the vast majority of them (n = 295, 84.8%). Man power for pit latrine construction was also reported to be available by most of the respondents (n = 240, 62.5%). Resources for pit latrine construction and maintenance did not have a statistically significant relationship with open defecation status in Luwero district (p<0.05). Seven CLTS activities had statistically significant contributions to the open defecation status of residents in Katikamu Sub County. These were whether anyone came around to check on the condition of latrines before the CLT sessions started (X2 = 8.784, p = 0.000), whether CLTS facilitation helped in realizing the importance of having a latrine among the respondents (X2 = 5.528, p = 0.019), whether was easy to attend CLTS follow up sessions (X2 = 17.390, p = 0.000), the Officials who did the CLTS follow-up (X2 = 16.757, p = 0.000), whether follow up was done on the outcome of CLTS (X2 = 28.959, p = 0.000), whether the Community was declared ODF (X2 =3.859 , p = 0.049), and whether the respondents felt shame and disgust during the triggering sessions (X2 = 15.417, p = 0.000). Respondents in areas where someone came around to check on the condition of latrines before the CLTS sessions started were less likely to practice OD (OR = 0.362). This was the same for Individuals who said that CLTS facilitation helped in realizing the importance of having a latrine (OR = 0.540), and those for whom it was easy to attend CLTS follow up sessions (OR = 0.596) Conclusion: Open defecation is low but still existent in about 2 of every ten residents in Katikamu Sub County. The community led total sanitation program is effective in Katikamu Sub County with some minimal gaps in the pre triggering and follow phases. Resources for latrine construction are available; however this does not affect ODF status. The community led total sanitation program activities have a significant effect on the ODF status in Katikamu Sub County.