title: Follow-up of a low cost latrine promotion programme in one district of Amhara, Ethiopia: characteristics of early adopters and non-adopters.
abstract: OBJECTIVE
  To verify reported construction of 22 385 household latrines in 2004, after community mobilization, as part of a trachoma control programme in one district of Amhara, Ethiopia, and to explore characteristics of early latrine adopters and non-adopters.
  
  
  METHODS
  We used a two-stage cluster sample survey design to randomly select eight sub-districts and 160 households listed as having built a latrine, and visited them to verify presence and use. Household heads were interviewed to determine latrine cost and knowledge, attitude and practice regarding latrines. Non-latrine adopting neighbours were interviewed for comparison. We estimated district latrine ownership and calculated adjusted odds ratios for factors associated with latrine use.
  
  
  RESULTS
  Latrines were present in 87% (95% CI 77-97) of listed households; 90% (81-99) were in use. Among all district residents we estimated ownership as 50.2% (44-56) and use as 45.2% (36-55). Of latrine owners who had built in 2004, 69% (53/77) had spent nothing on their latrine, those who paid spent an average of US$4.0 [standard deviation (SD) US$3.6]; overall the median cost was US$0 and the mean US$0.80 (SD US$1.7). Household heads adopting latrines were 1.9 times (95% CI 1.3-2.8) more likely to have any education and 1.5 times (95% CI 1.1-2.0) more likely to have a larger family than non-adopting neighbours. Cleanliness (48%, 56/116) and health benefits (42%, 49/116) were the most frequently reported advantages of latrines.
  
  
  CONCLUSIONS
  The latrine promotion programme dramatically increased latrine access and use at very low cost. The method of community mobilization used could be an effective way of reaching millennium development sanitation targets.
authors.affiliation: Epidemic Intelligence Service, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Rosalyn
authors.initials: R
authors.lastname: O'Loughlin
authors.forename: Gashu
authors.initials: G
authors.lastname: Fentie
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D004522:Educational Status; D004867:Equipment Design; D005002:Ethiopia; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006794:Household Articles / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D015397:Program Evaluation; D014038:Toilet Facilities / Q000191:economics; D014141:Trachoma / Q000517:prevention & control