title: User perceptions of shared sanitation among rural households in Indonesia and Bangladesh.
abstract: BACKGROUND
  The practice of sharing sanitation facilities does not meet the current World Health Organization/UNICEF definition for what is considered improved sanitation. Recommendations have been made to categorize shared sanitation as improved sanitation if security, user access, and other conditions can be assured, yet limited data exist on user preferences with respect to shared facilities.
  
  
  OBJECTIVE
  This study analyzed user perceptions of shared sanitation facilities in rural households in East Java, Indonesia, and Bangladesh.
  
  
  METHODS
  Cross-sectional studies of 2,087 households in East Java and 3,000 households in Bangladesh were conducted using questionnaires and observational methods. Relative risks were calculated to analyze associations between sanitation access and user perceptions of satisfaction, cleanliness, and safety.
  
  
  RESULTS
  In East Java, 82.4% of households with private improved sanitation facilities reported feeling satisfied with their place of defecation compared to 68.3% of households with shared improved facilities [RR 1.19, 95% CI 1.09, 1.31]. In Bangladesh, 87.7% of households with private improved facilities reported feeling satisfied compared to 74.5% of households with shared improved facilities [RR 1.15, 95% CI 1.10, 1.20]. In East Java, 79.5% of households who reported a clean latrine also reported feeling satisfied with their place of defecation; only 38.9% of households who reported a dirty latrine also reported feeling satisfied [RR 1.74, 95% CI 1.45, 2.08].
  
  
  CONCLUSIONS
  Simple distinctions between improved and unimproved sanitation facilities tend to misrepresent the variability observed among households sharing sanitation facilities. Our results suggest that private improved sanitation is consistently preferred over any other sanitation option. An increased number of users appeared to negatively affect toilet cleanliness, and lower levels of cleanliness were associated with lower levels of satisfaction. However, when sanitation facilities were clean and shared by a limited number of households, users of shared facilities often reported feeling both satisfied and safe.
authors.affiliation: Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, D.C., United States of America.
authors.forename: Kali B
authors.initials: KB
authors.lastname: Nelson
authors.affiliation: Washington, D.C., United States of America.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karver
authors.affiliation: World Bank Water and Sanitation Program, Washington, D.C., United States of America.
authors.forename: Craig
authors.initials: C
authors.lastname: Kullman
authors.affiliation: Department of Environmental and Occupational Health and Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C., United States of America.
authors.forename: Jay P
authors.initials: JP
authors.lastname: Graham
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012499:Sanitation / Q000706:statistics & numerical data*; D014038:Toilet Facilities / Q000592:standards
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