title: Ending open defecation in rural Tanzania: which factors facilitate latrine adoption?
abstract: Diarrheal diseases account for 7% of deaths in children under five years of age in Tanzania. Improving sanitation is an essential step towards reducing these deaths. This secondary analysis examined rural Tanzanian households' sanitation behaviors and attitudes in order to identify barriers and drivers to latrine adoption. The analysis was conducted using results from a cross-sectional study of 1000 households in five rural districts of Tanzania. Motivating factors, perceptions, and constraints surrounding open defecation and latrine adoption were assessed using behavioral change theory. Results showed a significant association between use of improved sanitation and satisfaction with current sanitation facility (OR: 5.91; CI: 2.95-11.85; p = 0.008). Livestock-keeping was strongly associated with practicing open defecation (OR: 0.22; CI 0.063-0.75; p < 0.001). Of the 93 total households that practiced open defecation, 79 (85%) were dissatisfied with the practice, 62 (67%) had plans to build a latrine and 17 (18%) had started saving for a latrine. Among households that planned to build a latrine, health was the primary reason stated (60%). The inability to pay for upgrading sanitation infrastructure was commonly reported among the households. Future efforts should consider methods to reduce costs and ease payments for households to upgrade sanitation infrastructure. Messages to increase demand for latrine adoption in rural Tanzania should integrate themes of privacy, safety, prestige and health. Findings indicate a need for lower cost sanitation options and financing strategies to increase household ability to adopt sanitation facilities.
authors.affiliation: Department of Environmental and Occupational Health, School of Public Health and Health Services, George Washington University, 2100 M St., NW Suite 200, Washington, DC 20037, USA. ssara@gwu.edu.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sara
authors.affiliation: Department of Environmental and Occupational Health, School of Public Health and Health Services, George Washington University, 2100 M St., NW Suite 200, Washington, DC 20037, USA. jgraham@gwu.edu.
authors.forename: Jay
authors.initials: J
authors.lastname: Graham
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003672:Defecation; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data; D012499:Sanitation; D013636:Tanzania; D014038:Toilet Facilities / Q000706:statistics & numerical data*; D055815:Young Adult