title: Latrine access and utilization among people with limited mobility: A cross sectional study.
abstract: BACKGROUND
  Latrine access is one of the challenges faced by people with physical disabilities that limit their mobility (PPDs) in their home and working environments. Latrines should be designed, built and located such that they are easily accessible and utilizable by PPDs. Therefore, the aim of this study was to determine latrine access and utilization, and explore the challenges in latrine use among PPDs in Bahir Dar city, northwest Ethiopia.
  
  
  METHODS
  A cross-sectional study design was conducted from July 15 to August 15, 2014. Data were collected using a structured and pre-tested questionnaire, and focus group discussions. Four hundred nineteen participants were included using a systematic random sampling technique. SPSS version 20 was used for data entry and analysis. Binary logistic regression was used to identify factors associated with latrine utilization. Qualitative data were analyzed using themes.
  
  
  RESULTS
  Of 419 participants, 142 (33.9 %) had access to latrines and 173 (41.3 %) had satisfactory latrine utilization. Family support while using latrine (AOR = 4.7, 95 % CI (2.7, 8.3), latrine accessibility (AOR = 2.1, 95 % CI (1.2, 3.7) and past latrine modification (AOR = 3.1, 95 % CI (1.8, 5.4) were factors associated with latrine utilization. Presence of steps at the latrine entrance, privacy while using latrine, absence of handrails, unavailability of family support, narrower latrine door, distant latrine, unclean floor of the latrine and elevated foot rests were challenges mentioned by PPDs.
  
  
  CONCLUSIONS
  Latrine access and utilization were low among PPDs. Family members should encourage and support PPDs when they need to use latrine, designing accessible latrines, modifying existing latrines to accommodate PPDs are the areas of interventions to increase latrine accessibility and utilization among PPDs.
authors.affiliation: Organization for Rehabilitation and Development in Amhara (ORDA), MDG - Urban Sanitation Project, P.O.Box 132, Bahir Dar, Ethiopia.
authors.forename: Berhanu
authors.initials: B
authors.lastname: Asfaw
authors.affiliation: School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
authors.forename: Muluken
authors.initials: M
authors.lastname: Azage
authors.affiliation: School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
authors.forename: Gebremedhin Berhe
authors.initials: GB
authors.lastname: Gebregergs
keywords: Disability; Latrine access; Latrine utilization; People with limited mobility