title: Effect of eliminating open defecation on diarrhoeal morbidity: an ecological study of Nyando and Nambale sub-counties, Kenya.
abstract: Defecating in the open predisposes people to soil transmitted helminthes and diarrhoeal diseases. An estimated 5.6 million Kenyans defecate in the open. Kenya launched a program to eradicate open defecation by 2013 in the rural areas. By end of 2013, only two sub-counties had eliminated open defecation. These are Nambale and Nyando. The study looked at the impact of eradicating open defecation on diarrhea prevalence among children in these two sub-counties.
  
  
  
  Data on diarrhoea morbidity among children under 5 years was extracted from the Kenya Health Information System for all the sub-counties in Busia and Kisumu counties for 2012, 2013 and 2014 respectively. Prevalence was calculated for each sub-county in Kisumu for comparison with Nyando's. Prevalence was also calculated for each sub-county in Busia County and compared to that of Nambale sub-county. A Mann-Whitney U Test was done to test the null hypothesis that diarrhoea prevalence was similar in both open defecation and open defecation free sub-counties.
  
  
  
  A Mann-Whitney U Test revealed significant difference in diarrhoeal prevalence of open defecation sub-counties (Md = 18.4, n = 34) and open defecation free sub-counties (Md = 9.8, n = 5), U = 9, z = -3.2, p = .001. Among the two Counties, Nambale had the lowest prevalence. It recorded a decline from 9.8 to 5.7 % across the three years. Prevalence for diarrhoea cases in Nyando declined from 19.1 to 15.2 % across the three years. Nyando initially had the second highest prevalence in Kisumu County and by 2014 it had the lowest prevalence.
  
  
  
  The two sub-counties with open defecation free status had lower prevalence of diarrhoea cases compared to sub-counties which were yet to attain open defecation free status. This suggests that elimination of open defecation may reduce the number of diarrhoea cases.
authors.affiliation: Mukurwe-ini sub-County Public Health Office, P.O. Box 112-10103, Mukurwe-ini, Kenya. jowanju2002@gmail.com.
authors.forename: John
authors.initials: J
authors.lastname: Njuguna
mesh_terms: D000818:Animals; D002675:Child, Preschool; D003672:Defecation; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D004463:Ecology; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology*; D006078:Government Programs; D006376:Helminths; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D015397:Program Evaluation; D012424:Rural Population; D012987:Soil; D014038:Toilet Facilities
chemical_list: D012987:Soil
keywords: Community- led total sanitation; Diarrhoea; Kenya; Open defecation