title: Is Using a Latrine "A Strange Thing To Do"? A Mixed-Methods Study of Sanitation Preference and Behaviors in Rural Ethiopia.
abstract: Latrines are the most basic form of improved sanitation and are a common public health intervention. Understanding motivations for building and using latrines can help develop effective, sustainable latrine promotion programs. We conducted a mixed-methods study of latrine use in the Amhara region of Ethiopia. We held 15 focus group discussions and surveyed 278 households in five communities. We used the Integrated Behavioral Model for Water, Sanitation, and Hygiene interventions to guide our qualitative analysis. Seventy-one percent of households had a latrine, but coverage varied greatly across communities. Higher household income was not associated with latrine use (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 0.5, 7.7); similarly, cost and availability of materials were not discussed as barriers to latrine use in the focus groups. Male-headed households were more likely to use latrines than households with female heads (OR = 3.5; 95% CI = 1.6, 7.7), and households with children in school were more likely to use latrines than households without children in school (OR = 2.3; 95% CI = 1.6, 3.3). These quantitative findings were confirmed in focus groups, where participants discussed how children relay health messages from school. Participants discussed how women prefer not to use latrines, often finding them strange or even scary. These findings are useful for public health implementation; they imply that community-level drivers are important predictors of household latrine use and that cost is not a significant barrier. These findings confirm that school-aged children may be effective conduits of health messages and suggest that latrines can be better marketed and designed for women.
authors.affiliation: Francis I Proctor Foundation, University of California San Francisco, San Francisco, California. kristen.aiemjoy@ucsf.edu.
authors.forename: Kristen
authors.initials: K
authors.lastname: Aiemjoy
authors.affiliation: Francis I Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Stoller
authors.affiliation: Francis I Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: Sintayehu
authors.initials: S
authors.lastname: Gebresillasie
authors.affiliation: The Carter Center, Atlanta, Georgia.
authors.forename: Ayalew
authors.initials: A
authors.lastname: Shiferaw
authors.affiliation: The Carter Center, Atlanta, Georgia.
authors.forename: Zerihun
authors.initials: Z
authors.lastname: Tadesse
authors.affiliation: Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia.
authors.forename: Tegene
authors.initials: T
authors.lastname: Sewent
authors.affiliation: Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia.
authors.forename: Bezuayehu
authors.initials: B
authors.lastname: Ayele
authors.affiliation: Amhara Regional Health Bureau, Bahir-Dar, Ethiopia.
authors.forename: Melsew
authors.initials: M
authors.lastname: Chanyalew
authors.affiliation: The Carter Center, Atlanta, Georgia.
authors.forename: Solomon
authors.initials: S
authors.lastname: Aragie
authors.affiliation: The Carter Center, Atlanta, Georgia.
authors.forename: Kelly
authors.initials: K
authors.lastname: Callahan
authors.affiliation: The Carter Center, Atlanta, Georgia.
authors.forename: Aisha
authors.initials: A
authors.lastname: Stewart
authors.affiliation: The Taskforce for Global Health, Decatur, Georgia.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.affiliation: Francis I Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
authors.affiliation: Francis I Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.affiliation: Francis I Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003252:Construction Materials / Q000191:economics; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012499:Sanitation; D012959:Socioeconomic Factors; D014038:Toilet Facilities; D055815:Young Adult