Sustainability of Post-Open Defecation-Free Status and Contributing Factors among Households in Kakamega County, Kenya
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Date
2025-03
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Kenyatta University
Abstract
Sanitation serves as a crucial metric of developmental progress, with over 24.4% of the global population currently without essential sanitation and 8.4% continuing to engage in open defecation in public areas. In Kenya, open defecation poses a considerable healthcare issue, facilitating occurrences of water-related diseases and neglected tropical diseases such as intestinal worms, schistosomiasis, and trachoma. The purpose of this study was to find out the sustainability of post-ODF status among certified households and factors that affect ODF in Butere Sub-County, Kakamega County in Kenya. The specific objectives include determining the current ODF status of households; identifying the socio-demographic, cultural, and environmental factors affecting post-ODF sustainability; and assessing the role of behaviour change communication (BCC) in sustaining post-ODF status. A cross-sectional survey design was employed. The research focused on 6,286 households from 66 ODF-certified villages in Butere Sub-County, which had a total population of 139,780 individuals. The research used multi-stage sampling to select the three wards (Marama Central, Marama West, and Marenyo-Shianda). The study targeted household heads from a sample of 376 households were selected using a proportionate random sampling technique. Quantitative data was collected using a structured questionnaire and observational checklist. Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) were conducted with the members of the community and health officials to yield qualitative information regarding post-ODF sustainability. A pre-test was done in two neighbouring villages within Kisa wards in Khiwisero Sub-County. A validity test was used to assess the study method and make sure it answered the researcher's questions about the suggested topic. Cronbach's alpha was used to test for reliability and an alpha value of 0.78 was obtained. SPSS (version 30.0) was used to analyse the quantitative data, employing statistical techniques such as univariate, bivariate, and multivariate analysis. NVivo 12 software supported the thematic analysis of qualitative data. The study found that only 9% of households sustained their post-ODF status. A significant correlation existed between demographic variables, including gender, age, level of education, employment, and post-ODF sustainability (p<.05). Employed individuals were 1.333 times more likely to maintain ODF status. Cultural factors, such as taboos on sharing sanitation facilities among in-laws, and environmental factors such as poor soil conditions had a statistically significant association with post-ODF sustainability. Communication on behaviour change, particularly through regular follow-ups by Community Health Promoters (CHPs), was crucial in reinforcing post-ODF sustainability. The study found that households that participated in CLTS triggering increased the likelihood of sustaining ODF by 1.491 times. The study concluded that socio-demographic, cultural, environmental factors and behaviour change communication influenced post-ODF sustainability. The study recommended that the Department of Public Health and Sanitation should enhance door-to-door monitoring and follow-up systems to effectively track post-ODF sustainability at the household level. WASH stakeholders should design and support economic empowerment programs tailored to increase household income and invest in research and innovation aimed at developing cost-effective and environmentally sustainable sanitation facilities.
Description
A Research Thesis Submitted in Partial Fulfilment of the Requirement for the Award of the Degree of Master of Public Health (Epidemiology and Disease Control) in the School of Health Sciences of Kenyatta University, March 2025.
Supervisors
1. Isaac Mwanzo
2. Anthony Wanjohi Nyambura