Adherence to CLTS practices: a qualitative examination of contextual factors that influence open defecation practices in the Zanzan district of Côte d'Ivoire Open Access

Abstract

Background: Open defecation is common in many low-and middle-income countries, including Côte d'Ivoire, which has a prevalence rate of 28% in rural areas and a national rate of 51%. Community-Led Total Sanitation (CLTS) was developed by Kar Kamal in 1999 as an approach to ending open defecation and encouraging community ownership of their sanitation problem.

Objective: My aim is to examine how contextual factors in the Zanzan district of Côte d'Ivoire influence the sustainability of open defecation cessation after the implementation of CLTS.

Methods: Twenty focus group discussions (FGDs) and demographic surveys were conducted from May-July 2015 with groups of men and women in ten villages categorized into three types according to their open defecation status following implementation of CLTS. Three in-depth interviews (IDIs) were also conducted with CLTS facilitators in July 2015. FGDs and IDIs transcripts were analyzed qualitatively using MAXQDA software, and descriptive statistics were drawn from the demographic surveys using the statistical software SAS.

Results: Participants indicated that the ability and willingness to end the practice of open defecation following implementation of CLTS was primarily contingent upon personal circumstances, some of which they had control over and others of which they did not. The catalyst for behavior change after CLTS implementation was framed in terms of receiving information about the negative health implications of open defecation, but once that knowledge was obtained, the desire to change was dependent on other factors. Financial constraint was seen as a prominent factor in the participants' ability to build latrines among all three types of villages. The inability to build latrines was also attributed to the physical environment. Community members' willingness to assist others in building their latrines, as well as the ability of the community's leaders to command authority, contributed to the village's open defecation status.

Conclusion: Programs that attempt to end the practice of open defecation through CLTS should adjust their project implementation to adequately address factors specific to the community, including personal benefits to be obtained from behavior cessation, financial constraints, and challenges with the environment that might hinder the uptake of latrine construction.

Table of Contents

CHAPTER I: INTRODUCTION ........................................................................................1

CONTEXT OF PROJECT ................................................................................................1

PROBLEM STATEMENT ................................................................................................3

PURPOSE OF PROJECT .................................................................................................4

DEFINITION OF TERMS ...............................................................................................5

CHAPTER II: LITERATURE REVIEW ..............................................................................6

GLOBAL BURDEN OF OPEN DEFECATION ....................................................................6

Health Implications .....................................................................................................7

Knowledge, attitudes and practices ...............................................................................9

BEHAVIOR CHANGE AND SANITATION .......................................................................11

COMMUNITY-LED TOTAL SANITATION .......................................................................13

Impact of CLTS ...........................................................................................................15

CHAPTER III: MANUSCRIPT .......................................................................................17

I. INTRODUCTION ......................................................................................................17

II. METHODS ..............................................................................................................20

Study Setting and Population .......................................................................................20

Data Collection ...........................................................................................................23

Data Processing and Analysis .......................................................................................24

Ethical Consideration ..................................................................................................24

Quality Control ...........................................................................................................25

III. RESULTS ...............................................................................................................25

Quantitative ...............................................................................................................25

Qualitative .................................................................................................................26

IV. DISCUSSION AND CONCLUSION ............................................................................40

Limitations ................................................................................................................43

V. RECOMMENDATIONS .............................................................................................45

VI. REFERENCES ........................................................................................................47

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General
Keyword	CLTS open defecation Côte d'Ivoire
Committee Chair / Thesis Advisor	Winskell Enger, Kate, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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