Perceptions of Latrine Safety and Mental Well-Being in urban Kampala, Uganda Pubblico

Abstract

Background: In Uganda, 60% of Kampala residents live in a slum, growing by 10% each year. Because of the growing population, shared sanitation facilities are increasingly common. Latrine users report these facilities as overused, dirty, and lacking adequate doors or proper lighting. The resulting loss of dignity, shame, and fear of harm associated with these latrines are stressors that influence how women navigate their sanitation options. Understanding which latrine attributes make women feel safe can highlight the characteristics that best improve women's sanitation experiences. This paper aims to understand the relationship between latrine attributes, safety, and anxiety among women in urban Kampala.

 

Methods: An Emory University team developed a cross-sectional survey to measure sanitation-related empowerment. Between December 2019 and February 2020, enumerators interviewed 1,024 women in Kampala. Latrine attributes included privacy, lockability, lighting, latrine sharing, and distance from the home. For outcomes, we assessed perceived lack of safety when using a latrine at night, and anxiety, using a two-question subscale of the PHQ-4. Multiple linear regressions determined the association between latrine attributes, perceived lack of safety, and anxiety.

 

Results: Sanitation locations were mostly private in location (71%), well-lit both on the way to and inside the latrine (60%), and capable of locking (83%). Approximately half (52%) of women reported never feeling unsafe using their latrine at night, and 33% of participants scored above the clinical anxiety threshold. Women who reported frequent perceived lack of safety had higher anxiety scores (p<0.01). A latrine's private location and ability to lock were associated with a more frequent perceived lack of safety. Private latrine locations were also associated with higher anxiety scores among women who did not perceive a lack of safety (p<0.01). Alternatively, women that used latrines with sufficient lighting reported more perceived safety and lower anxiety scores.

Conclusion: Latrine attributes play a significant role in how safe women feel using their latrines at night; however, these relationships are highly nuanced. Stakeholders can use this evidence to reassess latrine quality in urban Kampala and prioritize improving the attributes, like lighting inside latrines, that confer women the greatest feelings of safety.

Table of Contents

Table of Contents

Distribution Agreement................................................................................................................. 1

Abstract........................................................................................................................................... 4

Acknowledgments.......................................................................................................................... 6

1. Introduction................................................................................................................................ 8

1.1 Water, Sanitation and Hygiene (WASH) in Uganda................................................................ 8

1.2 WASH and Mental Well-being............................................................................................... 10

1.3 Research Objectives............................................................................................................... 12

2. Methods.................................................................................................................................... 14

2.1 Study Setting........................................................................................................................... 14

2.2 Study Design........................................................................................................................... 15

2.2.1 Target Sample Size.............................................................................................................. 15

2.2.2 Eligibility.............................................................................................................................. 16

2.2.3 Sampling.............................................................................................................................. 16

2.3 Data Collection....................................................................................................................... 16

2.4 Measures................................................................................................................................ 17

2.4.1 Outcomes............................................................................................................................. 17

2.4.2 Exposures............................................................................................................................. 19

2.4.3 Covariates............................................................................................................................ 20

2.5 Data Analysis.......................................................................................................................... 20

2.6 Ethics...................................................................................................................................... 21

3. Results....................................................................................................................................... 22

3.1 Sample Size and Demographics............................................................................................. 22

3.2 Perceived Lack of Safety......................................................................................................... 25

3.3 Mental Well-being.................................................................................................................. 27

4. Discussion................................................................................................................................. 30

4.1 Strengths and Limitations...................................................................................................... 33

5. Public Health Implications....................................................................................................... 36

Appendix....................................................................................................................................... 38

Bibliography.................................................................................................................................. 39

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Parola chiave	anxiety sanitation PHQ-4 women toilet
Committee Chair / Thesis Advisor	Dr. Thomas Clasen, Emory University Dr. Bethany Caruso, Emory University

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