Effect of a Community Health Worker Led Health Education Intervention on Latrine Coverage in Mwingi West Sub-County; Kenya: A Quasi-Experiment

Abstract

It is estimated that globally 2.4 billion people still lack access to improved sanitation and 946 million still practice open defecation. Every Kenyan has a right to adequate sanitation and the government of Kenya is committed to ensure that Kenyans enjoy adequate sanitation by the year 2030. Despite this commitment, latrine coverage in many parts of Kenya is low and the result is a high prevalence of hygiene and sanitation related illnesses. In Kitui County, open defecation is high at 30.9%. The aim of this study was to assess effect of Community Healthy Strategy (CHS) on latrine coverage in Mwingi West sub county, Kitui County-Kenya. The study was a pretest-post test experiment with intervention and control sites. Mwingi West and Mwingi North sub-counties were intervention and control sites respectively. Participants in intervention site received health education on importance latrine construction and safe fecal disposal while control site did not. In each site, 1 pre-intervention and 2 post-intervention surveys were conducted with each survey having a sample size of 422 households. An observation checklist and a questionnaire were the main data collection tools. In the intervention site, CHS significantly increased latrine coverage from baseline to midterm survey and from baseline to end-term survey by 21% (Z=7.0128, P=0.0001) and 27.6% (Z=9.7189, P=0.0001) respectively. Compared to baseline, households in intervention site-midterm survey and intervention site-endterm survey were 4 times more likely to have a latrine (adj. OR: 4.356, P<0.0001, 95% CI: 2.975-6.379 and 3 times more likely to have a latrine (adj. OR: 3.391, P<0.0001, 95% CI: 2.686-4.280) respectively. No significant difference was observed on latrine coverage in the control site. CHS significantly increased latrine coverage in Mwingi West Sub-county. To declare Kenya an Open Defecation Free country and help the country meet the global sanitation related Sustainable Development Goals by 2030, county governments need to scale up implementation of CHS to cover areas which have not been covered.