Skip to main content
Top
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

The role of psychological factors in predicting latrine ownership and consistent latrine use in rural Ethiopia: a cross-sectional study

Authors: Fikralem Alemu, Abera Kumie, Girmay Medhin, Janvier Gasana

Published in: BMC Public Health | Issue 1/2018

Login to get access

Abstract

Background

Inadequate sanitation is one of the leading causes of disease in poor and middle-income countries.

Objective

The objective of the study was to identify the psychological factors that predict latrine ownership and consistent latrine use in the rural Becho district of central Ethiopia.

Method

A quantitative, cross-sectional, community based study was conducted. A total of 1047 heads of household were interviewed using a structured questionnaire. Ownership of latrine and consistent latrine use constituted the outcome variable of the study. Data were entered using Epi Info version 3.5.4 and were analyzed using SPSS version 20.

Results

Of the 1047 households, 73% owned a traditional pit latrine. Among the psychological factors, attitude (AOR 1.70; 95% CI 1.21–2.37) and injunctive norm (AOR 6.18; 95% CI 4.46–10.44) were positively and significantly associated with latrine ownership. Among the demographic factors, having a family size of more than six (AOR = 1.43; 95% CI 1.01–1.97, having a child attending school (AOR = 1.88; 95% CI 1.17–3.02), and having a high school education (AOR = 1.98; 95% CI 1.34–2.87) were significantly associated with latrine ownership. With respect to exposure to communication about sanitation (the cues to action), households that had a family member who took part in Community Led Total Sanitation and Hygiene (CLTSH) triggering were three times more likely to be latrine owners than those who did not participate in CLTSH triggering (95% CI 1.92–4.78.) Results from adjusted logistic regression analysis of potential predictors of consistent latrine use showed that having a positive attitude (AOR 7.00; 95% CI 4.55–10.55), owning of a latrine that had superstructure (AOR 2.3 95% CI 1.47–3.48), having a clean latrine (AOR 1.69 95% CI 1.00–3.00), and having a latrine with a protected door (AOR 1.94; 95% CI 1.10–3.48) were significantly associated with consistent latrine use.

Conclusion

The study findings showed that attitude and injunctive norm are the psychological predictors of latrine ownership, and consistent latrine use was associated with attitude, cleanliness of the latrine, and its privacy. Hence, sanitation intervention needs to focus on changing societal norms, attitudes, and the promotion of latrine quality.
Literature
1.
go back to reference Clasen T, Bostoen K, Schmidt W, Boisson S, Fung I, Jenkins M, Scott B, Sugden S, Cairncross S: Interventions to improve disposal of human excreta for preventing diarrhoea. International journal of Epidemology 2010, Supplement 1(39):i193-i205. Clasen T, Bostoen K, Schmidt W, Boisson S, Fung I, Jenkins M, Scott B, Sugden S, Cairncross S: Interventions to improve disposal of human excreta for preventing diarrhoea. International journal of Epidemology 2010, Supplement 1(39):i193-i205.
2.
go back to reference Waddington H, Snilstveit B. Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea. Journal of development effectiveness. 2009;1(3):295–335.CrossRef Waddington H, Snilstveit B. Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea. Journal of development effectiveness. 2009;1(3):295–335.CrossRef
3.
go back to reference Barreto M, Genser B, Strina A, Assis A, Rego R, Teles C, Prado M, Matos S, Santos D, Santos L, et al. Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies. Lancet. 2007;370(9599):1622–8.CrossRefPubMedPubMedCentral Barreto M, Genser B, Strina A, Assis A, Rego R, Teles C, Prado M, Matos S, Santos D, Santos L, et al. Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies. Lancet. 2007;370(9599):1622–8.CrossRefPubMedPubMedCentral
5.
go back to reference Prüss-Ustün A, Bartram J, Clasen T, Colford JC, Cumming O, Curtis V, Bonjour S, Dangour A, France J, Fewtrell L, et al. Burden of disease from inadequate water, sanitation and hygiene in low and middle income settings: a retrospective analysis of data from 145 countries. Tropical Med Int Health. 2014;19(8):894–905.CrossRef Prüss-Ustün A, Bartram J, Clasen T, Colford JC, Cumming O, Curtis V, Bonjour S, Dangour A, France J, Fewtrell L, et al. Burden of disease from inadequate water, sanitation and hygiene in low and middle income settings: a retrospective analysis of data from 145 countries. Tropical Med Int Health. 2014;19(8):894–905.CrossRef
6.
go back to reference WHO, UNICEF: Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines; 2017. WHO, UNICEF: Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines; 2017.
7.
go back to reference WHO: Global health risks: mortality and burden of disease attributable to selected major risks: World Health Organization; 2009. WHO: Global health risks: mortality and burden of disease attributable to selected major risks: World Health Organization; 2009.
8.
go back to reference Black R, Cousens S, Johnson H, Lawn J, Rudan I, Bassani D, Jha P, Campbell H, Walker C, Cibulskis R, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969; 1987.CrossRef Black R, Cousens S, Johnson H, Lawn J, Rudan I, Bassani D, Jha P, Campbell H, Walker C, Cibulskis R, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969; 1987.CrossRef
9.
go back to reference Tessa W, Peter S, Clarissa B, Mickey C, Elizabeth M. Diarrhoea: why children are still dying and what can be done. Lancet. 2010;375(9718):870; 872. Tessa W, Peter S, Clarissa B, Mickey C, Elizabeth M. Diarrhoea: why children are still dying and what can be done. Lancet. 2010;375(9718):870; 872.
10.
go back to reference Hotez PJ, Kamath A. Neglected tropical diseases in sub-Saharan Africa: review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis. 2009;3(8):e412.CrossRefPubMedPubMedCentral Hotez PJ, Kamath A. Neglected tropical diseases in sub-Saharan Africa: review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis. 2009;3(8):e412.CrossRefPubMedPubMedCentral
11.
go back to reference Mathers C, Fat D, Boerma J. The global burden of disease: 2004 update. Geneva, Switzerland: world health. Organization. 2008; Mathers C, Fat D, Boerma J. The global burden of disease: 2004 update. Geneva, Switzerland: world health. Organization. 2008;
12.
go back to reference Deribe K, Meribu K, Gebre T, Hailu A, Ali A, Assefa A, Davey G. The burden of neglected tropical diseases in Ethiopia, and opportunities for integrated control and elimination. Parasites and Vectors. 2012;5(240):1; 15. Deribe K, Meribu K, Gebre T, Hailu A, Ali A, Assefa A, Davey G. The burden of neglected tropical diseases in Ethiopia, and opportunities for integrated control and elimination. Parasites and Vectors. 2012;5(240):1; 15.
13.
go back to reference CSA: Ethiopia Demographic and Health Survey 2016 Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: SA and ICF; 2017. CSA: Ethiopia Demographic and Health Survey 2016 Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: SA and ICF; 2017.
15.
go back to reference FMOH: Ethiopian National Hygiene & Sanitation Strategic Action Plan for Rural, Peri-Urban & Informal Settlements 2011–2015. Addis Ababa; 2011. FMOH: Ethiopian National Hygiene & Sanitation Strategic Action Plan for Rural, Peri-Urban & Informal Settlements 2011–2015. Addis Ababa; 2011.
16.
go back to reference FMOH: Ethiopian national sanitation marketing guideline. Addis Ababa; 2013. FMOH: Ethiopian national sanitation marketing guideline. Addis Ababa; 2013.
17.
go back to reference FMOH. Ethiopian health sector transformation plan (HSTP) 2015/2016–2019/2020. Federal Ministry of Health: Addis Ababa; 2015. FMOH. Ethiopian health sector transformation plan (HSTP) 2015/2016–2019/2020. Federal Ministry of Health: Addis Ababa; 2015.
18.
go back to reference FDRE. National Hygiene & Sanitation Strategic Action Plan for rural. Addis Ababa: Per-Urban & Informal Settlements in Ethiopia Part II. Edited by Health FMOH; 2011. FDRE. National Hygiene & Sanitation Strategic Action Plan for rural. Addis Ababa: Per-Urban & Informal Settlements in Ethiopia Part II. Edited by Health FMOH; 2011.
19.
go back to reference WHO: Progress on Water Drinking Water and Sanitation-2015 update. Geneva: World Health Organization; 2015. WHO: Progress on Water Drinking Water and Sanitation-2015 update. Geneva: World Health Organization; 2015.
20.
go back to reference Cairncross S, Shordt K. It does last! Some findings from a multi-country study of hygiene sustainability. Waterlines. 2004;22(3):4–7.CrossRef Cairncross S, Shordt K. It does last! Some findings from a multi-country study of hygiene sustainability. Waterlines. 2004;22(3):4–7.CrossRef
21.
go back to reference Mara D, Lane J, Scott B, Trouba D. Sanitation and health. PLoS Med. 2010;7(11) Mara D, Lane J, Scott B, Trouba D. Sanitation and health. PLoS Med. 2010;7(11)
22.
go back to reference Peal A, Evans B, van der Voorden C. Hygiene and sanitation software: an overview of approaches. Switherland: water supply and sanitation. Program. 2010; Peal A, Evans B, van der Voorden C. Hygiene and sanitation software: an overview of approaches. Switherland: water supply and sanitation. Program. 2010;
23.
go back to reference Merchant AT, Jones C, Kiure A, Kupka R, Fitzmaurice G, Herrera MG, Fawzi WW. Water and sanitation associated with improved child growth. European journal of clinical nutrition. Eur J Clin Nutr. 2003;57(12):1562–8.CrossRefPubMed Merchant AT, Jones C, Kiure A, Kupka R, Fitzmaurice G, Herrera MG, Fawzi WW. Water and sanitation associated with improved child growth. European journal of clinical nutrition. Eur J Clin Nutr. 2003;57(12):1562–8.CrossRefPubMed
24.
go back to reference Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010;31(1):399–418.CrossRefPubMed Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010;31(1):399–418.CrossRefPubMed
25.
go back to reference Dreibelbis R, Winch PJ, Leontsini E, Hulland K, Ram PK, Unicomb L, Luby SP. The Integrated Behavioral Model for Water, Sanitation, and Hygiene: a systematic review of behavioral models and a framework for designing and evaluating behavior change interventions in infrastructure-restricted settings. BMC Public Health. 2013;13(1015):1; 13. Dreibelbis R, Winch PJ, Leontsini E, Hulland K, Ram PK, Unicomb L, Luby SP. The Integrated Behavioral Model for Water, Sanitation, and Hygiene: a systematic review of behavioral models and a framework for designing and evaluating behavior change interventions in infrastructure-restricted settings. BMC Public Health. 2013;13(1015):1; 13.
26.
go back to reference Noar SM, Zimmerman RS. Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Educ Res. 2005;20(3):275–90.CrossRefPubMed Noar SM, Zimmerman RS. Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Educ Res. 2005;20(3):275–90.CrossRefPubMed
27.
go back to reference Mosler H-J. A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. Int J Environ Health Res. 2012;22:431–49.CrossRefPubMed Mosler H-J. A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. Int J Environ Health Res. 2012;22:431–49.CrossRefPubMed
28.
go back to reference Connell K: What influences open defecation and latrine ownership in rural households?: findings from global review. 2014. Connell K: What influences open defecation and latrine ownership in rural households?: findings from global review. 2014.
29.
go back to reference MOH: Becho Woreda Health Report. Becho; 2015. MOH: Becho Woreda Health Report. Becho; 2015.
30.
go back to reference CSA: Federal Democratic Republic of Ethiopia. Summary and Statistical Report of the 2007 Addis Ababa: Population Census Commission; 2008. CSA: Federal Democratic Republic of Ethiopia. Summary and Statistical Report of the 2007 Addis Ababa: Population Census Commission; 2008.
31.
go back to reference CSA: Ethiopia mini demographic health survey. Addis Ababa: Central Statistics Agency; 2014. CSA: Ethiopia mini demographic health survey. Addis Ababa: Central Statistics Agency; 2014.
32.
go back to reference Redding C, Rossi J, Rossi S, Velicer W, Prochaska J: Health Behavior Models. Journal of Health Education 2000, Special Issue: 180; 193. Redding C, Rossi J, Rossi S, Velicer W, Prochaska J: Health Behavior Models. Journal of Health Education 2000, Special Issue: 180; 193.
33.
go back to reference Lapinski MK, Anderson J, Shugart A, Todd E. Social influence in child care centers: a test of the theory of normative social behavior. Health Commun. 29(3):219–32. Lapinski MK, Anderson J, Shugart A, Todd E. Social influence in child care centers: a test of the theory of normative social behavior. Health Commun. 29(3):219–32.
34.
go back to reference Mullan B, Wong C. Using the Theory of Planned Behaviour to design a food hygiene intervention. Food Control. 21(11):1524–9. Mullan B, Wong C. Using the Theory of Planned Behaviour to design a food hygiene intervention. Food Control. 21(11):1524–9.
35.
go back to reference Trafimow D, Sheeran P. Some tests of the distinction between cognitive and affective beliefs. J Exp Soc Psychol. 1998;34(4):378–97.CrossRef Trafimow D, Sheeran P. Some tests of the distinction between cognitive and affective beliefs. J Exp Soc Psychol. 1998;34(4):378–97.CrossRef
36.
go back to reference Inauen J, Hossain MM, Johnston RB, Mosler H-J: Acceptance and use of eight arsenic-safe drinking water options in Bangladesh: Bibliothek der Universität Konstanz. Inauen J, Hossain MM, Johnston RB, Mosler H-J: Acceptance and use of eight arsenic-safe drinking water options in Bangladesh: Bibliothek der Universität Konstanz.
37.
go back to reference Graf J, Meierhofer R, Wegelin M, Mosler HJ. Water disinfection and hygiene behavior in an urban slum in Kenya: impact on childhood diarrhoea and influence of beliefs. International Journal of Environmental Health Research. 2008;18(5):335; 355.CrossRef Graf J, Meierhofer R, Wegelin M, Mosler HJ. Water disinfection and hygiene behavior in an urban slum in Kenya: impact on childhood diarrhoea and influence of beliefs. International Journal of Environmental Health Research. 2008;18(5):335; 355.CrossRef
38.
go back to reference Ajzen I. Constructing a theory of planned behavior questioner. In Brief Description of the Theory of Planned Behavior. 2006;1:7. Ajzen I. Constructing a theory of planned behavior questioner. In Brief Description of the Theory of Planned Behavior. 2006;1:7.
39.
go back to reference Ajzen I, Fischbein M: Understanding attitudes and predicting social behavior Englewood cliffs; 1980. Ajzen I, Fischbein M: Understanding attitudes and predicting social behavior Englewood cliffs; 1980.
40.
go back to reference Lapinski M, Rimal R. An explication of social norms. Communication Theory. 2005;152(2):127–47.CrossRef Lapinski M, Rimal R. An explication of social norms. Communication Theory. 2005;152(2):127–47.CrossRef
41.
go back to reference Rimal RN, Real K. How behaviors are influenced by perceived norms a test of the theory of normative social behavior. Commun Res. 2005;32(3):389–414.CrossRef Rimal RN, Real K. How behaviors are influenced by perceived norms a test of the theory of normative social behavior. Commun Res. 2005;32(3):389–414.CrossRef
42.
go back to reference Klöckner CA, Matthies E. How habits interfere with norm-directed behaviour: a normative decision-making model for travel mode choice. J Environ Psychol. 2004;24(3):319–27.CrossRef Klöckner CA, Matthies E. How habits interfere with norm-directed behaviour: a normative decision-making model for travel mode choice. J Environ Psychol. 2004;24(3):319–27.CrossRef
43.
go back to reference Rimal RN. Modeling the relationship between descriptive norms and behaviors: a test and extension of the theory of normative social behavior (TNSB). Health Commun. 2008;23:104–16.CrossRef Rimal RN. Modeling the relationship between descriptive norms and behaviors: a test and extension of the theory of normative social behavior (TNSB). Health Commun. 2008;23:104–16.CrossRef
44.
go back to reference Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211.CrossRef Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211.CrossRef
45.
go back to reference Anteneh A, Kumie A. Assessment of the impact of latrine utilization on diarrheal diseases in the rural community of Hulet Ejju Enessie Woreda, East Gojam Zone, Amhara Region. Ethiopian Journal of Helath Development. 2010;24(2):111; 117. Anteneh A, Kumie A. Assessment of the impact of latrine utilization on diarrheal diseases in the rural community of Hulet Ejju Enessie Woreda, East Gojam Zone, Amhara Region. Ethiopian Journal of Helath Development. 2010;24(2):111; 117.
46.
go back to reference Awoke W, Muche S. A cross sectional study: latrine coverage and associated factors among rural communities in the District of Bahir Dar Zuria, Ethiopia. BMC Public Health. 2013;13(99):1; 6. Awoke W, Muche S. A cross sectional study: latrine coverage and associated factors among rural communities in the District of Bahir Dar Zuria, Ethiopia. BMC Public Health. 2013;13(99):1; 6.
47.
go back to reference Ashebir Y, Rai Sharma H, Alemu K, Kebede G. Latrine use among rural households in northern Ethiopia: a case study in Hawzien district, Tigray. Int J Environ Stud. 2013;70(4):629–36.CrossRef Ashebir Y, Rai Sharma H, Alemu K, Kebede G. Latrine use among rural households in northern Ethiopia: a case study in Hawzien district, Tigray. Int J Environ Stud. 2013;70(4):629–36.CrossRef
48.
go back to reference WHO, UNICEF: Meeting the MDG drinking water and sanitation target: the urban and rural challenge of the decade; 2006. WHO, UNICEF: Meeting the MDG drinking water and sanitation target: the urban and rural challenge of the decade; 2006.
49.
go back to reference FMOH. National Hyegine and sanitation strategy. Addis Ababa: Federal Democratic Republic of Ethiopia Ministry of Health; 2005. FMOH. National Hyegine and sanitation strategy. Addis Ababa: Federal Democratic Republic of Ethiopia Ministry of Health; 2005.
50.
go back to reference Thys S, Mwape KE, Lefèvre P, Dorny P, Marcotty T, Phiri AM, Phiri IK, Gabriël S. Why latrines are not used: communities’ perceptions and practices regarding latrines in a Taenia solium endemic rural area in eastern Zambia. PLoS Negl Trop Dis. 2015 Mar 4;9(3):e0003570.CrossRefPubMedPubMedCentral Thys S, Mwape KE, Lefèvre P, Dorny P, Marcotty T, Phiri AM, Phiri IK, Gabriël S. Why latrines are not used: communities’ perceptions and practices regarding latrines in a Taenia solium endemic rural area in eastern Zambia. PLoS Negl Trop Dis. 2015 Mar 4;9(3):e0003570.CrossRefPubMedPubMedCentral
51.
go back to reference Sah S, Negussie A. Community led total sanitation (CLTS): addressing the challenges of scale and sustainability in rural Africa. Desalination. 2009;248(1):666–72.CrossRef Sah S, Negussie A. Community led total sanitation (CLTS): addressing the challenges of scale and sustainability in rural Africa. Desalination. 2009;248(1):666–72.CrossRef
52.
go back to reference Engel S, Susilo S. Shaming and sanitation in Indonesia: a return to colonial public health practices? Dev Chang. 2014;45(1):157; 178.CrossRef Engel S, Susilo S. Shaming and sanitation in Indonesia: a return to colonial public health practices? Dev Chang. 2014;45(1):157; 178.CrossRef
53.
go back to reference Jenkins MW, Scott B. Behavioral indicators of household decision-making and demand for sanitation and potential gains from social marketing in Ghana. Journal of Social Science and Medcine. 2007;64(12):2427–42.CrossRef Jenkins MW, Scott B. Behavioral indicators of household decision-making and demand for sanitation and potential gains from social marketing in Ghana. Journal of Social Science and Medcine. 2007;64(12):2427–42.CrossRef
54.
go back to reference Yimam YT, Gelaye KA, Chercos DH. Latrine utilization and associated factors among people living in rural areas of Denbia district, Northwest Ethiopia, 2013, a cross-sectional study. The Pan African medical journal. 2013;18 Yimam YT, Gelaye KA, Chercos DH. Latrine utilization and associated factors among people living in rural areas of Denbia district, Northwest Ethiopia, 2013, a cross-sectional study. The Pan African medical journal. 2013;18
55.
go back to reference Rheinländer T, Keraita B, H S, Dalsgaa A: Smell: an overlooked factor in sanitation promotion. Waterlines 2013, 32(2). Rheinländer T, Keraita B, H S, Dalsgaa A: Smell: an overlooked factor in sanitation promotion. Waterlines 2013, 32(2).
56.
go back to reference Lundblad B, Hellstrom AL. Perceptions of school toilets as a cause for irregular toilet habits among schoolchildren aged 6 to 16 years. J Sch Health. 2005;75(4):125–8.CrossRefPubMed Lundblad B, Hellstrom AL. Perceptions of school toilets as a cause for irregular toilet habits among schoolchildren aged 6 to 16 years. J Sch Health. 2005;75(4):125–8.CrossRefPubMed
Metadata
Title
The role of psychological factors in predicting latrine ownership and consistent latrine use in rural Ethiopia: a cross-sectional study
Authors
Fikralem Alemu
Abera Kumie
Girmay Medhin
Janvier Gasana
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5143-0

Other articles of this Issue 1/2018

BMC Public Health 1/2018 Go to the issue