Factors associated with Open Defecation Free (ODF) status among rural communities: A cross-sectional study
https://doi.org/10.52235/lp.v6i4.635
Keywords:
environmental health, health knowledge, hygiene, sanitationAbstract
Background: Open defecation remains a persistent public health challenge in many rural communities, particularly where behavioral, socioeconomic, and environmental barriers limit the adoption of safe sanitation practices. Despite national efforts to promote Community-Led Total Sanitation (CLTS), several villages in Indonesia—including Bangun Harjo—continue to experience gaps in Open Defecation Free (ODF) achievement.
Objective: This study aimed to examine the factors associated with ODF status among households in a rural Indonesian community, focusing on knowledge, income, environmental proximity to rivers, and family support.
Methods: A cross-sectional study was conducted among 232 household heads selected through proportional random sampling. Data were collected using a structured questionnaire and analyzed using univariate and chi-square bivariate tests to determine associations between independent variables and ODF status.
Results: The findings showed that 63.8% of households had achieved ODF status, while 36.2% continued practicing open defecation. Knowledge demonstrated a significant association with ODF status, where households with good knowledge were more likely to adopt safe sanitation practices (p < 0.001). Income was also significantly associated with ODF status, with higher-income households more capable of constructing and maintaining latrines (p < 0.001). Environmental distance showed strong influence, as households near rivers were more likely to practice open defecation (p < 0.001). Family support similarly contributed to increased ODF achievement, indicating the importance of household dynamics in sustaining sanitation behavior (p < 0.001).
Conclusion: ODF achievement in rural settings is shaped by interconnected factors, including knowledge levels, economic capacity, environmental accessibility, and family support. These determinants highlight the need for integrated and context-specific sanitation strategies.
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References
Abebe, T. A., & Tucho, G. T. (2020). Open defecation-free slippage and its associated factors in Ethiopia: A systematic review. Systematic Reviews, 9, 1–15. https://doi.org/10.1186/s13643-020-01511-6
Abramovsky, L., Augsburg, B., & Oteiza, F. (2015). Sustainable total sanitation – Nigeria baseline report. Institute for Fiscal Studies; Precision Consult. https://www.econstor.eu/bitstream/10419/201775/1/R134.pdf
Afzal, A., Javed, M., & Jabeen, T. (2022). Integrated behaviour change intervention for sustainable community development: A KAP study of WASH in district Gujrat, Pakistan. Journal of Water, Sanitation and Hygiene for Development. https://doi.org/10.2166/washdev.2022.243
Apanga, P. A., Garn, J. V., Sakas, Z., & Freeman, M. C. (2020). Assessing the impact and equity of an integrated rural sanitation approach: A longitudinal evaluation in 11 sub-Saharan Africa and Asian countries. International Journal of Environmental Research and Public Health, 17. https://doi.org/10.3390/ijerph17051808
Ayalew, A. M., Mekonnen, W. T., Abaya, S. W., & Mekonnen, Z. A. (2018). Assessment of diarrhea and its associated factors in under-five children among open defecation and open defecation-free rural settings of Dangla district, northwest Ethiopia. Journal of Environmental and Public Health, 2018, 4271915. https://doi.org/10.1155/2018/4271915
Azage, M., & Haile, D. (2015). Factors associated with safe child feces disposal practices in Ethiopia: Evidence from a demographic and health survey. Archives of Public Health, 73, 40. https://doi.org/10.1186/s13690-015-0090-z
Bhatt, N., Budhathoki, S. S., Lucero-Prisno, D. E. I., Shrestha, G., Bhattachan, M., Thapa, J., Sunny, A. K., Upadhyaya, P., Ghimire, A., & Pokharel, P. K. (2019). What motivates open defecation? A qualitative study from a rural setting in Nepal. PLOS ONE, 14, e0219246. https://doi.org/10.1371/journal.pone.0219246
Caruso, B. A., Clasen, T. F., Hadley, C., Yount, K. M., Haardörfer, R., Rout, M., Dasmohapatra, M., & Cooper, H. L. (2017). Understanding and defining sanitation insecurity: Women’s gendered experiences of urination, defecation and menstruation in rural Odisha, India. BMJ Global Health, 2, e000414. https://doi.org/10.1136/bmjgh-2017-000414
Chebet, J. J., Kilungo, A., Alaofè, H., Malebo, H., Katani, S., & Nichter, M. (2020). Local perceptions, cultural beliefs, practices and changing perspectives of handling infant feces: A case study in a rural Geita District, north-western Tanzania. International Journal of Environmental Research and Public Health, 17. https://doi.org/10.3390/ijerph17093084
Coffey, D., Spears, D., & Vyas, S. (2017). Switching to sanitation: Understanding latrine adoption in a representative panel of rural Indian households. Social Science & Medicine, 188, 41–50. https://doi.org/10.1016/j.socscimed.2017.07.001
Crocker, J., Saywell, D., & Bartram, J. (2017). Sustainability of community-led total sanitation outcomes: Evidence from Ethiopia and Ghana. International Journal of Hygiene and Environmental Health, 220, 551–557. https://doi.org/10.1016/j.ijheh.2017.02.011
Dickin, S., & Gautam, O. (2019). Behaviour change. Sustainable Sanitation Alliance. https://www.susana.org/en/workinggroups/behaviour-change
Dreibelbis, R., Jenkins, M., Chase, R. P., Torondel, B., Routray, P., Boisson, S., Clasen, T., & Freeman, M. C. (2015). Development of a multidimensional scale to assess attitudinal determinants of sanitation uptake and use. Environmental Science & Technology, 49, 13613–13621. https://doi.org/10.1021/acs.est.5b02985
Galvin, M. (2015). Talking shit: Is community-led total sanitation a radical and revolutionary approach to sanitation? WIREs Water, 2, 9–20. https://doi.org/10.1002/wat2.1055
Garn, J. V., Sclar, G. D., Freeman, M. C., Penakalapati, G., Alexander, K. T., Brooks, P., Rehfuess, E. A., Boisson, S., Medlicott, K. O., & Clasen, T. F. (2017). The impact of sanitation interventions on latrine coverage and latrine use: A systematic review and meta-analysis. International Journal of Hygiene and Environmental Health, 220, 329–340. https://doi.org/10.1016/j.ijheh.2016.10.001
Gedda, M. (2015). Traduction française des lignes directrices PRISMA pour l’écriture et la lecture des revues systématiques et des méta-analyses. Kinésithérapie, la Revue, 15, 39–44. https://doi.org/10.1016/j.kine.2014.11.004
Jiménez, A., Jawara, D., LeDeunff, H., & Naylor, K. A., & Scharp, C. (2017). Sustainability in practice: Experiences from rural water and sanitation services in West Africa. Sustainability, 9, 403. https://doi.org/10.3390/su9030403
JMP. (2021). Progress on household drinking water, sanitation and hygiene 2000–2020: Five years into the SDGs. World Health Organization & UNICEF. https://www.who.int/publications-detail-redirect/9789240030848
Kulkarni, S., O’Reilly, K., & Bhat, S. (2017). No relief: Lived experiences of inadequate sanitation access of poor urban women in India. Gender & Development, 25, 167–183. https://doi.org/10.1080/13552074.2017.1331531
Majorin, F., Torondel, B., Chan, G. K. S., & Clasen, T. (2019). Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD011055.pub2
Majorin, F., Torondel, B., Routray, P., Rout, M., & Clasen, T. (2017). Identifying potential sources of exposure along the child feces management pathway: A cross-sectional study among urban slums in Odisha, India. American Journal of Tropical Medicine and Hygiene, 97. https://doi.org/10.4269/ajtmh.16-0688
Miller-Petrie, M. K., Voigt, L., McLennan, L., Cairncross, S., & Jenkins, M. W. (2016). Infant and young child feces management and enabling products for their hygienic collection, transport, and disposal in Cambodia. American Journal of Tropical Medicine and Hygiene, 94. https://doi.org/10.4269/ajtmh.15-0423
Morita, T., Godfrey, S., & George, C. M. (2016). Systematic review of evidence on the effectiveness of safe child faeces disposal interventions. Tropical Medicine & International Health, 21. https://doi.org/10.1111/tmi.12773
Mugel, S. G., Clasen, T. F., & Bauza, V. (2022). Global practices, geographic variation, and determinants of child feces disposal in 42 low- and middle-income countries: An analysis of standardized cross-sectional national surveys from 2016–2020. International Journal of Hygiene and Environmental Health, 245, 114024. https://doi.org/10.1016/j.ijheh.2022.114024
Mukherjee, I., & Mukherjee, N. (2017). Designing for sustainable outcomes: Espousing behavioural change into co-production programmes. Policy and Society, 37, 326–346. https://doi.org/10.1080/14494035.2018.1383032
Novotný, J., Hasman, J., & Lepič, M. (2018). Contextual factors and motivations affecting rural community sanitation in low- and middle-income countries: A systematic review. International Journal of Hygiene and Environmental Health, 221, 121–133. https://doi.org/10.1016/j.ijheh.2017.10.018
Odagiri, M., Muhammad, Z., Cronin, A. A., Gnilo, M. E., Mardikanto, A. K., Umam, K., & Asamou, Y. T. (2017). Enabling factors for sustaining open defecation-free communities in rural Indonesia: A cross-sectional study. International Journal of Environmental Research and Public Health, 14, 1572. https://doi.org/10.3390/ijerph14121572
Osumanu, I. K., Kosoe, E. A., & Ategeeng, F. (2019). Determinants of open defecation in the Wa Municipality of Ghana: Empirical findings highlighting sociocultural and economic dynamics among households. Journal of Environmental and Public Health, 2019, 3075840. https://doi.org/10.1155/2019/3075840
Patwa, J., & Pandit, N. (2018). Open defecation-free India by 2019: How villages are progressing? Indian Journal of Community Medicine, 43, 246–247. https://doi.org/10.4103/ijcm.IJCM_83_18
Pickering, A. J., Djebbari, H., Lopez, C., Coulibaly, M., & Alzua, M. L. (2015). Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: A cluster-randomised controlled trial. The Lancet Global Health, 3, e701–e711. https://doi.org/10.1016/S2214-109X(15)00144-8
Routray, P., Schmidt, W.-P., Boisson, S., Clasen, T., & Jenkins, M. (2015). Socio-cultural and behavioural factors constraining latrine adoption in rural coastal Odisha: An exploratory qualitative study. BMC Public Health, 15. https://doi.org/10.1186/s12889-015-2206-3
Seidu, A.-A., Ahinkorah, B. O., Kissah-Korsah, K., Agbaglo, E., Dadzie, L. K., Ameyaw, E. K., Budu, E., & Hagan, J. E. J. (2021). A multilevel analysis of individual and contextual factors associated with the practice of safe disposal of children’s faeces in sub-Saharan Africa. PLOS ONE, 16. https://doi.org/10.1371/journal.pone.0254774
Shrestha, S., Ahmad, T., & Shrestha, P. K. (2018). Sustainability of ODF in Nepal. Loughborough University. https://hdl.handle.net/2134/35932
Singh, S., & Balfour, N. (2015). Sustainability of ODF practices in Kenya. WASH Field Note, Nairobi.
Thys, S., Mwape, K. E., Lefèvre, P., Dorny, P., Marcotty, T., Phiri, A. M., Phiri, I. K., & Gabriël, S. (2015). Why latrines are not used: Communities’ perceptions and practices regarding latrines in a Taenia solium endemic rural area in Eastern Zambia. PLOS Neglected Tropical Diseases, 9. https://doi.org/10.1371/journal.pntd.0003570
USAID. (2018). An examination of CLTS’s contributions toward universal sanitation. https://www.globalwaters.org/resources/assets/washpals/examination-cltss-contributions-toward-universal-sanitation
Venkataramanan, V., Crocker, J., Karon, A., & Bartram, J. (2018). Community-led total sanitation: A mixed-methods systematic review of evidence and its quality. Environmental Health Perspectives. https://doi.org/10.1289/EHP1965
WHO. (2017). Integrating neglected tropical diseases in global health and development: Fourth WHO report on neglected tropical diseases. World Health Organization.
WHO. (2019). Lignes directrices relatives à l’assainissement et à la santé [Guidelines on sanitation and health]. World Health Organization.
Yusliza, M. Y., Amirudin, A., Rahadi, R. A., Nik Sarah Athirah, N. A., Ramayah, T., Muhammad, Z., Dal Mas, F., Massaro, M., Saputra, J., & Mokhlis, S. (2020). An investigation of pro-environmental behaviour and sustainable development in Malaysia. Sustainability, 12. https://doi.org/10.3390/su12177083
Zuin, V., Delaire, C., Peletz, R., Cock-Esteb, A., Khush, R., & Albert, J. (2019). Policy diffusion in the rural sanitation sector: Lessons from community-led total sanitation (CLTS). World Development, 124, 104643. https://doi.org/10.1016/j.worlddev.2019.104643
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