Date Published: August 02, 2017
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Seungman Cha, Jae Eun Lee, Dong Sik Seo, Byoung Mann Park, Paul Mansiangi, Jae-sang Hwang, Jungwook Lee.
Despite the importance of sanitation, few studies have assessed the effects of latrines on the health outcomes of children under 5 years of age. We assessed the relations between latrine coverage and the prevalence of diarrhea in children under 4 years of age. In this cross-sectional study, we analyzed the baseline data obtained as part of a longitudinal survey targeting 720 households in Idiofa, Bandundu, Democratic Republic of the Congo. We categorized latrines according to the presence of each major component and investigated whether diarrhea prevalence of children under 4 years of age is associated with latrine availability and improvement. Latrines have health benefits regardless of whether they are improved. Also worth noting is that comparatively well-equipped and more appropriately managed latrines could prevent child diarrhea more effectively than less equipped or inappropriately managed latrines. Households who have a latrine with a superstructure, roof, and no flies (a partly improved latrine) were found to be 52% less likely to report cases of diarrhea than households with unimproved latrines (adjusted odds ratio [OR] = 0.48, confidence interval [CI] = 0.31–0.76), which are all the other latrines not included in the partly improved latrine category. We have observed the profound protective effect of latrines with a superstructure. This study demonstrates that latrines are associated with significant improvements in health even when they do not fully meet the conditions of improved latrines. This study adds value to the limited evidence on the effect of latrines on health parameters by demonstrating that latrines have correlations with health benefits regardless of whether they are improved, as well as by elucidating the most essential components of improved latrines.
An estimated 2.4 billion people do not have access to improved sanitation, as defined by the World Health Organization/United Nations Children’s Fund (WHO/UNICEF) Joint Monitoring Program, and 946 million people openly defecate,1 including an estimated 7.1 million in the Democratic Republic of the Congo (DRC).2–4 Diarrhea accounted for 9.2% of deaths in children under 5 years of age (U5C) in the DRC in 2013, and inadequate sanitation and poor hygiene are the main factors that contribute to the disease burden of diarrhea.5,6
This study demonstrates that even suboptimal latrines are associated with significant improvements in health-related parameters. In the study area, no household had an improved latrine that fully met all of the criteria established by UNICEF DRC (a superstructure, a roof, a cement slab, a pit hole deeper than 1.5 m, a pit hole cover, and a handwashing facility within 1 m). However, the households with a latrine showed a lower prevalence of diarrhea among U4C than households without a latrine, regardless of the latrine type. This suggests that the latrine itself provides health benefits, even if it is not fully equipped with the elements necessary to be considered improved. This cannot be directly interpreted as the effect of using a latrine compared with open defecation, because the majority of households without a latrine reported utilization of a neighbor’s facility instead of open defecation, although we cannot rule out the possibility of courtesy bias. This result adds to the body of evidence demonstrating the need for encouraging the uptake of latrines at the household level.