Pit latrine use in the prevention of diarrheal diseases in Mutwot location, Nandi County, Kenya

Abstract

Background: Globally, achieving universal access to adequate and equitable sanitation and hygiene by 2030 is a major challenge in many parts of the world. This sanitation crisis means untreated human waste is spreading diseases through water supplies and the food chain for billions of people. The Kenya Health Information System (KHIS,2015) indicates that, 37% of households in Chesumei Sub-County lack pit latrines. Health records available for Mutwot Location show that diarrheal diseases are the fifth most common cause of morbidity. Objectives: To determine pit latrine coverage, assess the use of pit latrines, and determine the association between the type of pit latrine and diarrheal diseases in Mutwot Location, Nandi County. Methods: A descriptive cross-sectional study was carried out in Mutwot Location covering a sample of 324 households. Stratified and simple random sampling techniques were used to obtain the respondents. Interviewer-administered structured questionnaires to household heads and observation checklists on the type, state, and use of pit latrines were the data collection instruments. Descriptive data were analysed using frequencies, while relationships between variables were analysed using Chi-square tests and multiple correspondence analysis. Results: A total of 324 questionnaires were administered to household heads or representatives, with 100% response rate. An observation checklist was used to establish consistency or otherwise with the findings in the questionnaire. Pit latrine coverage in Mutwot Location was 80% (n=259). Respondents’ education level (χ2 (3) = 83.35, p<0.0001) and occupation (χ2 (3) =28.89, p<0.0001) influenced ownership of pit latrine. High cost of construction 58% (n=36) and lack of construction materials 42% (n=26) were strong antecedents in the lack of ownership of pit latrines. Among those who had pit latrines, 98% (n=255) used them. Amongst households which had latrines, one out of every ten latrines (12%, n=31) could not be used by children, the elderly, and persons with disabilities. The latrines consisted of mostly simple pits (41%, n=118), followed by ventilated improved types (35%, n =101) and shallow pits (8%, n=22) while a significant segment (16%, n=46,) of the population practiced open defecation. These findings were counter-checked with an observation checklist and similar results were obtained. The study found a significant relationship (χ2 (3) = 103.21, p<0.0001) between diarrheal episodes and the practice of open defecation and use of shallow pit latrine. Conclusion: Pit latrine coverage in the location was significantly higher relative to the national and greater Nandi County, but still off-target in achieving universal access to adequate sanitation. Low literacy levels, high cost, and lack of construction materials were strong antecedents in the lack of ownership of pit latrines. Most households with pit latrines used them, but some still practiced open defecation. The diarrheal disease prevalence was highly correlated with open defecation and use of shallow pit latrines. Recommendations: Health care personnel should initiate Community-Led Total Sanitation (CLTS) approaches to scale up efforts with community members to adopt the use of cheap and locally available materials to construct pit latrines. Health promotion providers should sensitize those with low education level on the importance of a pit latrine and the relationship between poor disposal of human excreta and diarrheal diseases. County health department should ensure that pit latrines are constructed in a way that allows children, the elderly, and persons with disabilities to comfortably use them.