Thesis:

Determinants of the effectiveness of community-led total sanitation in kilifi and marsabit counties, kenya

Sanitation and hygiene are crucial for human survival, and their inadequate availability negatively impacts the quality of life and development efforts in many areas. SDG 6.2 recognizes the crucial significance of sanitation and hygiene. However, achieving this target is hindered by multiple factors such as human behavior, politics, geography, inequality, urbanization, climate change, and financial deficiencies. Poor sanitation contributes to about 775,000 deaths annually, and is one of the world’s largest health and environmental challenges, especially in developing nations. This study examined determinants of major interventional factors on community-led total sanitation as an approach to delivering ODF societies and improving health and wellbeing among the selected population in Kilifi and Marsabit Counties in Kenya. The study methodology included a comparative cross-sectional study of the two diverse study populations. Eight hundred and eleven participants were recruited for the data collection phase of the study. A multistage sampling procedure was used to sample the villages and the households. Quantitative data was analyzed using STATA. Descriptive statistics were used to determine the different regional CLTS uptake. Inferential statistics, including multivariate logistic regression were used to determine associations between variables. Propensity score matching (PSM) was used to estimate the impact of CLTS intervention on the sample population in the two counties. This technique was adopted to eliminate the effect of confounders. All tests in this study were done at the level of significance of P ≤0.05. On average, about 13.45% of residents in the two counties practiced open defecation after intervention, a significant drop from the 30% rate reported in the Water and Sanitation Report. The study found significant statistical association between household heads having a college level education (A.O.R=10.273, p=0.013), household heads being of above 61 years (A.O.R=4.046, p=0.009), households having a cumulative monthly income of between 10,001-15,000 (A.O.R=6.461, p=0.091), and household heads being female (A.O.R=1.792, p=0.03), and owning a sanitation facility. Also, households with household heads having good handwashing awareness (A.O.R=2.459, p=0.002) and CLTS awareness (A.O.R=4.317, p=0.022) were statistically associated with owning a sanitation facility. Furthermore, the PSM analysis demonstrates that CLTS programs impacted sanitations status in Kilifi and Marsabit significantly. The intervention resulted in a 42% increase in households owning a sanitation facility. Conclusively, the study established a statistical significance of CLTS and ownership of sanitation facilities in Kilifi and Marsabit Counties. The results show that CLTS program are effective and have positively impacted sanitation status, such as reducing open defecation levels in Kilifi and Marsabit.