Thesis:

Predictors of the resurgence and sustainability of open defecation-free status among adult residents in Kibwezi east sub county, Makueni county, Kenya

Worldwide, 2.4 billion persons lack improved sanitation and practice open defecation. In Kenya, about 14% of its population defecates in the open. Makueni County ranked 44th out of 47 counties defecating openly. Kibwezi East showed that, 48% of certified villages (235 out of 488) had resumed to OD, more than the Counties of Busia (10%), Siaya (12.5%), and Kitui (32%). The study objectives were socio-demographic characteristics, individual characteristics, infrastructural factors and interventions influencing the sustainability of ODF status. This study employed various approaches to achieve the required sample size of 423 respondents in Kibwezi East. Data was analyzed using SPSS version 27, and Chi2 assessed significant differences between categorical variables. The results were presented in tables, graphs, and pie charts. The study reported that approximately 17.1% to 20.9% practiced open defecation. Most respondents were Christians (98.8%), completed primary education (52.9%), females (68.6%) and married (89.1%). Regarding knowledge of ODF, majority identified community meetings (69.50%) as their primary source of information. Disposable diapers were the primary choice for child waste disposal (48.0%). Respondents who believed OD had not been eradicated were less likely to sustain ODF (uOR = 0.481, p = 0.004), those not attending community meetings had lower ODF sustainability odds (uOR = 0.551, p = 0.004). On socioeconomic characteristics, majority of participants were unemployed (91.5%), had outside toilets (89.6%), and pit latrines (95.1%). Lack of vent pipes was associated with a 1.701 times higher likelihood of not maintaining ODF sustainability (p = 0.019). Households with ODF sustainability had a slightly higher mean monthly income (Kshs. 3928.9). Most participants had handwashing (69.6%) and cleansing (60.8%) facilities in their toilets. Households lacking toilet cleansing facilities were 2.583 times more likely, those without handwashing facilities were 4.757 times more likely, individuals who did not frequently wash their hands were 3.007 times more likely to experience ODF unsustainability (p < 0.05).On further analysis, most sanitary facilities (59.5%) were located within 10-50 meters, with a median walking time of 3.0 minutes. ODF sustainability was less likely in households without user-friendly sanitary facilities (uOR = 2.47, p < 0.001) and roofless toilets (uOR = 0.355, p < 0.001). Longer walking times (>3 minutes) were associated with reduced ODF sustainability (uOR = 0.341, p < 0.001).Conversely, the absence of designated open defecation sites increased the odds of ODF sustainability by 1.669 times (UOR = 1.669, p < 0.001), and households with toilets emitting no unpleasant odors were more likely to sustain ODF (UOR = 1.287, p = 0.030). Approximately 57% of participants attended recent sanitation training, with the majority (71%) not receiving incentives. Statistically significant associations were found between ODF sustainability and awareness of sanitation campaigns (p = 0.006), sanitation marketing awareness (p = 0.009), and partner support for sanitation marketing (p = 0.013). In conclusion, this study achieved a high response rate. The findings indicate that education levels, knowledge, practices, access to user friendly sanitary facilities and infrastructure play a significant role in ODF sustainability.