Graduating Rural Households as Model Families Has Increased Latrine Utilization in West Gojjam Zone, Amhara Region, Ethiopia

Abstract

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Background: Since 2003, Ethiopia has launched a nationwide primary health initiative known as the Health Extension Program at the grassroots level in order to increase public access to basic health services. The program was designed to increase the coverage of primary health care services, mainly by producing model households. This study assessed whether households that fully implemented the Health Extension Program have adopted latrine utilization.

Methods: A cross-sectional community-based survey was conducted to collect data from 1320 mothers. A multistage sampling technique was used to select study participants, using a structured questionnaire and observation checklist. A multivariate logistic regression was used to identify the predictors of latrine utilization. A propensity score analysis was used to determine the contribution of the Health Extension Program model to households on latrine utilization.

Result:  The overall latrine utilization was 83.5% (87.0% in model households, 72.1% in non-model households). Model households in the Health Extension Program (AOR = 2.39; 95% CI = 1.70 to 3.35) were more likely to utilize latrines compared to non- model households. The former contributed to 19.80% (t = 4.50) of the increase in latrine utilization. In addition, households obtained more frequent home visits (AOR = 1.45; 95% CI = 1.04, 2.01),  whose mothers identified at least one benefit of using the latrine (AOR = 3.49; 95% CI = 2.34, 5.20), headed by married couples (AOR = 1.64; 95% CI = 1.03, 2.63), and  who were large in size (AOR = 1.39; 95% CI = 1.01, 1.91) were more likely to utilize latrines than the reference groups.

Conclusion: Latrine utilization was found to be relatively high, especially among model households. Being models, frequent HEW visits, and knowledge about the benefits of latrine were found to be the predictors of latrine utilization. When implemented fully, the Health Extension Program could help to step up latrine utilization and improve the status of sanitation and hygiene in rural communities.