Exploring the interplay of socio-demographic enablers in sustaining open defecation-free status among households in Kakamega county, Kenya

Abstract

This study aimed to explore the interplay between socio-demographic enablers and the sustainability of post-open-defecation-free status among households in Butere Sub-County, Kakamega County, Kenya. The research adopted a cross-sectional survey to assess the sustainability of the open defecation-free status at the household level, surveying 6286 certified Open Defecation Free (ODF) households through stratified random sampling. A sample size of 376 households across three wards was selected for the study. Both quantitative and qualitative data were employed; quantitative data was analysed using SPSS Version 28.1, summarized using descriptive statistics, and presented in tables, pie charts, and frequency tables, whereas qualitative data was analysed thematically. Data analysis involved three stages; univariate, bivariate and multivariate analyses. Chi-square tests analysed the statistically significant association between dependent and independent variables. Binary logistic regression predicted the probability of post-ODF status (whether the ODF status was sustainable or not), and 2x2 contingency tables were used to compute the odd ratio. Results revealed that only 9% of households sustained post-ODF status. The chi-square tests revealed a significant association between respondents' gender (χ² = 0.124, p = 0.009*), age distribution (χ² = 6.471, p < 0.05), presence of children under 5 years old in the household (χ² = 1.884, p = 0.004*), level of education (χ² = 5.726, p = 0.006*), employment status (χ² = 9.602, p = 0.006*), and monthly earning brackets (χ² = 11.783, p<0.001*). However, there was no statistically significant association between marital status (χ² = 10.409, p = 0.94>0.05), household size (χ² = 1.782, p = 0.56>0.05), and the sustainability of ODF. On the other hand, the odds ratio for employment status suggests that significant association (OR=1.333; p = 0.007*<0.05; 95% CI: 1.082-1.642), where employed individuals were 1.333 times more likely to sustain ODF status. Further analysis revealed that employment status was a statistically significant predictor of post-ODF sustainability (aOR=1.837 P=0.011; 95% CI: 1.132-2.980). The study concluded that most households (91%) did not sustain post-ODF status after the ODF declaration. It was recommended that health practitioners improve door-to-door monitoring and develop post-ODF tracking tools at the household level, focusing on important parameters from Ministry of Health guidelines. The government and other Water sanitation and hygiene (WASH) stakeholders should support communities in establishing and enhancing economic empowerment programs to increase household income and encourage investments in sanitation infrastructure and hygiene promotion activities.