Post on 19-Jan-2016
Factors affecting cleanliness of shared urban slum toilets in Dhaka, Bangladesh
Mahbub-Ul AlamResearch Investigator; mahbubalam@icddrb.org
Water, Sanitation and Hygiene Research Group, icddr,b
Water and Health Conference, Chapel Hill, North CarolinaOctober 26, 2015
Background
• Shared toilets in urban slums are often unclean and poorly maintained
• Unclean, poorly maintained toilets may be underutilized or abandoned encouraging open defecation
• Poor hygiene and maintenance can lead to negative health outcomes
2
Rationale
• Objective indicators of cleanliness of shared toilets are lacking
• Determinants of shared toilet cleanliness was not well identified
3
• Shared toilets' cleanliness is a key health issue which needs to be measured accurately
• Previous studies have measured cleanliness based on users’ perceptions
Objectives
• To describe multiple objective indicators of cleanliness of shared toilets
• To identify the factors associated with toilet cleanliness
4
Study design
• A behavior change intervention to improve toilet cleanliness and maintenance– 1,226 shared toilet users in 23 urban slums of Dhaka
• Slums were divided into 38 clusters– by road, market, canal, drain
• Conducted pre-intervention baseline survey• Analyzed baseline data
5
Toilet and respondent selection
• Selected first toilet after entering the slum:– Skip next – Select subsequent– <40 toilets per cluster
6
• One adult user per toilet:– From second nearest
household
Methods: spot check of toilet• Observed toilet:
- Structure- Provision of water
• Presence of:- Visible feces- Urine/other liquid- Solid waste
7
– Within- Squatting area - Pan
Methods: interview of toilet user
• Interviewed one adult user per shared toilet:– Demographic
information– Toilet management
8
Data analysis• Definition of clean toilet (Günther et al. 2012):
– absence of • Feces• Liquids• Dirt
• To identify factors associated with toilet cleanliness:– Prevalence ratio– Generalized estimating equations to account for
clustering
9
– within • Squatting area • Pan
Toilet characteristics (n=1,226)
• Toilet built by:– Landlord: 65%– NGO: 18%
• Average user households: 6
• Average users: 24
Landlord built toilets were more commonly connected to a canal or ditch than NGO built toilets (63% vs. 26%, PR: 2.7)
Toilet excreta released (n=1,226)
Water seal present: 27%
Connected to canal/
ditch
Piped sewer system
Septic tank Pit latrine 0
20
40
60
80
100
57
18 14 11
%
Type of toilet
11
• NGO built toilets were more commonly pit, septic tank or piped sewer system toilets with a functional water seal than landlord built toilets (39% vs. 3%, PR: 8.3, 95% CI: 4.2-16).
Facilities for toilet (n=1,226)
• No water storage facility: 45%• Water available: 12%• Average distance to water
source: 18 feet• Waste bin inside toilet: 0.5%• Brush and washing agent
available: 5%
12
Toilet maintenance
• Toilet cleaning responsibilities (n=1,226):– Rotated among the user households: 78%– Landlord paid a caretaker: 10%
• Emptying septic tank or pit was landlord’s responsibility: 83% (n=290)
• Hired manual labor to emptying: 75% (n=81)• Among 81 toilets, 98% of fecal sludge was
disposed into the slum environment
13
Solid waste disposal inside toilet (n=1,226)
• Reported waste disposal practice in the toilet:– Menstrual cloths/rags: 16%– Paper: 12%– Plastic bags: 9%
14
Toilet cleanliness (n=1,226)
• Feces visible:– Inside pan hole: 47%– Inside the pan: 28%
15
Toilet cleanliness (n=1,226)• Feces visible:
– Outside pan: 8%– On the footrest of the pan: 2%– On the path leading up to the
toilet: 14%
16
*Absence of feces, liquids or dirt within the squatting area and pan of the toilet
• Toilets classified as clean*: 34%
Determinants of toilet cleanliness (n=459)
Available (N=150)
Not available (N=1077)
0
20
40
60
80
100
53
35
Toilets were more commonly clean when water was available inside or beside the toilet (PR: 1.9, 95% CI: 1.5-2.4)
Water present inside/beside clean toilet
%
17
Determinants of toilet cleanliness (n=459)
Toilets were more commonly clean when there was a water storage beside the toilet (PR: 1.1, 95% CI: 1.1-1.2) 18
Available (N=670) Not available (N=557)0
102030405060708090
100
4034
%
Water storage container available inside/beside clean toilet
Conclusion
• Majority of shared toilets in urban slums were not clean
• Presence of water and water storage container were associated with toilet cleanliness
• It is possible to measure toilet cleanliness using objective indicators
19
Recommendations
• Use combined scale/matrix using multiple objective indicators to measure toilet cleanliness
• Efforts to provide adjacent sources of water will likely have an impact on cleanliness
• Efforts to reduce excreta release in the environment should be emphasized
20
Study teamIcddr,b:
Leanne UnicombFarzana BegumFosiul NizameMahbubur RahmanFarzana YeasminMahbub-Ul AlamAbdullah-Al Masud Probir Ghosh
For more information: mahbubalam@icddrb.org
Stanford University:
Stephen Luby
WSUP:
Guy NormanAnita LaydenSam DrabbleAbdus ShaheenHabibur RahmanNasrin Akter
Johns Hopkins University:
Peter WinchRonald Saxton
Acknowledgement:
Study participants; Diana DiazGranados; Astrid Dier; Mahbubur Rahman
21
icddr,b thanks the study Donors
22