PT  - JOURNAL ARTICLE
AU  - Cha, Seungman
AU  - Jung, Sunghoon
AU  - Abera, Tadesse
AU  - Beyene, Ermias Tadesse
AU  - Schmidt, Wolf-Peter
AU  - Ross, Ian
AU  - Jin, Yan
AU  - Bizuneh, Dawit Belew
TI  - Performance of Pit Latrines and Their Herd Protection Against Diarrhea: A Longitudinal Cohort Study in Rural Ethiopia
AID  - 10.9745/GHSP-D-22-00541
DP  - 2024 Jun 27
TA  - Global Health: Science and Practice
PG  - e2200541
VI  - 12
IP  - 3
4099  - http://www.ghspjournal.org/content/12/3/e2200541.short
4100  - http://www.ghspjournal.org/content/12/3/e2200541.full
SO  - GLOB HEALTH SCI PRACT2024 Jun 27; 12
AB  - Key MessagesWe compared the performance of a well-constructed latrine with a pit of 2 m or more depth, slab of any material, drop-hole cover, wall, roof, door, and handwashing facilities (water and soap observed) with a poorly constructed one, missing 1 or more of these features or having only a pit latrine with a slab, on interrupting the fecal-oral transmission pathway and reducing child diarrhea.Children living in households with a well-constructed latrine were less likely to have diarrhea than those living in households with a poorly constructed one.In villages with 50% or more of households having well-constructed latrines and 70% or more of households having a pit latrine with a slab (high coverage), children living in a household with no latrine or a poorly constructed one were less likely to contract diarrhea than those with no latrine or a poorly constructed one in a village with low coverage.Key ImplicationsPolicymakers should advocate for universal health coverage of water, sanitation, and hygiene interventions to confer herd protection against disease transmission.Future research should investigate the relationship between latrine design and health outcomes.In sanitation policies, “improved sanitation” is often broadly described as a goal with little rationale for the minimum standard required. We conducted a secondary analysis of data collected as part of a cluster randomized controlled trial in rural Ethiopia. We compared the performance of well-constructed and poorly constructed pit latrines in reducing child diarrhea. In addition, we explored whether having a well-constructed household latrine provides indirect protection to neighbors if cluster-level coverage reaches a certain threshold. We followed up children aged younger than 5 years (U5C) of 906 households in rural areas of the Gurage zone, Ethiopia, for 10 months after community-led total sanitation interventions. A study-improved latrine was defined as having all the following: pit of ≥2 m depth, slab of any material, drop-hole cover, wall, roof, door, and handwashing facilities (water and soap observed). U5C in households with a study-improved latrine had 54% lower odds of contracting diarrhea than those living in households with a latrine missing 1 or more of the characteristics (adjusted odds ratio [aOR]=0.46; 95% confidence interval [CI]=0.27, 0.81; P=.006). Analyses were adjusted for child age and sex, presence of improved water for drinking, and self-reported handwashing at 4 critical times. The odds of having diarrhea among those with an improved latrine based on the World Health Organization/UNICEF Joint Monitoring Program (JMP) definition (i.e., pit latrines with slabs) were not substantially different from those with a JMP-unimproved latrine (aOR=0.99; 95% CI=0.56, 1.79; P=.99). Of U5C living in households without a latrine or with a study-unimproved latrine, those in the high-coverage villages were less likely to contract diarrhea than those in low-coverage villages (aOR=0.55; 95% CI=0.35, 0.86; P=.008). We recommend that academic studies and routine program monitoring and evaluation should measure more latrine characteristics and evaluate multiple latrine categories instead of making binary comparisons only.