Open defecation: risk factors for adverse outcomes in Indonesia

The increasing number of Indonesian population has caused serious issue of open defecation. Indonesia ranks the second large of open defecation prevalence in the world, after India. Human’s excrement was disposed in trench, drain, terrace, grassland, backwoods, forest, river, lake or other open spaces, thus, contaminates the water system. Open defecation can lead to the increasing risk of transmission of water-boene diseases of child morbidity in Indonesia. This study aimed at exploring different socio-economic and demographic factors of Indonesians who practice open defecation. Data were obtained from 49,627 female respondents of the 2017 Indonesia Demographic and Health Survey. The data were examined utilizing descriptive and logistic regression. The results reveal that the practice of open defecation is significantly influenced by place of residence, household’s wealth quintile, and household’s water supply. The findings suggest the needs for toilet construction and water supply sustainability in public area as well as in poor neighbourhood to eliminate open defecation in the country.

Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana

Community-led total sanitation (CLTS) is a widely used approach to reduce open defecation in rural areas of low-income countries. Following CLTS programs, communities are designated as open defecation free (ODF) when household-level toilet coverage reaches the threshold specified by national guidelines (e.g., 80% in Ghana). However, because sanitation conditions are rarely monitored after communities are declared ODF, the ability of CLTS to generate lasting reductions in open defecation is poorly understood. In this study, we examined the extent to which levels of toilet ownership and use were sustained in 109 communities in rural Northern Ghana up to two and a half years after they had obtained ODF status. We found that the majority of communities (75%) did not meet Ghana’s ODF requirements. Over a third of households had either never owned (16%) or no longer owned (24%) a functional toilet, and 25% reported practicing open defecation regularly. Toilet pit and superstructure collapse were the primary causes of reversion to open defecation. Multivariate regression analysis indicated that communities had higher toilet coverage when they were located further from major roads, were not located on rocky soil, reported having a system of fines to punish open defecation, and when less time had elapsed since ODF status achievement. Households were more likely to own a functional toilet if they were larger, wealthier, had a male household head who had not completed primary education, had no children under the age of five, and benefitted from the national Livelihood Empowerment Against Poverty (LEAP) program. Wealthier households were also more likely to use a toilet for defecation and to rebuild their toilet when it collapsed. Our findings suggest that interventions that address toilet collapse and the difficulty of rebuilding, particularly among the poorest and most vulnerable households, will improve the longevity of CLTS-driven sanitation improvements in rural Ghana.

Gambaran Pencapaian Lima Pilar Sanitasi Total Berbasis Masyarakat di Desa Lokotoy Kabupaten Banggai Laut

Tantangan yang dihadapi Indonesia terkait pembangunan kesehatan khususnya bidang higiene dan sanitasi masih sangat besar, untuk itu perlu dilakukan intervensi terpadu melalui pendekatan sanitasi total. Tujuan penelitian ini adalah memperoleh gambaran pencapaian lima pilar Sanitasi Total Berbasis Masyarakat (STBM) di Desa Lokotoy Kecamatan Banggai Utara Kabupaten Banggai Laut.Jenis penelitian ini adalah observasional deskriptif, dengan jenis data kuantitatif, teknik pengambilan sampel yang digunakan yaitu sampling jenuh atau teknik penentuan sampel bila semua populasi dijadikan sampel yaitu sebanyak 443 KK.Hasil penelitian menunjukan bahwa sanitasi total berbasis masyarakat di Desa Lokotoy Kecamatan Banggai Utara Kabupten Banggai Laut, berdasarkan Peraturan Menteri Kesehatan Republik Indonesia Nomor 3 Tahun 2014 tentang Pencapaian Sanitasi Total Berbasis Masyarakat yaitu stop buang air besar sembarangan yang baik sebesar 94,6%, cuci tangan pakai sabun yang baik sebesar 26,0%, pengelolaan air minum dan makanan rumah tangga yaitu baik sebesar 26,0%, pengamanan sampah rumah tangga yang baik sebesar 0%, pengamanan air limbah rumah tangga yang baik sebesar 0%, Sehingga kesimpulannya adalah STBM di Desa Lokotoy Kecamatan Banggai Utara Kabupaten Banggai Laut sebesar 0%. Saran bagi penentu kebijakan, Puskesmas, maupun pemerintah desa setempat dapat melakukan pemicuan stop buang air besar sembarangan, cuci tangan pakai sabun, pengelolaan air minum dan makanan rumah tangga, pengamanan sampah rumah tangga, dan pengamanan air limbah rumah tangga untuk meningkatkan pencapaian lima pilar sanitasi total berbasis masyarakat. The challenges faced by Indonesia related to health development, especially in the field of hygiene and sanitation are still very large, for that it is necessary to carry out integrated interventions through a total sanitation approach. The purpose of this study was to obtain an overview of the achievement of the five pillars of Community-Based Total Sanitation (STBM) in Lokotoy Village, North Banggai District, Banggai Laut Regency.This type of research is descriptive observational, with quantitative data type, the sampling technique used is saturated sampling or sampling technique when all populations are sampled, namely as many as 443 families.The results showed that community-based total sanitation in Lokotoy Village, North Banggai District, Banggai Laut Regency, based on the Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2014 concerning the Achievement of Community-Based Total Sanitation, namely stopping open defecation is good at 94.6%, washing hands good use of soap is 26.0%, household drinking water and food management is good at 26.0%, good household waste security is 0%, good household waste water security is 0%, so the conclusion is STBM in Lokotoy Village, North Banggai District, Banggai Laut Regency by 0%. Suggestions for policy makers, Puskesmas, and local village governments can trigger open defecation, wash hands with soap, manage drinking water and household food, safeguard household waste, and secure household wastewater to improve the achievement of the five pillars of sanitation. totally community based.

The sanitation arc: an alternative examination of WASH behavior change

A primary goal of the WASH sector is to facilitate transitions from open defecation to improved sanitation. Many residents of low-income countries desire improved sanitation but lack the resources to obtain or maintain access to toilets. For such persons, describing the goal as ‘behavior change’ implies a deficiency in mindset, failing to capture contextual factors affecting sanitation access. Furthermore, household circumstances affect movement both up and down the sanitation ladder, a phenomenon that the sector tends to overlook. This study, based on interviews with 308 former subscribers to Haitian container-based-sanitation service EkoLakay, tracks household sanitation access at four points in time: prior to subscribing, during the subscription period, immediately upon unsubscribing, and at the time of interview. We describe this movement through time as the ‘sanitation arc’. Prior to subscribing, households were more likely to practice open defecation or rely on non-household sanitation, and less likely to have private improved sanitation than the average urban Haitian. This distribution is reversed among former subscribers. Nearly half of former subscribers, however, could not afford continuous access to EkoLakay; 80% of involuntary terminations resulted in loss of access to private improved sanitation, and over one-third of these households reverted to open defecation.

School Sanitation-Related Psychosocial Stressors among Nigerian Students

Psychosocial stressors are indicative of challenges associated with the social and environmental conditions an individual is subjected to. In a bid to clearly understand the present gaps in school sanitation, this cross-sectional study aimed to identify the sanitation-related psychosocial stressors experienced by students in a Nigerian peri-urban community and their associated impacts. A three-stage sampling technique was used to select 400 students from 10 schools. The students to toilet ratio were 1,521:0 and 1,510:0 for the public-school boys and girls, respectively, and 74:1 and 70:1 for the private-school boys and girls, respectively. Furthermore, public-school students had a significantly higher average stress level (P < 0.001, η2p = 0.071) and a significantly higher proportion of students experiencing school absenteeism (P < 0.001; odds ratio [OR] = 4.8; 95% confidence interval [C.I] = 2.7–8.2), missed classes (P < 0.001; OR = 5.8; CI = 2.8–12.0), long urine/fecal retention time (P < 0.001; OR = 2.9; CI = 1.8–4.7), open defecation practice (P < 0.001; OR = 4.2; CI = 2.5–7.1), and open defecation-related anxiety (P < 0.001; OR = 3.6; CI = 2.0–6.5). Moreover, the inability to practice menstrual hygiene management was significantly associated with student-reported monthly school absence among girls (P < 0.001; OR = 4.5; CI = 2.2–9.4). Overall, over 50% of the respondents had reportedly been subjected to at least 14 of the 17 stressors outlined. The most prevalent stressors identified were concerns about disease contraction, toilet cleanliness, toilet phobia, privacy, and assault/injury during open defecation/urination. In conclusion, results show that the absence of functional sanitation facilities purportedly has a grievous effect on the mental, physical, social, and academic well-being of the students. This was clearly seen among public-school students. Subsequent sanitation interventions need to be targeted at ameliorating identified stressors.

Monitoring and Evaluation for Rural Sanitation and Hygiene: Framework

The monitoring and evaluation (M&E) Guidelines and Framework presented in this document (and in the accompanying M&E Indicator Framework) aim to encourage stakeholders in the rural sanitation and hygiene sector to take a more comprehensive, comparable and people focused approach to monitoring and evaluation. Many M&E frameworks currently reflect the interests and ambitions of particular implementing agencies – that is, community-led total sanitation (CLTS) interventions focused on open-defecation free (ODF) outcomes in triggered communities; market-based sanitation interventions focused on the number of products sold and whether sanitation businesses were profitable; and sanitation finance interventions reporting the number of facilities built using financial support. Few M&E frameworks have been designed to examine the overall sanitation and hygiene situation – to assess how interventions have affected sanitation and hygiene outcomes across an entire area (rather than just in specific target communities); to look at who (from the overall population) benefitted from the intervention, and who did not; to report on the level and quality of service used; or examine whether public health has improved. Since 2015, the Sustainable Development Goals (SDGs) have extended and deepened the international monitoring requirements for sanitation and hygiene. The 2030 SDG sanitation target 6.2 includes requirements to: • Achieve access to adequate sanitation and hygiene for all • Achieve access to equitable sanitation and hygiene for all • End open defecation • Pay special attention to the needs of women and girls • Pay special attention to those in vulnerable situations The 2030 SDG sanitation target calls for universal use of basic sanitation services, and for the elimination of open defecation, both of which require M&E systems that cover entire administration areas (i.e. every person and community within a district) and which are able to identify people and groups that lack services, or continue unsafe practices. Fortunately, the SDG requirements are well aligned with the sector trend towards system strengthening, in recognition that governments are responsible both for the provision of sustainable services and for monitoring the achievement of sustained outcomes. This document provides guidelines on the monitoring and evaluation of rural sanitation and hygiene, and presents an M&E framework that outlines core elements and features for reporting on progress towards the 2030 SDG sanitation target (and related national goals and targets for rural sanitation and hygiene), while also encouraging learning and accountability. Given wide variations in the ambition, capacity and resources available for monitoring and evaluation, it is apparent that not all of the M&E processes and indicators described will be appropriate for all stakeholders. The intention is to provide guidelines and details on useful and progressive approaches to monitoring rural sanitation and hygiene, from which a range of rural sanitation and hygiene duty bearers and practitioners – including governments, implementation agencies, development partners and service providers – can select and use those most appropriate to their needs. Eventually, it is hoped that all of the more progressive M&E elements and features will become standard, and be incorporated in all sector monitoring systems.

Environmental sanitation factors as prevalence support of soil transmitted helminths

The prevalence of soil transmitted helminths (STH) is closely related to the defecation facilities for rural communities, such as: the habit of defecating openly on the ground, in gardens and using open latrines in rivers. The aim of this study was to determine the effect of environmental sanitation risk factors on the prevalence of STH infection. This study was included in an analytical epidemiological study at two locations, using a cross sectional study as the research design. The location were Sri Kembang Village, Bukit Village, which is included in Betung District, Banyuasin Regency, and South Sumatra, Indonesia for 30 days. There were 252 students as the research sample. Data analysis showed that the prevalence of T. trichiura was higher in Sri Kembang State Primary School Number 1 with mild to very severe infection degrees. The intensity of A. lumbricoides infection in Bukit State Primary School Number 1 got a higher prevalence than Sri Kembang. Open defecation, gardens or open latrines, and types of houses with dirt floors indicate environmental sanitation factors that are sufficient to support the prevalence of STH. For further research, it is recommended to examine socio-economic risk factors.

Monitoring and Evaluation for Rural Sanitation and Hygiene: Framework

The monitoring and evaluation (M&E) Guidelines and Framework presented in this document (and in the accompanying M&E Indicator Framework) aim to encourage stakeholders in the rural sanitation and hygiene sector to take a more comprehensive, comparable and people focused approach to monitoring and evaluation. Many M&E frameworks currently reflect the interests and ambitions of particular implementing agencies – that is, community-led total sanitation (CLTS) interventions focused on open-defecation free (ODF) outcomes in triggered communities; market-based sanitation interventions focused on the number of products sold and whether sanitation businesses were profitable; and sanitation finance interventions reporting the number of facilities built using financial support. Few M&E frameworks have been designed to examine the overall sanitation and hygiene situation – to assess how interventions have affected sanitation and hygiene outcomes across an entire area (rather than just in specific target communities); to look at who (from the overall population) benefitted from the intervention, and who did not; to report on the level and quality of service used; or examine whether public health has improved. Since 2015, the Sustainable Development Goals (SDGs) have extended and deepened the international monitoring requirements for sanitation and hygiene. The 2030 SDG sanitation target 6.2 includes requirements to: • Achieve access to adequate sanitation and hygiene for all • Achieve access to equitable sanitation and hygiene for all • End open defecation • Pay special attention to the needs of women and girls • Pay special attention to those in vulnerable situations The 2030 SDG sanitation target calls for universal use of basic sanitation services, and for the elimination of open defecation, both of which require M&E systems that cover entire administration areas (i.e. every person and community within a district) and which are able to identify people and groups that lack services, or continue unsafe practices. Fortunately, the SDG requirements are well aligned with the sector trend towards system strengthening, in recognition that governments are responsible both for the provision of sustainable services and for monitoring the achievement of sustained outcomes. This document provides guidelines on the monitoring and evaluation of rural sanitation and hygiene, and presents an M&E framework that outlines core elements and features for reporting on progress towards the 2030 SDG sanitation target (and related national goals and targets for rural sanitation and hygiene), while also encouraging learning and accountability. Given wide variations in the ambition, capacity and resources available for monitoring and evaluation, it is apparent that not all of the M&E processes and indicators described will be appropriate for all stakeholders. The intention is to provide guidelines and details on useful and progressive approaches to monitoring rural sanitation and hygiene, from which a range of rural sanitation and hygiene duty bearers and practitioners – including governments, implementation agencies, development partners and service providers – can select and use those most appropriate to their needs. Eventually, it is hoped that all of the more progressive M&E elements and features will become standard, and be incorporated in all sector monitoring systems.

Evaluasi Program Sanitasi Total Berbasis Masyarakat Stop BABS di Puskesmas Lanjut Kecamatan Singkep Pesisir Kabupaten Lingga Tahun 2020

STBM adalah pendekatan untuk mengubah perilaku higienis dan saniter melalui pemberdayaan masyarakat dengan cara pemicuan. Berdasarkan data dari Dinas Kesehatan Provinsi Kepulauan Riau tahun 2019 Kabupaten Lingga termasuk tertinggi dengan 93% desa melaksankan STBM, atau sebanyak 76 desa dari total 82 desa yang telah melaksanakan STBM. Mengevaluasi Program Sanitasi Total Berbasis Masyarakat Stop BABS di Kecamatan Singkep Pesisir Kabupaten Lingga Tahun 2019. Informan pada penelitian ini terdiri dari informan Utama yaitu Plt.Kepala Puskesmas Lanjut, Penanggung Jawab UKM, Petugas Kesehatan Lingkungan. Dan informan pendukung yaitu Kepala Desa Sedamai dan Plt.Kepala Desa Berindat. Metode penelitian ini adalah penelitian Kualitatif deskriptif dengan waawncara dan observasi. Hasil penelitian ini adalah SDM yang cukup dalam menjalankan program STBM Stop BABS. Anggaran yang sudah mencukupi dalam pelaksanaan program. Sarana Prasarana yang kurang memenuhi kebutuhan petugas kesehatan. Kebijakan yang tidak sesuai dengan persyaratan yang sudah ditetapkan. Program STBM telah dilakukan sosisalisasi untuk memicu masyarakat agar tidak BAB Sembarangan yang bertujuan untuk mencapai keadaan Open Defecation Free (ODF) dan Pemantaun dilakukan oleh pihak puskesmas 3 bulan sekali. Adapun tidak tercapainya target dikarenakan tidak adanya peraturan desa yang tetapkan untuk program STBM Stop BABS dan kurangnya pengalaman petugas kesehatan. Hendaknya desa membuat peraturan terkait program STBM dan pelatihan khusus petugas kesehatan.