Sanitation-Hygiene Practices and Social Norms in Community-led Total Sanitation for Sustainability of Open Defecation Free Status: A Survey of Suna West Sub-County, Migori County, Kenya.

BackgroundCommunity-led total sanitation (CLTS) has been used to stir sanitation-related behaviour change and attain open defecation free (ODF) status. CLTS interventions suffer high rates of reversion such that their gains are unsustainable in most contexts. ObjectiveThis study aimed to determine the role of sanitation hygiene practices and social norms on open defecation free status in Suna West Sub County. MethodologyA cross-section study design was employed using questionnaire and observation checklist to collect data from 384 households. ResultsResults revealed that 66.1% households had partially reverted to non-ODF status. The sanitation-hygiene practices associated with being ODF includes: use of elevated racks (AOR=0.81; CI=0.34-1.90; p=0.625), use of treating water (AOR=2.81; CI=(0.97-8.06); p=0.055), regularly clean latrines (AOR=2.96; CI=0.63-13.89; p=0.17), pouring of ash over the pit of the latrine (AOR=4.08; CI=1.73-9.62; p<0.001) and use of dug out pits for waste disposal (AOR=2.41; CI=1.02-5.68; p<0.045). On social norms, the study found that laws/penalties (AOR=4.15; CI=2.20-7.80; p<0.001) and rewards/incentives (AOR=0.17; CI=0.096-0.306; p<0.001) had less odds of being ODF. Moreover, odds of being ODF was low for households who reported that construction/maintenance materials were expensive (AOR=0.17; CI=0.84-2.79; p=0.169), that it was embarrassing to people defecate in the open (AOR=0.060; CI0.19-1.23=; p<0.129) and that it is okay to defecate in bushes/rivers/dams (AOR=0.623; CI=;0.329-1.179 p<0.146). ConclusionThe results of this study show partial reversion to non-ODF status in previously certified villages. However, households that sustained ODF status had several sanitation hygiene practices. Interestingly, households that displayed social norms were less likely to be ODF. Overall, the findings of the present study demonstrate that the CLTS process failed to instil social norms around proper sanitation to inspire community collective action thus little influence on sustainable behaviour change. The findings of this study therefore highlight the need to enhance good hygiene sanitation practices, while instilling social norms to inspire community collective action.