Evaluating the impact of community led total sanitation in improving selected hygiene and sanitation related health outcomes in Traditional Authority Mwadzama in Nkhotakota district, central Malawi

Abstract

Sanitation and hygiene-related diseases are one of the greatest challenges to the achievement of the Millennium Development Goals for Nkhotakota District. The overall coverage of access to adequate sanitation in the District is 20%. To increase coverage of hygiene and sanitation, Hygiene Village Project (HVP) is implementing a five-year hygiene and sanitation project in Traditional Authority (T/A) Mwadzama in Nkhotakota District of Malawi using the Community Led Total Sanitation (CLTS). Although there has been high coverage in hygiene and sanitation related indicators as a result of implementing CLTS in the area, not much is known about the impact on health outcomes. The study therefore, aimed at evaluating the impact of CLTS in improving hygiene and sanitation related health outcomes in the area by comparing data collected before and after CLTS implementation. Data for this study were collected from 247 households using a questionnaire based survey, 19 focus group discussions, 7 key informant interviews and a review of relevant documents. All the collected quantitative data were processed and analysed using International Business Machine Statistical Package for Social Sciences (IBM SPSS) Modeler 14.0 (IBM Corp., 2013) and Stata 14 (StataCorp., 2015). Qualitative data was transcribed and later word processed using Microsoft Word package. The findings showed that there was an increase in latrine coverage from 75% in 2012 to 95% in 2015. The occurrence of diarrhoea decreased from 19% in 2012 to 13.4% in 2014. The prevalence of acute respiratory infections (ARI) increased from 33% in 2012 to 58% in 2014. Sanitation and hygiene related mortality rates from diseases such as ARI, malnutrition and diarrhoea decreased from 21 to 12, 31 to 12, and 30 to 24 per 1,000 respectively. These findings showed that there was significant improvement in most of the health outcomes after CLTS was implemented in the study area. The study therefore, recommends that government and its implementing partners should consider scaling up the implementation of this initiative to all the remaining Traditional Authority areas in the District.