Effects of community-led total sanitation and hygiene implementation on diarrheal diseases prevention in children less than five years of age in South Western Ethiopia: A quasi- experimental study

BACKGROUND: Lack of improved sanitation is the most important contributing factor to diarrheal disease among under-five children in low and middle-income countries. There was no study to identify the effect of Community-Led Total Sanitation and Hygiene intervention on diarrheal diseases in the study area. Hence, this study was designed with the aim of finding the effects of Community-led Total Sanitation and Hygiene implementation for preventing diarrhea among under-five children. METHODS: A community-based Quasi-Experimental study was conducted among a sample of 846 households selected from intervention (kersa) and comparison (mana) districts using the four-stage random cluster-sampling method. A Semi-structured questionnaire was used to collect data. The collected data was cleaned, coded, and entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. Difference-in Difference method with McNemar’s tests was used to compare the prevalence of diarrhea between the intervention and comparison districts, and the significance of change between the pre-test and post-test was declared at p-value less than 0.05 with 95% confidence interval. RESULTS: The intervention led to decreased diarrhea prevalence [pp = -8.2, 95% CI: -15.9, -0.5], increased latrine ownership [pp = 5.6, 95% CI: 0.5, 10.8], and increased latrine utilization [pp = 10.7, 95% CI: 4.7, 16.6] in intervention district at post-test compared to the baseline; while the presence of handwashing facility near the latrine, home-based water treatment, and proper water storage and handling practice were decreased at post-test compared to the baseline. CONCLUSION: Implementation of Community-Led Total Sanitation improved sanitation and hygiene status of community that resulted in the reduction of diarrhea diseases in under-five children. Further implementation, evaluation, and scale-up of the interventions are needed to reduce diarrheal disease in under-five children.