ISSN 2360-7920
Abstract
Malawi adopted the Community-Led Total Sanitation (CLTS) approach to eliminate open defecation (OD) through behavioural change. Balaka District, an open defecation-free certified model district, was among the first four open defecation-free (ODF) status-certified districts in Malawi.This study assessedthe sustainability of sanitation and hygiene practices in Balaka four years after ODF certification. A descriptive cross-sectional study design was employed, using both quantitative and qualitative methods. Data were collected from 438 household heads, 19 key informants, and six focus group discussions involving sanitation stakeholders. Latrine coverage remains high (89%) but falls short of the 100% target required for ODF re-verification. Hand washing facility (HWF) coverage is low (36%), with only 24% of respondents reporting hand washing with soap after toilet use. There was a positiveand significant association between age (β = 0.012, p = 0.003), household size (β = 0.126, p = 0.008), and latrine use. Marital status and religion were significantly associated with both HWF availability (β = 0.056, p = 0.019; β = -0.293, p = 0.000) and hand washing with soap (β = 0.060, p = 0.008; β = 0.187, p = 0.002). Community CLTS knowledge was significantly associated with HWF availability (F = 2.349, p = 0.008)and hand washingwith soap (F = 5.188,p = 0.000). Attitude was a significant predictor only for HWF availability (F = 2.774, p = 0.005). Findings indicate marginal improvements in sanitation and hygiene behaviour four years post-ODFcertification. To sustainsanitation gains, increasedfocus is needed on promoting latrine construction and handwashing facilities and encouraging handwashing with soap.
Keywords: Certification, Community Led Total Sanitation, Hand-washing with soap, Open defecation, Sustainable sanitation.