Massa Khalid, Kilamile Fadhili, Safari Emmanuela, Seleman Amour, Mwakitalima Anyitike, Balengayabo Jonas G, Kassile Telemu, Mangesho Peter E, Mubyazi Godfrey M
Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania.
Ardhi University, School of Environmental Science and Technology, Dar es Salaam, Tanzania.
PLoS One. 2017 Nov 6;12(11):e0185875. doi: 10.1371/journal.pone.0185875. eCollection 2017.
Health risks associated with poor sanitation behaviours continue to be reported mostly from low-income countries (LICs). Reports show that various factors limit many people from accessing and using improved latrines, forcing some to opt for sharing latrines with neighbours, others practicing open defecation. Meanwhile, debate prevails on whether shared latrines should be categorised as unimproved according to WHO/UNICEF-JMP criteria. We contribute to this debate based on results from a study undertaken in three regions, Tanzania.
Data were collected through observations in 1,751 households with latrines, coupled with collection of opinions from heads of such households regarding the latrine-sharing practices. Bivariate and multivariate logistic regression analyses were performed to assess associations between the outcome and possible predictor variables.
Of all 1,751 latrines, 14.6% were shared. Among the shared latrines, 74.2% were found being generally clean as compared to 69.2% of the non-shared ones. Comparing the shared and non-shared latrines, the non-shared latrines were significantly less likely to be found with floors built with permanent materials (OR = 0.73, 95% CI: 0.55, 0.98); washable floors (OR = 0.69; 95% CI: 0.51, 0.93); and lockable doors (OR = 0.73; 95% CI: 0.56, 0.95). Shared latrines were less likely to have floors with faecal matter, functional handwashing facilities (HWFs), HWFs with running water, and roofs; albeit the differences in all these scenarios were not statistically significant. Respondents expressed desire for improved latrines, but also did not find it wrong to share latrines if cleanliness was maintained.
Having an 'improved' latrine remains important as JMP recommends, but based on our study findings, we argue that possessing a non-shared latrine neither guarantees safety to its users nor its categorisation as 'improved'. Instead, the state of the latrine, the construction technology used and the behaviours of the users may be more important.
与不良卫生行为相关的健康风险大多仍来自低收入国家（LICs）。报告显示，多种因素限制了许多人使用改良厕所，迫使一些人选择与邻居共用厕所，另一些人则露天排便。与此同时，对于共用厕所是否应根据世界卫生组织/联合国儿童基金会联合监测计划（WHO/UNICEF-JMP）标准归类为未改良厕所，仍存在争议。我们根据在坦桑尼亚三个地区进行的一项研究结果，为这场辩论提供依据。
通过对1751户有厕所的家庭进行观察，并收集这些家庭户主对共用厕所做法的意见来收集数据。进行双变量和多变量逻辑回归分析，以评估结果与可能的预测变量之间的关联。
在所有1751个厕所中，14.6%是共用的。在共用厕所中，74.2%被发现总体清洁，而非共用厕所的这一比例为69.2%。比较共用和非共用厕所，非共用厕所采用永久性材料建造地板的可能性显著更低（比值比[OR]=0.73，95%置信区间[CI]：0.55，0.98）；有可冲洗地板的可能性更低（OR=0.69；95%CI：0.51，0.93）；有可锁门的可能性更低（OR=0.73；95%CI：0.56，0.95）。共用厕所地板有粪便、有功能性洗手设施（HWFs）、有自来水的HWFs以及有屋顶的可能性更低；尽管在所有这些情况下的差异均无统计学意义。受访者表示希望有改良厕所，但也认为如果能保持清洁，共用厕所并无不妥。
正如联合监测计划所建议的，拥有一个“改良”厕所仍然很重要，但根据我们的研究结果，我们认为拥有一个非共用厕所既不能保证使用者的安全，也不能保证其被归类为“改良”厕所。相反，厕所的状况、所使用的建造技术以及使用者的行为可能更为重要。
