Laboratory of Human Ecology, Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
Laboratory of Human Ecology, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
PLoS One. 2020 May 13;15(5):e0232763. doi: 10.1371/journal.pone.0232763. eCollection 2020.
Accounting for peri-urban sanitation poses a unique challenge due to its high density, unplanned stature, with limited space and funding for conventional sanitation instalment. To better understand users, needs and inform peri-urban sanitation policy, our study used multivariate stepwise logistic regression to assess the factors associated with use of improved (toilet) and unimproved (chamber) sanitation facilities among peri-urban residents. We analysed data from 205 household heads in 1 peri-urban settlement of Lusaka, Zambia on socio-demographics (economic status, education level, marital status, etc.), household sanitation characteristics (toilet facility, ownership and management) and household diarrhoea prevalence. Household water, sanitation and hygiene (WASH) facilities were assessed based on WHO-UNICEF criteria. Of particular interest was the simultaneous use of toilet facilities and chambers, an alternative form of unimproved sanitation with focus towards all-in-one suitable alternatives. Findings revealed that having a regular income, private toilet facility, improved drinking water and handwashing facility were all positively correlated to having an improved toilet facility. Interestingly, both improved toilets and chambers indicated increased odds for diarrhoea prevalence. Odds of chamber usage were also higher for females and users of unimproved toilet facilities. Moreover, when toilets were owned by residents, and hygiene was managed externally, use of chambers was more likely. Findings finally revealed higher diarrhoea prevalence for toilets with more users. Results highlight the need for a holistic, simultaneous approach to WASH for overall success in sanitation. To better access and increase peri-urban sanitation, this study recommends a separate sanitation ladder for high density areas which considers improved private and shared facilities, toilet management and all-inclusive usage (cancelling unimproved alternatives). It further calls for financial plans supporting urban poor access to basic sanitation and increased education on toilet facility models, hygiene, management and risk to help with choice and proper facility use to maximize toilet use benefit.
由于人口密度高、规划不规范、传统卫生设施安装空间和资金有限，城市周边地区的卫生设施规划带来了独特的挑战。为了更好地了解用户需求并为城市周边地区卫生设施政策提供信息，我们使用多元逐步逻辑回归分析评估了与城市周边居民使用改良（厕所）和非改良（茅坑）卫生设施相关的因素。我们分析了赞比亚卢萨卡市一个城市周边住区 205 户家庭户主的社会人口统计学数据（经济状况、教育水平、婚姻状况等）、家庭卫生设施特征（厕所设施、所有权和管理）和家庭腹泻流行情况。家庭用水、卫生和环境卫生设施是根据世卫组织-儿基会标准评估的。特别感兴趣的是同时使用厕所设施和茅坑，这是一种非改良卫生设施的替代形式，重点是寻找所有功能都适用的替代方案。研究结果表明，有稳定收入、私人厕所设施、改良饮用水和洗手设施与拥有改良厕所设施呈正相关。有趣的是，改良厕所和茅坑都表明腹泻流行的几率增加。女性和使用非改良厕所设施的用户使用茅坑的几率也更高。此外，当厕所归居民所有，卫生管理由外部负责时，使用茅坑的可能性更大。研究结果还表明，使用厕所的人数越多，腹泻流行的几率就越高。研究结果强调，需要采用整体的、同步的方法来实现用水、卫生和环境卫生的全面成功。为了更好地获取和增加城市周边地区的卫生设施，本研究建议为高密度地区制定单独的卫生设施阶梯，其中考虑了改良的私人和共享设施、厕所管理以及综合使用（取消非改良的替代方案）。此外，还需要制定财政计划，支持城市贫困人口获得基本卫生设施，并增加有关厕所设施模式、卫生、管理和风险的教育，以帮助做出选择并正确使用设施，最大限度地发挥厕所的使用效益。
