Davies Katherine, Panulo Mindy, MacLeod Clara, Wilbur Jane, Morse Tracy, Chidziwisano Kondwani, Dreibelbis Robert
Department of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom.
Centre for Water, Sanitation, Health, and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Blantyre, Malawi.
PLOS Glob Public Health. 2024 Aug 29;4(8):e0003005. doi: 10.1371/journal.pgph.0003005. eCollection 2024.
Community-led total sanitation (CLTS) is embraced as a key strategy to achieve universal sanitation coverage (Sustainable Development Goal 6.2). Although inclusion is identified as a predictor of CLTS success, people living with disabilities are often excluded from community sanitation programmes and there is limited research exploring CLTS participation amongst people living with disabilities. This study aims to explore the extent to which people living with disabilities participated in a CLTS intervention delivered in rural Malawi using standard approaches. This cross-sectional study was conducted in the Chiradzulu district of Malawi. A household questionnaire was administered to collect information about CLTS participation. Multivariable logistic regression was performed to compare participation in different CLTS activities between households with (n = 80) and without a member with a disability (n = 167), and between household members with (n = 55) and without a disability (n = 226). No difference in CLTS participation was observed at the household-level, but there were marked differences in CLTS participation between household members with and without a disability. Household members without a disability felt they could give more input in triggering activities (OR = 3.72, 95%CI 1.18-11.73), and reported higher participation in the transect walk (OR = 4.03, 95%CI 1.45-11.18), community action planning (OR = 2.89, 95%CI 1.36-6.13), and follow-up visits (OR = 3.37, 95%CI 1.78-6.40) compared to household members with disabilities. There was no difference in the likelihood of being invited to triggering (OR = 0.98, 95%CI 0.41-2.36), attending triggering (OR = 2.09, 95%CI 0.98-4.46), or participating in community mapping (OR = 2.38, 95%CI 0.71-7.98) between household members with and without a disability. This study revealed intra-household inequalities in CLTS participation. To improve participation in CLTS interventions, facilitators should be trained on action steps to make CLTS more inclusive. Further research could include an in-depth analysis of predictors of CLTS participation amongst people living with disabilities, including disability types, severity and age.
社区主导的全面卫生（CLTS）被视为实现全民卫生覆盖（可持续发展目标6.2）的一项关键战略。尽管包容性被认为是CLTS成功的一个预测因素，但残疾人往往被排除在社区卫生项目之外，而且探索残疾人参与CLTS的研究有限。本研究旨在探讨在马拉维农村地区采用标准方法实施的CLTS干预措施中，残疾人的参与程度。这项横断面研究在马拉维的奇拉祖卢区进行。通过发放家庭问卷来收集有关CLTS参与情况的信息。进行多变量逻辑回归分析，以比较有残疾成员的家庭（n = 80）和无残疾成员的家庭（n = 167）之间，以及有残疾的家庭成员（n = 55）和无残疾的家庭成员（n = 226）之间在不同CLTS活动中的参与情况。在家庭层面未观察到CLTS参与情况的差异，但有残疾和无残疾的家庭成员在CLTS参与方面存在显著差异。无残疾的家庭成员认为他们在启动活动中能提供更多意见（比值比=3.72，95%置信区间1.18 - 11.73），并且报告在横断面走访（比值比=4.03，95%置信区间1.45 - 11.18）、社区行动计划制定（比值比=2.89，95%置信区间1.36 - 6.13）以及后续走访（比值比=3.37，95%置信区间1.78 - 6.40）中的参与度更高。有残疾和无残疾的家庭成员在被邀请参加启动活动（比值比=0.98，95%置信区间0.41 - 2.36）、参加启动活动（比值比=2.09，95%置信区间0.98 - 4.46）或参与社区绘图（比值比=2.38，95%置信区间0.71 - 7.98）的可能性上没有差异。本研究揭示了CLTS参与中的家庭内部不平等现象。为提高对CLTS干预措施的参与度，应培训促进者采取行动步骤以使CLTS更具包容性。进一步的研究可包括深入分析残疾人参与CLTS的预测因素，包括残疾类型、严重程度和年龄。
