Asiimwe John Bosco, Namawejje Hellen, Mirembe Faith Rachel, Adong Annet, Achola Jolly, Nabaasa Herbert, Mulusew Jebena, Izudi Jonathan, Kadengye Damazo T
Department of Planning and Applied Statistics, Makerere University, Kampala, Uganda.
Department of Statistical Methods and Actuarial Science, Makerere University, Kampala, Uganda.
PLoS One. 2025 Jul 24;20(7):e0329307. doi: 10.1371/journal.pone.0329307. eCollection 2025.
A substantial proportion (7%) of people in Uganda practice open defecation. A Community-Led Total Sanitation (CLTS) project was started in 2011 to reduce indiscriminate disposal of excreta but the effect has not been rigorously evaluated. We, therefore, evaluated the effect of CLTS on reducing open defecation in the program intervention districts in Uganda. We used the 2016 Uganda Demographic and Health Survey (UDHS) data to conduct a quasi-experimental study using a propensity score matching (PSM) approach. The intervention group consisted of districts that implemented the CLTS and the comparison group were districts that did not implement the CLTS. We matched the intervention and comparison groups on several covariates in a 1:1 ratio within a caliper of 20% of the standard deviation of the propensity score. We confirmed balance in covariates using standardized mean difference (SMD) being <0.1 or 10%. We applied a conditional logit regression model on the matched dataset adjusting for matched pairs to estimate the intervention effect, reported as odds ratio (OR) and 95% confidence interval (CI). We assessed the robustness of the estimate using Mantel-Haenszel sensitivity analysis. There were 17,415 participants (4,373 intervention vs. 13,042 comparison) before PSM and 8,470 participants (4,235 comparison vs. 4,235 intervention) after PSM. In the unmatched weighted dataset, 5.4% of participants had open defecation (7.9% intervention vs. 4.6% comparison). In the matched weighted data, open defecation was 9.3% and 7.6% in the comparison and intervention groups, respectively. Results show that CLTS reduced the prevalence of open defecation by 37% (OR 0.63, 95% CI 0-54-0.74) and this finding is robust to unmeasured confounders (Gamma = 1.35, p = 0.052). We recommend the scale-up of CLTS to the remaining districts by the Government of Uganda to reduce open defecation.
乌干达有相当一部分人（7%）有露天排便的习惯。2011年启动了一个由社区主导的全面卫生（CLTS）项目，以减少粪便的随意处置，但该项目的效果尚未得到严格评估。因此，我们评估了CLTS在乌干达项目干预地区减少露天排便方面的效果。我们使用2016年乌干达人口与健康调查（UDHS）数据，采用倾向得分匹配（PSM）方法进行了一项准实验研究。干预组由实施CLTS的地区组成，对照组是未实施CLTS的地区。我们在倾向得分标准差的20%范围内，以1:1的比例在几个协变量上对干预组和对照组进行匹配。我们使用标准化平均差（SMD）<0.1或10%来确认协变量的平衡。我们在匹配数据集上应用条件logit回归模型，对匹配对进行调整以估计干预效果，以比值比（OR）和95%置信区间（CI）报告。我们使用Mantel-Haenszel敏感性分析评估估计的稳健性。倾向得分匹配前有17415名参与者（4373名干预组 vs. 13042名对照组），倾向得分匹配后有8470名参与者（4235名对照组 vs. 4235名干预组）。在未匹配的加权数据集中，5.4%的参与者有露天排便行为（干预组为7.9%，对照组为4.6%）。在匹配的加权数据中，对照组和干预组的露天排便率分别为9.3%和7.6%。结果表明，CLTS使露天排便率降低了37%（OR 0.63，95% CI 0.54 - 0.74），并且这一发现对未测量的混杂因素具有稳健性（Gamma = 1.35，p = 0.052）。我们建议乌干达政府将CLTS推广到其余地区，以减少露天排便现象。
