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. 2025 May 28;25(1):1974.
doi: 10.1186/s12889-025-23208-y.

Open defecation free status and its determinants in rural Uganda: a cross-sectional survey

Moses Ntaro  1   2 , John Bosco Isunju  3 , Edgar Mulogo  4 , John C Ssempebwa  3
Affiliations

Open defecation free status and its determinants in rural Uganda: a cross-sectional survey

Moses Ntaro et al. BMC Public Health. .

Abstract

Introduction: Globally, the progress to attain the open defecation free (ODF) environment has remained very slow. This study examined context specific factors influencing household open defecation free status in Uganda.

Methods: A cross-sectional study was conducted in Kabale district in southwestern Uganda and 492 participants were randomly selected at household level. Data was obtained through conducting a face-to-face interview using the mobile data collection software KoBoCollect v2021.3.4 installed on tablet devices. Using the Firth's penalized logistic regression, bivariate and multivariate analysis was conducted to determine if there existed significant associations between the outcome Household Open Defecation (HODF) status and independent variables. Variables with P < 0.2 at bivariate analysis comprised the global model for the multivariate analysis.

Results: The average age of the participants was 49 (SD 23.4) years. Most (67.68%) of the study participants, were females while 144 (29.27%) of the participants had no formal education. The households that were open defecation free were as few as 15 (3%). At multivariable analysis, gender of the participants, remembering handwashing, latrine and household cleanliness factors were significantly association with HODF status. Male participants had more odds of having open defecation free households (aOR: 3.89; 95% CI: 1.26-12.06) compared to female participants. Households with clean compounds, with latrines not having their holes soiled with feces and where respondents always remembered to wash hands after visiting latrine had high odds of being open defecation free (aOR: 3.15; 95% CI: 1.03-9.66, aOR: 10.56; 95% CI: 1.87-59.63 and aOR: 3.96; 95% CI: 1.24-12.68, respectively).

Conclusion: The prevalence of HODF was very low and factors associated with it were; the gender of the participants, the latrine and household cleanliness and the behavioral factor of remembering handwashing. We propose behavioral change interventions that empower communities to adapt improved sanitation behavior, such as Community Led Total Sanitation and Hygiene (CLTSH) in order to increase households with the Open Defecation Free status.

Keywords: CLTSH; Determinants; Household open defecation free (HODF) status; Open defecation (OD).

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Conflict of interest statement

Declarations. Human ethics and consent to participate: Informed consent was obtained from all household heads or their spouses that participated in the study. The study protocol was approved by the High Degrees Research and Ethics Committee of School of Public Health, College of Health Sciences, Makerere University. The final approval and registration was done by the Uganda National Council of Science and Technology (UNCST). The research registration number of UNCST is HS1135ES. The Helsinki declaration ethical considerations were observed in conducting this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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