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. 2025 Jun 12;17(6):e85858.
doi: 10.7759/cureus.85858. eCollection 2025 Jun.

Effect of Health Profession Students' Community Engagement on Open Defecation-Free Status: A Quantitative Assessment of a Community-Led Total Sanitation and Hygiene Program in Southwestern Uganda

Moses Ntaro  1 , JohnBosco Isunju  2 , Fassou M Grovogui  3 , Jonathan Izudi  1 , Lenka Benova  4 , Edgar Mulogo  1 , John C Ssempebwa  2
Affiliations

Effect of Health Profession Students' Community Engagement on Open Defecation-Free Status: A Quantitative Assessment of a Community-Led Total Sanitation and Hygiene Program in Southwestern Uganda

Moses Ntaro et al. Cureus. .

Abstract

Introduction Uganda's Community-Led Total Sanitation (CLTS) strategy is based on the use of health extension workers (HEWs) for its implementation at the community level. However, identification of other facilitators to improve and accelerate the scaling up of the CLTS intervention has not been explored. This study evaluated the effect of a student-led CLTS intervention on open defecation and open defecation-free status outcomes. Methods The study was conducted in two sub-counties in Kabale district in southwestern Uganda, Rubaya and Buhara. We used a pre-post study with a nonequivalent control group quasi-experimental study design to measure the effect of a student-led CLTS intervention on' the levels of household open defecation (OD)-free (HODF) status. A total of six parishes from two study sub-counties with no main towns and having low latrine coverage were selected. A total of 50 villages were randomly selected, and 25 villages were assigned to each of the two study groups: (i) the student-led CLTS intervention group, and (ii) the conventional CLTS control group. To avoid contamination between the sub-counties, a buffer sub-county was left between. A total of 492 respondents from different households participated in the before and after CLTS intervention surveys. Results In the intervention group, the proportion of households practicing OD decreased (24.69% to 14.04%), and the households that obtained the HODF status also increased (2.88% to 6.14%). On the other hand, in the control group, OD increased (23.69% to 39.92%), and households with HODF status reduced (3.21% to 0.84%). The results showed that the households in the intervention group had higher odds of not practicing OD (OR 3.73; 95%CI: 1.01-13.77) compared to the households in the control group. Similarly, in the intervention group, households had a higher odds of attaining the HODF status (OR 13.20; 95%CI: 3.26- 53.55) compared to the control group. Conclusion The student-led CLTS reduced OD in the parishes where they worked. This study shows that other resource persons, such as health profession students, are a valuable resource that can fill in the gap in sanitation promotion activities. They will be able to successfully complement the already overburdened health workers, as in the case of Uganda.

Keywords: community enagement; community led total sanitation; health extension works; health profession students; odf; open defecation; open defecation free status; students; uganda.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Higher Degrees Research Ethics Committee, School of Health Sciences, College of Public Health, Kampala, Uganda issued approval dated October 20, 2021. The study was conducted in compliance with the ethical guidelines of conducting research in Institutions of Higher Education. The study was registered with the Uganda National Council of Science and Technology with registration number HS1135ES. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Timeline and sequence of the pre-post quasi-experimental study design
Adapted from: Crocker et al., 2016 [6] CLTA: Community-Led Total Sanitation; HH: household
See this image and copyright information in PMC

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