A socio-ecological analysis of barriers to sustained adoption of rural sanitation in Ethiopia, a qualitative study

The objective of the study was to explore barriers influencing the sustained adoption and use of sanitation facilities. A qualitative study was conducted in rural Ethiopia using in-depth interview and focus group discussion techniques. A social-ecological model and IBM-WASH framework were employed for the designing and analysis. Barriers for sustained adoption and use of sanitation facilities were categorized into1)individual level (past latrine experience, lack of demand to improved latrine), 2) household level factors (unaffordability, lack of space and, absence of physically strong family member), 3) community level factors (lack of access to public latrine, lack of shared rules against open defecation, lack of financial access for the poor) and, 4) societal level factors (lack of strong local leadership, flooding, soil condition, lack of appropriate sanitation technology, lack of promotion and demand creation on improved latrine). Hence, there is a need to consider multi-level intervention to address the identified barriers

Multivariable logistic regression model for remaining within the TT surgery programme, West Amhara Region, Ethiopia.

<p>Multivariable logistic regression model for remaining within the TT surgery programme, West Amhara Region, Ethiopia.</p

Multiple logistic regression model for performing any static-site surgery.

<p>Multiple logistic regression model for performing any static-site surgery.</p

Characteristics of the individuals trained in TT surgery in West Amhara Region, Ethiopia.

<p>Subdivided into those who are (IN) and are not (LOST) working in the programme. Univariate associations are shown for continuing to work in the programme.</p><p>*Unpaired t-test.</p

Trichiasis surgeons trained in West Amhara Region, Ethiopia.

<p>Flow diagram showing the numbers trained, identified, interviewed and still working in the TT surgery programme.</p

Univariate and multivariable associations for having been previously offered TT surgery.

*<p>Entropion grade 3 or worse.</p>†<p>Visual acuity worse than logMAR 0.7.</p

Reasons for not previously having TT surgery.

<p>The overall frequency of each reported barrier and the frequency it was reported as either the primary or secondary barrier.</p>*<p>Alternative treatments used with expectation of curing TT:</p><p>Expected Azithromycin provided in mass drug administration campaign to treat trichiasis: 8 people.</p><p>Church/prayer: 4 people.</p><p>Unidentified medicine: 2 people.</p><p>Epilation: 3 people.</p>†<p>>1 barrier cited by some study participants.</p>‡<p>1311 participants did not cite a secondary barrier.</p

Consort flow chart 2.

<p>Surgery versus epilation for the treatment of minor trichiasis in ethiopia: a randomised controlled noninferiority trial. PLoS Med 8: e1001136.</p

Demographic characteristics of participants and the clinical phenotype of all eyes.

*<p>See <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001766#pntd.0001766.s001" target="_blank">protocol S1</a> for description of corneal scar and entropion grades.</p>†<p>These eyes without TT were the second eye of patient's with unilateral disease.</p><p>Abbreviations:</p><p>CF: count fingers.</p><p>HM: hand movements.</p><p>PL: perception of light.</p><p>NPL: no perception of light.</p><p>VA: visual acuity.</p

Barriers to attending for surgery divided by age (less or greater than 50 years).

<p>Part a) All barriers cited by participants divided by age less or greater than 50 years. Part b) Analysis of association between being ≥50years and specific barriers.</p>*<p>Denominator is number of men/women; numerator is number of men/women citing each barrier. For example 16.1% of participants age<50 years and 9.9% of participants age≥50 years cited no symptoms as a barrier.</p