Sensor-measured versus reported latrine use to characterize sanitation intervention uptake in a randomized controlled trial among households in rural Bangladesh

Mahfuza Islam ¹, Jesse D Contreras ², Leanne Unicomb ³

¹Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
²Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
³Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
⁴Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Sweden.
⁵Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
⁶Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA.
⁷Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, USA.
⁸Mortenson Center in Global Engineering, University of Colorado Boulder, USA.
⁹Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA.

⁰Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.

International Journal of Hygiene and Environmental Health +

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December 14, 2024

View abstract on PubMed

Summary

Objective measurement of latrine use in Bangladesh showed higher sensor-detected use in sanitation intervention groups initially, but this benefit diminished over time. Self-reported use was often inflated, highlighting the need for objective, longitudinal sanitation program assessments.

Area Of Science

Public Health
Environmental Health
Behavioral Science

Background

Sanitation program evaluations often rely on self-reported data, which may not accurately reflect actual latrine usage.
Objective measurement tools are crucial for understanding the long-term impact and uptake of sanitation interventions.

Purpose Of The Study

To objectively measure latrine use using motion sensors in households participating in a randomized controlled trial (WASH Benefits) in Bangladesh.
To compare sensor-measured latrine use between sanitation intervention and control groups over time.
To assess the accuracy of self-reported latrine use against objective sensor data.

Main Methods

A randomized controlled trial (WASH Benefits) in Bangladesh provided upgraded latrines and behavioral promotion.
Motion sensors were installed in household latrines across two waves, capturing data 1.5-2.5 and 2.5-3.5 years post-intervention.
Zero-inflated negative binomial regression was used to analyze daily latrine use events per person, comparing groups and self-reported use levels.

Main Results

Sanitation intervention recipients showed higher sensor-measured latrine use than controls at 1.5-2.5 years but not at 2.5-3.5 years, suggesting reduced long-term uptake.
In the sanitation group, self-reported exclusive latrine use did not correlate with higher sensor-measured use.
In the control group, higher self-reported exclusive latrine use was associated with objectively higher sensor-measured use.

Conclusions

Objective sensor data reveal that the positive impact of sanitation interventions on latrine use may decrease over time.
Self-reported latrine use data can be unreliable, particularly among intervention recipients.
Longitudinal follow-up and objective measurement methods are essential for accurate sanitation program evaluation.

Keywords:

Hygiene Latrine use Sanitation Sensor Uptake