Community-based interventions addressing open defecation in Sub-Saharan Africa: a scoping review

Open defecation (OD) remains a major public health issue, particularly in rural Sub-Saharan Africa (SSA), where a significant proportion of the population still lacks access to basic sanitation. It increases the risk of infectious diseases, psychosocial stress, and sexual violence, especially for women. Community-based interventions, such as Community-Led Total Sanitation (CLTS), have been implemented to eliminate OD through behaviour change. This scoping review aimed to map community-based approaches used to eliminate OD in SSA. It followed Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines. Peer-reviewed primary studies published since 2010 on community-based interventions addressing OD in SSA were included. Nationwide or poorly described interventions were excluded. Searches were conducted in MEDLINE, Web of Science, and CINAHL. Two reviewers independently screened, extracted, and synthesised data. Fifteen studies on community-based interventions were included. Most (n = 12) focused on CLTS, with some combining additional components or using alternative interventions including health education, or shared latrine construction. Outcomes included latrine use (n = 6), OD reduction (n = 5), both latrine use and OD reduction (n = 1), diarrhoea incidence (n = 2), Water, Sanitation, and Hygiene (WASH) behaviours (n = 2), and psychosocial stress (n = 1). CLTS-related interventions generally reported on improved latrine ownership and reduced OD. Other non-CLTS interventions often reported limited or inconsistent improvements. Barriers included limited facilitator skills and weak implementation fidelity, while facilitators included small village size, and strong social cohesion. In conclusion, context-specific interventions, engaging leaders, and focusing on smaller communities may facilitate reduction in OD practices. Future research and practice should prioritise long-term evaluation and sustaining behaviour change.