Contributing to the debate on categorising shared sanitation facilities as ‘unimproved’: An account based on field researchers’ observations and householders’ opinions in three regions, Tanzania

BackgroundHealth risks associated with poor sanitation behaviours continue to be reported mostly from low-income countries (LICs). Reports show that various factors limit many people from accessing and using improved latrines, forcing some to opt for sharing latrines with neighbours, others practicing open defecation. Meanwhile, debate prevails on whether shared latrines should be categorised as unimproved according to WHO/UNICEF-JMP criteria. We contribute to this debate based on results from a study undertaken in three regions, Tanzania.Materials and methodsData were collected through observations in 1,751 households with latrines, coupled with collection of opinions from heads of such households regarding the latrine-sharing practices. Bivariate and multivariate logistic regression analyses were performed to assess associations between the outcome and possible predictor variables.ResultsOf all 1,751 latrines, 14.6% were shared. Among the shared latrines, 74.2% were found being generally clean as compared to 69.2% of the non-shared ones. Comparing the shared and non-shared latrines, the non-shared latrines were significantly less likely to be found with floors built with permanent materials (OR = 0.73, 95% CI: 0.55, 0.98); washable floors (OR = 0.69; 95% CI: 0.51, 0.93); and lockable doors (OR = 0.73; 95% CI: 0.56, 0.95). Shared latrines were less likely to have floors with faecal matter, functional handwashing facilities (HWFs), HWFs with running water, and roofs; albeit the differences in all these scenarios were not statistically significant. Respondents expressed desire for improved latrines, but also did not find it wrong to share latrines if cleanliness was maintained.ConclusionHaving an ‘improved’ latrine remains important as JMP recommends, but based on our study findings, we argue that possessing a non-shared latrine neither guarantees safety to its users nor its categorisation as ‘improved’. Instead, the state of the latrine, the construction technology used and the behaviours of the users may be more important.研究背景 与不良卫生行为相关的健康风险，目前仍主要在低收入国家（low-income countries, LICs）中被频繁报道。相关调研显示，诸多因素制约了多数人群获取并使用改良型厕所（improved latrines），致使部分人群选择与邻居共用厕所，另有部分人群则采取露天排便的方式。与此同时，针对是否应依据世界卫生组织/联合国儿童基金会联合监测项目（WHO/UNICEF-JMP）的判定标准，将共用厕所归类为非改良型厕所的议题，学界仍存在广泛争议。本研究基于在坦桑尼亚三个区域开展的调研结果，为该争议提供新的分析视角与论据。 材料与方法 本研究通过对1751户拥有厕所的家庭进行实地观察，并收集这些家庭户主关于共用厕所行为的相关意见，完成数据采集。研究采用双变量及多变量逻辑回归分析方法，评估结局变量与潜在预测变量之间的关联关系。 结果 在全部1751座厕所中，14.6%为共用厕所。其中，共用厕所中整体清洁的占比为74.2%，而非共用厕所的这一占比为69.2%。经对比分析，非共用厕所采用永久性材料铺设地板的概率显著更低（优势比（Odds Ratio, OR）=0.73，95%置信区间（95% Confidence Interval, 95% CI）：0.55~0.98）；可水洗地板的配置概率同样显著更低（OR=0.69，95% CI：0.51~0.93）；且带有可锁房门的概率也显著更低（OR=0.73，95% CI：0.56~0.95）。共用厕所的地板存在粪便、配备功能性洗手设施（Handwashing Facilities, HWFs）、配备带流水的洗手设施以及带有屋顶的概率均更低，不过上述差异均未达到统计学显著性水平。受访户主既表达了对改良型厕所的需求，同时也认为，只要能够保持清洁，共用厕所并无不妥。 结论 正如世界卫生组织/联合国儿童基金会联合监测项目（WHO/UNICEF-JMP）所倡导的，拥有‘改良型厕所’依然至关重要。但基于本研究结果，我们认为，仅拥有非共用厕所，既无法保障使用者的健康安全，也不能将其直接归类为‘改良型厕所’。相较之下，厕所的卫生状况、所采用的建造技术以及使用者的行为习惯，或许才是更为关键的影响因素。