Entrenching social norms in Community-led total sanitation for sustainability of open defecation free status: A survey of Suna West Sub-County, Migori County, Kenya

Background: Community-led total sanitation (CLTS) has been used to stir sanitation-related behaviour change and attain open defecation free (ODF) status. CLTS interventions suffer high rates of reversion such that their gains are unsustainable in most contexts including Suna West sub-County, Kenya. Objective: This study aimed at determining the role of sanitation hygiene practices and social norms on open defecation free status in Suna West Sub County. Methodology: Survey study design was employed using questionnaire and observation checklist to collect data from 384 households. Results: Results revealed that 66.1% households had partially reverted to non-ODF status. The sanitation-hygiene practices associated with maintenance of ODF includes: use of treated water (OR=3.17; CI=1.20-8.40; p=0.020), use of elevated racks (OR=2.17; CI=1.08-4.37; p=0.030), regularly clean latrines (OR=4.88; CI=1.12-21.37; p=0.035), pouring of ash over the pit of the latrine (OR=4.25; CI=4.20-8.87; p<0.001) and use of dug out pits for waste disposal (OR=4.51; CI=2.09-9.78; p<0.001). On social norms, the study found that laws/penalties (OR=0.31; CI=0.21-0.48; p<0.001), need to improve things in the family (OR=0.50; CI=0.28-0.92; P=0.025), and rewards/incentives (OR=0.21; CI=0.13-0.33; p<0.001) would reduce odds of being ODF. Moreover, odds of being ODF was less likely for households with perception that; construction/maintenance materials were expensive (OR=0.52; CI=0.33-0.80; p=0.003), most people dont have a latrine (OR=0.40; CI=0.25-0.64; p<0.001) and it is okay to defecate in bushes/rivers/dams (OR=0.31; CI=0.19-0.51; p<0.001). Conclusion: This study findings provides evidence of ODF status reversion in previously certified villages. However, household with retained ODF status was enhanced by several sanitation hygiene practices. Interestingly, households that displayed social norms were less likely to be ODF. This reveals that the CLTS process failed to instil social norms around proper sanitation to inspire community collective action thus little influence on sustainable behaviour change. The findings of this study therefore highlight the need to enhance good hygiene sanitation practices, while instilling social norms to inspire community collective action.