Assessing latrine use in low-income countries: a field study in rural India

Sanitation programme monitoring is often limited to latrine access and coverage, with little emphasis on use of the facilities. This may be partially explained by the challenges associated with measuring individual and household latrine use. The conventional methods used each have their limitations. The overall goal of this research was to improve the methods for assessing latrine use in low-income countries and enhance our understanding of the patterns and determinants of latrine use in rural India. The evidence from a cross-sectional study to compare reported latrine use with a technology based measure, Passive Latrine Use Monitors, indicated that reported latrine use, though already suggesting low adoption, likely exaggerates the actual level of uptake of government constructed latrines in rural Odisha, India. Moderate agreement was obtained when comparing daily reported use during the previous 48 hours with the average daily PLUM count. Thus, if self-report measures are used, survey questions should focus on the 48 hours prior to the date of the survey rather than asking about “usual” latrine use behavior. The study also assessed patterns and determinants of individual latrine use over 12 months in the study population. Based on a prior 48 hour recall measure of reported use, we classified use into three categories—“never”, “sometimes” and “always/usually”. We also assessed consistency of latrine use across the dry cold, dry hot and rainy seasons. Overall, we found that latrine use was poor. There was significant seasonal variation in use. There was increased reported likelihood of consistently using the latrine among females and where latrines had a door and roof. Older age groups and an increase in household size were associated with a decreased reported likelihood of consistently always/usually using the latrine versus never using it. The leading reported reason for non-use of latrines was a preference for open defecation.