Socio-Demographic Factors Associated with the Uptake of Community Led Total Sanitation: An Empirical Study among the Residents of Isiolo County, Kenya

  • Osman Mahad Bagaja Kenyatta University
  • Isabella King’ori, PhD Kenyatta University
  • Anthony Ireri, PhD Kenyatta University
Keywords: CLTS, Isiolo County, Residents, Socio-Demographic Factors, Uptake
Share Article:


Despite Kenya aiming to achieve 100% ODF status by 2030 and adopting CLTS, about 5.6 million (14%) of the population practice OD. Thus, this study was guided by the research question: What is the level of uptake of community led total sanitation among residents of Isiolo County? The study used a descriptive cross-sectional methodology and conducted among residents of Isiolo Sub-County, Kenya. The study sampled 373 household heads from population of about 21,870 household heads for the study. Systematic random sampling was used to select the participants. An inclusion and exclusion criteria-based period lived in the county and consent to participate in the study were used. Data collection instruments entailed structured questionnaires for households’ heads, key informant interview (KII) guides for opinion leaders, and an observation checklist. The content validity of the tools was assessed by expert from the department of Environmental Health at Kenyatta University. The tools were piloted in Longopito Sub-location with 37 households. Reliability of the tools was assessed using the piloted data through the test-retest technique. The paired data sets were correlated, giving R=0.75. The study found an association between demographic factors and the uptake of CLTS in Isiolo county. The uptake of CLTS was found to be low with almost half of the sampled residents lacking latrines. The study concludes there were a number of demographic factors that were significantly associated with the utilization of CLTS including the highest level of education (χ2=66.866, p = 0.001), Occupation (χ2=12.690, p = 0.002), Average monthly family income (KShs) (χ2=43.373, p = 0.012) and number of household members (χ2=6.948, p = 0.044). The study also found that Isiolo County had a low uptake rate for community-led total sanitation. Only three out of ten households in the county uptake CLTS. The study recommends that the County Government of Isiolo should scale up health education programs on community led total sanitation


Download data is not yet available.


Abebe, T. A., & Tucho, G. T. (2020). Open defecation-free slippage and its associated factors in Ethiopia: a systematic review. Systematic Reviews, 9(1), 1-15.

Abramovsky, L., Augsburg, B., & Oteiza, F. (2019). Sustainable total sanitation-Nigeria: Final research report (No. R156). IFS Report.

Adeoti, O., Akinola, F. F., Ogundare, S. A., & Awe, B. S. (2021). Freshwater requirement to attain open-defecation-free status in Nigeria by 2025. Journal of Water, Sanitation and Hygiene for Development, 11(1), 152-164.

Alemu, F., Kumie, A., Medhin, G., & Gasana, J. (2018). The role of psychological factors in predicting latrine ownership and consistent latrine use in rural Ethiopia: a cross-sectional study. BMC Public Health, 18(1), 1-12.

Alhassan, A., & Anyarayor, B. K. (2018). Determinants of adoption of open defecation-free (ODF) innovations: A case study of Nadowli-Kaleo district, Ghana. Journal of Development and Communication Studies, 5(2), 54-69.

Aluoch, N. R., Asweto, C. O., & Onyango, P. O. (2022). 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. medRxiv, 2022-12.

Ashenafi, T., Dadi, A. F., & Gizaw, Z. (2018). Latrine utilization and associated factors among Kebeles declared open defecation free in Wondo Genet district, South Ethiopia, 2015. ISABB Journal of Health and Environmental Sciences, 5(5), 43-51.

Ashinhurst, H. (2020). Case studies in gender integration–Community-led sanitation in Timor-Leste. Gates Open Res, 4(8), 8.

Ayalew, A. M., Mekonnen, W. T., Abaya, S. W., & Mekonnen, Z. A. (2018). Assessment of diarrhea and its associated factors in under-five children among open defecation and open defecation-free rural settings of Dangla District, Northwest Ethiopia. Journal of Environmental and Public Health, 2018.

Biswas, R., Arya, K., & Deshpande, S. (2020). More toilet infrastructures do not nullify open defecation: a perspective from squatter settlements in megacity Mumbai. Applied Water Science, 10(4), 1-9.

Busienei, P. J., Ogendi, G. M., & Mokua, M. A. (2019). Latrine structure, design, and conditions, and the practice of open defecation in Lodwar town, Turkana County, Kenya: A quantitative methods research. Environmental Health Insights, 13, 1178630219887960.

Clarke, N. E., Dyer, C. E., Amaral, S., Tan, G., & Vaz Nery, S. (2021). Improving uptake and sustainability of sanitation interventions in Timor-Leste: a case study. International Journal of Environmental Research and Public Health, 18(3), 1013.

Curtis, V. (2019). Explaining the outcomes of the'Clean India'campaign: institutional behaviour and sanitation transformation in India. BMJ Global Health, 4(5), e001892.

Dwipayanti, N. M. U., Rutherford, S., & Chu, C. (2019). Cultural determinants of sanitation uptake and sustainability: local values and traditional roles in rural Bali, Indonesia. Journal of Water, Sanitation and Hygiene for Development, 9(3), 438-449.

Genet, A., Motbainor, A., Samuel, T., & Azage, M. (2021). Prevalence and associated factors of soil transmitted helminthiasis among school-age children in wetland and non-wetland areas of Blue Nile Basins, northwest Ethiopia: A community-based comparative study. SAGE Open Medicine, 9, 20503121211063354.

Harter, M. (2018). Understanding mechanisms and effectiveness of community-led total sanitation (CLTS) in promoting the use of safe sanitation services (Doctoral dissertation, University of Zurich).

Harter, M., Lilje, J., & Mosler, H. J. (2019). Role of implementation factors for the success of community-led total sanitation on latrine coverage. a case study from rural Ghana. Environmental science & technology, 53(9), 5466-5472.

Hendrix, S. J. (2020). Exploring determinants of community led total sanitation (clts) on latrine adoption among rural cambodians utilizing the diffusion of innovation theory: a pragmatic approach. The University of Alabama.

Hoo, Y. R., Joseph, G., Rivera, R., Smets, S., Nguyen, H., Ljung, P., ... & Albert, J. (2022). Strategic complements: Poverty-targeted subsidy programs show additive benefits on household toilet purchases in rural Cambodia when coupled with sanitation marketing. Plos one, 17(6), e0269980.

Isiolo County Integrated Development Plan 2013-2017. 2013. County Government of Isiolo.

Joseph, O. O. (2020). Uptake of Community-Led Total Sanitation Approach towards Attainment of Open-Defecation-Free Status in Siaya County, Kenya. Nairobi, Kenyatta University.

Jung, S. H. (2014). Stratified Fisher's exact test and its sample size calculation. Biom J. 2014 Jan;56(1):129-40. doi: 10.1002/bimj.201300048. Epub 2013 Nov 11. PMID: 24395208; PMCID: PMC3884832.

Kafle, S., & Pradhan, B. (2018). Situation of Water, Sanitation and Hygiene and Diarrhoeal Disease After Open Defecation Free Declaration and Associated Factors of Makwanpur District, Nepal. Journal of Nepal Health Research Council, 16(2), 160-164.

Keera, J. (2019). Barriers and motivators to achieving open defecation free communities using community led total sanitation approach in Kisekka sub county, Lwengo District (Doctoral dissertation, Makerere University).

Landrigan, P. J., Fuller, R., Acosta, N. J., Adeyi, O., Arnold, R., Baldé, A. B., ... & Zhong, M. (2018). The Lancet Commission on pollution and health. The Lancet, 391(10119), 462-512.

Lee, Y. J., & Radcliff, T. (2021). Community interactions and sanitation use by the urban poor: Survey evidence from India’s slums. Urban Studies, 58(4), 715-732.

Lenai, S., Mabonga, L., & Mateyo, D. C. (2021). Evaluation of factors contributing to sustainability of open defecation free status of communities in Butere Sub-County, Kakamega County, Kenya.

Logo, C. K. (2020). Availability of Toilets and Hand Wash Facilities in the Wa Campus of the University for Development Studies (Doctoral dissertation).

Mahendra, I., Diyanah, K. C., Hadi, M. I., Saputro, S. A., & Sari, S. A. R. (2021). Mapping of Diarrhea in Toddlers with Open Defecation Free (ODF) Status in Tuban Regency. Journal Kesehatan Kingkungan, 13(2), 113-120.

Mara, D. (2017). The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals. Journal of Water, Sanitation and Hygiene for Development, 7(1), 1-12.

Markle, L., Maganani, A., Katooka, O., Tiwari, A., Osbert, N., Larsen, D. A., & Winters, B. (2017). A mobile platform enables unprecedented sanitation uptake in Zambia. PLoS Neglected Tropical Diseases, 11(1), e0005131.

Mbogo, B., Karanja, S., & Lugayo, D. (2018). Household access to safe water, sanitation and hygiene in Kajiado County, Kenya. Nairobi, Kenya.

MoH (2014). Water and Sanitation Program, County Sanitation Profiles. Nairobi: WHO Water and Sanitation Program, 2014.

Monje, F., Ario, A. R., Musewa, A., Bainomugisha, K., Mirembe, B. B., Aliddeki, D. M., ... & Zhu, B. P. (2020). A prolonged cholera outbreak caused by drinking contaminated stream water, Kyangwali refugee settlement, Hoima District, Western Uganda: 2018. Infectious Diseases of Poverty, 9, 1-10.

Muchangi, M., & Kimathi, G. (2017): Lessons learnt from implementation of outcome linked community led total sanitation intervention in Busia Kenya. Loughborough University: London, United Kingdom.

Mumbi, T. L., & Cholo, W. (2017). An Assessment of Open Defecation among Residents of Thika East Sub-County, Kiambu County, Kenya. Int. J Medicine Research, 2(3), 09-20.

Musyoki, S. M. (2016). Roles and responsibilities for post-ODF engagement: building an enabling institutional environment for CLTS sustainability. Sustainable Sanitation for All: Experiences, Challenges, and Innovations, 167.

Mwapasa, T., Chidziwisano, K., Lally, D., & Morse, T. (2022). Hygiene in early childhood development centres in low-income areas of Blantyre, Malawi. International Journal of Environmental Health Research, 1-17.

Mwatsahu, F. G. (2022). Effectiveness of Community-Led Total Sanitation Activities on Selected Health Outcomes among Children Aged Below Five Years in Kinango Sub-County, Kwale County, Kenya (Doctoral dissertation, JKUAT-COHES).

Njuguna, J. (2019). Progress in sanitation among poor households in Kenya: evidence from demographic and health surveys. BMC Public Health, 19(1), 1-8.

Nyoni, D. S. P., & Nyoni, M. T. (2020). Open Defecation Resurgence in Tanzania? Early Warning Signals from the Box-jenkins Approach. People, 6(10).

Nzioki, J. M., & Korir, A. (2018). Effect of a Community Health Worker Led Health Education Intervention on Latrine Coverage in Mwingi West Sub-County; Kenya: A Quasi-Experiment. American Journal of Public Health, 6(3), 134-138.

Okolimong, C. D., Ndejjo, R., Mugambe, R. K., & Halage, A. A. (2020). Effect of a Community-Led Total Sanitation Intervention on Sanitation and Hygiene in Pallisa District, Uganda. The American Journal of Tropical Medicine and Hygiene, 103(4), 1735-1741.

Okullo JO, Moturi WN, Ogendi GM. Open Defaecation and Its Effects on the Bacteriological Quality of Drinking Water Sources in Isiolo County, Kenya. Environmental Health Insights. 2017;11. doi:10.1177/1178630217735539

Okullo, J. O., Moturi, W. N., & Ogendi, G. M. (2017). Open defaecation and its effects on the bacteriological quality of drinking water sources in Isiolo County, Kenya. Environmental Health Insights, 11, 1178630217735539.

Oribhabor, C. & Anyanwu, C. (2019). Research Sampling and Sample Size Determination: A practical Application. 2. 47-56.

Osumanu, I. K., Kosoe, E. A., & Ategeeng, F. (2019). Determinants of open defecation in the Wa municipality of Ghana: empirical findings highlighting sociocultural and economic dynamics among households. Journal of Environmental and Public Health, 2019.

Pertiwi, H. S. I., Rahardjo, M., & Nurjazuli, N. (2018). Hubungan Pengetahuan, Sikap BAB, dan Kepemilikan Septic Tank Dengan Status ODF (Open Defecation Free) di Kecamatan Candisari Kota Semarang. Jurnal Kesehatan Masyarakat (Undip), 6(6), 143-149.

Radin, M., Wong, B., McManus, C., Sinha, S., Jeuland, M., Larbi, E., ... & Whittington, D. (2020). Benefits and costs of rural sanitation interventions in Ghana. Journal of Water, Sanitation and Hygiene for Development, 10(4), 724-743.

Ravuluvulu, F. R. (2018). Effects of open defecation on geophagic soils and water resources: A case study of Siloam village in Limpopo Province, South Africa.

Republic of Kenya. (2016). Economic Impacts Of Poor Sanitation In Africa.

Tiwari, A., Russpatrick, S., Hoehne, A., Matimelo, S. M., Mazimba, S., Nkhata, I., ... & Larsen, D. A. (2017). Assessing the impact of leveraging traditional leadership on access to sanitation in rural Zambia. The American Journal of Tropical Medicine and Hygiene, 97(5), 1355.

Trepanier, L., Orare, J., Nyagwencha, J., & Grady, C. (2021). How are we actually doing? Comparing water and sanitation in Kenya with MDG and SDG criteria. Journal of Water, Sanitation and Hygiene for Development.

Umar, A., & Varma, S. (2018). Partnering with government and communities to achieve open defecation free status at scale: an example from the Indian state of Bihar.

UNDP. (2015). What are the Sustainable Development Goals?

UNICEF and WHO (2020). State of the World’s Sanitation: An urgent call to transform sanitation for better health, environments, economies and societies. New York: United Nations Children’s Fund.

USAID (2018). An Examination of CLTS’s Contributions towards Universal Sanitation: USAID water, sanitation, and hygiene partnerships and sustainability (WASHPaLS) project. USAID: Washington, DC.

Venkataramanan, V., Crocker, J., Karon, A., & Bartram, J. (2018). Community-led total sanitation: a mixed-methods systematic review of evidence and its quality. Environmental Health Perspectives, 126(2), 26001.

Wamera, E. K. (2019). Gender outcomes of the Community Led Total Sanitation approach in selected Counties in Kenya.

WHO. (2021). WHO issues new recommendations on human genome editing for the advancement of public health.

World Bank, World Development Report 2018: New WHO Guidelines on Sanitation and Health. The World Bank, Washington, DC, USA, 2018

World Bank, World Development Report 2019: Open defecation nearly halved since 2000 but is still practiced by 670 Million, The World Bank, Washington, DC, USA, 2019

Xu, X., Nie, S., Ding, H., & Hou, F. F. (2018). Environmental pollution and kidney diseases. Nature Reviews Nephrology, 14(5), 313-324.

Zeleke, D. A., Gelaye, K. A., & Mekonnen, F. A. (2019). Community-Led Total Sanitation and the rate of latrine ownership. BMC Research Notes, 12(1), 1-5.

10 February, 2024
How to Cite
Bagaja, O., King’ori, I., & Ireri, A. (2024). Socio-Demographic Factors Associated with the Uptake of Community Led Total Sanitation: An Empirical Study among the Residents of Isiolo County, Kenya. East African Journal of Health and Science, 7(1), 80-94.