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Open defecation-free slippage and its associated factors in Ethiopia: a systematic review

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Abebe, Thomas Ayalew, Tucho, Gudina Terefe·2020·Systematic Reviews
DOI 10.1186/s13643-020-01511-6PMC PMC7641843
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Abstract

BACKGROUND: Recent studies have shown an increase in open defecation and slippage of open defecation-free certified villages in Ethiopia, despite significant progress the country made on sanitation programs. Hence, realizing of existing facts, this study was conducted aiming at a critical review of available literature and to provide consolidated data showing the level of slippage and its associated factors in Ethiopia. METHODS: test statistics were used to check heterogeneity among the studies. To negotiate heterogeneity from qualitative data, we used a mixed-method approach. The researchers also conducted a publication bias assessment and sensitivity analysis. A random effect meta-analysis was employed to determine the pooled estimates of open defecation free slippage rate with a 95% confidence interval (CI). The data analysis was performed using the CMA V.3 software program. RESULT: After screening 1382 studies, 12 studies were finally included in this systematic review. The estimated pooled rate of open defecation-free slippage in Ethiopia was 15.9% (95% CI 12.9-19.4%). The main contributing factors for open defecation-free slippage were lack of technical support, financial constraints, low-quality building materials, improper program implementation, and lack of sanitation marketing. CONCLUSION: It was estimated that 1 out of 6 Ethiopian households engaged in open defecation after they have certified open defecation-free status, implying the low possibility of achieving sustainable development goals of 2030, which aims to ensure sanitation for all. Therefore, the government of Ethiopia and donors should better give special attention to the following options: (1) awareness for open defecation-free slippage, (2) launch a post-open defecation-free program, and (3) encourage research on pro-poor sustainable sanitation technologies.

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  • In prior studies, a fraction of the population (ranging from 4% to 39%) may revert to open defecation in the years following ODF verification.

    “the limited data available indicate that a fraction of the population (ranging from 4%-39% in prior studies) may revert to open defecation in the years following ODF verification [6, 8–12].”

    From Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana (2022) · cites this paper as [8]

    The Background reports that Ethiopian ODF villages slipped back within 1–2 years of certification, supporting the claim that reversion can occur after ODF certification. But it gives prior-study slippage rates of 7–28.4%, not 4–39%; the Results likewise identify 7% and 28.4% as the lowest and highest rates among the reviewed districts. The cited paper therefore does not support the stated numerical range. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In other areas, the primary cause for open defecation may be the absence of functional toilets.

    “In others, the primary cause for open defecation may be the absence of functional toilets.”

    From Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana (2022) · cites this paper as [8]

    The Discussion section on factors contributing to open defecation-free slippage says that malfunctioning or collapsed toilets can lead people back to open defecation. It identifies poor toilet quality as one contributing factor, reported in 25% of the analyzed research, but does not establish the absence of functional toilets as the primary cause in any area. The cited passages have no page numbers in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The levels of open defecation observed were on the higher end of reversions previously observed in Africa: Ethiopia systematic review 7%-28% (average 16%) 0-5 years after ODF; across eight countries, Robinson found 0%-39% (8% in Ghana) 1-5 years after ODF.

    “They were also on the higher end of reversions previously observed in Africa: in Ethiopia, a systematic review reported open defecation levels of 7%-28% (average of 16%) 0–5 years after ODF achievement [8]; and across eight countries, Robinson found open defecation levels ranging from 0%-39% (8% in Ghana) 1–5 years after ODF achievement [10].”

    From Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana (2022) · cites this paper as [8]

    The Background reports Ethiopian slippage rates of 7–28.4%, and Results > Pooled Open defecation-free slippage rate reports a pooled rate of 15.9%, supporting the cited range and rounded average. Our copy does not establish that these rates were measured 0–5 years after ODF achievement; the Background says most villages slipped back within 1–2 years. The Robinson comparison has a separate citation and is not attributed to this source. (LLM, conf=0.85)

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Authors
Abebe, T. A., & Tucho, G. T.
Affiliations
Jimma University (ET)
Corresponding author
Abebe, Thomas Ayalew
ORCID
Venue
Systematic Reviews
Publisher
Springer Science and Business Media LLC
Published
2020-11-03
Volume
9
Issue
1
Pages
252-252
ISSN
2046-4053 (ISSN-L)
DOI
10.1186/s13643-020-01511-6
PMC
PMC7641843
OpenAlex
W3096843994
Cited by
75
References
12
Citations by year
2026: 7 · 2025: 14 · 2024: 16 · 2023: 15 · 2022: 15 · 2021: 8
FWCI
1.17
Type
journal article
Language
en
Open access
Licence
Locations
  • Systematic Reviews (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Jimma University
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
  • Social Sciences › Safety Research › Poverty, Education, and Child Welfare
Keywords
open defecation, sanitation programs, Ethiopia, associated factors, technical support, financial constraints, building materials, program implementation, sanitation marketing, SDG 6
MeSH terms
Ethiopia, Family Characteristics, Humans, Research Design, Rural Population, Sanitation

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