Is using a latrine “a strange thing to do?” a mixed-methods study of sanitation preference and behaviors in rural Ethiopia
Open accessAbstract
Latrines are the most basic form of improved sanitation and are a common public health intervention. Understanding motivations for building and using latrines can help develop effective, sustainable latrine promotion programs. We conducted a mixed-methods study of latrine use in the Amhara region of Ethiopia. We held 15 focus group discussions and surveyed 278 households in five communities. We used the Integrated Behavioral Model for Water, Sanitation, and Hygiene interventions to guide our qualitative analysis. Seventy-one percent of households had a latrine, but coverage varied greatly across communities. Higher household income was not associated with latrine use (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 0.5, 7.7); similarly, cost and availability of materials were not discussed as barriers to latrine use in the focus groups. Male-headed households were more likely to use latrines than households with female heads (OR = 3.5; 95% CI = 1.6, 7.7), and households with children in school were more likely to use latrines than households without children in school (OR = 2.3; 95% CI = 1.6, 3.3). These quantitative findings were confirmed in focus groups, where participants discussed how children relay health messages from school. Participants discussed how women prefer not to use latrines, often finding them strange or even scary. These findings are useful for public health implementation; they imply that community-level drivers are important predictors of household latrine use and that cost is not a significant barrier. These findings confirm that school-aged children may be effective conduits of health messages and suggest that latrines can be better marketed and designed for women.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
One study in rural Ethiopia found that male-headed households were ∼4-fold more likely to use household latrines than female-headed families.
“However, one study in rural Ethiopia found that male-headed households were ∼4-fold more likely to use household latrines than female-headed families (Aiemjoy et al., 2017).”
From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Aiemjoy et al., 2017
Cites
Human agency in social cognitive theory.
Bandura, A. (1989) · American Psychologist · doi:10.1037/0003-066x.44.9.1175 · Cited by 8,263 · see citing works
Dirt, Disgust, and Disease: Is Hygiene in Our Genes?
Curtis, V. A., & Biran, A. (2001) · Perspectives in biology and medicine · doi:10.1353/pbm.2001.0001 · Cited by 643 · see citing works
Clasen, T., Boisson, S., Routray, P., Torondel, B., Bell, M., Cumming, O., Ensink, J., Freeman, M., Jenkins, M., Odagiri, M., et al. (2014) · The Lancet Global Health · doi:10.1016/s2214-109x(14)70307-9 · Cited by 537 · see citing works
Dreibelbis, R., WINCH, P. J., Leontsini, E., Hulland, K. R. S., Ram, P. K., UNICOMB, L. E., & Luby, S. P. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-1015 · Cited by 419 · see citing works
Sahoo, K. C., Hulland, K. R. S., Caruso, B. A., Swain, R., Freeman, M. C., Panigrahi, P., & Dreibelbis, R. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.06.031 · Cited by 300 · see citing works
Achieving the ‘good life’: Why some people want latrines in rural Benin
Jenkins, M. W., & Curtis, V. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.04.036 · Cited by 273 · see citing works
Jenkins, M. W., & Scott, B. (2007) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.03.010 · Cited by 248 · see citing works
Barnard, S., Routray, P., Majorin, F., Peletz, R., Boisson, S., Sinha, A., & Clasen, T. (2013) · PLoS ONE · doi:10.1371/journal.pone.0071438 · Cited by 237 · see citing works
The toilet tripod: Understanding successful sanitation in rural India
O’Reilly, K., & Louis, E. (2014) · Health & Place · doi:10.1016/j.healthplace.2014.05.007 · Cited by 170 · see citing works
Dirt, disgust and disease: a natural history of hygiene
Curtis, V. A. (2007) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2007.062380 · Cited by 169 · see citing works
Thys, S., Mwape, K. E., Lefèvre, P., Dorny, P., Marcotty, T., Phiri, A. M., Phiri, I. K., & Gabriël, S. (2015) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0003570 · Cited by 122 · see citing works
Can the emotion of disgust be harnessed to promote hand hygiene? Experimental and field-based tests
Porzig-Drummond, R., Stevenson, R., Case, T., & Oaten, M. (2009) · Social Science & Medicine · doi:10.1016/j.socscimed.2009.01.013 · Cited by 122 · see citing works
Gebre, T., Ayele, B., Zerihun, M., Genet, A., Stoller, N. E., Zhou, Z., House, J. I., Yu, S. N., Ray, K. J., Emerson, P. M., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61515-8 · Cited by 89 · see citing works
Social network predictors of latrine ownership
Shakya, H. B., Christakis, N. A., & Fowler, J. H. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.03.009 · Cited by 80 · see citing works
O’Loughlin, R. E., Fentie, G., Flannery, B. L., & Emerson, P. M. (2006) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2006.01689.x · Cited by 77 · see citing works
Yimam, Y. T., Gelaye, K. A., & Chercos, D. H. (2014) · Pan African Medical Journal · doi:10.11604/pamj.2014.18.334.4206 · Cited by 73 · see citing works
Clasen, T., Fabini, D. H., Boisson, S., Taneja, J., Song, J., Aichinger, E., Bui, A. L., Dadashi, S., Schmidt, W., Burt, Z., et al. (2012) · Environmental Science & Technology · doi:10.1021/es2036702 · Cited by 73 · see citing works
Stoller, N. E., Gebre, T., Ayele, B., Zerihun, M., Assefa, Y., Habte, D., Zhou, Z., Porco, T. C., Keenan, J. D., House, J. I., et al. (2011) · International Health · doi:10.1016/j.inhe.2011.03.004 · Cited by 65 · see citing works
Awoke, W., & Muche, S. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-99 · Cited by 60 · see citing works
Rodgers, A. F., Ajono, L. A., Gyapong, J. O., Hagan, M., & Emerson, P. M. (2007) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2007.01848.x · Cited by 52 · see citing works
Tissir, R., Lamchahab, M., Benhassou, M., Quachouh, M., Rachid, M., Benchakroun, S., & Quessar, A. (2012) · Europe PMC (PubMed Central) · Cited by 37 · see citing works
Demand for sanitation in Salvador, Brazil: A hybrid choice approach
Santos, A. C., Roberts, J. A., Barreto, M. L., & Cairncross, S. (2011) · Social Science & Medicine · doi:10.1016/j.socscimed.2011.02.018 · Cited by 36 · see citing works
Effect of a community intervention with pit latrines in five districts of Amhara, Ethiopia
Ngondi, J., Teferi, T., Gebre, T., Shargie, E. B., Zerihun, M., Ayele, B., Adamu, L., King, J. D., Cromwell, E. A., & Emerson, P. M. (2010) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2010.02500.x · Cited by 30 · see citing works
Latrine Promotion for Trachoma: Assessment of Mortality from a Cluster-Randomized Trial in Ethiopia
Gebre, T., Ayele, B., Zerihun, M., House, J. I., Stoller, N. E., Zhou, Z., Ray, K. J., Gaynor, B. D., Porco, T. C., Emerson, P. M., et al. (2011) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2011.10-0720 · Cited by 22 · see citing works
Risk Factors for Ocular Chlamydia after Three Mass Azithromycin Distributions
Ayele, B., Gebre, T., Moncada, J., House, J. I., Stoller, N. E., Zhou, Z., Porco, T. C., Gaynor, B. D., Emerson, P. M., Schachter, J., et al. (2011) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0001441 · Cited by 17 · see citing works
Ross, R. K., King, J. D., Damte, M., Ayalew, F., Gebre, T., Cromwell, E. A., Teferi, T., & Emerson, P. M. (2011) · International Health · doi:10.1016/j.inhe.2011.06.007 · Cited by 15 · see citing works
Rotondo, L. A., Ngondi, J., Rodgers, A. F., King, J. D., Kamissoko, Y., Amadou, A., Jip, N., Cromwell, E. A., & Emerson, P. M. (2009) · International Health · doi:10.1016/j.inhe.2009.08.001 · Cited by 15 · see citing works
Lessons learned from NGO experiences in the water and sanitation sector
Smout, I. K., & Parry-Jones, S. (2019) · Loughborough University Research Repository (Loughborough University) · Cited by 7 · see citing works
Social Network Predictors of Latrine OwnershipPreprint
Shakya, H. B., Christakis, N. A., & Fowler, J. H. (2012) · SSRN Electronic Journal · doi:10.2139/ssrn.2182130 · Cited by 5 · see citing works
Flagged first, then by citations
2 of the 31 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health
Pouramin, P., Nagabhatla, N., & Miletto, M. (2020) · Frontiers in Water · doi:10.3389/frwa.2020.00006 · Cited by 96 · see citing works
What motivates open defecation? A qualitative study from a rural setting in Nepal.
Bhatt, N., Budhathoki, S. S., Lucero-Prisno, D. E. I., Shrestha, G., Bhattachan, M., Thapa, J., Sunny, A. K., Upadhyaya, P., Ghimire, A., & Pokharel, P. K. (2019) · PLoS ONE · doi:10.1371/journal.pone.0219246 · Cited by 95 · see citing works
Odagiri, M., Muhammad, Z., Cronin, A., Gnilo, M., Mardikanto, A., Umam, K., & Asamou, Y. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14121572 · Cited by 68 · see citing works
Nute, A. W., Endeshaw, T., Stewart, A. E. P., Sata, E., Bayissasse, B., Zerihun, M., Gessese, D., Chernet, A., Chanyalew, M., Tedessse, Z., et al. (2018) · Parasites & Vectors · doi:10.1186/s13071-018-3008-0 · Cited by 59 · see citing works
Tamene, A., & Afework, A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0245289 · Cited by 53 · see citing works
Alemu, F., Kumie, A., Medhin, G., Gebre, T., & Godfrey, P. C. (2017) · BMC Public Health · doi:10.1186/s12889-017-4717-6 · Cited by 53 · see citing works
Aiemjoy, K., Gebresillasie, S., Stoller, N. E., Shiferaw, A., Tadesse, Z., Chanyalew, M., Aragie, S., Callahan, K., & Keenan, J. D. (2017) · The American Society of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.16-0800 · Cited by 41 · see citing works
Viral species richness and composition in young children with loose or watery stool in Ethiopia
Aiemjoy, K., Altan, E., Aragie, S., Wittberg, D. M., Phan, T. G., Deng, X., Chanyalew, M., Tadesse, Z., Callahan, E. K., Delwart, E., et al. (2019) · BMC Infectious Diseases · doi:10.1186/s12879-019-3674-3 · Cited by 31 · see citing works
Sustainable Development Goals (SDG) Target 6.2 in Ethiopia: Challenges and Opportunities
Baye, D. (2021) · OALib · doi:10.4236/oalib.1107458 · Cited by 27 · see citing works
Household-level sanitation in Ethiopia and its influencing factors: a systematic review
Novotný, J., & Mamo, B. G. (2022) · BMC Public Health · doi:10.1186/s12889-022-13822-5 · Cited by 26 · see citing works
Lopez, V. K., Berrocal, V. J., Angulo, B. C., Ram, P. K., Trostle, J., & Eisenberg, J. N. S. (2019) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.18-0144 · Cited by 26 · see citing works
Narratives of sanitation: Motivating toilet use in India
Leong, C. (2020) · Geoforum · doi:10.1016/j.geoforum.2019.10.001 · Cited by 24 · see citing works
The social and political construction of latrines in rural Ethiopia
Novotný, J., Humňalová, H., & Kolomazníková, J. (2018) · Journal of Rural Studies · doi:10.1016/j.jrurstud.2018.08.003 · Cited by 19 · see citing works
Chambers, K. G., Carrico, A. R., & Cook, S. M. (2021) · Environmental Science Water Research & Technology · doi:10.1039/d1ew00263e · Cited by 13 · see citing works
Aiemjoy, K., Aragie, S., Gebresillasie, S., Wittberg, D. M., Dagnew, A., Hailu, D., Chanyalew, M., Tadesse, Z., Stewart, A. E. P., Callahan, K., et al. (2018) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.17-0806 · Cited by 15 · see citing works
Luo, Q., Zhang, M., Yao, W., Yan-fen, F., Wei, H., Tao, Y., Liu, J., & Yao, H. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15112510 · Cited by 14 · see citing works
Hendrickson, S. M., Thomas, A., Prongay, K., Haertel, A. J., Garzel, L. M., Gill, L., Barr, T., Rhoades, N. S., Reader, J. R., Galan, M. A., et al. (2022) · Nature Communications · doi:10.1038/s41467-021-27925-x · Cited by 13 · see citing works
Changing hygiene behaviours: a cluster-randomized trial, Ethiopia
Aragie, S., Tadesse, W., Dagnew, A., Hailu, D., Dubie, M., Wittberg, D. M., Melo, J. S., Haile, M., Zeru, T., Freeman, M. C., et al. (2021) · Bulletin of the World Health Organization · doi:10.2471/blt.21.285915 · Cited by 13 · see citing works
Bennett, A., Demaine, J., Dorea, C. C., & Cassivi, A. (2023) · Journal of Water and Health · doi:10.2166/wh.2023.293 · Cited by 10 · see citing works
Social-Cultural Factors Influence on Management of Shared Sanitation, in Nakuru Town West Slums
Aaron, K., Kubai, P. K., & Mutembei, J. (2024) · International Journal of Innovative Science and Research Technology (IJISRT) · doi:10.38124/ijisrt/ijisrt24aug1709 · Cited by 5 · see citing works
Chakraborty, S., Novotný, J., Das, J., Patel, P. P., Maity, I., & Roy, U. (2024) · The Professional Geographer · doi:10.1080/00330124.2023.2287167 · Cited by 4 · see citing works
Odour reduction interventions for simple pit latrines in rural Ethiopia: a randomized study
Aragie, S., Wittberg, D. M., Aiemjoy, K., Melo, J. S., Smith, M. J., Nash, S. D., Tadesse, Z., & Keenan, J. D. (2020) · Transactions of the Royal Society of Tropical Medicine and Hygiene · doi:10.1093/trstmh/traa039 · Cited by 2 · see citing works
Lopez, V. K., West, B. T., Clarke, P. J., Quentin, E., & Eisenberg, J. N. S. (2019) · BMC Public Health · doi:10.1186/s12889-018-6373-x · Cited by 2 · see citing works
Evaluation of IDEA project in Bangladesh: a baseline report
(3ie), I. I. F. I. E., Barooah, B., Iversen, V., Wendt, A., Sengupta, P., (3ie), I. I. F. I. E., Martin, A., Bravo, C., (3ie), I. I. F. I. E., Reza, M., et al. (2022) · doi:10.23846/wp0053 · Cited by 2 · see citing works
Effect of water, sanitation, and hygiene on childhood growth in Ethiopia: a cluster-randomized trial
Frank, T. D., Thompson, I. J. B., Aragie, S., Wittberg, D. M., Tadesse, W., Dagnew, A., Hailu, D., Melo, J. S., Zeru, T., Tadesse, Z., et al. (2025) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2025.114718 · Cited by 1 · see citing works
Tetui, M., Wamani, H., Ssennono, M., Agabiirwe, C. N., Luwangula, A. K., RHITES-EC, U. U., Michaud‐Létourneau, I., Society for Implementation Science in Nutrition (SISN), Tumwesigye, N., RHITES-EC, U. U., et al. (2021) · doi:10.23846/wp0043
Understanding barriers to and facilitators of latrine use in rural India
(3ie), I. I. F. I. E., Jones, R., Lane, C. E., & (3ie), I. I. F. I. E. (2021) · doi:10.23846/wp0044
Ilango, M., Stalin, P., & Velavan, A. (2025) · Indian Journal of Community Medicine · doi:10.4103/ijcm.ijcm_70_24
Factors Affecting Sanitation Behavior Among Rural Communities in Low and Middle‐Income Countries
Ghosh, A., Sharma, P., & Malik, P. (2025) · Wiley eBooks · doi:10.1002/9781394303243.ch14
- Authors
- Aiemjoy, K., Stoller, N. E., Gebresillasie, S., Shiferaw, A., Tadesse, Z., Sewent, T., Ayele, B., Chanyalew, M., Aragie, S., Callahan, K., Stewart, A., Emerson, P. M., Lietman, T. M., Keenan, J. D., & Oldenburg, C. E.
- Affiliations
- University of California, San Francisco (US)
- Carter Center (US)
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia.
- Amhara Regional Health Bureau (ET)
- The Task Force for Global Health (US)
- Corresponding author
- Aiemjoy, Kristen
- ORCID
- Venue
- The American Society of Tropical Medicine and Hygiene
- Published
- 2017-01-11
- Volume
- 96
- Issue
- 1
- Pages
- 65-73
- ISSN
- 0002-9637 (ISSN-L)
- 1476-1645
- PMC
- PMC5239711
- OpenAlex
- W2555506461
- Cited by
- 30
- References
- 31
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 4 · 2017: 3
- FWCI
- 3.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Tropical Medicine and Hygiene (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (R25MH083620)
- National Institute on Drug Abuse (T32DA013911)
- National Eye Institute (U10EY016214)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Social Sciences › Gender Studies › Gender Studies and Social Issues
- Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
- Keywords
- latrine use, sanitation behavior, rural Ethiopia, Amhara region
- MeSH terms
- Adolescent, Adult, Aged, Construction Materials, Female, Humans, Male, Middle Aged, Sanitation, Socioeconomic Factors, Toilet Facilities, Health Behavior, Odds Ratio, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
