Effect of health profession students’ community engagement on open defecation-free status: a quantitative assessment of a community-led total sanitation and hygiene program in Southwestern Uganda

Introduction
Uganda’s Community-Led Total Sanitation (CLTS) strategy is based on the use of health extension workers (HEWs) for its implementation at the community level. However, identification of other facilitators to improve and accelerate the scaling up of the CLTS intervention has not been explored. This study evaluated the effect of a student-led CLTS intervention on open defecation and open defecation-free status outcomes.

Methods
The study was conducted in two sub-counties in Kabale district in southwestern Uganda, Rubaya and Buhara. We used a pre-post study with a nonequivalent control group quasi-experimental study design to measure the effect of a student-led CLTS intervention on’ the levels of household open defecation (OD)-free (HODF) status. A total of six parishes from two study sub-counties with no main towns and having low latrine coverage were selected. A total of 50 villages were randomly selected, and 25 villages were assigned to each of the two study groups: (i) the student-led CLTS intervention group, and (ii) the conventional CLTS control group. To avoid contamination between the sub-counties, a buffer sub-county was left between. A total of 492 respondents from different households participated in the before and after CLTS intervention surveys.

Results
In the intervention group, the proportion of households practicing OD decreased (24.69% to 14.04%), and the households that obtained the HODF status also increased (2.88% to 6.14%). On the other hand, in the control group, OD increased (23.69% to 39.92%), and households with HODF status reduced (3.21% to 0.84%). The results showed that the households in the intervention group had higher odds of not practicing OD (OR 3.73; 95%CI: 1.01-13.77) compared to the households in the control group. Similarly, in the intervention group, households had a higher odds of attaining the HODF status (OR 13.20; 95%CI: 3.26- 53.55) compared to the control group.

Conclusion
The student-led CLTS reduced OD in the parishes where they worked. This study shows that other resource persons, such as health profession students, are a valuable resource that can fill in the gap in sanitation promotion activities. They will be able to successfully complement the already overburdened health workers, as in the case of Uganda.