Effect of eliminating open defecation on diarrhoeal morbidity: an ecological study of Namable sub-county, Kenya

Kenya launched a program to eradicate open defecation (OD) in rural areas by 2013 using the community led total sanitation (CLTS) methodology. By 2014, only two out of 265 sub-Counties had been declared open defecation free (ODF). Nambale sub-County was the first to be declared ODF in 2012. This study looked at the impact of eliminating OD on diarrhoea morbidity among children less than 5 years of age. Mean monthly diarrhoea cases declined from 208 a year before elimination of OD, to 149 a year after elimination of OD, and 92 two years after elimination of OD. This is a reduction of 28.4% after first year and 38.3% after second year of becoming OD. Number of diarrhoeal cases reduced significantly after eliminating OD (t (3.2) = 14.1 sig 0.006 95% CI (30-148). This study recommends that the remaining sub-Counties strive to attain and sustain ODF status.