Turkana leads counties in use of ‘bush toilets’, new survey shows

In some places in Kenya, open defecation is not frowned upon, rendering the need for toilets unnecessary.

However residents in 15 counties are courting health risks by having open defecation rates above 40 per cent, according to a recent study done in the 47 counties.

According to John Njuguna, a public health officer, Mukurweini Sub County, who led the study that looked at the use of ‘bush toilets’ in the 47 counties, the mean open defecation rates was 23.5 per cent with counties like Turkana reporting 88.4 per cent while the lowest was in 0.1 per cent in Nyandarua County.

Open defecation refers to the practice where people relief themselves in fields, bushes, forests, water bodies or other open spaces.

Interestingly, some of the most common reasons for persons ‘going outside’ than using latrines or toilets include collapse of the facilities, difficulty in their use especially by the elderly and/or children, shared facilities or if they are located far away.

“Some counties have unacceptably high open defecation rates. It is worrying that 15 counties had open defecation rates of 40 per cent and above. Alleviating poverty may reduce open defecation in Kenya,” Mr Njuguna told The Standard on Sunday.

Twenty one counties had open defecation rates of less than 5 per cent and are well on track to eradicate open defecation by 2030, Njuguna added.

He said lack of sanitation facilities contributes significantly to infant deaths with a child dying every two and a half minutes from preventable diseases like diarrhoea.

“The vulnerable sections of the population are most adversely affected by lack of sanitation. This includes the disabled, women, and school-going girls. Women are at risk of gender-based violence as they go in search of sanitary facilities,” he said.

In the research presented last week at the Kenya Medical Training Centre (KMTC) scientific conference Njuguna and his colleague Charles Muruka, programme officer - Mother to Mother NGO, found that poverty was to blame for open defecation.

“Poor people are unable to invest in sanitation and live in poor environmental conditions eg pollution overcrowding, bad drainage, and insufficient water supply,” read excerpts of the study presented at the 4th KMTC scientific conference,” read excerpts of the joint study by Njuguna and Muruka titled, ‘Predictors of Open Defecation among residents in the 47 Counties in Kenya.’

Njuguna said eliminating open defecation would require approximately 1.2 million latrines to be built in Kenya and properly used.

The research also showed that in a densely populated area, the residents were unlikely to defecate in the open due to lack of privacy.

“The higher the population density the higher the likelihood of not having privacy if one opts for open defecation thus this may discourage the practice,” he noted.

Nomadism was also found to contribute to high open defecation rates with Kajiado and Narok counties at 45.5 per cent and 50.3 per cent respectively.

“The economic mainstay of pastoralists is raising livestock. They tend to move with their animals in search of water and pasture. As they move with their animals they rarely carry mobile toilets along, tending rather to defecate in the open,” Njuguna said.

Transmission of diseases

He also acknowledged the role of culture in encouraging open defecation. “Open defecation is also influenced by culture. In some culture sharing latrines between a father-in-law and daughter-in-law is frowned upon, leading to open defecation,” he said.

The report further stated that the poorest in Kenya are 270 times more likely to practice open defecation than the richest and estimates that about 5.6 million Kenyans defecate in the open.

Health experts warn that this practice is a fertile ground for the transmission for water-borne diseases like diarrhoea and parasitic worms. The World Health Organisation (WHO) expressed concern that this is a global sanitation crisis practiced by one billion persons.

Closer home, a 2014 report on sanitation audit shows that poor sanitation represents one of the biggest development challenges and costs Kenya Sh27 billion with many people in rural areas practicing open defecation (15 per cent) compared to urban areas (3 per cent).

“Ending the practice can help reduce hospital visits, child deaths and missed school days,” reads the global campaign that seeks to cut down open defecation.

The WHO is concerned that in sub-Saharan Africa the number of people defecating in the open is still increasing as the numbers reduce globally.

In the November 2105 Unicef Kenya report, even after constructing latrines, some residents reverted to open defecation blaming this on lack of access to a latrine, shared latrines that are too far away and dis-functional or collapsed toilets.

According to the Unicef report, the most common de-motivating factors for using a toilet were the physical aspects like the fear of collapse of the structures, lack of privacy and the need to share with others.

Unicef has also rolled out a global awareness programme in collaboration with governments to mitigate the effect of open defecation on the welfare of children estimating that everyday children drink water mixed with their neighbour’s faeces.

Acting Director of Public Health at the Ministry of Health Kefa Ombacho said Kenya had developed a roadmap to reduce the prevalence of open defecation.

“We set off on an ambitious journey to ensure that we become open defecation free by 2013 and even though this wasn’t achieved uniformly countrywide, it improved the sanitation levels and reduced the high cholera rates in areas like Nyando and Busia,” he said.

Dr Ombacho blamed cholera outbreak in about 30 counties on failure to prioritise environmental health hygiene and promote behaviour change and attitudes on sanitation.

“We need to increase awareness on environmental health and promote hygienic practices like proper use of latrines and hand washing to reduce disease transmission,” he said.