Comparison of respondent-reported and sensor-recorded latrine utilization measures in rural Bangladesh: a cross-sectional study

• Type of Material: Article
• Authors: Maryann G. Delea, Emory University; Corey L. Nagel, Portland State University; Evan A. Thomas, Portland State University; Amal K. Halder, International Centre for Diarrhoeal Disease Research; Nuhu Amin, International Centre for Diarrhoeal Disease Research; Abul K. Shoab, International Centre for Diarrhoeal Disease Research; Matthew Freeman, Emory University; Leanne Unicomb, International Centre for Diarrhoeal Disease Research; Thomas Clasen, Emory University
• Language: English
• Date: 2017-07-01
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option B
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/trstmh/trx058
• Title of Journal or Parent Work: Transactions of The Royal Society of Tropical Medicine and Hygiene
• ISSN: 0035-9203
• Volume: 111
• Issue: 7
• Start Page: 308
• End Page: 315
• Grant/Funding Information: Funding: This work was supported by the Bill & Melinda Gates Foundation (Global Development Grant number OPP1102989).
• Keywords: HYGIENE BEHAVIORS; WASH; Bangladesh; Sanitation; DIARRHEA; GHANA; Public, Environmental & Occupational Health; SANITATION; Science & Technology; Tropical Medicine; Public health; TRIAL; Life Sciences & Biomedicine; INDIA
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Environmental Sciences

Abstract

Background: Health improvements realized through sanitation are likely achieved through high levels of facilities utilization by all household members. However, measurements of sanitation often rely on either the presence of latrines, which does not guarantee use, or respondent-reported utilization of sanitation facilities, which is prone to response bias. Overstatement of sanitation metrics limits the accuracy of program outcome measures, and has implications for the interpretation of related health impact data. Methods: We conducted a cross-sectional study of 213 households in 14 village water, sanitation and hygiene committee clusters throughout rural Bangladesh and used a combined data- and relationship-scale approach to assess agreement between respondent-reported latrine utilization and sensor-recorded measurement. Results: Four-day household-level respondent-reported defecation averaged 28 events (inter-quartile range [IQR] 20-40), while sensor-recorded defecation averaged 17 events (IQR 11-29). Comparative analyses suggest moderately high accuracy (bias correction factor=0.84), but imprecision in the data (broad scatter of data, Pearson's r=0.35) and thus only weak concordance between measures (ρc=0.29 [95% BCa CI 0.15 to 0.43]). Conclusions: Respondent-reported latrine utilization data should be interpreted with caution, as evidence suggests use is exaggerated. Coupling reported utilization data with objective measures of use may aid in the estimation of latrine use.