Sustainable Latrine Utilization and Associated Factors Among Open Defecation Free Declared Villages in Ebinat District, Northwest Ethiopia: A Community Based Mixed Method Study Design

Background Globally, approximately 3.5 billion people lack safely managed sanitation services. In Africa, 45% of the population uses either shared or unimproved sanitation facilities. Ethiopia continues to be ranked among the countries with the lowest levels of hygiene and sanitation coverage. Moreover, many villages and kebeles who have latrine practicing open defecation. So the objective of this study is to assess sustainable latrine utilization and associated factors among open defecation free (ODF) declared villages in Ebinat District. Methods A community based cross-sectional study triangulated with qualitative data was conducted from January 17 to February 11/2017 in Ebinat District. Multistage sampling was employed to select study subjects. A total of 752 households were selected by using systematic random sampling technique. Four focus group discussion and seven key informant interview participants were selected purposively to collect qualitative data. The Data entered using Epi Info version 7 and exported to SPSS version 20 for analysis. Crude and adjusted odds ratio with 95% CI were computed to identify the predictors of sustainable latrine utilization. Open Code software was used for thematic content analysis. Results The overall sustainable latrine utilization was 31.5 % with 95% CI of (28.2, 34.8). Factors associated by households were presence of children 7-18 years old, attending elementary school AOR:1.63, 95% CI: (1.09-2.45), HHs ever visited in a year by health extension workers AOR:3.15, 95% CI: (1.80-5.53), HHs ever visited in a year by health development armies AOR:3.23, 95% CI: (1.99-5.26) and family member attending Community-Lead Total Sanitation and Hygiene triggering AOR:1.78, 95% CI: (1.16-2.67) and distance of latrine from dwelling AOR:3.22, 95% CI: (1.54-6.72). Conclusion In this study, sustainable latrine utilization is lower than expected level. Therefore, program implementers should prioritize behavioral change interventions, and health workers and HDAs should conduct frequent follow-ups after the ODF declaration.