The Effect of Community-Led Total Sanitation on Development of Anemia among Children Aged Below Five Years in Kinango Sub-County, Kwale County

Abstract

Anemia is a widespread public health problem with detrimental effects on both children and adults. The problem is particularly severe in the developing world, as anemia is closely associated with inadequate nutrition and poor sanitation. Though in Kenya the overall prevalence of anemia among the children is estimated to be 28.8%, a recent nested study of a 2012-2016 maternal-child cohort in coastal Kenya reported that 76% of children have been anemic on at least one time point since birth. Community Led Total Sanitation (CLTS) is a widely used approach to improve community sanitation. In Kwale County, the prevalence of open defecation is high at 51 %. Though CLTS is not primarily a nutritional intervention, previous studies have established that it has potential to reduce helminthic infections among children, improve iron absorption and thus reduce anemia. This study sought to establish the effect of CL TS on Anemic status of children under five years in in Kinango Sub-County, Kwale County. This was a quasi-experiment with an intervention and control site. The intervention site received the Community-Led Total Sanitation (CLTS) intervention while the control site received no sanitation related intervention at all. Data on Anemia among children under five years was collected before and after the intervention in a sample size of 402 and 405 respondents in control and intervention sites respectively. Results established that CLTS was found to be effective in reducing the prevalence of Anemia in intervention site compared to control site. A Difference in Differences (DiD) statistic indicated that CL TS reduced prevalence of anemia by 16.1 % in intervention site compared to control site. Children in intervention site were 3 times less likely to develop Anemia compared to children in the control site (Adj. OR= 3.064, 95% CI of OR=2.026-4.634, P<0.05). To help reduce Anemia among children under five years, there is need to scale up implementation of CL TS in other parts of K wale County and in Kenya. Studies linking reduction of Anemia with adequate sanitation are not common. Therefore, more studies are also recommended to help establish more evidence linking CL TS with reduced prevalence of Anemia among children less than five years of age.