Effect of community-led total sanitation on open defecation in Uganda: A propensity score-matched analysis

by John Bosco Asiimwe, Hellen Namawejje, Faith Rachel Mirembe, Annet Adong, Jolly Achola, Herbert Nabaasa, Jebena Mulusew, Jonathan Izudi, Damazo T. Kadengye

A substantial proportion (7%) of people in Uganda practice open defecation. A Community-Led Total Sanitation (CLTS) project was started in 2011 to reduce indiscriminate disposal of excreta but the effect has not been rigorously evaluated. We, therefore, evaluated the effect of CLTS on reducing open defecation in the program intervention districts in Uganda. We used the 2016 Uganda Demographic and Health Survey (UDHS) data to conduct a quasi-experimental study using a propensity score matching (PSM) approach. The intervention group consisted of districts that implemented the CLTS and the comparison group were districts that did not implement the CLTS. We matched the intervention and comparison groups on several covariates in a 1:1 ratio within a caliper of 20% of the standard deviation of the propensity score. We confirmed balance in covariates using standardized mean difference (SMD) being