Open defecation among Kenyan households: an analysis of demographic and health survey 2022 and census report of 2019

Abstract

Open defecation (OD) is the disposal of human excreta in the fields, bushes, water bodies and other open spaces. It poses a public health risk as it can lead to the spread of diarrhoea, cholera, soil-transmitted helminths and trachoma. Kenya aims to achieve 100% open defecation free status by 2030 in line with Sustainable development goal number 6. This study sought to determine factors influencing OD at the household level as well as quantify the number of households practicing OD in each of the 47 Kenyan counties. Data from the household questionnaire of the Kenya Demographic and Health Survey, 2022 was analysed. Bivariate logistic regression was done with open defecation status as the dependent variable. Independent variables were poverty status, place of residence, ownership of farm animals, gender and educational level of household head. The number of households practicing OD per county were determined using the Kenya Census report of 2019. Poverty was the strongest predictor of a household practicing OD (OR 43.8 95% CI 26.1–73.8) followed by educational status of the household head (OR 3.3 95% CI 2.3–4.6 ) and the household not owning livestock ( OR 0.7 95% CI 0.6–0.9). An estimated 7.4% of households practice OD. These are estimated to be 814,223 households. Out of these, 686,051 households (84.3%) are found in the 15 counties ranked as having a high population practicing OD. Five counties have managed to eliminate OD and another nine have OD rates of less than 0.5%. Kenya has made commendable progress in eliminating OD. Poverty is a significant predictor of OD at the household level. To eliminate OD, it is advised that more efforts be targeted towards poor households as well as the 15 counties having a high number of OD-practicing households.