Results
Broader results of improved sanitation
In addition to the main study results, this cohort of researchers contributed valuable insights that further strengthen the case for communal sanitation blocks and shared latrines. Their findings highlight the broader social, psychological, and practical benefits of improved sanitation. Together, this research demonstrates that high-quality shared facilities not only improve hygiene but also reduce stress, foster stronger community cooperation, and improve overall quality of life, with particularly strong benefits for women and girls. These findings add a rich layer of evidence to support the implementation of such interventions.
2018 findings: Reduced stress for women
In 2017, researchers conducted a qualitative research study which looked at causes and levels of psychosocial stress among users of traditional shared latrines and high-quality shared toilets in Maputo (Mozambique). The findings suggest that high-quality shared toilets can substantially reduce feelings of stress associated with fear of robbery, physical assault or sexual assault when using the toilet.
However, fear of violence was not totally eliminated, reflecting high crime levels in these communities, and suggesting that additional measures (such as improved compound fencing) may be necessary.
This research was led by Tess Shiras and Robert Dreibelbis of the London School of Hygiene & Tropical Medicine, and was funded under a grant to the MapSan project by the Bill & Melinda Gates Foundation.
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2018 findings: Importance of a compound leader
In 2018, survey data was collected, covering various aspects of the intervention implementation, participant behaviours and demographic characteristics of individuals and compounds. 845 household respondents were surveyed of which 389 were MapSan trial participants and 300 were compound leaders.
Participant response showed that the intervention significantly improved the experience of using sanitation facilities. Compared to control latrines, intervention latrines were much more likely to be private, nearly twice as likely to be clean, and twice as likely to be well maintained. In addition, intervention respondents reported higher individual cleaning frequency amongst this, frequent collective cleaning.
Results showed that the presence of a compound leader affected soap and water availability and adherence to a cleaning rota, supporting qualitative findings that compound leaders can facilitate collective decision-making and resolve conflict. Together, these findings reveal the importance of training and funding a dedicated resident to promote change.
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2019 findings: Better quality of life
In 2019, the researchers also went back to the MapSan intervention to see if they could establish a link between improved shared sanitation and people’s mental wellbeing and perceived quality of life. They interviewed over 400 participants from both the control group and the group that had received new toilets, and used the sanitation-related quality of life (SanQoL) index to assess toilet users’ perceptions of sanitation-related disgust, privacy, safety, health, and shame. Secondary outcomes were the WHO-5 mental wellbeing index and a sanitation visual analogue scale.
The intervention group experienced a 1.6 standard deviation gain in SanQoL compared to the control group. This adjusted SanQoL gain was 0.34 (95% CI: 0.29-0.38) on a 0-1 scale with control mean 0.49. Effect sizes were largest for safety and privacy attributes. Intervention respondents also experienced a 0.2 standard deviation gain in mental wellbeing. The adjusted gain was 6.2 (95% CI: 0.3-12.2) on a 0-100 scale with control mean 54.4.
Quality of life outcomes are highly valued by toilet users and can be improved by sanitation interventions. Such outcomes should be measured in future sanitation trials, to help identify interventions which most improve people’s lives. Since SanQoL weights are derived from respondent valuation, the measure can also be used in economic evaluation.