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

  • Francis Gwama Mwatsahu Jomo Kenyatta University of Agriculture and Technology
  • Simon Karanja Jomo Kenyatta University of Agriculture and Technology
  • Mohamed Karama Umma University, Kajiado, Kenya
  • Michael Bruce Zimmermann ETH Zürich, Zürich, Switzerland
  • Calvin Otieno Jomo Kenyatta University of Agriculture and Technology
Keywords: Anemia, children under five years, community led total sanitation


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.

Article Views and Downloands Counter

Download data is not yet available.


Belizario, V. Y., Joy, H., Liwanag, C., Rose, J., Naig, A., Lester, P., Chua, C., Madamba, M. I., & Dahildahil, R. 0. (2015). Acta Tropica Parasitological and nutritional status of school-age and preschool-age children in four villages in Southern Leyte , Philippines: Lessons for monitoring the outcome of Community-Led Total Sanitation. Acta Tropica, 141, 16-24. https://doi.org/10.1016/j.actatropica.2014.09 .008

Coffey, D., Geruso, M., & Spears, D. (2017). Sanitation, Disease Externalities And Anemia: Evidence From Nepal*. 128(2013), 1395-1432. https://doi.org/10.1111/ecoj.12491

County Government ofKwale. (2018). Kwale county integrated development plan (2018-2022) (Issue June). County Government ofKwale.

Freeman, M. C., Garn, J. V, Sclar, G. D., Boisson, S., Medlicott, K., Alexander, K. T., Penakalapati, G., Anderson, D., Mahtani, A.G., Grimes, J.E. T., Rehfuess, E. A., & Clasen, T. F. (2017). The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis. International Journal ofHygiene and Environmental Health, 220, 928-949. https://doi.org/10.1016/j.ijheh.2017.05.007

Grimes, J. E. T., Tadesse, G., Gardiner, I. A., Yard, E., Wuletaw, Y., Templeton, M. R., Harrison, W. E., & Drake, L. J. (2017). Sanitation, hookworm, anemia, stunting, and wasting in primary school children in southern Ethiopia: Baseline results from a study in 30 schools. PloS One, 11(10). https://doi.org/10.1371/journal.pntd.0005948

Harter, M., Mosch, S., & Mosler, H.-J. (2018). How does Community-Led Total Sanitation (CLTS) affect latrine ownership? A quantitative case study from Mozambique. BMC Public Health, 18(387). https://doi.org/10.1186/sl2889-018-5287-y

Kao, J., Mutuku, F., Martin, S., Lee, J., Mwandi, J., Mukoko, D., Malhotra, I., King, C. H., & Labeaud, A. D. (2019). Early Childhood Anemia in a Birth Cohort in Coastal Kenya: Links to Infection and Nutrition. Am. J. Trap. Med. Hyg, 101(1), 242-252. https://doi.org/10.4269/ajtmh.17-0688

Ngesa, 0., & Mwambi, H. (2014). Prevalence and Risk Factors of Anemia among Children Aged between 6 Months and 14 Years in Kenya. PloS One, 9(11). https://doi.org/10.1371/journal.pone.0113756

Osazuwa, F., Ayo, 0. M., & Imade, P. (2011). A significant association between intestinal helminth infection and anemia burden in children in rural communities of Edo state, Nigeria. North American Journal ofMedical Sciences, 3(1), 30-34. https://doi.org/10.4297/najms.2011.330

Patil, S. R., Arnold, B. F., Salvatore, A. L., Briceno, B., Ganguly, S., Colford, J.M., & Gertler, P. J. (2014). The Effect oflndia's Total Sanitation Campaign on Defecation Behaviors and Child Health in Rural Madhya Pradesh: A Cluster Randomized Controlled Trial. PLoS Medicine, 11(8), el 001709. https://doi.org/10.1371/journal.pmed.1001709

World Health Organization. (2013). A draft framework for the global monitoring of the Comprehensive Implementation Plan on Maternal , Infant and Young Child Nutrition. In WHO Informal Consultation with Member States and UN Agencies on a Proposed Set of Indicators for the Global Monitoring Framework for Maternal, Infant and Young Child Nutrition (Issue October). World Health Organization. https://www.who.int/nutrition/events/2013_consultation_indicators_globalmonitoringframework_WHO_ MIYCN.pdf
How to Cite
Mwatsahu, F., Karanja, S., Karama, M., Zimmermann, M., & Otieno, C. (2021). Effect of Community-Led Total Sanitation on Development of Anemia among Children Aged Below Five Years in Kinango Sub-County, Kwale County. Africa Journal of Technical and Vocational Education and Training, 6(1), 189-198. Retrieved from https://afritvet.org/index.php/Afritvet/article/view/134