Socio-Demographic characteristics of respondent
A total of 810 households were included in the study with a response rate of 96%. The mean (±SD) age of respondents was 46.3 (12.5) years. Most, 660(81.5%) study respondents reside in sub-tropical. About 215(28%) fathers and 86(11%) mothers were literate. Among the households, 695(85.8%) had children attending at primary or secondary school (Table 1).
Sanitation Facilities
Of the total households, 771(95.3%) had functional latrines and 739(91%), and five hundred forty-nine (67.7%) required maintenance. Above half household’s used grass and wood to superstructure of the latrine facilities (Table 2).
Behavioral factors
Over all latrine utilization in the study area was 44.5%. Above half 526(65%) respondents explained open defecation causes diarrheal disease and 78% of the respondents were satisfied with the latrine utilization (see additional file1). The main reasons to construct and utilize latrines was because of getting advice from health extension workers about its benefit (see additional file2).
Predictors of latrine utilization
In binary logistic regression analysis, presence of school aged children in the households 4 times more likely to use latrine compared to those who don’t have (AOR= 4.3, 95% CI: 2.25, 8.26). Households having fathers who can read and write were about 1.5 times more likely utilized its counterpart (AOR=1.5, 95% CI: 1.03, 2.2). Households owning latrine >=2 years were 3 times more likely utilize it than <2 years (AOR=3.0, 95% CI: 1.88, 4.92). Households that had latrine >10 meters away from home were 68% less likely to utilize latrine than <6 meters away (AOR= 0.32, 95% CI: 0.19, 0.55). Household that had latrines which need maintenance were 50% less likely to utilize than which don’t need (AOR= 0.5, (95% CI: 0.36, 0.75). Those households who learn the benefit of latrine from peer group were 2 times more consistently utilize it than those enforced by other bodies (AOR=2.11, 95% CI: 1.05, 4.22). The extent of latrine utilization 77% less likely in the households who construct and use by themselves than households advised by health extension workers (AOR=0.23, 95%CI: 0.11, 0.502) (Table 3).
Qualitative results: Most of the discussants explained that the presence of barriers and negligence on community and health sectors for the consistent latrine utilization. Lack of awareness, the poor quality of constructed latrines, absence of detail understanding on importance of latrine utilization, infrequent supervision and follow up by concerned bodies, shortage of necessary materials for latrine construction, latrines constructed with enforcement without communities will.
Poor quality of latrines (Them 1)
Discussants raised that majority of constructed latrines had a quality problem.
35 years’ health personnel explain that “most of the communities had substandard latrine facilities which needs frequent maintenance and majority served only for dry seasons because of the material they constructed..”
Poor methods of community mobilization (Them2)
The discussants explain the presence of poor method of community mobilization to construct and use latrine facilities.
One FGD participants indicates that, “most of latrines constructed with campaign with fear of punishment without teaching the importance of utilizing latrine”
Lack of frequent Supervision and follow up (Them 3)
From district health office to community level, problems were not solved and no supportive supervision and follow up concerning latrine utilization.
Male FGD participant explained that, “the practice of communities of latrine utilization is different. Some of them practice what is taught by health extension workers. Another did what they understand when they are learning, this categories need follow up. The rest group had poor attitude and do not respond what the health providers saying and the health development army also.”
Poor knowledge and attitudes on latrine use (Them 4)
The majority of FGD participants reported that, “generally latrine utilization was high among those who know latrines as diarrheal disease prevention compared. For example, majority believed that: someone is at risk of getting diarrhea if neighbor practiced open defecation.”