Haiti's Open Defecation Crisis: Unraveling the Social and Demographic Threads

 

Open defecation (OD), the disposal of human feces in open spaces, poses a significant health threat in low- and middle-income countries like Haiti. Despite international efforts to eradicate this practice, an estimated 20% of Haitians still defecate in the open, exposing them to various infectious diseases and highlighting the urgent need for improved sanitation solutions.

This summary aims to understand the key factors driving open defecation in Haiti by examining its socio-economic and demographic determinants. While previous research has explored these factors in other developing countries, Haiti's specific context necessitates dedicated investigation.

 

Methods

This research investigates open defecation (OD) in Haiti, the poorest country in the Latin America and Caribbean (LAC) region. Situated on the island of Hispaniola, Haiti has a dense population of 11.7 million and limited economic resources.

The study employs a cross-sectional, retrospective design, analyzing secondary data from the most recent Haiti Demographic and Health Surveys (HDHS) conducted between 2016-2017. This nationally representative survey, overseen by the Haitian Institute for Children with ICF International technical support, gathered extensive data on household demographics, health, and access to sanitation, including toilet facilities.

A stratified two-stage cluster sampling design ensured participant diversity. In the first stage, 450 geographic areas were chosen. During the second stage, a random sample of 13,451 households within these areas was drawn, with an impressive 99.7% completion rate. Detailed sampling information can be found in related HDHS publications.

By examining individual and community-level factors associated with OD within this rich dataset, this study aims to provide crucial insights for designing effective interventions and policies to eliminate OD and improve public health in Haiti.

 

Open defecation (OD) is examined in the summary, in Haiti through a rich dataset from the 2016-2017 Haiti Demographic and Health Surveys (HDHS).

The variables are defined as following:

Dependent Variable

Coded "yes" if any household member defecated in the open, "no" otherwise.

 

Independent Variables

·         Place of Residence: Urban or rural

·         Region: 11 administrative regions within Haiti

·         Household Head Characteristics

a)       Sex (male/female)

b)      Age (categorized into 6 groups)

c)       Education level (no formal, primary, secondary, higher)

·         Household Composition:

a)       Number of members (categorized into 3 groups)

b)      Number of children aged 1-14 (categorized into 4 groups)

c)       Number of elderly (aged 65+) (categorized into 3 groups)

d)      Number of men and women (categorized into 3 groups based on relative proportions)

·         Socioeconomic Factors:

a)       Access to mass media (yes/no)

b)      Wealth quintile (excluding toilet facilities and media access)

c)       Marital status (never married, in union, divorced/widowed/separated)

 

Data Analysis Steps

This study utilizes the STATA 14 software to analyze data from the 2016-2017 Haiti Demographic and Health Surveys (HDHS) and investigate the factors associated with open defecation (OD) in Haiti.

Frequency tables were generated to understand the socio-economic and demographic profiles of households. A bivariate Analysis and a multivariate analysis were proceeded respectively. Pearson's chi-square test assessed associations between OD and individual variables. Binary logistic regression identified significant predictors of OD while controlling for other factors.

The model was applied to urban/rural, poor/non-poor, and low/high education subgroups to explore variations in OD prevalence. Hosmer-Lemeshow test confirmed good model fit (except for urban area). The Variance Inflation Factor (VIF) ensured no multicollinearity issues.

 

Ethical Considerations

 Publicly available data and obtained approval from the DHS Program for data use were utilized to ensure ethical research practices. Precisely data from the 2016-2017 Haiti Demographic and Health Surveys (HDHS) were utilized.

 

Results

The results can be presented as following:

  • 25.3% of Haitian households practice OD, significantly higher than in neighboring Dominican Republic and comparable to sub-Saharan African countries.
  • OD is more prevalent in rural areas (35.8%) compared to urban areas (16%), with Grand'Anse region having the highest prevalence (49.5%).
  • Poorer households, those lacking access to mass media, and households with uneducated heads are more likely to practice OD.
  • Younger household heads, households with divorced/widowed heads, and households with 4 or more children aged 1-14 are more likely to practice OD.

 

Reflections on the subject

Several socio-economic and demographic factors are associated with OD. Poverty stands out, with poor households more likely to lack toilets due to financial constraints. Education plays a role as well, with higher education levels correlated with increased sanitation awareness and the ability to afford toilets. Notably, the study identifies lack of access to mass media as a predictor of OD, highlighting its potential for raising awareness and promoting behavior change.

Furthermore, geographical disparities exist. Rural areas see significantly higher OD rates compared to urban settings, likely due to factors like limited access to sanitation infrastructure and differing societal norms. Grand-Anse region, particularly hard-hit by poverty and hurricane Matthew, exhibits the highest OD prevalence.

Interestingly, gender and household composition influence OD too. Households headed by women and larger households with elderly members tend to practice OD less, possibly due to greater economic vulnerability and mobility constraints in the latter case. Conversely, younger heads-of-households and those with numerous children aged 1-4 are more likely to engage in OD, potentially reflecting economic challenges and rural living.

 

 

Policy Implications

There are actions that could assist in addressing the problem. They can be cited as followed:

·         Targeted interventions for high-risk groups, including rural populations, poorer households, and those lacking access to education and media.

  • Investments in sanitation infrastructure and hygiene promotion campaigns.
  • Addressing gender disparities in access to sanitation facilities.
  • Utilizing mass media effectively to raise awareness and promote behavioral change.

These key points, policymakers and stakeholders if addressed can work towards eliminating OD in Haiti and ensuring improved sanitation and health outcomes for all citizens.

 

 Conclusion

Haiti has the highest prevalence of OD in the Latin America and Caribbean region, putting its population at considerable risk. The fact that this is detrimental cannot be overlooked, OD contaminates soil, water, and air, leading to the spread of diarrheal diseases, parasitic infections, and other health problems. Identifying the socio-economic and demographic factors associated with OD is essential for designing effective interventions that address the root causes of the practice. Existing research on OD determinants has largely neglected Haiti, making this summary vital for informing future public health strategies in the country.

 DOI: https://doi.org/10.1186/s12889-022-14619-2

 

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