Mobility up the sanitation ladder following community-led total sanitation in rural Zambia

Scott Russpatrick, Amy Tiwari, Laurie Markle, Engervell Musonda, Anne Mutunda, Nicolas Osbert, John Pinfold, Anna Winters, Benjamin Winters, David A. Larsen

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Scaling the sanitation ladder decreases exposure to various illnesses including diarrheal disease, soiltransmitted helminths and trachoma. In rural Zambia, community-led total sanitation (CLTS) has been deployed to help Zambians scale the sanitation ladder. Analysis of monthly routine surveillance data of village-level sanitation coverage of 13,688 villages shows that villages moved up the sanitation ladder following CLTS intervention with more than one third of villages achieving 100% coverage of adequate sanitation. Villages also moved down the sanitation ladder – approximately half of those achieving 100% coverage of adequate sanitation also dropped from that coverage at some point during monitoring. Larger villages were less likely to achieve 100% coverage, and more likely to drop if they did achieve 100% coverage. Drops were more likely to occur during the wet season. Of those villages dropping from 100% coverage, more than half rebounded to 100% coverage. The adequate latrine components most likely to drop off from 100% coverage were handwashing stations and lids to cover holes, both key components in preventing disease transmission. These results have implications for water, sanitation and hygiene (WASH) programming – sustained support may be required to ensure villages move up the sanitation ladder and stay there.

Original languageEnglish (US)
Pages (from-to)436-444
Number of pages9
JournalJournal of Water Sanitation and Hygiene for Development
Issue number3
StatePublished - Sep 2017


  • Community-led total sanitation
  • Sanitation ladder

ASJC Scopus subject areas

  • Development
  • Water Science and Technology
  • Waste Management and Disposal
  • Pollution
  • Public Health, Environmental and Occupational Health


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