JMIR Publications

ABSTRACT

Background:

Fecal‑oral diseases remain a major public health challenge in sub‑Saharan Africa, where sanitation infrastructure is limited and cultural barriers hinder adoption of improved practices. Compost latrines are promoted as an ecological solution, but their acceptability is uncertain.

Objective:

This study aimed to assess household knowledge, attitudes, and practices (KAP) regarding fecal‑oral disease prevention in Nyamugo, Democratic Republic of Congo, and to explore perceptions of compost latrine acceptability. The objective was to identify both enabling factors and barriers, including cultural and economic determinants, in order to inform integrated public health interventions.

Methods:

A mixed‑methods cross‑sectional design was used. Quantitative data were collected from 432 households through structured questionnaires, and qualitative insights were obtained via focus group discussions and key informant interviews. Chi‑square and logistic regression analyses examined associations between KAP indicators and sociodemographic variables. Both significant and non‑significant results were reported to ensure transparency.

Results:

Households demonstrated partial knowledge of fecal‑oral diseases. Cholera was widely recognized (88.9%), while hookworm and poliomyelitis were rarely mentioned. Preventive methods such as sanitation (69.2%) and hand hygiene (54.5%) were most frequently cited, with education significantly increasing the odds of reporting sanitation knowledge (OR = 2.1, 95% CI: 1.4–3.2). Other methods, including vaccination and parasite control, showed no significant associations but were reported for completeness. Attitudes revealed strong recognition of fecal hazard prevention (94.2%), yet compost latrine acceptability remained low (42.2%). Regression confirmed that higher education increased the odds of favorable attitudes (OR = 1.9, 95% CI: 1.2–3.0). However, qualitative findings highlighted persistent cultural taboos: participants described compost latrines as “impure” or “shameful,” echoing evidence from Malawi and Mozambique. Practices were inconsistent. Although 87.9% of households owned latrines, only 30.2% maintained them hygienically, and open defecation persisted in 31.6% of households. Larger household size predicted open defecation (OR = 1.8, 95% CI: 1.2–2.7), while education was associated with improved latrine hygiene (OR = 2.3, 95% CI: 1.4–3.6). Compost latrines were not used at all. Diarrheal episodes in children under five were reported in 38.7% of households, with unimproved water sources significantly increasing risk (OR = 2.4, 95% CI: 1.5–3.8). Qualitative testimonies reinforced these findings, emphasizing poverty, lack of infrastructure, and cultural resistance as key barriers.

Conclusions:

This study confirms a persistent gap between knowledge and practice in fecal‑oral disease prevention. Cultural taboos and economic constraints limit compost latrine adoption, even among educated households. Nevertheless, participants expressed openness to adoption if external support—through subsidies, training, and sensitization—is provided. Public health interventions should integrate financial support, cultural dialogue, and infrastructure strengthening to sustainably reduce diarrheal disease burden. Future research should assess long‑term impacts of compost latrine adoption, explore cost‑effectiveness, and evaluate behavior change strategies.