JMIR Publications

ABSTRACT

Background:

Fecal-oral diseases remain a major public health challenge in low- and middle-income countries. In the Democratic Republic of Congo (DRC), open defecation persists in urban and peri-urban areas, including Nyamugo health area, Bukavu, where sanitation infrastructure is limited. Ecological compost latrines represent a sustainable alternative, but their adoption depends on household knowledge, attitudes, practices (KAP), and social acceptability.

Objective:

This study aimed to assess household KAP regarding fecal-oral disease prevention in Nyamugo health area and to evaluate the social acceptability of ecological compost latrines.

Methods:

A mixed-methods cross-sectional study was conducted between March and April 2024. Quantitative data were collected from 432 households using stratified random sampling. Variables included sociodemographic characteristics, sanitation practices, and child health indicators. Data were analyzed with descriptive statistics and chi-square tests. Qualitative data were obtained through five focus groups and four semi-structured interviews with community leaders and policymakers, analyzed thematically using NVivo 10. Ethical approval was granted by the School of Public Health, University of Kinshasa (Approval No. ESP/CE/47/2024).

Results:

University education was uncommon (12.5%), and unemployment was high (37.4%). Nearly 30% of households practiced open defecation, and 65.8% of latrines were unhygienic. More than half consumed unimproved water, and only 12.3% reported daily tap water supply. Child health practices were inconsistent: 47.6% reported routine deworming, while 46.2% of children under five had experienced diarrhea within three months prior to the survey. A statistically significant but moderate association was found between positive perceptions of prevention and continued open defecation (p < .01; Phi = 0.29). Qualitative findings revealed skepticism toward compost latrines, cultural taboos, and financial barriers, but also recognition of potential health and agricultural benefits.

Conclusions:

Households expressed positive attitudes toward fecal-oral disease prevention, yet practices remain insufficient. Compost latrines could serve as a sustainable solution if supported by community sensitization, financial subsidies, and integration into local health policies. Multi-sectoral interventions are urgently needed to reduce fecal contamination and improve child health outcomes, in line with Sustainable Development Goals (SDG 3 and SDG 6).