Latrine Utilization and Associated Factors Among Households in East Africa: A Systematic Review and Meta-Analysis

Introduction: The utilization of sanitation facilities is recognized as critical factor in disrupting the transmission of diseases associated with the fecal-oral route. Nevertheless, there exists a paucity of evidence regarding the aggregated prevalence of latrine utilization across East Africa. Objective: This study aimed to determine the pooled prevalence of latrine utilization and its associated factors among households in East Africa. Methods: This systematic review and meta-analysis was designed based on the PRISMA guidelines. A comprehensive systematic literature search focused on prevalence of latrine utilization and its associated factors in East African was conducted using the PubMed, Science Direct Cochrane Library, and African Journals Online (AJOL) databases. Gray literature was explored through Google Scholar and Google Search. Review authors independently extracted all necessary data using a standardized data extraction format. STATA 14 statistical software was used to analyze the data. A random effect model was computed to estimate the pooled level of latrine utilization in East Africa. Results: After reviewing 1806 studies, 24 studies were finally included in this systematic review and meta-analysis. The result of 24 studies revealed that the pooled prevalence of latrine utilization level in East Africa was 57.05% (95% CI: [50.51, 63.60]). The factors associated with the utilization of latrine included educational status (AOR: 3.69, 95% CI: [2.07, 6.60]), latrine distance from dwelling (AOR: 2.73, 95% CI: [1.70, 4.36]), and latrine cleanness (AOR = 5.06, 95% CI: [2.76, 9.27]). Conclusions: In this review, the pooled prevalence of latrine utilization in East Africa was low. Factors significantly associated with latrine utilization were educational status, latrine distance from dwelling and cleanness of the latrine. Therefore, it is recommended that measures to promote behavioral change toward further improvement in sustainable and consistent latrine utilization should be carried out based on the evidence of the determinant factors found in this systematic review.