Seungman Cha,1,2 Jae Eun Lee,1* Dong Sik Seo,3 Byoung Mann Park,3 Paul Mansiangi,4 Jae-sang Hwang,1 and Jungwook Lee1

1Korea International Cooperation Agency, Seongnam-si, Republic of Korea; 2Faculty of Infectious and Tropical Disease, Department of Disease
Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; 3Korea Environment Corporation, Incheon, Republic of
Korea; 4Kinshasa University, Kinshasa, Democratic Republic of the Congo

Abstract. Despite the importance of sanitation, few studies have assessed the effects of latrines on the health outcomes of children under 5 years of age. We assessed the relations between latrine coverage and the prevalence of diarrhea in children under 4 years of age. In this cross-sectional study, we analyzed the baseline data obtained as part of a longitudinal survey targeting 720 households in Idiofa, Bandundu, Democratic Republic of the Congo. We categorized latrines according to the presence of each major component and investigated whether diarrhea prevalence of children under 4 years of age is associated with latrine availability and improvement. Latrines have health benefits regardless of whether they are improved. Also worth noting is that comparatively well-equipped and more appropriately managed latrines could prevent child diarrhea more effectively than less equipped or inappropriately managed latrines. Households who have a latrine with a superstructure, roof, and no flies (a partly improved latrine) were found to be 52% less likely to report cases of diarrhea than households with unimproved latrines (adjusted odds ratio [OR] = 0.48, confidence interval [CI] = 0.31–0.76), which are all the other latrines not included in the partly improved latrine category.Wehave observed the profound protective effect of latrines with a superstructure. This study demonstrates that latrines are associated with significant improvements in health even when they do not fully meet the conditions of improved latrines. This study adds value to the limited evidence on the effect of latrines on health parameters by demonstrating that latrines have correlations with health benefits regardless of whether they are improved, as well as by elucidating the most essential components of
improved latrines.

Am. J. Trop. Med. Hyg., 97(2), 2017, pp. 460–468
doi:10.4269/ajtmh.16-0361
Copyright © 2017 by The American Society of Tropical Medicine and Hygiene