Adoption and Sustained Use of the Arborloo in Rural Ethiopia: A Cross-Sectional Study Dionna Fry 1, Bekele Abaire 2, Yeshewahareg Feyisa 2, Dejene Mideksa 2, Katherine Cunliffe 2, Argaw Ambelu 3, Matthew Freeman 1 1 Emory Rollins School of Public Health; Department of Environmental Health & Hubert Department of Global Health, 2 Catholic Relief Services; 3 Jimma University Katherine Cunliffe, MPH Regional Technical Advisor for Water, Sanitation & Hygiene Catholic Relief Services

Background In rural Ethiopia, just 23% of the population has access to improved sanitation (JMP 2014) Ethiopia’s per capita income of $470 per annum is substantially lower than the regional average (World Bank 2014) Simple, low-cost sanitation solutions that are easy to use and maintain are needed. 2

The Arborloo 3

The Arborloo – How it works 4

CRS’ Arborloo promotion in Ethiopia 5 Began promoting the Arborloo in 2004 Arborloo was chosen because it is an affordable and easy to construct option for rural households CRS has helped households construct more than 80,000 Arborloos in rural Ethiopia

Research Aims Primary aim: Evaluate the reach and sustainability of Catholic Relief Services (CRS) Ethiopia’s Arborloo sanitation intervention program 10 years after it began Secondary aims: Examine why people continued using the Arborloo over time Examine if there were differences in the populations that adopted and sustained Arborloo use as compared to the general population 6

Methods Data Collection Conducted a cross-sectional survey of 690 adults in 20 villages in Oromia region Random selection of villages and households Interviewed 24 key informants Conducted 33 in-depth interviews 7

Results 8

9 Among 462 households that had an arborloo in the last 10 years, 76.2% sustained arborloo use

Results 10

Qualitative Results - Pros 11 Most important benefit is the ability to plant on the filled pit Safer than the traditional latrine, especially for children, since it is shallow Easier and cheaper to construct than a traditional latrine Fewer flies and smells than other latrines Papaya tree planted on a Arborloo pit

Qualitative Results - Cons 12 Not receiving a seedling or having a seedling die prompted a switch to a traditional latrine No reason other than the pit filling up for stopping Arborloo use and returning to open defecation

Limitations 13 Responses to a households’ present and past latrine types was used to establish sustained arborloo use which may be subject to bias. Since this is a cross-sectional study, no causal relationship can be established

Conclusions 14 There was strong evidence that arborloo usage was sustained in intervention communities even after many years Factors such as pit usage and concrete slab availability were found to be strongly associated with arborloo sustainability No clear relationship between household wealth and arborloo uptake or continued use was observed

Recommendations Improve access to arborloo materials via sanitation marking Understand why Islamic households are not using the arborloo for planting and adjust program messages accordingly 15

Acknowledgements 16