EVALUATING THE EFFECTIVENESS OF COMMUNITY-LED TOTAL SANITATION INTERVENTIONS IN REDUCING WATERBORNE DISEASES IN RIVERS STATE: A COMPARATIVE ANALYSIS

Abstract

Introduction: Waterborne diseases remain a major public health concern in developing regions, disproportionately affecting vulnerable populations such as children and the elderly. In Nigeria’s riverine communities, reliance on contaminated surface water and inadequate sanitation infrastructure heightens the risk of outbreaks. Community participation in Water, Sanitation, and Hygiene (WASH) initiatives is essential for sustainable disease prevention. Methodology: A mixed-methods, quasi-experimental pretest–post-test design was employed across ten highly vulnerable riverine Local Government Areas in Rivers State. Approximately 45,000 residents from 15 communities were targeted, with 600 households sampled for quantitative surveys and qualitative data collected until thematic saturation. Data were analyzed using SPSS for quantitative measures and thematic analysis for qualitative insights, ensuring triangulation for validity. Results: Baseline findings indicated that 80.4% of households experienced at least one waterborne disease, predominantly diarrhea, typhoid, and schistosomiasis. Post-intervention, overall disease prevalence declined by 19.7%, with the largest reductions observed in cholera (–46.1%) and dysentery (–34.6%). Preventive practices improved significantly, with poor practices declining from 52.4% to 26.8% and good practices doubling. Discussion: The intervention’s success was driven by active WASH committees, complete infrastructure, SMS-based behavior reinforcement, and strengthened social norms, while persistent schistosomiasis rates highlight disease-specific challenges. Recommendations: Policymakers should integrate community-led WASH committees into rural health and water policies, allocating dedicated budgets for training and support to sustain participation and maximize public health gains. Conclusion: CLTS interventions effectively reduce waterborne disease burden through structured community engagement, enhanced practices, and local ownership, representing a replicable model for high-risk riverine settings.