Climate Variability, Community-Led Sanitation and Child Health: An Analysis of CLTS Effectiveness in Malawi, 2021–2026

This study evaluates the effectiveness of community-led total sanitation (CLTS) in reducing childhood diarrhoea in Malawi under conditions of climate variability. It addresses the critical problem of whether CLTS, a key national policy, can sustain health gains when confronted with climate-related disruptions like flooding and drought, which compromise sanitation infrastructure and hygiene practices. Employing a longitudinal, mixed-methods design, the research analysed health surveillance data (2021–2026) from four districts, alongside qualitative data from community focus group discussions and key informant interviews with health surveillance assistants. Quantitative analysis employed regression models to measure changes in diarrhoeal incidence, while qualitative data were examined using thematic analysis. The results demonstrate that CLTS implementation initially correlated with a significant reduction in diarrhoeal disease under stable conditions. However, these health gains were substantially eroded in communities experiencing severe climate shocks, particularly floods that contaminated water sources and damaged latrines. The findings indicate that the prevailing CLTS model, focused on initial community mobilisation, lacks integrated adaptive mechanisms for climate resilience. This reveals a critical gap in current public health strategy. The paper concludes that for Malawi and similar contexts, integrating climate adaptation planning—including promoting climate-resilient sanitation technologies and strengthening community-led disaster preparedness—into sanitation programming is imperative to safeguard child health.