Vol. 1 No. 1 (2023)
Climate Variability, Community-Led Sanitation and Child Health: An Analysis of CLTS Effectiveness in Malawi, 2021–2026
Abstract
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.
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- Adam, E., & Badu, E. (2024). Community-led total sanitation (CLTS) implementation in West Mamprusi Municipal Assembly in Ghana. What do communities think eleven years on?. Global Health Journal. https://doi.org/10.1016/j.glohj.2024.05.003
- Banda, B.M. (2024). Reframing Climate Change Policies and National Development Plans for Sustainable Development in Malawi. The Oxford Handbook of the Malawi Economy. https://doi.org/10.1093/oxfordhb/9780198890164.013.20
- Bronstert, A., Mtilatila, L., & Vormoor, K. (2025). Hydro-electrical potential at risk und climate change: the case of Lake Malawi basin and the Shire River in Malawi / Southeast Africa. https://doi.org/10.5194/egusphere-egu24-11698
- Cardarelli, R., & Pomper, H. (2024). Climate-Driven Migration – Africa (Case Studies of Malawi and Kenya). Children and the Climate Migration Crisis: A Casebook for Global Climate Action in Practice and Policy. https://doi.org/10.1108/978-1-80455-910-920241003
- Chirwa, A.C., Ngongondo, C., & Vunain, E. (2024). Influence of large scale climate drivers on hydro-climate variability in Dwangwa River Basin, Malawi. Discover Atmosphere. https://doi.org/10.1007/s44292-024-00007-5
- Chirwa, A.C., Ngongondo, C., & Vunain, E. (2024). Influence of the Indian Ocean Dipole (IOD) on Hydro-climate variability in Dwangwa River Basin, Malawi. https://doi.org/10.21203/rs.3.rs-4252531/v1
- Hara, C., Gogoda, C., & Chitawo, M.L. (2024). Pioneering Community Energy for Development in Malawi. Community Energy and Sustainable Energy Transitions. https://doi.org/10.1007/978-3-031-57938-7_9
- Kadziponye, A., & Sailence, J. (2024). Learning from the Ground Up: Community Energy Stories from Malawi. Community Energy and Sustainable Energy Transitions. https://doi.org/10.1007/978-3-031-57938-7_10
- Kouassi, H.A.A., Andrianisa, H.A., Sossou, S.K., Traoré, M.B., & Nguematio, R.M. (2023). Sustainability of facilities built under the Community-Led Total Sanitation (CLTS) implementation: Moving from basic to safe facilities on the sanitation ladder. PLOS ONE. https://doi.org/10.1371/journal.pone.0293395
- Muktar, A., Saba, C., & Adzo, D. (2024). Knowledge, Attitudes and Practices (KAP) Towards Community-Led Total Sanitation (CLTS) Behaviours Among Communities in Northern Ghana. Journal of Health and Environmental Research. https://doi.org/10.11648/j.jher.20241003.12
- Mumin, A.A., Mohammed, A., Issahaku, T., & Musah, B.I. (2023). How has community-led total sanitation (CLTS) affected open defecation in urban communities in the Tamale Metropolis?. Environment, Development and Sustainability. https://doi.org/10.1007/s10668-023-03533-1
- Munguambe, C. (2023). Adaptation of the Community-led Total Sanitation (CLTS) Protocol During the COVID-19 Response. https://doi.org/10.19088/slh.2023.007
- Nthezemu Kamanga, C. (2024). Mental illness, herbal medicine, climate change and Vimbuza performers in Rumphi, Malawi. Diakonian tutkimus. https://doi.org/10.37448/dt.129125
- Omufwoko, T.M., Odongo, A.O., & Karama, M. (2024). Major factors influencing the effectiveness of community-led total sanitation among communities in Kilifi and Marsabit Counties in Kenya. International Journal Of Community Medicine And Public Health. https://doi.org/10.18203/2394-6040.ijcmph20242854
- Omufwoko, T.M., Odongo, A.O., & Karama, M. (2024). Awareness of community-led total sanitation and its impact on sanitation among residents of Kilifi and Marsabit Counties, Kenya. International Journal Of Community Medicine And Public Health. https://doi.org/10.18203/2394-6040.ijcmph20243433
- Omufwoko, T.M., Odongo, A.O., & Karama, M. (2024). Level of Awareness of Community-Led Total Sanitation (CLTS) Among Communities in Kilifi and Marsabit Counties in Kenya. International Journal of Health Sciences. https://doi.org/10.47941/ijhs.2262
- Panulo, M., Chidziwisano, K., MacLeod, C., Kapazga, T., Dreibelbis, R., Beattie, T.K., & Morse, T. (2024). CLTS implementation in Malawi: process evaluation of a sanitation and hygiene intervention. https://doi.org/10.31219/osf.io/9bfqd
- Ramadhan, N.U.Z., & Budiono, I. (2025). Determinants of Low Open Defecation Free (ODF) Status in the Implementation of the First Pillar of Community-Led Total Sanitation (CLTS) Program in Panjunan Village, Coastal Area of Cirebon City, Indonesia. Journal of Health Education. https://doi.org/10.15294/jhealthedu.v10i1.16601
- Sahani, W., Inayah, I., & Syamsuddin, S. (2025). Implementation of Pillar I and Pillar III Community-Led Total Sanitation (CLTS) in Reducing the Incident of Stunting in Pangkep District. Jurnal Kesehatan Masyarakat. https://doi.org/10.15294/kemas.v20i3.21230
- Salanjae, M., Masiye, F., & Lipunga, A.M. (2025). Impact of Internal Audit Functions on Corporate Governance Effectiveness in Public Universities in Malawi. Journal of Public Administration Studies. https://doi.org/10.21776/ub.jpas.2025.010.01.2
- Stanfield, E.W., & Ngulube, E. (2025). Rural women and the overlapping climate and energy injustices in Malawi: An intersectional feminist overview. Intersectional Climate Justice in Eastern Africa. https://doi.org/10.5040/9781350516465.ch-10
- Suryanti, R. (2025). Implementation of the Open Defecation Free (ODF) Pillar of Community-Led Total Sanitation (CLTS) Program in East Kalimantan, Indonesia. KESANS : International Journal of Health and Science. https://doi.org/10.54543/kesans.v5i2.485
- Swalisu, M. (2025). Climate Change, Culture and Marriage Timing in Malawi. https://doi.org/10.2139/ssrn.5337630
- Syam, D.M., & Bungawati, A. (2024). The effectiveness of community-led total sanitation cadre intervention in improving stunting knowledge and behavior. Healthcare in Low-resource Settings. https://doi.org/10.4081/hls.2024.13109
- Trisnaini, I., Pratiningsih, W.A., Putri, D.A., Juniarni, A., Febriana, D., Safana, H., & Firdaus, A. (2025). Association Between Community-Based Total Sanitation (CLTS) Pillars and Diarrhea Incidence in Wetland Communities of South Indralaya. Gema Lingkungan Kesehatan. https://doi.org/10.36568/gelinkes.v23i4.363