African Tropical Medicine and Health | 01 June 2008
An Ethnographic Study of a Social Norms-Based Community-Led Total Sanitation Intervention and Childhood Diarrhoeal Disease in Nouna, Burkina Faso
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Abstract
Childhood diarrhoeal disease remains a leading cause of morbidity and mortality in sub-Saharan Africa. Community-led total sanitation (CLTS) is a widely implemented approach, but its effectiveness is variable. There is a need to understand the social dynamics influencing outcomes when CLTS is explicitly designed to shift social norms. This ethnographic study investigated the implementation and local reception of a social norms-based CLTS intervention in rural Burkina Faso. It aimed to understand how the intervention’s focus on shifting collective sanitation norms influenced household behaviours and childhood diarrhoea prevalence. An immersive ethnographic approach was employed in the Nouna Health District. Data collection included participant observation in multiple villages, in-depth interviews with caregivers, community leaders, and intervention facilitators, and focus group discussions. Field notes and interview transcripts were analysed thematically. The intervention instigated widespread construction of household latrines. A key theme, however, was the divergence between public compliance and private practice. The new norm was often publicly adhered to but privately contested, with many households reverting to open defecation at night or in distant fields. This discrepancy was linked to persistent local beliefs about latrine use and disease. No substantial sustained reduction in reported childhood diarrhoea was observed. While the intervention altered public behaviour and infrastructure, it did not sufficiently internalise new norms or translate them into sustained health gains. The study highlights the complexity of norm change and the limitations of focusing primarily on public compliance. Future CLTS interventions should incorporate deeper ethnographic engagement with local beliefs and practical constraints from the outset. Monitoring should move beyond latrine counting to assess sustained use and private behaviours. Programmes should allow for longer-term, flexible community engagement. ethnography, community-led total sanitation, social norms, diarrhoea, child health, Burkina Faso, qualitative research. This study provides an in-depth ethnographic perspective on the gap between public compliance and private practice in a norms-based sanitation programme, offering evidence for redesigning monitoring frameworks and intervention strategies.