Sanitation Practices and Child Health Outcomes in Gulu District: The Moderating Effect of Climate, Age, and Water Access

Abstract

Abstract Background The sanitation crisis poses a significant public health risk, leading to diseases like diarrhoea, cholera, and typhoid, which impede children’s health and development in developing countries like Uganda. Improving sanitation infrastructure is crucial for safeguarding child health and future generations. However, the link between sanitation and children’s health is complex, influenced by various factors. This investigation in Gulu scrutinises the correlation between sanitation practices and child well-being, considering moderating factors such as age, climate, and consistent water accessibility. Methods The study used a convergent parallel design with equal priority. The Social Ecological Model, Social Learning Theory, and Diffusion of Innovations Model guided it. Researchers collected data from 10 health facilities and 317 households, using purposive and simple random sampling. They used sampling proportions proportional to village size within strata. The researcher analysed quantitative data using SPSS with factor analysis, structural equation modelling, and multivariate analysis. To analyse qualitative data, they used DQA Minor Lite software, which facilitated thematic analysis. Results The finding shows 56.8% of households had low socio-economic status. Sanitation was poor; 24.9% household had improved latrines, 20.5% had handwashing facilities with soap, and 68.1% used basic anal cleansing. For nutrition, 38.5% of children were malnourished by MUAC; by Z-scores, 28.7% were stunted, 16.4% underweight, 13.6% wasted. Diarrhoea affected 62% of children. Climate worsened sanitation: 48.3% had latrines collapse from floods, and 63.4% of waterborne diseases occurred in both dry and wet seasons. Moderation analysis on childhood diarrhoea shows that sociocultural factors (β = -0.20, p < 0.001), sanitation (β = -0.15, p < 0.001), and health system response (β = -0.18, p < 0.001) reduced diarrhoea. Climate change increased risk (β = 0.15, p < 0.001) and moderated sanitation effects (β = 0.01, p < 0.05). Models explained 10–14% variance. Age and water access had no moderating effect. While childhood malnutrition shows that sociocultural factors (β = -0.43, p < 0.001) and health system response (β = -0.13, p < 0.001) reduced malnutrition. Sanitation had no effect (β = 0.01, p > 0.05). Age increased malnutrition risk (β = 0.28, p < 0.01) and moderated sociocultural effects (β = 0.16, p < 0.001), but not sanitation. The model explained 21% variance, R² = 0.21, p < 0.001. Conclusion Sociocultural improvements and health system responses lower both diarrhoea and malnutrition. Climate worsens diarrhoea and alters sanitation’s impact. Age worsens malnutrition and changes sociocultural effects. These findings are valuable for policymakers, healthcare professionals, and researchers