Drivers and barriers to sustained use of Blair ventilated improved pit latrine after nearly four decades in rural Zimbabwe

BACKGROUND : Some latrines remain unused even under conditions of high coverage in rural areas of low-and middle-income countries. Not much is known on household latrine use in the long term in the absence of an intervention. The current work assesses drivers and barriers to sustained use of a ventilated improved pit latrine (Blair VIP) design where it originated and how rural households adapt it to climate change. METHODS : A mixed methods study was conducted from November 2020 to May 2021 among rural households of Mbire district, Zimbabwe. A cross sectional survey of 238 households with Blair ventilated improved pit (BVIP) latrines was conducted using a questionnaire and a latrine observation checklist. Data were analysed using logistic regression. Qualitative data were collected using six focus groups among house heads and analysed by thematic analysis. RESULT : The latrine has perceived health, non-health and hygiene benefits for its sustained use. However, there are design, environmental and social barriers. The quantitative study indicated that determinants of latrine use were contextual (individual and household levels) and technology (individual level) factors. Focus groups indicated that latrine use was influenced by social, technology and contextual factors at multiple level factors. Interplay of factors influenced the intention to adapt the BVIP latrine to climate change. Local climate change adaptation strategies for the latrine were odour and erosion control, construction of the conventional latrine design and raised structures. CONCLUSION : The conventional BVIP latrine design is durable and relatively resilient to climate change with high local household use. High construction cost of the latrine causes households to build incomplete and poor quality designs which affect odour and fly control. These are barriers to sustained latrine use. The government should implement the new sanitation policy which considers alternative sanitation options and offer community support for adapting sanitation to climate change.SUPPORTING INFORMATION : S1 Fig. Modified steps of the focus group discussion technique with permission [43]. https://doi.org/10.1371/journal.pone.0265077.s001S1 Table. Integrated behavioural model for water, sanitation and hygiene [30]. https://doi.org/10.1371/journal.pone.0265077.s002S1 File. Latrine use household questionnaire. https://doi.org/10.1371/journal.pone.0265077.s003S2 File. Informed consent document. https://doi.org/10.1371/journal.pone.0265077.s004S3 File. Blair ventilated improved pit latrine construction checklist. https://doi.org/10.1371/journal.pone.0265077.s005S4 File. Focus group discussion guide. https://doi.org/10.1371/journal.pone.0265077.s006S5 File. Phases of thematic analysis [46]. https://doi.org/10.1371/journal.pone.0265077.s007http://www.plosone.orgdm2022School of Health Systems and Public Health (SHSPH