Prevalence and factors associated with Open Defecation in Burkina Faso: A trend analysis of the 2003-2021 Burkina Faso Demographic and Health Surveys

Background Open defecation (OD) is the disposal of human faecal matter in open fields, forests, water bodies, or any other place not enclosed or explicitly built for sanitation. This practice has far-reaching health and economic implications, costing Burkina Faso approximately 2% of its GDP annually due to lost productivity and healthcare expenditures. There is a lack of country-specific and nationally representative analysis in Burkina Faso to inform policy interventions. This study examined the trends, determinants, and prevalence of open defecation in Burkina Faso between 2003 and 2021. Methods We analysed the 2003, 2010, and 2021 Burkina Faso Demographic and Health Survey (BDHS) data, and included a final sample of 7,241 in 2003, 16,930 in 2010, and 10,987 in 2021. Sample characteristics and weighted prevalence were described and summarised using frequencies, percentages, and confidence intervals (CI). Multilevel mixed-effect logistic regression models were used to establish the determinants of OD. Results The overall weighted prevalence of OD in Burkina Faso was 70.3% in 2003, 59.4% in 2010, and 33.0% in 2021. In 2021, the prevalence of OD was highest among male-headed households (34.1%), aged 15–29 years (40.7%), rural residents (46.3%), households more than 4 members (35.2%), and those with an unimproved water source (52.2%).In the 2021 survey, households headed by individuals aged 60+ (aOR = 0.55, 95% CI: 0.44,0.69), female-headed households (aOR = 0.74, 95%: 0.59,0.69), and the rich wealth index (aOR = 0.08, 95% CI: 0.06,0.10) had lower odds of open defecation. Households from communities with high level of community poverty had increased odds of OD (aOR = 2.36, 95% CI: 1.37, 4.07) Conclusion There has been a downward trend in the overall prevalence of OD in Burkina Faso. Nevertheless, OD remains high among poor households, rural regions, and those lacking improved access to water sources. Eradication of OD will require interventions that focus on gender-sensitive strategies, rural and low-income populations, reinforcement of educational and behavioural change initiatives, and increased access to affordable and sustainable sanitation facilities to shape hygiene behaviours. Additionally, targeted community-level strategies will be a significant focus, ensuring no community is left behind.