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Predictors of Functional Status and Abandonment of Tippy-Tap Handwashing Technology Following CLTS Programme Exit in Traditional Authority Chiwere, Dowa District, Malawi: A Cross-Sectional Analytical Study

Mzungu¹ PJ, Chirwa¹ E, Soko¹ M, Nyirenda¹ JL, Mbakaya BC · 16 Oct 2026

Abstract

Abstract Background Tippy-taps are widely promoted as a low-cost handwashing solution in rural sub-Saharan Africa, but post-programme coverage collapse is common and poorly understood at the mechanism level. Traditional Authority (T/A) Chiwere, Dowa District, Malawi, achieved 98.5% household tippy-tap coverage following Community-Led Total Sanitation (CLTS) mobilisation in 2018; coverage fell to 3.1% by 2022 after the implementing partner exited in 2021. Methods This was a cross-sectional analytical study of 415 households in T/A Chiwere, selected using multistage probability sampling with systematic random selection of households, conducted in 2024. Knowledge, attitudes, and functional status were analysed descriptively and with one-way ANOVA. A multivariable logistic regression model was fitted among the subset of households reporting a tippy-tap present with known functional status (n = 135) to identify correlates of functionality. The Capability-Opportunity-Motivation (COM-B) framework was applied after data analysis to organize interpretation of the quantitative findings. Results Most respondents (92.5%, 384/415) showed moderate knowledge of tippy-tap construction, use and maintenance; in univariate analysis, knowledge varied significantly by religion, household size and presence of an under-five child (all p < 0.05) but not significantly by gender. Only 145/415 households (34.9%) reported a tippy-tap present. Among the 135 households with both a tippy-tap present and known functional status, presence of a child under five was independently associated with lower odds of functionality (adjusted OR 0.27, 95% CI 0.10–0.72, p = 0.009), as was smaller household size (1–2 vs 3–5 members; OR 0.25, 95% CI 0.06–0.95, p = 0.042). Conclusions Functional collapse in T/A Chiwere is not explained by knowledge or attitude deficits, both of which were favourable across most households. Household-level caregiving and labour constraints indexed by presence of a young child and smaller household size were independently associated with non-functionality. Programmes should treat working tippy-taps, rather than distributed ones, as the unit of success, and target maintenance support to households with young children rather than relying on repeat sensitisation.