Convincing the community of Mandahazo in southwestern Madagascar to give up open air defecation a start using latrines became something of a spiritual struggle. That is because in the village there was a belief latrines were linked to evil spirits that kill the children.

"Convincing people to use a latrine has been very difficult. When people were asked why they defecated in the open air, they told us that keeping feces between four walls was taboo and was attracting the devil,” says Lambo Jean Mahafetsy, a Community Health Agent working with the USAID-funded ASOTRY project implemented by the Adventist Development and Relief Agency (ADRA).

The village had been suffered many deaths due to diarrhea, a disease closely linked with poor sanitation.

"Before, the village was very dirty. In many spots of the village, there was always a risk of walking on feces. Yet the water we drank was not far from the area where we defecated. That is why so many children died of diarrhea, "says Jean Rabemananjara, a local health agent in charge of hygiene.

The ASOTRY project, through AIM – the Action Intercoopération Madagascar - implements sanitation and hygiene activities in this area of the Atsimo Andrefana region, including CLTS or Community Led Total Sanitation. Project technicians came to the village of Mandahazo to make people aware of the negative impacts that open defecation has on health.

 "We take them to the areas where they defecate, and then we ask them if they would like to eat next to the place, and they start to be disgusted. Then we explain that flies carry microbes from their feces to their food, which is the source of the diseases such as diarrhea that killed their children… this is how we convinced them,” explained Lambo Jean.

The project’s efforts helped to change attitudes in the community, which began to build latrines. The area where people used to defecate has now become cassava fields.

"Some projects had already built some latrines, but no one had used them. It was ASOTRY who convinced us to give up our bad practice ... now, diseases are starting to decrease, "says Lamboharimana Gilbert, another Community Health Agent.

"We encountered some difficulties during the construction of the latrines, but it did not discourage us. Today, our village has about 40 latrines in total, " he explains.

Now, the Mandahazo village has been certified ODF (Open Defecation Free).