Formative research for a One Health, animal-inclusive approach to Community-Led Total Sanitation in rural Mali.

Background: Despite its focus on preventing human fecal matter from entering the environment, Community-Led Total Sanitation (CLTS) places little emphasis on animal feces management. Integrating safe management of animal waste into an existing community-level program to safely manage human feces may substantially reduce overall exposure to feces and improve both human and animal health. Methods: We conducted formative research to inform the development of an animal-inclusive CLTS intervention in rural Mali. Across five villages eligible for the national CLTS program, we conducted focus group discussions and individual interviews with livestock owners, child caregivers, and other community stakeholders, unstructured observations of households with young children, a household-level survey, and community workshops. Results: Our results highlight the close interactions between men, women, boys, and girls with a range of domestic animals, animal products, and animal waste, including fecal waste. We documented animal husbandry practices beyond feces management that may impact human, animal, and/or environmental health, including unhygienic milking and slaughtering practices, and the management of sick animals, along with generally low awareness and knowledge about zoonotic diseases. Conclusions: Integrated interventions, like an animal-inclusive approach to CLTS, should be informed by both WASH and animal health sectors, and would benefit from a One Health perspective, where human, animal, and environmental health are accounted for. An animal-inclusive intervention should consider the types of animals present; gender- and age-specific roles that household members play in animal husbandry; potential interventions at critical control points; and context-specific practices, perceptions, and priorities that will influence intervention content and delivery.