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Subsidised sanitation interventions are often criticised due to the possibility of the infrastructure being neglected or culturally inappropriate for target communities. The BALatrine intervention is a novel approach consisting of a community-wide subsidised recipient-aided installation of an improved latrine with septic tank (\u2018BALatrine\u2019) and education package. This study aimed to investigate the long-term usage and cultural acceptability of the BALatrine project four to six years following its implementation in a main trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional follow-up study in September 2022 of 88 households who received BALatrines in two villages between 2016 and 2017. Quantitative and qualitative interviews with the household head and members were conducted to understand BALatrine usage and perceptions. Descriptive statistics were used to tabulate interview responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The BALatrines were still in excellent condition with 89% still functional as initially intended corresponding to 95% of participants regularly passing a bowel motion in the BALatrine. A 77% reduction in self-reported open defecation was achieved. Participants expressed concerns towards the prospect of having to empty the septic tanks. Interviews with key village stakeholders demonstrated participants desire for aid and financial difficulties in obtaining and maintaining such improved sanitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Follow-up results of the BALatrine intervention demonstrate that the BALatrine\u2019s in the two surveyed villages are overall culturally acceptable and well-maintained. The BALatrine intervention may be suitable for use in other rural areas of Indonesia and the region for improving sanitation coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40249-026-01499-6","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T07:26:07Z","timestamp":1788247567000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term usage, condition, and cultural acceptability of the BALatrine project: findings from a subsidised sanitation improvement intervention in rural Central Java, Indonesia"],"prefix":"10.1186","volume":"15","author":[{"given":"Callum","family":"Lowe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Amaral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Novia","family":"Handayani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bagoes","family":"Widjanarko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Budiyono","family":"Budiyono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nissa","family":"Kusariana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Budi","family":"Laksono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juniawati","family":"Juniawati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muharsono","family":"Muharsono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukoto","family":"Sukoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suharyo","family":"Hadisaputro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinley","family":"Wangdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Lal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Kurscheid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana Vaz","family":"Nery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo J.","family":"Soares-Magalhaes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Halton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"McCarthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archie C. 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Participants signed a consent form to be involved in the study and for data collectors to visit their BALatrine. Participants were given the opportunity to refuse audio recording of the qualitative interview which was conducted in privacy within their homes. The inspection of the BALatrine was only done with the consent of the household head and in privacy. Data was anonymized and kept on the principal investigator\u2019s computer. Identifying information was removed from transcripts presented in this publication in order to protect participants privacy. This research was conducted in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"95"}}