It is only if the entire community adopts sanitation simultaneously (as opposed to individual households adopting) that full health benefits can materialise and that the spread of epidemics (such as cholera) can be stopped. As a result, it is often assumed that significant reductions in the prevalence of diarrhoea can only be achieved when an entire community gains access to sanitation rather than isolated individuals. This observation underlies community-led approaches to sanitation, such as the Community-Led Total Sanitation (CLTS) campaigns, which rely on eliminating open-defecation in a particular area.17 Barreto et al. The study was developed in the context of a city-wide programme (Bahia Azul) to increase sanitation coverage. When the programme started in 1995, only 26% of the population of Salvador (2.5 million inhabitants) was connected to the sewerage system. When the program officially ended in 2004, coverage had increased to 70% and it has since risen to almost 90% in the city itself.