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 communityled approaches to sanitation such as the communityled total sanitation clts campaigns which rely on eliminating opendefecation in a particular area barreto et al the study was developed in the context of a citywide programme bahia azul to increase sanitation coverage when the programme started in only of the population of salvador million inhabitants was connected to the sewerage system when the program officially ended in coverage had increased to and it has since risen to almost in the city itself