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Beardsley R, Lebu S, Anthonj C, Manga M. Child feces disposal practices in humanitarian and non-humanitarian settings across 34 low- and middle-income countries. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 940:173547. [PMID: 38802000 DOI: 10.1016/j.scitotenv.2024.173547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024]
Abstract
Globally, safe sanitation has improved significantly in the last two decades, but unsafe child feces disposal remains a growing challenge in many regions, exposing household members and communities to infectious pathogens. The drivers associated with child feces disposal in several contexts including humanitarian settings are not well understood. This study investigated child feces disposal (CFD) practices and associated factors in low- and middle-income countries, including in humanitarian settings. Data from 352,173 women in 34 countries, collected between 2012 and 2021 through Demographic and Health Surveys (DHS), were used. We utilized multivariate logistic regression to assess CFD practices among children under two years old and the factors linked to these practices. We incorporated data from the United Nations High Commissioner for Refugees (UNHCR) regarding refugee camps' locations in the analysis. Time series and local spatial autocorrelation analyses were run to examine changes in safe CFD practices over time and space, respectively. Results showed minimal improvement in safe child feces disposal over the past decade, with 55.6 % of respondents in non-humanitarian settings and 38.1 % in humanitarian settings improperly disposing of feces. Improper CFD significantly correlated with increased odds of diarrhea in non-humanitarian settings (OR 1.09 95 % CI: 1.05-1.13) but not in humanitarian settings (OR 1.14 95 % CI: 0.53-2.49). The most significant factors (p < 0.05) associated with safe CFD included being in the richest wealth quintile (OR 3.27 95 % CI: 3.06-3.49), having basic education (OR 1.28 95 % CI: 1.22-1.33), children eating solid food (OR 1.53 95 % CI: 1.48-1.57), improved sanitation access (OR 1.88 95 % CI: 1.81-1.96), and listening to radio at least weekly (OR 1.40 95 % CI: 135-1.46). Policymakers and development partners must include safe CFD guidelines in national policies and programs, as well as prioritize investments in household-level sanitation and educate caregivers about safe CFD practices.
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Affiliation(s)
- Rachel Beardsley
- Department of Health Behavior, University of North Carolina at Chapel Hill, USA
| | - Sarah Lebu
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, USA
| | - Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands
| | - Musa Manga
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, USA.
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Rahaman M, Roy A, Chouhan P, Rana MJ. Exploring drivers of unsafe disposal of child stool in India using hierarchical regression model. PLoS One 2024; 19:e0295788. [PMID: 38498574 PMCID: PMC10947681 DOI: 10.1371/journal.pone.0295788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/29/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Disposal of children's stools is often neglected in Indian sanitation programs, putting them at higher risk of diseases transmitted through the fecal-oral route. Therefore, the current study aims to identify the socioeconomic and demographic factors associated with the unsafe disposal of child stool in India and to estimate the geographical variation in unsafe disposal. METHODS The study used 78,074 births under two years from the fifth round of the National Family Health Survey (2019-21). Descriptive statistics, bivariate analysis with the chi-square test, and a four-level hierarchical logistic regression model were applied to accomplish the study objectives. RESULTS Findings revealed a 61.3% prevalence of unsafe stool disposal nationwide, significantly varying between rural (45%) and urban (67%) areas. Multilevel logistic regression highlighted that mother's education, wealth quintile, and sanitation facility were significant predictors of unsafe disposal of child stools. Random intercept statistics revealed a substantial geographical unit-level variance in unsafe stool practice in India. CONCLUSION The study emphasizes the widespread unsafe disposal of child stool among Indian mothers with young children below two years, and the study underscores a range of contributing factors, including education, media exposure, prosperity, water availability, and sanitation. It also accentuates the significance of the geographical variance in the unsafe disposal of child stool in India, particularly at the household level, followed by the community level. Hence, the findings underscore the importance of focused interventions, including targeted household-level poverty alleviation programs, initiatives to enhance sanitation and water facilities, and community-level public health awareness programs.
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Affiliation(s)
- Margubur Rahaman
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Deonar, Mumbai, India
| | - Avijit Roy
- Department of Geography, Malda College, State Aided College Teacher, Malda, West Bengal, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
| | - Md. Juel Rana
- Govind Ballabh Pant Social Science Institute (GBPSSI), Allahabad, India
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Thattil AMT, Agrawal T, Surti AK, Sebastian S, Mirza K, Jacob G, Fathima FN. No Child's Play: Under-five Child Feces Management in a Rural Area of Bengaluru Urban District, India. Indian J Community Med 2024; 49:138-143. [PMID: 38425963 PMCID: PMC10900461 DOI: 10.4103/ijcm.ijcm_141_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/06/2023] [Indexed: 03/02/2024] Open
Abstract
Background Inappropriate feces disposal leads to environmental contamination, and increases the risk of exposure to children. We aimed to estimate the proportion of rural households with knowledge and practice of safe management of feces (SMoF) among under-five children and to identify associated factors. Materials and Methods A cross-sectional study was conducted in eight villages in Bengaluru Urban district over 2 months, using a face-validated semi-structured interview schedule. SMoF was defined based on five criteria - defecation site, transport tool, feces disposal, cleaning of transport tool, and hand washing. Results Out of 320 under-five children surveyed, 15.7% were pre-ambulatory and 84.3% were ambulatory. The majority of the caregivers (92.5%) felt that children should defecate in the latrine and only 23.7% were aware that child feces were more infectious than adult feces. SMoF was only practiced by caregivers of ambulatory children (52.6%). Households with older caregivers (P = 0.01) and those living in a pucca house (P = 0.02) with a latrine inside (P = 0.04) were found to practice SMoF. Children of households that practiced unsafe disposal of child feces experienced more diarrheal episodes (P = 0.04). Caregivers >20 years were found to have better odds of SMoF [20-25 years (adjusted odds ratio, aOR: 9.02), 26-30 years (aOR: 12.17), >30 years (aOR: 8.93)] compared to those <20 years. Conclusion The proportion of households with knowledge and practice of SMoF was low. Awareness of SMoF is essential to reduce the incidence of diarrheal diseases and improve sanitation. Our findings also call for awareness building at schools and colleges.
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Affiliation(s)
| | - Twinkle Agrawal
- Department of Community Health, St. John’s Medical College, Karnataka, India
| | - Abdul Kader Surti
- Department of Community Health, St. John’s Medical College, Karnataka, India
| | - Stallon Sebastian
- Department of Community Health, St. John’s Medical College, Karnataka, India
| | - Kiyana Mirza
- Department of Community Health, St. John’s Medical College, Karnataka, India
| | - George Jacob
- Department of Community Health, St. John’s Medical College, Karnataka, India
| | - Farah Naaz Fathima
- Department of Community Health, St. John’s Medical College, Karnataka, India
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Essuman MA, Storph RP, Ahinkorah BO, Budu E, Yaya S. Hygienic Disposal of Children's Stools Practices Among Women of Children With Diarrhoea in Sub-Saharan Africa. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231204764. [PMID: 37899844 PMCID: PMC10605691 DOI: 10.1177/11786302231204764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023]
Abstract
Background Diarrhoea stools contain infectious agents and pose a public health threat to children and members of the entire family when exposed to them. Therefore, their hygienic disposal is essential. Empirical data are needed to stir the needed public health interventions to encourage or enforce proper disposal practices to curb associated clinical issues. This study assessed the prevalence and correlates of hygienic stool disposal practices by mothers of children with diarrhoea in sub-Saharan Africa (SSA). Methods The Demographic and Health Surveys (DHS) data of 16 sub-Saharan African countries from 2015 to 2021 involving 22 590 mother-child pairs were analysed. Multilevel binary logistic analysis was conducted to assess the individual- and household-level factors associated with the hygienic disposal of stool practices by mothers of children with diarrhoea. The results were presented using adjusted odds ratios (AOR) and 95% confidence intervals (CI) at a statistical significance of P < .05. Results The overall prevalence of hygienic disposal of children's stools among women of children with diarrhoea was 49.01% (95% CI: 48.40-49.62) and ranged from 15.70% in Liberia to 86.6% in Rwanda. The practice of hygienic disposal of stools of children with diarrhoea was likely to increase among mothers who are working (AOR: 1.19; 95% CI: 1.09-1.30), those with partners with primary level of education (AOR: 1.18; 95% CI: 1.06-1.31), Muslims (AOR: 1.69; 95% CI: 1.49-1.91) and widowed/divorced (AOR: 8.94, 95% CI: 3.55-22.53). Again, mothers in the richer (AOR: 1.23; 95% CI: 1.08-1.39) wealth index had increased odds of disposing of stools hygienically compared to those in the poorest wealth index. Women who were 20 years and above, to who belonged to Traditional Religions (AOR: 0.57; 95% CI: 0.43-0.74), and those with unimproved sources of water (AOR: 0.89; 95% CI: 0.82-0.98) and toilet facilities (AOR: 0.63; 95% CI: 0.58-0.69) were less likely to dispose of child's diarrhoea stool hygienically than their counterparts. Conclusion The study reveals that the unhygienic disposal of the stool of children with diarrhoea is prevalent in SSA and requires a concerted effort to curb it. Sanitation practices such as educating mothers about hygienic disposal of children's stool and improving water and sanitation facilities are crucial in lowering the high prevalence of unhygienic disposal of the diarrhoeic stool of children. Additional country-level research is needed to assess children's defecation behaviours and the disposal of diarrhoeic stools using different methodologies.
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Affiliation(s)
- Mainprice Akuoko Essuman
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Central, Ghana
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Alemu F, Eba K, Bonger ZT, Youya A, Gerbaba MJ, Teklu AM, Medhin G. The effect of a health extension program on improving water, sanitation, and hygiene practices in rural Ethiopia. BMC Health Serv Res 2023; 23:836. [PMID: 37550670 PMCID: PMC10408105 DOI: 10.1186/s12913-023-09833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND To make basic primary health care services accessible, especially to the rural community, the government of Ethiopia launched the Health Extension Program (HEP) in 2004. Most of components of HEP are dedicated to hygiene and sanitation. Few studies have assessed the role of the Health Extension Program in improving water, hygiene, and sanitation (WASH) practices in Ethiopia. This study explored the role of health extension workers (HEWs) in influencing household water treatment practices, latrine ownership, latrine use and ownership, and the use of hand-washing facilities on the incidence of diarrheal diseases among the children under five years of age in rural Ethiopia. METHODS Using a cross sectional design, we conducted a national assessment that covered all nine regions of Ethiopia. We conducted face-to-face interviews among a sample of 6430 rural households using a structured questionnaire and an observation checklist to collect data from March 2018 to May 2019. Multilevel logistic regressions models were used to determine the relationships between the exposure of households to HEWs and WASH practice outcomes such as the use of water from an improved water source, household water treatment practices, availability of hand-washing and hand-washing with soap and water, availability of latrines, and use of latrines as well as the incidence of diarrheal diseases among children age 5 and younger. Our models were adjusted for covariates and confounders and P-values less than 5% were set to determine statistical significance. RESULTS We found that 72.7% of rural households had some type of latrine and 27.3% reported practicing open defecation. A total of 71.5% of rural households had access to drinking water from improved water sources, but only 9.4% reported practicing household water treatment. Exposure to HEWs was positively associated with household water treatment practices (AOR: 1.46; 95% CI = 1.01-2.10) and latrine availability (AOR: 1.44; 95% CI = 1.15-1.80). Among the households who were either visited by HEWs at their home or the that visited health posts to meet with the HEWs, being exposed to WASH health education by HEWs was significantly associated with the availability of a hand-washing facility (AOR: 5.14; 95% CI = 4.11-6.42) and latrine availability (AOR: 1.48; 95% CI = 1.10-2.01). However, we did not find a relationship between the incidence of diarrhea among children age 5 and under and exposure to HEWs (AOR: 2.09; 95% CI = 0.73- 6.62). CONCLUSION Our results show a significant association between exposure to the Health Extension Program/ HEWs and improved household water treatment practices, latrine construction, and the availability of hand-washing facilities in rural Ethiopia, suggesting the need to strengthen efforts to change WASH behavior through the Heath Extension Program. On the other hand, further investigation is needed regarding the spillover effect of latrine use practices and the reduction of the incidence of diarrheal diseases.
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Affiliation(s)
| | - Kasahun Eba
- Department of Environmental Health Sciences and Technology, Jimma University, Jimma, Ethiopia
| | | | | | | | | | - Girmay Medhin
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Girmay AM, Weldetinsae A, Mengesha SD, Adugna EA, Alemu ZA, Wagari B, Serte MG, Awoke KS, Bedada TL, Weldegebriel MG, Dinssa DA, Alemayehu TA, Kenea MA, Tekulu KT, Gobena W, Fikresilassie G, Wube W, Melese AW, Redwan E, Hoffmann V, Tessema M, Tollera G. Associations of WHO/UNICEF Joint Monitoring Program (JMP) Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e071296. [PMID: 37500269 PMCID: PMC10387618 DOI: 10.1136/bmjopen-2022-071296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To determine the associations of WHO/UNICEF Joint Monitoring Program Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia. DESIGN A community-based cross-sectional study. SETTING Bishoftu town, Ethiopia, January-February 2022. PARTICIPANTS A total of 1807 mothers with at least one child under 5 years were included. Sociodemographic and WASH variables were collected using a structured questionnaire. 378 drinking water samples were collected. OUTCOME The response variable was diarrhoeal disease among children under 5 years. RESULTS The 2-week prevalence of diarrhoeal disease among children under 5 years was 14.8%. Illiteracy (adjusted OR 3.15; 95% CI 1.54 to 6.47), occupation (0.35; 0.20 to 0.62), mother's age (1.63; 1.15 to 2.31), family size (2.38; 1.68 to 3.39), wealth index (5.91; 3.01 to 11.59), residence type (1.98; 1.35 to 2.90), sex of the child (1.62; 1.17 to 2.24), child's age (3.52; 2.51 to 4.93), breastfeeding status (2.83; 1.74 to 4.59), food storage practice (3.49; 1.74 to 8.26), unimproved drinking water source (8.16; 1.69 to 39.46), limited drinking water service (4.68; 1.47 to 14.95), open defecation practice (5.17; 1.95 to 13.70), unimproved sanitation service (2.74; 1.60 to 4.67), limited sanitation service (1.71; 1.10 to 2.65), no hygiene service (3.43; 1.91 to 6.16) and limited hygiene service (2.13; 1.17 to 3.86) were significantly associated with diarrhoeal disease. CONCLUSION In this study, diarrhoea among children is a significant health issue. Child's age, drinking water service, residence type and hygiene service were the largest contributors with respect to the prevalence of diarrhoeal disease. This investigation provides information that could help to inform interventions to reduce childhood diarrhoea. The findings suggest that state authorities should initiate robust WASH strategies to achieve the Sustainable Development Goal 3 agenda.
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Affiliation(s)
- Aderajew Mekonnen Girmay
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abel Weldetinsae
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sisay Derso Mengesha
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ermias Alemayehu Adugna
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zinabu Assefa Alemu
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bedasa Wagari
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melaku Gizaw Serte
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kaleab Sebsibe Awoke
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tesfaye Legesse Bedada
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mesaye Getachew Weldegebriel
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Danial Abera Dinssa
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tsigereda Assefa Alemayehu
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Moa Abate Kenea
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kirubel Tesfaye Tekulu
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Waktole Gobena
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getinet Fikresilassie
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Wendayehu Wube
- Department of Hygiene and Environmental Health, Ministry of Health, Addis Ababa, Ethiopia
| | - Abayew Wassie Melese
- Department of Hygiene and Environmental Health, Ministry of Health, Addis Ababa, Ethiopia
| | - Ekram Redwan
- Department of Hygiene and Environmental Health, Ministry of Health, Addis Ababa, Ethiopia
| | - Vivian Hoffmann
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
- Department of Economics and School of Public Policy and Administration, Carleton University, Ottawa, Ontario, Canada
| | - Masresha Tessema
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getachew Tollera
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Kouassi HAA, Andrianisa HA, Traoré MB, Sossou SK, Momo Nguematio R, Ymélé SSS, Ahossouhe MS. Review of the slippage factors from open defecation-free (ODF) status towards open defecation (OD) after the Community-Led Total Sanitation (CLTS) approach implementation. Int J Hyg Environ Health 2023; 250:114160. [PMID: 36958189 DOI: 10.1016/j.ijheh.2023.114160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
Open-defecation (OD) is one of the most widespread sanitation practices in low-income countries. This practice often causes diarrheal diseases and 760,000 deaths per year. To eradicate OD, several approaches have been developed, including Community-Led-Total Sanitation (CLTS) which is a participatory and community approach. The specificity of CLTS is that it is managed by the community itself, as its name implies, and that no subsidies or financial contributions from outside the community are used in the construction of the facilities. Although, the CLTS is effective in the short-term for eradicating OD, the long-term results are not encouraging: Open-Defecation-Free (ODF) communities revert to OD or partially use latrines. The present research is based on literature review and authors investigation in Burkina Faso. It was conducted to provide a comprehensive understanding of the factors that affect the sustainability of ODF-status leading to slippage in communities. It was found that these factors can be grouped into five categories: behavioral and social, technological, organizational, and vulnerability factors. The last one, socio-political factors, is a contribution from the authors as it was not reported in the literature yet. The authors have proposed graphical synthesis of all the slippage factors and their associated categories in the ODF-communities. Finally, authors have suggested that to sustain ODF-status of communities: include all stages of the sanitation value chain (SVC) in the CLTS, the follow-up activities after achieving ODF-status must be planned well in advance, sanitation marketing should be developed and the sanctions against the practice of OD have to be reinforced. Governments and donors should pay particular attention to the following options: raising awareness and regular monitoring after ODF certification, encouraging research on sustainable and pro-poor sanitation technologies, and building the capacity of implementing actors including facilitators. While obtaining ODF status is materialized by a sign with the status on it, this paper drew the attention of CLTS implementers to the lack of materialization of slippage when it occurs, and the absence of studies on the evolution of the community sanitation scale after ODF-status.
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Affiliation(s)
- Hemez Ange Aurélien Kouassi
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso.
| | - Harinaivo Anderson Andrianisa
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Maïmouna Bologo Traoré
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Seyram Kossi Sossou
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Rikyelle Momo Nguematio
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Sidesse Sonia Saapi Ymélé
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Mahugnon Samuel Ahossouhe
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
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Demissie GD, Zerihun MF, Ekubagewargies DT, Yeshaw Y, Jemere T, Misganaw B, Tariku A, Atnafu A. Associated factors of safe child feces disposal in sub-Saharan Africa: Evidence from recent demographic and health surveys of 34 sub-Saharan countries. PLoS One 2023; 18:e0281451. [PMID: 36758034 PMCID: PMC9910663 DOI: 10.1371/journal.pone.0281451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Children's feces are thought to pose a greater public health risk than those of adults' due to higher concentrations of pathogens. The aim of this study was to determine the associated factors of safe child feces disposal among children under two years of age in Sub-Saharan Africa. METHODS The most recent demographic and health survey datasets of 34 sub-Saharan countries were used. A total weighted sample of 78, 151 mothers/caregivers of under two children were included in the study. Both bivariable and multivariable multilevel logistic regression were done. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for each independent variables included in the model. RESULTS Those mothers/caregivers from urban residence (AOR = 1.42; CI: 1.36, 1.48), mothers with primary education (AOR = 1.49; CI: 1.44, 1.56), richer (AOR = 1.78; CI: 1.69, 1.88) and richest wealth quintiles (AOR = 2.17; CI: 2.01, 2.31), family size <5 (AOR = 1.06; CI: 1.02-1.09), access to improved water source (AOR = 1.29; CI: 1.25, 1.34), mothers who owned toilet (AOR = 3.09; 2.99-3.19) and who had media exposure (AOR = 1.19; CI: 1.15, 1.24) had higher odds of practicing safe child feces disposal than their counter parts. However, mothers/care givers who are not currently working (AOR = 0.83; CI: 0.80, 0.86), higher education (AOR = 0.85; CI: 0.76-0.94) and from Western region of Africa (AOR = 0.82; CI: 0.79-0.86) had reduced chance of safe child feces disposal as compared to their counter parts. CONCLUSION Residence, mothers' level of education, wealth index, water source, toilet ownership and media exposure were factors associated with safe child feces disposal. It is advisable to implement health promotion and behavioral change intervention measures especially for those women /caregivers from rural residence, poor economic status, who cannot access improved water and for those with no media exposure to improve the practice of safe child feces disposal.
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Affiliation(s)
- Getu Debalkie Demissie
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Muluken Fekadie Zerihun
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniale Tekelia Ekubagewargies
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadeg Jemere
- Department of Biomedical Sciences, College of Health Sciences, Debretabor University, Debretabor, Ethiopia
| | - Bisrat Misganaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sclar GD, Bauza V, Bisoyi A, Clasen TF, Mosler HJ. Contextual and psychosocial factors influencing caregiver safe disposal of child feces and child latrine training in rural Odisha, India. PLoS One 2022; 17:e0274069. [PMID: 36083872 PMCID: PMC9462565 DOI: 10.1371/journal.pone.0274069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022] Open
Abstract
Child feces are an important source of fecal exposure in household environments. Typically, one of two behaviors is necessary to mitigate this risk: either caregivers dispose of their children’s feces into a latrine or children learn how to use a latrine. Although past studies have examined factors associated with these two behaviors collectively (i.e. “safe disposal”), there is a need to separately analyze these distinctive practices to better inform programming. This study aims to quantitatively examine contextual and psychosocial factors influencing caregiver safe disposal and, separately, child latrine training. We surveyed 791 primary female caregivers, who reported on 906 children <5 years old, across 74 villages in rural Odisha, India. At their last defecation event, 38% of children used the latrine and another 10% had their feces safely disposed of into the latrine. Since caregiver safe disposal was rare, we instead assessed safe disposal intention. We used linear regression and multilevel mixed effects models to examine contextual and psychosocial factors. For contextual factors, we found caregivers had stronger safe disposal intention when they came from wealthier households and had greater informational support, but weaker intention when their latrine was near the household. Caregivers more intensely practiced latrine training with their child when they themselves used the latrine for defecation, the latrine was fully intact, and they had greater instrumental support. For psychosocial factors, caregivers had stronger safe disposal intention when their households expected them to practice safe disposal, they felt strongly committed to the behavior, and had a plan for what to do when faced with a water shortage. Caregivers more intensely taught their child how to use the latrine when they believed their child was at risk of becoming sick if they practiced open defecation (OD); viewed child OD as unbeneficial; liked teaching their child; personally felt it was important for the child’s father to help; felt confident in their ability to teach their child; and had greater action control over their training practice. Interestingly, caregivers put less effort into latrine training when they felt more concerned for their child’s safety when the child defecated outside. These findings underscore the critical need to separately assess unique child feces management (CFM) practices and also provide a road map for practitioners on the types of behavior change strategies to consider in their CFM programming.
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Affiliation(s)
- Gloria D. Sclar
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Psychology, University of Zürich, Zürich, Switzerland
- * E-mail:
| | - Valerie Bauza
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Global practices, geographic variation, and determinants of child feces disposal in 42 low- and middle-income countries: An analysis of standardized cross-sectional national surveys from 2016 - 2020. Int J Hyg Environ Health 2022; 245:114024. [PMID: 36029740 PMCID: PMC9489922 DOI: 10.1016/j.ijheh.2022.114024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022]
Abstract
Background Despite considerable progress improving water and sanitation access globally, unsafe child feces disposal remains common in many low- and middle-income countries (LMICs), posing an important health risk. The present study characterizes the current prevalence of child feces disposal practices and child latrine use across low- and middle-income countries and investigates determinants associated with appropriate disposal practices. Methods Data for children ranging from 0 through 4 years of age were analyzed from standardized and nationally-representative surveys of 42 LMICs collected from 2016 to 2020 to assess child feces disposal practices. We report child feces disposal in three categories: disposal in any type of latrine, disposal in an improved latrine, and disposal through means other than in a latrine. Survey weighted multiple Poisson regression models were used to explore factors associated with these practices. Results Data on 403,036 children (weighted N = 191 million) demonstrated that a minority (40.3%) of children have their feces disposed of in a latrine of any kind, and just 29% have feces disposed of in an improved latrine. Prevalence varied considerably by country and region. In adjusted analyses, both child feces disposal in any latrine and disposal in an improved latrine increased with child age, higher intra-country relative wealth, and urban living, and decreased with breastfeeding and shared sanitation facilities. Disposal in improved latrines additionally increased with access to higher levels of service for drinking water and higher mother's education. Nevertheless, the role of facility access alone was insufficient, as only about half of children with household access to any latrine or improved latrines had their feces disposed of in these facilities. Child latrine use among households with latrine access was also low and highly variable across countries. Conclusions Children's feces in LMICs are infrequently disposed of in any latrine type, and even less frequently in improved latrines. In order to minimize health risks in LMICs, increased effort must be undertaken not just to increase sanitation coverage but to address these common barriers to safe child feces disposal and child latrine use. Global child feces disposal in latrines is low and variable between countries. Latrine access is insufficient to explain low use for child feces management. Household relative wealth is associated with increased disposal in latrines. Child latrine use increases with age but remains low and varied between countries.
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Addis M, Worku W, Bogale L, Shimelash A, Tegegne E. Hygienic Child Feces Disposal Practice and Its Associated Factors among Mothers/Caregivers of Under Five Children in West Armachiho District, Northwest Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221114738. [PMID: 35910283 PMCID: PMC9335496 DOI: 10.1177/11786302221114738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Children's feces are 5 times more dangerous than that of adults. Unhygienic disposal of child feces has been reported as one of the major sanitation problems in Sub-Saharan African countries. However, there is a scanty of information in the study area and evidences are insufficient in Ethiopia. Therefore, this study intends to assess child feces disposal practices and associated factors among Mothers/Caregivers of Under Five Children in West Armachiho District, Northwest Ethiopia. METHODS A community-based cross-sectional study was conducted in the West Armachho district from March 10, 2019 to April 10, 2019 by using a multistage cluster sampling method. Binary and multivariable logistic regression models were employed to identify factors associated to child faces disposal practice. The adjusted odds ratio with a 95% confidence interval and a P-value of ⩽.05 were used to declare statistical significance. RESULT The proportion of safe child feces disposal practice was 37.8% (95% CI: 34.6-40.89). Child feces disposal practice was significantly associated with the age of the child (AOR = 5.07, 95% CI: 2.52-10.21), the educational status of fathers (AOR = 2.34, 95% CI: 1.05-5.25), getting health education (AOR = 2.77, 95% CI: 1.84-4.16), utilization of basic type of latrine (AOR = 2.79, 95% CI: 1.55-5.02), knowledge of feces disposal technology options (AOR = 2.58, 95% CI: 1.88-3.96), and media exposure about child feces (AOR = 1.88, 95% CI: 1.22-2.99). CONCLUSION The practice of safe CFD was low. Age of the child, fathers' educational status, receiving health education, basic type of latrine, feces disposal technology options used, and media exposure were independent predictors of safe CFD practice. Interventions need to be designed targeting safe CFD practices taking into account different media outlets and advocacy of improved sanitation technology use by policy makers.
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Affiliation(s)
- Moges Addis
- Abirha Jira Health Office, West Armachiho District, Abirha Jira, Ethiopia
| | - Walelegn Worku
- Institutes of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Laekemariam Bogale
- Institutes of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Shimelash
- Department of Environmental Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Eniyew Tegegne
- Department of Environmental Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Tetteh J, Adomako I, Udofia EA, Yarney E, Quansah H, Yawson AO, Essuman A, Yawson AE. Hygienic disposal of stools and risk of diarrheal episodes among children aged under two years: Evidence from the Ghana Demographic Health Survey, 2003–2014. PLoS One 2022; 17:e0266681. [PMID: 35390094 PMCID: PMC8989342 DOI: 10.1371/journal.pone.0266681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background Most childhood diarrheal illnesses are a result of the faeco-oral transmission of infected food, water, and unclean fingers. The present paper was conducted to estimate the prevalence of hygienic disposal of stools (HDS) and its associated factors, and further quantify the impact of HDS on diarrheal diseases among children under two years. Methods A cross-sectional design was used to evaluate three rounds of the Ghana Demographic Health Survey (GDHS) from 2003–2014 involving 4869 women with children aged under two years. The outcomes were prevalence of HDS and diarrheal diseases. Poisson regression model was employed to assess risk factors associated with HDS and dominance analysis was used to rank the important risk factors. Inverse Probability Weighting Poisson Regression Adjustment (IPWPRA) with Propensity Score 1:1 density kernel-based matching was employed to assess impact. Results The pooled prevalence rate of HDS was 26.5%(95%CI = 24.6–28.4) and it ranged from 18.7% (95%CI = 16.4–21.2) in 2014 to 38.8%(95%CI = 35.3–42.4) in 2003. Diarrhea diseases pooled prevalence was 17.9%(95%CI = 16.4–19.5) and ranged from 13.3%(95%CI = 11.1–15.9) in 2014 to 25.4%(95%CI = 22.2–28.9) in 2003. The overall growth rate for HDS and prevalence of diarrhea diseases, decreased by 21.6% and 11.4% respectively. The most important risk factors of HDS from dominance analysis included; age of the child, wealth index, and differences in region. From pooled data wealth index, increasing age of the child, and regional disparity constituted approximately 72% of the overall impact (Weighted Standardized Dominance Statistics (WSDS) = 0.30, 0.24, and 0.19 respectively). In 2014, they constituted approximately 79% (WSDS = 0.139, 0.177 and 0.471 respectively). The average prevalence of diarrheal diseases among children of women who practiced HDS reduced over the period of the GDHS compared to those whose mothers did not practice HDS [2008 ATE(95%CI) = -0.09(-0.16–0.02), 2014 ATE(95%CI) = -0.05(-0.09–0.01) and Pooled data ATE(95%CI) = -0.05(-0.09–0.02)]. Conclusion This analysis has provided empirical evidence of the impact of practicing HDS in Ghana from a national household survey. Implementation of the WASH agenda in this low-income setting requires a synergy of interventions and collaborations of actors (government, private and development partners) to improve water and sanitation facilities and to increase hygiene education to prevent the spread of diseases including diarrhea by 2025.
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Affiliation(s)
- John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - Isaac Adomako
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Emilia Asuquo Udofia
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Elom Yarney
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Henry Quansah
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Anita Ohenewa Yawson
- Ground Floor Surgical Intensive Care Unit, Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Akye Essuman
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Afework A, Beyene H, Ermias A, Tamene A. Moving Up the Sanitation Ladder: A Study of the Coverage and Utilization of Improved Sanitation Facilities and Associated Factors Among Households in Southern Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221080825. [PMID: 35237046 PMCID: PMC8883407 DOI: 10.1177/11786302221080825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Improved sanitation facilities offer numerous advantages, ranging from the reduction of diarrheal illnesses and helminth infections to the improvement of psychosocial well-being. At the household level, attaining universal access to improved sanitation facilities demands a thorough understanding of the factors that influence their adoption and use. As a result, the purpose of this study was to assess the availability and utilization of improved sanitation facilities, as well as the factors that influence the adoption and proper use of such a facility among households in the Gedeb district of Southern Ethiopia. METHODS A community-based cross-sectional household survey was conducted from March to April 2019. A systematic random sampling technique was used to select 630 households at random. A pre-tested questionnaire was used to collect the respondents' self-reported data, which comprised socio-demographic, home characteristics, behavioral, and environmental elements. The factors related to the availability and utilization of improved sanitation facilities were identified using multivariable logistic regression. RESULT Improved sanitation facilities were present in 172 (27.3%) of the 630 households surveyed, with 111 (64.5%) of them being used properly. The availability of improved sanitation was associated with educational status [AOR = 2.73, 95% CI (1.59, 4.67)], upper wealth quintile [AOR = 2.18, 95% CI (1.21, 3.93)], ever hearing educational messages about latrines [AOR = 3.9, 95% CI (1.86, 8.18)], favorable attitude toward latrine construction [AOR = 2.81, 95% CI (1.67, 4.74)], and receiving support during construction [AOR = 3.78, 95% CI (2.15, 6.65)]. Furthermore, utilization was associated with the absence of children under the age of 5, knowledge of sanitation-related diseases, and a positive attitude toward latrine use. CONCLUSION Both the availability of improved sanitation facilities and the rate at which they were used properly fell far short of the National Hygiene and Environmental Health Strategy's goals. This study contributes to the body of knowledge on how to improve the availability of improved sanitation in Ethiopia.
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Affiliation(s)
- Abel Afework
- Dilla University Referral Hospital, Dilla University, Dilla, Ethiopia
| | - Hunachew Beyene
- Department of Environmental Health, College of Medicine and Health Sciences, Hawassa University, Awassa, Ethiopia
| | - Adane Ermias
- Department of Environmental Health, College of Medicine and Health Sciences, Hawassa University, Awassa, Ethiopia
| | - Aiggan Tamene
- Department of Environmental Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
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Behera M, Parida S, Pradhan H, Priyabadini S, Dehury R, Mishra B. Household sanitation and menstrual hygiene management among women: Evidence from household survey under Swachh Bharat (Clean India) Mission in rural Odisha, India. J Family Med Prim Care 2022; 11:1100-1108. [PMID: 35495782 PMCID: PMC9051715 DOI: 10.4103/jfmpc.jfmpc_1593_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/17/2021] [Accepted: 12/13/2021] [Indexed: 11/04/2022] Open
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Mosisa D, Aboma M, Girma T, Shibru A. Determinants of diarrheal diseases among under five children in Jimma Geneti District, Oromia region, Ethiopia, 2020: a case-control study. BMC Pediatr 2021; 21:532. [PMID: 34847912 PMCID: PMC8630872 DOI: 10.1186/s12887-021-03022-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Globally, in 2017, there were nearly 1.7 billion cases of childhood diarrheal diseases, and it is the second most important cause of morbidity and mortality among under-five children in low-income countries, including Ethiopia. Sanitary conditions, poor housing, an unsanitary environment, insufficient safe water supply, cohabitation with domestic animals that may carry human pathogens, and a lack of food storage facilities, in combination with socioeconomic and behavioral factors, are common causes of diarrhea disease and have had a significant impact on diarrhea incidence in the majority of developing countries. Methods A community-based unmatched case-control study was conducted on 407 systematically sampled under-five children of Jimma Geneti District (135 with diarrhea and 272 without diarrhea) from May 01 to 30, 2020. Data was collected using an interview administered questionnaire and observational checklist adapted from the WHO/UNICEF core questionnaire and other related literature. Descriptive, bivariate, and multivariate binary logistic regression analyses were done by using SPSS version 20.0. Result Sociodemographic determinants such as being a child of 12–23 months of age (AOR 3.3, 95% CI 1.68–6.46; P < 0.05) and mothers’/caregivers’ history of diarrheal diseases (AOR 7.38, 95% CI 3.12–17.44; P < 0.05) were significantly associated with diarrheal diseases among under-five children. Environmental and behavioral factors such as lack of a hand-washing facility near a latrine (AOR 5.22, 95% CI 3.94–26.49; P < 0.05), a lack of hand-washing practice at critical times (AOR 10.6, 95% CI 3.74–29.81; P < 0.05), improper domestic solid waste disposal (AOR 2.68, 95% CI 1.39–5.18; P < 0.05), and not being vaccinated against rotavirus (AOR 2.45, 95% CI 1.25–4.81; P < 0,05) were found important determinants of diarrheal diseases among under-five children. Conclusion The unavailability of a hand-washing facility nearby latrine, mothers’/caregivers’ history of the last 2 weeks’ diarrheal diseases, improper latrine utilization, lack of hand-washing practice at critical times, improper solid waste disposal practices, and rotavirus vaccination status were the determinants of diarrheal diseases among under-five children identified in this study. Thus, promoting the provision of continuous and modified health information programs for households on the importance of sanitation, personal hygiene, and vaccination against rotavirus is fundamental to decreasing the burden of diarrheal disease among under-five children.
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Affiliation(s)
- Dejene Mosisa
- Department of Public Health, Medicine and Health Sciences College, Ambo University, P.O.BOX:19, Ambo, Oromia, Ethiopia
| | - Mecha Aboma
- Department of Public Health, Medicine and Health Sciences College, Ambo University, P.O.BOX:19, Ambo, Oromia, Ethiopia.
| | - Teka Girma
- Department of Public Health, Medicine and Health Sciences College, Ambo University, P.O.BOX:19, Ambo, Oromia, Ethiopia
| | - Abera Shibru
- Department of Public Health, Medicine and Health Sciences College, Ambo University, P.O.BOX:19, Ambo, Oromia, Ethiopia
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Beardsley R, Cronk R, Tracy W, Fleming L, Ng'ambi M, Tidwell JB, Manga M. Factors associated with safe child feces disposal in Ethiopia, India, and Zambia. Int J Hyg Environ Health 2021; 237:113832. [PMID: 34454254 DOI: 10.1016/j.ijheh.2021.113832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/14/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
Safe child feces disposal (CFD) is defined as a child or caregiver placing or rinsing child feces into an improved sanitation facility. In low- and middle-income countries (LMICs), 48% of households with children under five report that child feces were safely disposed. Despite its widespread prevalence and harmful health effects, little is known about the determinants of safe CFD. We analyzed determinants of CFD across three countries that differently address safe CFD in their policies. We used data from a cross-sectional survey of 3737 households in rural areas of Ethiopia, India, and Zambia. Multivariable logistic regression models were used to identify factors associated with safe child feces disposal (CFD) in these countries. Safe CFD was positively associated with whether a female head of household attended primary school in Zambia and India, whether someone spoke to households about cleanliness in Ethiopia, and whether a community had a WaSH committee that met in the past year in Ethiopia. In all three countries, households with a member who practiced open defecation were significantly less likely to practice safe CFD. Increasing the education level of female head of households, reducing open defecation, speaking to a household, and having an active WaSH committee are important programmatic considerations for actors who seek to address CFD in low resource settings. Unsafe CFD is a substantial challenge to transformative WaSH, and more studies should be conducted to evaluate the causes, determinants, and behaviors of CFD.
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Affiliation(s)
- Rachel Beardsley
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC, 27599, United States.
| | - Ryan Cronk
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC, 27599, United States; ICF, 2635 Meridian Parkway Suite 200, Durham, NC, 27713, United States
| | - Wren Tracy
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC, 27599, United States; ICF, 2635 Meridian Parkway Suite 200, Durham, NC, 27713, United States
| | - Lisa Fleming
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC, 27599, United States
| | | | | | - Musa Manga
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC, 27599, United States; Department of Construction Economics and Management, College of Engineering, Design, Art and Technology (CEDAT), Makerere University, P.O. Box 7062, Kampala, Uganda.
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Seidu AA, Ahinkorah BO, Kissah-Korsah K, Agbaglo E, Dadzie LK, Ameyaw EK, Budu E, Hagan JE. A multilevel analysis of individual and contextual factors associated with the practice of safe disposal of children's faeces in sub-Saharan Africa. PLoS One 2021; 16:e0254774. [PMID: 34339451 PMCID: PMC8328335 DOI: 10.1371/journal.pone.0254774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background Over the years, sanitation programs over the world have focused more on household sanitation, with limited attention towards the disposal of children’s stools. This lack of attention could be due to the misconception that children’s stools are harmless. The current study examined the individual and contextual predictors of safe disposal of children’s faeces among women in sub-Saharan Africa (SSA). Methods The study used secondary data involving 128,096 mother-child pairs of under-five children from the current Demographic and Health Surveys (DHS) in 15 sub-Saharan African countries from 2015 to 2018. Multilevel logistic analysis was used to assess the individual and contextual factors associated with the practice of safe disposal of children’s faeces. We presented the results as adjusted odds ratios (aOR) at a statistical significance of p< 0.05. Results The results show that 58.73% (57.79–59.68) of childbearing women in the 15 countries in SSA included in our study safely disposed off their children’s stools. This varied from as high as 85.90% (84.57–87.14) in Rwanda to as low as 26.38% (24.01–28.91) in Chad. At the individual level, the practice of safe disposal of children’s stools was more likely to occur among children aged 1, compared to those aged 0 [aOR = 1.74; 95% CI: 1.68–1.80] and those with diarrhoea compared to those without diarrhoea [aOR = 1.17, 95% CI: 1.13–1.21]. Mothers with primary level of education [aOR = 1.42, 95% CI: 1.30–1.5], those aged 35–39 [aOR = 1.20, 95% CI: 1.12–1.28], and those exposed to radio [aOR = 1.23, 95% CI: 1.20–1.27] were more likely to practice safe disposal of children’s stools. Conversely, the odds of safe disposal of children’s stool were lower among mothers who were married [aOR = 0.74, 95% CI: 0.69–0.80] and those who belonged to the Traditional African Religion [aOR = 0.64, 95% CI: 0.51–0.80]. With the contextual factors, women with improved water [aOR = 1.13, 95% CI: 1.10–1.16] and improved toilet facility [aOR = 5.75 95% CI: 5.55–5.95] had higher odds of safe disposal of children’s stool. On the other hand, mothers who lived in households with 5 or more children [aOR = 0.89, 95% CI: 0.86–0.93], those in rural areas [aOR = 0.86, 95% CI: 0.82–0.89], and those who lived in Central Africa [aOR = 0.19, 95% CI: 0.18–0.21] were less likely to practice safe disposal of children’s stools. Conclusion The findings indicate that between- and within-country contextual variations and commonalities need to be acknowledged in designing interventions to enhance safe disposal of children’s faeces. Audio-visual education on safe faecal disposal among rural women and large households can help enhance safe disposal. In light of the strong association between safe stool disposal and improved latrine use in SSA, governments need to develop feasible and cost-effective strategies to increase the number of households with access to improved toilet facilities.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- * E-mail:
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Kwaku Kissah-Korsah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - John Elvis Hagan
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
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Vong P, Banchonhattakit P, Sim S, Pall C, Dewey RS. Unhygienic stool-disposal practices among mothers of children under five in Cambodia: Evidence from a demographic and health survey. PLoS One 2021; 16:e0249006. [PMID: 34197455 PMCID: PMC8248716 DOI: 10.1371/journal.pone.0249006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Unhygienic disposal of children’s stools affects children’s health in terms of their susceptibility to many diseases. However, there are no existing studies into the impact of unhygienic stool disposal in Cambodia. Therefore, this study aimed to identify factors associated with the unhygienic disposal of children’s stools among children under the age of five in Cambodia. Methods An analytical cross-sectional study was conducted using data from the Cambodia Demographic and Health Survey (CDHS) 2014. A multivariable binary logistic regression was conducted using Stata to analyze factors associated with the unhygienic disposal of children’s stools. Results Overall, the prevalence of practicing unhygienic disposal of children’s stools was 29.27% (95%CI: 27.51%- 31.09%). Factors statistically associated with this practice were: living in the Central Plain, Plateau and Mountains, Coastal and Sea regions (AOR = 1.65; 95% CI: 1.33–2.04), (AOR = 2.53; 95% CI: 1.98–3.24) and (AOR = 4.16; 95% CI: 3.15–5.48) respectively, poor household wealth (AOR = 1.58; 95% CI: 1.31–1.91), the mother having no education (AOR = 1.45; 95% CI: 1.14–1.85), a high number of children aged under five (AOR = 1.11; 95% CI: 1.03–1.20), being in the “other” religious category (AOR = 1.77; 95% CI: 1.25–2.51), living in a household with unimproved toilet facilities (AOR = 1.22; 95% CI: 1.11–1.34), living in a household with inadequate hygiene (AOR = 1.33; 95% CI: 1.12–1.59), and the household not being visited by a family planning worker in the last year (AOR = 1.45; 95% CI: 1.19–1.77). However, an increase in the child’s age by even a month had significant negative associations with unhygienic practice (AOR = 0.65; 95% CI: 0.60–0.70), even when controlling for other covariates. Conclusion Almost one third of the mothers do not practice hygienic disposal of children’s stools in Cambodia. Unhygienic practices were more prevalent in certain regions, and were also associated with low wealth, lack of education, an increase in the number of children under five in the household, religion, lack of sanitation and access to healthcare professionals. Conversely, the child’s age was found to be positively associated with the hygienic disposal of children’s stools.
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Affiliation(s)
- Pisey Vong
- Office of Rural Health Care, Provincial Department of Rural Development, Pursat, Cambodia
- * E-mail:
| | | | - Samphors Sim
- Chea Sim University of Kamchaymear, Prey Veng, Cambodia
| | - Chamroen Pall
- Ministry of Education, Youth and Sport, Phnom Penh, Cambodia
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Sahiledengle B, Teferu Z, Tekalegn Y, Awoke T, Zenbaba D, Bekele K, Tesemma A, Seyoum F, Woldeyohannes D. Geographical variation and factors associated with unsafe child stool disposal in Ethiopia: A spatial and multilevel analysis. PLoS One 2021; 16:e0250814. [PMID: 33914836 PMCID: PMC8084221 DOI: 10.1371/journal.pone.0250814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Unsafe disposal of children’s stool makes children susceptible to fecal-oral diseases and children remain vulnerable till the stools of all children are disposed of safely. There is a paucity of data on spatial distribution and factors associated with unsafe child stool disposal in Ethiopia. Previous estimates, however, do not include information regarding individual and community-level factors associated with unsafe child stool disposal. Hence, the current study aimed (i) to explore the spatial distribution and (ii) to identify factors associated with unsafe child stool disposal in Ethiopia. Methods A secondary data analysis was conducted using the recent 2016 Ethiopian demographic and health survey data. A total of 4145 children aged 0–23 months with their mother were included in this analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of unsafe child stool disposal. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant spatial clusters. A multilevel multivariable logistic regression model was fitted to identify factors associated with unsafe child stool disposal. Results Unsafe child stool disposal was spatially clustered in Ethiopia (Moran’s Index = 0.211, p-value< 0.0001), and significant spatial SaTScan clusters of areas with a high rate of unsafe child stool disposal were detected. The most likely primary SaTScan cluster was detected in Tigray, Amhara, Afar (north), and Benishangul-Gumuz (north) regions (LLR: 41.62, p<0.0001). Unsafe child stool disposal is more prevalent among households that had unimproved toilet facility (AOR = 1.54, 95%CI: 1.17–2.02) and those with high community poorer level (AOR: 1.74, 95%CI: 1.23–2.46). Higher prevalence of unsafe child stool disposal was also found in households with poor wealth quintiles. Children belong to agrarian regions (AOR: 0.62, 95%CI 0.42–0.91), children 6–11 months of age (AOR: 0.65, 95%CI: 0.52–0.83), 12–17 months of age (AOR: 0.68, 95%CI: 0.54–0.86), and 18–23 months of age (AOR: 0.58, 95%CI: 0.45–0.75) had lower odds of unsafe child stool disposal. Conclusions Unsafe child stool disposal was spatially clustered. Higher odds of unsafe child stool disposal were found in households with high community poverty level, poor, unimproved toilet facility, and with the youngest children. Hence, the health authorities could tailor effective child stool management programs to mitigate the inequalities identified in this study. It is also better to consider child stool management intervention in existing sanitation activities considering the identified factors.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
- * E-mail:
| | - Zinash Teferu
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kebebe Bekele
- Department of Surgery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Abdi Tesemma
- Department of Surgery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Fikadu Seyoum
- Department of Pediatrics, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
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Soboksa NE. Associations Between Improved Water Supply and Sanitation Usage and Childhood Diarrhea in Ethiopia: An Analysis of the 2016 Demographic and Health Survey. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211002552. [PMID: 33795933 PMCID: PMC7975481 DOI: 10.1177/11786302211002552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/15/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Diarrheal disease is one of the leading causes of death in children under the age of 5. Access to and use of improved water and sanitation services is associated with this, but there is little country-level evidence for this relationship in Ethiopia. Therefore, associations between improved water supply and sanitation usage and childhood diarrhea in Ethiopia have been identified as the objective of this study. METHODS This study was a cross-sectional study using data from Ethiopia's 2016 Demographic and Health Survey. Through interviews with mothers/caregivers who had children under the age of 5 years, data was collected. The outcome of this study was the response of the mothers/caregivers interviewed to the 2-week occurrence of diarrhea. Logistic regression analysis was used to examine the relationship between dependent and independent variables. RESULTS The survey results found that the use of improved drinking water and latrine facilities was 59.3% (95% CI: 58.36-60.31) and 17.3% (95% CI: 16.59-18.09), respectively. With respect to the handling practices of child feces, 24.8% (95% CI: 23.8-25.70) of the child feces of the interviewed mothers/caregivers were disposed of safely. The prevalence of childhood diarrhea in the preceding 2 weeks was 11% (95% CI: 10.36-11.61). Residence of Somali Region (AOR = 1.81, 95% CI: 1.25-2.61), having more than 2 under-5 children (AOR = 1.21, 95% CI: 1.01-1.46), having more than 5 family members (AOR = 1.18, 95% CI: 1.03-1.36), sex of the indexed child (AOR = 0.88, 95% CI: 0.77-0.99) and unsafe child feces disposal practices (AOR: 1.32; 95% CI: 1.14-1.54) were significantly associated with childhood diarrhea. CONCLUSION Residing in the Somali region, having more than 2 children under the age of 5 and having more than 5 household members, indexed child sex, and safe disposal of child feces were significantly associated with diarrhea. Therefore, in Ethiopia, the prevention of childhood diarrhea should concentrate on eliminating household crowding and encouraging the safe disposal of child feces.
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Affiliation(s)
- Negasa Eshete Soboksa
- Negasa Eshete Soboksa, School of Public
Health, College of Health Sciences and Medicine, Dilla University, P.O. Box,
419, Dilla, Ethiopia.
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Seidu AA. Are children's stools in Ghana disposed of safely? Evidence from the 2014 Ghana demographic and health survey. BMC Public Health 2021; 21:113. [PMID: 33422043 PMCID: PMC7797132 DOI: 10.1186/s12889-021-10155-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 01/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Safe disposal of children’s faeces has always been one of the main challenges to good hygiene in Ghana. Although it has been proven that children’s faeces are more likely to spread diseases than adults’ faeces, people usually mistake them for harmlessness. This study, therefore, sought to determine the prevalence and factors associated with safe disposal of children’s faeces in Ghana. Methods Data from the 2014 Ghana Demographic and Health Survey was used for the analysis. A sample size of 2228 mother-child pairs were used for the study. The outcome variable was disposal of children stools. Both bivariate and multivariable logistic regression analyses were performed to identify the factors with safe child stool disposal. Results The prevalence of safe child stool disposal in Ghana was 24.5%. Women in the middle [Adjusted odds ratio (AOR) = 4.62; Confidence Interval (CI) = 3.00–7.10], Coastal Zone [AOR = 4.52; CI = 2.82–7.22], mothers whose children were aged 12–17 [AOR = 1.56; CI = 1.15–2.13] and 18–23 months [AOR = 1.75; CI = 1.29–2.39], and mothers whose household had improved type of toilet facility [AOR = 2.04; CI = 1.53–2.73] had higher odds of practicing safe children’s faeces disposal. However, women from households with access to improved source of drinking water [AOR = 0.62; CI = 0.45–2.7] had lower odds of practicing safe children’s faeces disposal. Conclusion Approximately only about 25 out of 100 women practice safe disposal of their children’s faeces in Ghana. The age of the child, ecological zone, the type of toilet facilities, and the type of drinking water source are associated with the disposal of child faeces. These findings have proven that only improved sanitation (i.e. drinking water and toilet facilities) are not enough for women to safely dispose of their children’s faeces. Therefore, in addition to provision of toilet facilities especially in the northern zone of Ghana, there is also the need to motivate and educate mothers on safe disposal of children’s stools especially those with children below 12 months. More so, mothers without access to improved toilet facility should also be educated on the appropriate ways to bury their children’s stools safely. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10155-7.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
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Seidu AA, Agbaglo E, Ahinkorah BO, Dadzie LK, Bukari I, Ameyaw EK, Yaya S. Individual and contextual factors associated with disposal of children's stools in Papua New Guinea: evidence from the 2016-2018 demographic and health survey. BMC Public Health 2020; 20:1762. [PMID: 33228606 PMCID: PMC7686747 DOI: 10.1186/s12889-020-09852-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Proper sanitation has been one of the topmost priorities on the global public health agenda. In the past few decades, sanitation programs targeting households have often paid little attention to the disposal of children's stools. We assessed the individual and contextual factors associated with disposal of children's faeces in Papua New Guinea. METHODS The data used for this study forms part of the 2016-2018 Papua New Guinea Demographic and Health Survey (PDHS). For this study, we focused on women with children less than five years (n = 2095). Both descriptive and inferential analyses were carried out. Descriptive statistics were used to summarize the data, using frequency counts and percentages. The inferential analysis used multilevel logistic regression models to investigate the individual and contextual factors associated with disposal of children's stools. These models were presented as adjusted odds ratio (AORs), together with their corresponding 95% confidence intervals. Statistical significance was set at p < 0.05. RESULTS More than half (56%) of the women had disposed of their children's stools unsafely. With the individual level factors, the results showed that women with children < 12 months [AOR =1.71; CI = 1.28-2.29] and women aged 20-24 [AOR =2.58; CI = 1.24-5.37], 35-39 [AOR =2.34; CI = 1.09-5.04], and 40 years and above [AOR =2.51; CI = 1.09-5.79] were more likely to practice unsafe disposal of children's stool. The odds of unsafe disposal of faeces was also higher among women who visited the health facility for child diarrhea [AOR =1.69; CI = 1.25-2.28]. With the contextual factors, the odds of unsafe disposal of children's stool was higher among women who lived in the Southern region [AOR =4.82; CI = 2.08-11.18], those who lived in male-headed households [AOR =1.79; CI = 1.19-2.70], and those who had unimproved toilet facilities [AOR =1.96; CI = 1.39-2.76]. On the contrary, women with unimproved source of drinking water were less likely to dispose of their children's stool unsafely [AOR =0.54; CI = 0.35-0.83]. CONCLUSION Both individual and contextual factors predict unsafe disposal of children's faeces in Papua New Guinea. It is recommended that sanitation programs should focus on behavioral change and not only on the extension of water and improved toilet facilities. Such programs should also focus on both individual and contextual factors of women.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, UK
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Perspectives and Practices on Water, Sanitation, and Hygiene from a Fishing Community along Lake Malombe, Southern Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186703. [PMID: 32942533 PMCID: PMC7559501 DOI: 10.3390/ijerph17186703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
People living in fishing communities have a high burden of preventable water, sanitation, and hygiene (WASH) related diseases but have often been neglected in research and policy. We explored practices and perspectives on WASH among fishing villages around Lake Malombe, Malawi. We employed a mixed methods design, and data were initially collected through participant observations (five weeks), followed by a second phase of qualitative interviews (n = 16), focus group discussions (n = 7), and quantitative surveys (n = 242). We observed that safe water sources were scarce; latrines were basic; and handwashing facilities were limited. Seventy-one percent (n = 174) of households collected water from unsafe sources (open wells and the lake). Eighty-six percent (n = 207) of households had basic short-term latrines. Twenty-four percent (n = 59) of households had handwashing facilities with soap. Qualitative data supported these observations and identified additional factors which compounded poor WASH practices including, a high transient population associated with the fishing trade, poor infrastructure design and construction which lacked consideration of the environmental factors, context and social and cultural norms. As such, fishing communities are underserved and marginalised with constrained access to WASH services, which must be addressed through behaviour-centered and context appropriate solutions.
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Majorin F, Nagel CL, Torondel B, Routray P, Rout M, Clasen TF. Determinants of disposal of child faeces in latrines in urban slums of Odisha, India: a cross-sectional study. Trans R Soc Trop Med Hyg 2020; 113:263-272. [PMID: 30668852 PMCID: PMC6515899 DOI: 10.1093/trstmh/try142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Even among households that have access to improved sanitation, children's faeces often do not end up in a latrine, the international criterion for safe disposal of child faeces. METHODS We collected data on possible determinants of safe child faeces disposal in a cross-sectional study of 851 children <5 y of age from 694 households in 42 slums in two cities in Odisha, India. Caregivers were asked about defecation and faeces disposal practices for all the children <5 y of age in the household. RESULTS Only a quarter (25.5%) of the 851 children's faeces were reported to be disposed of in a latrine. Even fewer (22.3%) of the 694 households reported that the faeces of all children <5 y of age in the home ended up in the latrine the last time the child defecated. In multivariate analysis, factors associated with being a safe disposal household were education and religion of the primary caregiver, number of children <5 y of age in the household, wealth, type and location of the latrine used by the household, household members >5 y of age using the latrine for defecation and mobility of children <5 y of age in the household. CONCLUSIONS Few households reported disposing of all of their children's faeces in a latrine. Improving latrine access and specific behaviour change interventions may improve this practice.
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Affiliation(s)
- Fiona Majorin
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Corey L Nagel
- OHSU/PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Belen Torondel
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Parimita Routray
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Manaswini Rout
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas F Clasen
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Islam M, Rahman M, Unicomb L, Kafi MAH, Rahman M, Alam M, Sen D, Islam S, Pickering AJ, Hubbard AE, Luby SP, Arnold BF, Colford JM, Ercumen A. Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea. PLoS One 2020; 15:e0236163. [PMID: 32687513 PMCID: PMC7371197 DOI: 10.1371/journal.pone.0236163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
Child open defecation is common in low-income countries and can lead to fecal exposure in the domestic environment. We assessed associations between child feces management practices vs. measures of contamination and child diarrhea among households with children <5 years in rural Bangladesh. We visited 360 households quarterly and recorded caregiver-reported diarrhea prevalence, and defecation and feces disposal practices for children <5 years. We examined caregiver and child hands for visible dirt and enumerated E. coli in child and caregiver hand rinse and stored drinking water samples. Safe child defecation (in latrine/potty) and safe feces disposal (in latrine) was reported by 21% and 23% of households, respectively. Controlling for potential confounders, households reporting unsafe child defecation had higher E. coli prevalence on child hands (prevalence ratio [PR] = 1.12, 1.04-1.20) and in stored water (PR = 1.12,1.03-1.21). Similarly, households reporting unsafe feces disposal had higher E. coli prevalence on child hands (PR = 1.11, 1.02-1.21) and in stored water (PR = 1.10, 1.03-1.18). Effects on E. coli levels were similar. Children in households with unsafe defecation and feces disposal had higher diarrhea prevalence but the associations were not statistically significant. Our findings suggest that unsafe child feces management may present a source of fecal exposure for young children.
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Affiliation(s)
- Mahfuza Islam
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Leanne Unicomb
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | | | - Mostafizur Rahman
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Mahfuja Alam
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Debashis Sen
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Sharmin Islam
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Amy J. Pickering
- Civil and Environmental Engineering, Tufts University, Medford, MA, United States of America
| | - Alan E. Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, United States of America
| | - Stephen P. Luby
- Woods Institute for the Environment, Stanford University, Stanford, CA, United States of America
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, United States of America
| | - John M. Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, United States of America
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, United States of America
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Sahiledengle B. Unsafe child feces disposal status in Ethiopia: what factors matter? Analysis of pooled data from four demographic and health surveys. BMC Public Health 2020; 20:800. [PMID: 32460735 PMCID: PMC7254708 DOI: 10.1186/s12889-020-08945-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 05/18/2020] [Indexed: 12/21/2022] Open
Abstract
Background The only safest way to dispose of a child’s feces is to help the child use a toilet or, for very young children, to put or rinse their feces into a toilet, whereas other methods are considered unsafe. This study aimed to determine the magnitude and factors associated with unsafe child feces disposal in Ethiopia. Methods This was a cross-sectional study using pooled data from the four rounds of Demographic and Health Surveys (DHS) conducted in Ethiopia (2000, 2005, 2011, and 2016). Data on child feces disposal practice was collected for all children born during the 5 years preceding survey. Mothers were asked for the youngest child born, “The last time child passed stools, what was done to dispose of the stools?”.Descriptive statistics were computed to illustrate the given data. Multivariable logistic regression was performed to identify factors associated with unsafe child feces disposal. Results The pooled dataset contains data for 40,520 children younger than 5 years, male accounts 20,629 (50.9%). Overall, 77.7% (95%CI: 76.3–79.0) of children feces disposed of unsafely. In the multivariable logistic regression model, those mothers whose child was 13–24 months [AOR: 0.68, 95% CI: (0.60–0.78)] and ≥ 25 months [AOR: 0.66, 95% CI: (0.60–0.72)] were lower odds of unsafe child’s feces disposal. Children born into households having two or fewer children were 33% lower [AOR: 0.67, 95% CI: (0.56–0.79)] odds of unsafe child’s feces disposal than their counterparts. The odds of disposing of feces unsafely among households having improved toilet facility was 76% lower [AOR: 0.24, 95% CI: (0.19–0.29)] that of households lacking such facilities. Further, being an urban resident, having improved drinking water facility, a high level of maternal and paternal education, paternal occupational status (work in non-agriculture), and maternal age (25–34 and ≥ 35 years) were factors that associated with lower odds of unsafe child’s feces disposal. Conclusions Three in four Ethiopian children feces disposed of unsafely. Household and socio-demographic factors, such as access to improved toilet facility, the child’s age (older age), and both higher maternal and paternal education levels were important factors that significantly associated with lower odds of unsafe child feces disposal.
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Affiliation(s)
- Biniyam Sahiledengle
- School of Health Science, Department of Public Health, Madda Walabu University Goba Referral hospital, Bale-Goba, Ethiopia.
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Nkoka O. Correlates of appropriate disposal of children's stools in Malawi: a multilevel analysis. BMC Public Health 2020; 20:604. [PMID: 32357929 PMCID: PMC7195806 DOI: 10.1186/s12889-020-08725-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Management of children's stools is an important aspect of achieving open defecation free communities and reduction of diarrhea. However, information regarding individual- and community- level factors associated with safe child stool disposal in Malawi is limited. The current study aimed to assess the prevalence of safe child stool disposal and the associated individual- and community- level factors in Malawi. METHODS The cross-sectional study used data from the 2015-16 Malawi Demographic Health Survey in which 6326 children aged under 2 years, nested within 850 communities, were analyzed. Individual- and community- level factors were tested for association with safe child stool disposal practice using multilevel logistic regression models. RESULTS Results revealed that 85.6% of the women reported to have safely disposed of their children's stools. Women from households with improved sanitation had 36.0% greater odds of safely disposing of their children's stools compared with those from households with unimproved sanitation [(adjusted odds ratio (aOR): 1.36; 95% confidence interval (CI): 1.12-1.65). Further, women from communities with a middle (aOR: 1.62; 95% CI: 1.18-2.21) and high (aOR: 1.45; 95% CI: 1.14-1.84) percentage of educated women were more likely to have their children's stools safely disposed of than those from communities with a low percentage of educated women. Children's age, media exposure, and region were significantly associated with safe stool disposal. CONCLUSION Both Individual- and community-level factors were revealed to be important factors for child stool disposal. Public health strategies designed to promote sanitation/safe child stools disposal need to conduct thorough community assessments to identify community-specific needs/barriers. Additionally, public health practitioners should take into consideration the geographical and wealth inequalities when designing programs aimed to improve safe child stood disposal.
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Affiliation(s)
- Owen Nkoka
- Institute for Health Research and Communication (IHRC), P. O Box 1958, Lilongwe, Malawi.
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, 110, Taiwan.
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Chebet JJ, Kilungo A, Alaofè H, Malebo H, Katani S, Nichter M. Local Perceptions, Cultural Beliefs, Practices and Changing Perspectives of Handling Infant Feces: A Case Study in a Rural Geita District, North-Western Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093084. [PMID: 32365476 PMCID: PMC7246464 DOI: 10.3390/ijerph17093084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 11/21/2022]
Abstract
We report on the management of infant feces in a rural village in Geita region, Tanzania. Findings discussed here emerged incidentally from a qualitative study aimed at investigating vulnerability and resilience to health challenges in rural settings. Data was gathered through semi-structured focus group discussions (FDGs) with women (n = 4; 32 participants), men (n = 2; 16 participants), and community leaders (n = 1; 8 participants). All FDGs were audio recorded, transcribed verbatim and thematically analyzed using Atlas.ti. Respondents reported feces of a child under the age of six months were considered pure compared to those of older children. Infant feces were seen as transitioning to harmful at the point when the child began to eat solid food, resulting in their stool visually changing in appearance. Caregivers reportedly used soft implements to handle infant feces due to the belief that tools with hard surfaces would physically harm the child. Infant feces were disposed in environments around the house due to the belief that disposal in latrines would prevent developmental milestones and result in other perceived negative health outcomes for the child. Changing views expressed by participants suggest a window of opportunity to implement evidence-based and culturally relevant interventions to encourage the safe disposal of infant feces.
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Affiliation(s)
- Joy J. Chebet
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
- Correspondence:
| | - Aminata Kilungo
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
- Department of Environmental Health Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Halimatou Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Hamisi Malebo
- National Institute for Medical Research, 11101 Dar es Salaam, Tanzania
| | - Shaaban Katani
- National Institute for Medical Research, 11101 Dar es Salaam, Tanzania
| | - Mark Nichter
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
- Department of Anthropology, University of Arizona, Tucson, AZ 85724, USA
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Aliyu AA, Dahiru T. Factors Associated with Safe Disposal Practices of Child's Faeces in Nigeria: Evidence from 2013 Nigeria Demographic and Health Survey. Niger Med J 2019; 60:198-204. [PMID: 31831940 PMCID: PMC6892328 DOI: 10.4103/nmj.nmj_3_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/15/2019] [Accepted: 09/02/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Stool disposal practices have been shown to be associated with childhood diarrhea. There exist variations in explanatory variables of safe child's faecal disposal practices depending on the context of the study. Thus, the need for this study to assess factors associated with safe disposal practices of children's faeces in Nigeria. Methods: This study utilized the 2013 Nigeria Demographic and Health Survey data. Child's faecal disposal practice was classified as safe and unsafe as defined by the World Health Organization/UNICEF Joint Monitoring Program. Binary and multivariate logistic regression models were used to identify factors associated with safe faecal disposal practices. The analysis was restricted to a weighted sample of 19, 288 youngest children in the households. Results: Overall, the prevalence of safe disposal of child's faeces was 59.4%. Safe child's faeces disposal was the highest among older women (64.4%), highly educated women and their husbands (67.1%) and (66.4%), respectively; among rich households (72.3%), Muslim (68.7%), urban areas (68.8%), and in North West zone (78.4%). In multivariate analysis, safe faecal disposal was significantly associated with the age of mother, maternal education level, wealth index, religion, source of water, and type of toilet facility. Marital status, geopolitical zone, having diarrhea in the past 2 weeks before the survey and sex of the child were not significant determinants of safe faecal disposal practice. Conclusion: Understanding the prevailing faecal disposal practices is a prerequisite to the formulation of effective intervention strategies. It is pertinent, therefore, that programs and interventions designed to improve safe child's faecal disposal practices need to take into consideration the factors identified in this study.
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Affiliation(s)
- Alhaji A Aliyu
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Tukur Dahiru
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
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Sahiledengle B. Prevalence and associated factors of safe and improved infant and young children stool disposal in Ethiopia: evidence from demographic and health survey. BMC Public Health 2019; 19:970. [PMID: 31331313 PMCID: PMC6647302 DOI: 10.1186/s12889-019-7325-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/16/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Infant and young children stools are often considered innocuous, and are not disposed of safely despite having a higher pathogen load than adult feces. In Ethiopia, sanitary management of young children's stool is often overlooked and transmission of fecal-oral diseases is still a significant health burden. The study, therefore, describes the prevalence and associated factors of safe and improved child stool disposal. METHODS Data from the fourth round of the Ethiopian Health and Demographic Survey (EDHS) conducted in 2016 was used for this analysis. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with safe and improved child stool disposal. RESULTS The prevalence of safe and improved child stool disposal in Ethiopia was 36.9% (95%CI: 33.4-40.5%) and 5.3% (95%CI: 4.3-6.5%) respectively. There was regional variation in the prevalence of safe and improved child stool disposal. The odds of safe stool disposal among households with richest wealth index had 4.54 (AOR: 4.54; 95%CI: 2.89-7.12), richer 3.64 (AOR: 3.64; 95%CI: 2.46-5.38), middle 3.26 (AOR: 2.26; 95%CI: 2.27-4.68), and poorer 1.93 (AOR: 1.93; 95%CI: 1.39-2.68) times higher odds of practicing safe child stool disposal than households with poorest wealth index. Similarly, households found in richest, richer, middle, and poorer wealth index had also (AOR: 20.23; 95%CI: 8.59-47.66), (AOR: 12.53; 95%CI: 5.59-28.10) (AOR: 4.91; 95%CI: 1.92-12.55), and (AOR: 4.50; 95%CI: 2.06-9.84) higher odds of practicing improved child stool disposal than households from poorest wealth index respectively. The odds of safe child stool disposal were higher among households whose children age between 6 and 11 months (AOR: 1.57; 95%CI: 1.17-2.09), 12-17 months (AOR: 1.39; 95%CI: 1.00-1.95), and 18-23 months (AOR: 1.43; 95%CI: 1.03-1.99) than households whose children age between 0 and 5 months. The odds of safe child stool disposal were 1.31 (AOR: 1.31; 95%CI: 1.00-1.72) and 1.44 (AOR: 1.44; 95%CI: 1.04-2.01) times higher among mothers whose age between 25 and 34 and greater than 34 years compared to mothers whose age between 15 and 24 years, respectively. In addition, children's stools are more likely to be disposed of safely in urban households than in rural households (AOR: 3.12; 95%CI: 1.86-5.22). The present study also revealed households with access to improved sanitation facilities fail to use them for disposal of child stool (AOR: 0.99; 95% CI: 0.67-1.45). CONCLUSIONS The prevalence of safe and improved child stool disposal in Ethiopia was found to be very low. Household socio-demographic and economic determinate were the key factors associated with child stool disposal. Appropriate strategic interventions to ensure safe and improved child stool disposal in Ethiopia is necessary. In addition, integrating child stool management into the existing sanitation interventions programs should be strongly recommended.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
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Bauza V, Reese H, Routray P, Clasen T. Child Defecation and Feces Disposal Practices and Determinants among Households after a Combined Household-Level Piped Water and Sanitation Intervention in Rural Odisha, India. Am J Trop Med Hyg 2019; 100:1013-1021. [PMID: 30793682 PMCID: PMC6447099 DOI: 10.4269/ajtmh.18-0840] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/14/2018] [Indexed: 12/29/2022] Open
Abstract
Latrine access alone may be insufficient to encourage households to dispose of young children's feces safely in a latrine, and little is known about the determinants of improved child feces disposal. We used longitudinal data collected at up to three timepoints for children less than 5 years of age from households in Odisha, India, which received a combined household-level piped water supply and sanitation intervention, but did not specifically promote the safe disposal of child feces. Among the 85% of intervention households who reported access to improved sanitation, we characterized child defecation and feces disposal practices by age, across time, and season, and assessed determinants of improved disposal. Feces from children less than 3 years of age was commonly picked up by caregivers but disposed of unsafely with garbage into open areas (56.3% of households) or in a drain/ditch (6.2%). Although children 3 and 4 years were more likely to use a latrine than younger children, their feces was also more likely to be left in the open if they did not defecate in a latrine. For children less than 5 years of age, most (84.7%) children's feces that was safely disposed of in a latrine was because of the children defecating in the latrine directly. Significant predictors for disposing of child feces in an improved latrine were the primary female caregiver reporting using a latrine to defecate, the child's age, and water observed at place for handwashing. These findings suggest that child feces interventions should focus on encouraging children to begin using a toilet at a younger age and changing the common behavior of disposing of young child's feces into open areas.
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Affiliation(s)
- Valerie Bauza
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Heather Reese
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Parimita Routray
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Caruso BA, Sclar GD, Routray P, Majorin F, Nagel C, Clasen T. A cluster-randomized multi-level intervention to increase latrine use and safe disposal of child feces in rural Odisha, India: the Sundara Grama research protocol. BMC Public Health 2019; 19:322. [PMID: 30885158 PMCID: PMC6423860 DOI: 10.1186/s12889-019-6601-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/27/2019] [Indexed: 11/11/2022] Open
Abstract
Background Despite health benefits of sanitation, an estimated 12% of the global population practices open defecation, including an estimated 50% of the population of India. Current estimates, however, do not include households that own toilets but do not use them, suggesting that the actual number of people defecating in the open is underestimated. This protocol describes a cluster randomized controlled trial to evaluate an intervention specifically designed to increase latrine use, including the safe disposal of child feces, in rural Odisha, India. Methods The trial engages 66 villages in Puri district, 33 randomly allocated to receive the intervention and 33 to serve as controls. The primary outcome is latrine use and is recorded at baseline and endline for all members of all households that own latrines in all trial vilalges. Additional data on determinants of latrine use and safe child feces disposal are also collected to assess change based on the intervetntion. A process evaluation assesses the delivery of the intervention and qualiative research takes place in non-trial villages as well as post-endline in trial villages to help explain trial findings. Discussion This is one of four trials taking place simultaneously in rural India with latrine use as the primary outcome. All four studies use the same outcome to gerenate comparable data across sites that can serve the government of India. The trial in Odisha is unique in that it collects latrine use data from all potential users in all households that own latrines, enabling a thorough view of the sanitation situation and factors that influence use at the community level. That latrine use is collected via self-report is a limitation, however any bias in reporting should be the same across villages and not impact the overall assessment of intervention impact. Trial registration This trial is registered at clinicaltrials.gov: NCT03274245.
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Affiliation(s)
- Bethany A Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Gloria D Sclar
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Fiona Majorin
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Corey Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Mekonnen GK, Alemu BM, Mulat W, Sahilu G, Kloos H. Risk factors for acute childhood diarrhea: A cross-sectional study comparing refugee camps and host communities in Gambella Region, Ethiopia. Travel Med Infect Dis 2019; 31:101385. [PMID: 30772602 DOI: 10.1016/j.tmaid.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 12/26/2018] [Accepted: 02/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diarrhea is one of the most common causes of child morbidity and mortality in refugee camps, aggravated by inadequate water, sanitation and hygiene services, and malnutrition, particularly in developing countries. METHODOLOGY A comparative cross-sectional study was conducted to assess acute diarrhea and associated risk factors among under-five children in refugee and host communities in Gambella Region, Ethiopia. Descriptive statistics were used, and bivariate and multivariate logistic regressions were performed to identify variables associated with diarrhea. RESULTS A total of 1667 under-five children was included in this study, and prevalence of diarrhea differed between the refugee (38%) and host (33%) communities [OR = 1.37, 95% CI 1.04, 1.8]. Refugee camp households using uncovered water containers, consuming low quantities of water, and lacking hand washing setups were more likely to report children with diarrhea. Within host communities, households were more likely to report acute childhood diarrhea if they consumed surface water or did not have a latrine. CONCLUSION The two-week prevalence of diarrhea was significantly higher among children in the refugee camps than those in the host communities. Therefore, further collaboration between government and non-government organizations is required to identify persisting factors of diarrhea transmission in various communities in the region.
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Affiliation(s)
- Getachew Kabew Mekonnen
- Addis Ababa University, Ethiopian Institute of Water Resources, Ethiopia; Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia.
| | | | - Worku Mulat
- University of Connecticut, Department of Civil and Environmental Engineering, Storrs, USA.
| | - Geremew Sahilu
- Addis Ababa University, Ethiopian Institute of Water Resources, Ethiopia.
| | - Helmut Kloos
- University of California, Department of Epidemiology and Biostatistics, San Francisco, USA.
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Islam M, Ercumen A, Ashraf S, Rahman M, Shoab AK, Luby SP, Unicomb L. Unsafe disposal of feces of children <3 years among households with latrine access in rural Bangladesh: Association with household characteristics, fly presence and child diarrhea. PLoS One 2018; 13:e0195218. [PMID: 29621289 PMCID: PMC5886761 DOI: 10.1371/journal.pone.0195218] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Young children frequently defecate in the living environment in low-income countries. Unsafe child feces disposal has been associated with risk of diarrhea. Additionally, reported practices can underestimate socially undesirable unhygienic behaviors. This analysis aimed to assess (1) the sensitivity of reported child feces disposal practices as an indicator for observed presence of human feces in the domestic environment, (2) household characteristics associated with reported unsafe feces disposal and (3) whether unsafe feces disposal is associated with fly presence and diarrhea among children <3 years. METHODS We recorded caregiver-reported feces disposal practices for children <3 years; unsafe disposal was defined as feces put/rinsed into a drain, ditch, bush or garbage heap or left on the ground and safe disposal as feces put/rinsed into latrine or specific pit or buried. We conducted spot checks for human feces, counted flies in the compound and recorded caregiver-reported child diarrhea prevalence among 803 rural Bangladeshi households. We assessed associations using generalized estimating equations (GEE) and generalized linear models (GLM) with robust standard errors. RESULTS Unsafe disposal of child feces was reported by 80% of households. Reported disposal practices had high sensitivity (91%) but low positive predictive value (15%) as an indicator of observed feces in the compound. Unsafe disposal was more common among households that reported daily adult open defecation (PR: 1.13, 1.02-1.24) and had children defecating in a nappy or on the ground versus in a potty (PR: 2.92, 1.98-4.32), and less common in households where adults reported always defecating in latrines (PR: 0.91, 0.84-0.98). The presence of observed human feces was similarly associated with these household characteristics. Reported unsafe feces disposal or observed human feces were not associated with fly detection or child diarrhea. CONCLUSION Despite access to on-site sanitation, unsafe child feces disposal was reported by the majority of households. However, this practices was not associated with diarrhea; suggesting that child feces may not be the most important fecal exposure. Before resources are invested to improve child feces management practices, studies should explore whether these contribute meaningfully to risk of enteric disease.
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Affiliation(s)
- Mahfuza Islam
- Environmental Intervention Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ayse Ercumen
- University of California, Berkeley, CA, United States of America
| | - Sania Ashraf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mahbubur Rahman
- Environmental Intervention Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abul K. Shoab
- Environmental Intervention Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P. Luby
- Woods Institute for the Environment, Stanford University, Stanford, United States of America
| | - Leanne Unicomb
- Environmental Intervention Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Merali HS, Morgan MS, Boonshuyar C. Diarrheal knowledge and preventative behaviors among the caregivers of children under 5 years of age on the Tonle Sap Lake, Cambodia. Res Rep Trop Med 2018; 9:35-42. [PMID: 30050353 PMCID: PMC6047598 DOI: 10.2147/rrtm.s156702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Although Cambodia has made significant progress toward lowering the under-five mortality rate since 2000, diarrhea still accounts for 6% of the total number of these deaths. A vast majority of these deaths is preventable. In this study, we sought to examine diarrheal knowledge and preventative behaviors of caregivers of children under the age of 5 years, to determine caregiver factors associated with knowledge and behavior scores. PATIENTS AND METHODS This was a cross-sectional household-level study conducted in two floating villages on the Tonle Sap Lake, Cambodia between January and February 2014. Caregivers of children under 5 years of age in the villages of Steung Trov and Moat Khla were asked 31 true or false questions to assess their knowledge of diarrhea. They also filled out a questionnaire to assess diarrhea preventative behaviors (DPBs). Comparison of mean scores to categorical caregiver variables was performed using one-way ANOVA analysis. Spearman's rank correlation was applied to identify the relationship between the knowledge and preventative behavior scores and independent quantitative variables. RESULTS A total of 101 caregivers of 161 children under 5 years of age were interviewed. The majority of them (85.1%) was classified as having good knowledge and scored >80% on the assessment. Those with Khmer ethnicity (mean=28.10) scored significantly higher than those with Vietnamese ethnicity (mean 26.00; p=0.004). Older age was correlated with higher knowledge scores (ρ=0.2260; p=0.023) and DPB scores (ρ=0.2320; p=0.019). Significant differences were found between the DPB score and ethnicity, educational background, and wealth (p<0.01). CONCLUSION Although the majority of caregivers had high diarrheal knowledge scores, preventative behaviors for diarrhea as assessed by this study were poor among almost all study participants. Vietnamese, wealthier, older, and more educated participants had better prevention scores. Future interventions in this remote region may benefit from these data as a guide to determine which specific preventative behaviors should be targeted.
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Affiliation(s)
- Hasan S Merali
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada,
| | - Mieko S Morgan
- Services for Health in Asian and African Regions (SHARE), Phnom Penh, Cambodia
- Faculty of Public Health, Thamasart University, Bangkok, Thailand
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Ritter RL, Peprah D, Null C, Moe CL, Armah G, Ampofo J, Wellington N, Yakubu H, Robb K, Kirby AE, Wang Y, Roguski K, Reese H, Agbemabiese CA, Adomako LAB, Freeman MC, Baker KK. Within-Compound Versus Public Latrine Access and Child Feces Disposal Practices in Low-Income Neighborhoods of Accra, Ghana. Am J Trop Med Hyg 2018; 98:1250-1259. [PMID: 29557327 PMCID: PMC5953368 DOI: 10.4269/ajtmh.17-0654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In crowded urban settlements in low-income countries, many households rely on shared sanitation facilities. Shared facilities are not currently considered "improved sanitation" because of concerns about whether hygiene conditions sufficiently protect users from the feces of others. Prevention of fecal exposure at a latrine is only one aspect of sanitary safety. Ensuring consistent use of latrines for feces disposal, especially child feces, is required to reduce fecal contamination in households and communities. Household crowding and shared latrine access are correlated in these settings, rendering latrine use by neighbors sharing communal living areas as critically important for protecting one's own household. This study in Accra, Ghana, found that household access to a within-compound basic latrine was associated with higher latrine use by children of ages 5-12 years and for disposal of feces of children < 5 years, compared with households using public latrines. However, within-compound access was not associated with improved child feces disposal by other caregivers in the compound. Feces was rarely observed in household compounds but was observed more often in compounds with latrines versus compounds relying on public latrines. Escherichia coli and human adenovirus were detected frequently on household surfaces, but concentrations did not differ when compared by latrine access or usage practices. The differences in latrine use for households sharing within-compound versus public latrines in Accra suggest that disaggregated shared sanitation categories may be useful in monitoring global progress in sanitation coverage. However, compound access did not completely ensure that households were protected from feces and microbial contamination.
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Affiliation(s)
| | - Dorothy Peprah
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Clair Null
- Mathematica Policy Research, Washington, District of Columbia.,Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Christine L Moe
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - George Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joseph Ampofo
- Council for Scientific and Industrial Research Water Research Institute, Accra, Ghana
| | - Nii Wellington
- Training Research and Networking for Development (TREND), Accra, Ghana
| | - Habib Yakubu
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Katharine Robb
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Amy E Kirby
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Yuke Wang
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Katherine Roguski
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Heather Reese
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | | | | | - Matthew C Freeman
- Department of Environmental Health, Emory University, Atlanta, Georgia.,Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Kelly K Baker
- College of Public Health, University of Iowa, Iowa City, Iowa.,Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
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Okullo JO, Moturi WN, Ogendi GM. Open Defaecation and Its Effects on the Bacteriological Quality of Drinking Water Sources in Isiolo County, Kenya. ENVIRONMENTAL HEALTH INSIGHTS 2017; 11:1178630217735539. [PMID: 29051705 PMCID: PMC5637965 DOI: 10.1177/1178630217735539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/02/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND INFORMATION The post-2015 Sustainable Development Goals for sanitation call for universal access to adequate and equitable sanitation and an end to open defaecation by 2030. In Isiolo County, a semi-arid region lying in the northern part of Kenya, poor sanitation and water shortage remain a major problem facing the rural communities. OBJECTIVE The overall aim of the study was to assess the relationship between sanitation practices and the bacteriological quality of drinking water sources. The study also assessed the risk factors contributing to open defaecation in the rural environments of the study area. METHODS A cross-sectional study of 150 households was conducted to assess the faecal disposal practices in open defaecation free (ODF) and open defaecation not free (ODNF) areas. Sanitary surveys and bacteriological analyses were conducted for selected community water sources to identify faecal pollution sources, contamination pathways, and contributory factors. Analysis of data was performed using SPSS (descriptive and inferential statistics at α = .05 level of significance). RESULTS Open defaecation habit was reported in 51% of the study households in ODNF villages and in 17% households in ODF villages. Higher mean colony counts were recorded for water samples from ODNF areas 2.0, 7.8, 5.3, and 7.0 (×103) colony-forming units (CFUs)/100 mL compared with those of ODF 1.8, 6.4, 3.5, and 6.1 (×103) areas for Escherichia coli, faecal streptococci, Salmonella typhi, and total coliform, respectively. Correlation tests revealed a significant relationship between sanitary surveys and contamination of water sources (P = .002). CONCLUSIONS The water sources exhibited high levels of contamination with microbial pathogens attributed to poor sanitation. Practising safe faecal disposal in particular is recommended as this will considerably reverse the situation and thus lead to improved human health.
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Affiliation(s)
- Joab Odhiambo Okullo
- Joab Odhiambo Okullo, Department of Environmental Science, Egerton University, P.O. BOX 536-20115, Egerton, Kenya.
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Adane M, Mengistie B, Kloos H, Medhin G, Mulat W. Sanitation facilities, hygienic conditions, and prevalence of acute diarrhea among under-five children in slums of Addis Ababa, Ethiopia: Baseline survey of a longitudinal study. PLoS One 2017; 12:e0182783. [PMID: 28854200 PMCID: PMC5576656 DOI: 10.1371/journal.pone.0182783] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/23/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In developing countries, children under the age of five years who live in slums are highly vulnerable to diarrhea. However, there is a paucity of information on the relationship between sanitation facilities and hygienic conditions to acute diarrhea among under-five children in slum areas of Addis Ababa, Ethiopia. Therefore, this study examines the sanitation facilities and hygienic conditions in the slums of Addis Ababa and identifies the main factors significantly associated with acute diarrhea among children aged 0-50 months in those slums. METHODS A community-based cross-sectional household survey was carried out between September and November 2014, that then served as the baseline survey of a longitudinal study. For this survey, 697 children aged 0-50 months were recruited from two slum districts in Addis Ababa. A pre-tested structured questionnaire and an observational checklist were used for data collection. Multivariable logistic regression analysis was used to identify sanitation facilities and hygiene-related factors that were significantly associated with acute diarrhea by controlling potential confounding effects of selected socio-demographic factors. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was used to quantify the strength of association. MAIN FINDINGS The prevalence of acute diarrhea among children aged 0-50 months in the study area was 11.9% and 94.6% of the sanitation facilities were unimproved. Sharing of a sanitation facility by six or more households (AOR = 4.7; 95% CI: 2.4-9.4), proximity of sanitation facilities within 15 meters of homes (AOR = 6.6; 95% CI: 2.5-17.0), presence of feces (AOR = 3.9; 95% CI: 1.5-10.3) and flies (AOR = 2.5; 95% CI: 1.3-5.0) on the floor of and/or around sanitation facilities, and presence of uncollected garbage inside house compounds (AOR = 3.2; 95% CI: 1.2-8.4) were significantly associated with acute diarrhea. CONCLUSION This study reveals the slum environment to be high risk for diarrhea due to close proximity of sanitation facilities to homes, sharing of sanitation facilities, and poor hygiene of the sanitation facilities and housing compounds. We recommend the development of a comprehensive diarrheal disease prevention program that focuses on improving the cleanliness of the sanitation facilities and housing compounds. Increasing the number of improved sanitation facilities at an appropriate distance from houses is also essential in order to reduce the number of households that share one latrine.
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Affiliation(s)
- Metadel Adane
- Ethiopian Institute of Water Resources (EIWR), Addis Ababa University, Addis Ababa, Ethiopia
| | - Bezatu Mengistie
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States of America
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Worku Mulat
- Department of Civil and Environmental Engineering, University of Connecticut, Storrs, United States of America
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Budhathoki SS, Shrestha G, Bhattachan M, Singh SB, Jha N, Pokharel PK. Latrine coverage and its utilisation in a rural village of Eastern Nepal: a community-based cross-sectional study. BMC Res Notes 2017; 10:209. [PMID: 28606171 PMCID: PMC5469064 DOI: 10.1186/s13104-017-2539-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/08/2017] [Indexed: 11/29/2022] Open
Abstract
Background A little more than 1/3rd of the rural households in Nepal have improved latrine facility. The government of Nepal is working towards making an open defecation free area all over Nepal. There is no data found in literature searches regarding the status of latrines and its utilisation in Nepal. This study aims to estimate the coverage and utilisation of latrine and its associated factors in a rural community of Nepal. Methods We conducted a cross sectional study in March 2015–September 2015 among 625 households in Hattimuda Village, Morang district in Eastern Nepal using semi-structured pre-tested questionnaire with observational checklists. Results Out of 623 households, 473 (76.9%) have latrine facilities. There is an increase in latrine coverage in Hattimuda by 37% (38.9% in 2011 to 75.9% in 2016). Majority of the latrines (89.9%) were functional, however 32.3% needs maintenance. The extent of latrine utilisation among those households with a toilet at home was satisfactory (94.3%). Presence of child below 5 years of age at home (OR 2.37, 95% CI 0.05–0.46), functional latrine (OR 27.37, 95% CI 6.84–109.45), frequency of cleaning (OR 3.66, 95% CI 1.09–12.29) and latrine constructed with self-initiation (OR 4.21, 95% CI 1.06–16.66) are factors significantly associated with the utilisation of the latrine. Conclusions While the coverage needs to be increased, appropriate interventions to increase the utilisation of latrine needs to be in place so that the village moves closer to open defecation free (ODF) status. As other studies are not found from Nepal, the findings from this study can be used a reference for other rural areas of Nepal. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2539-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shyam Sundar Budhathoki
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Gambhir Shrestha
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Meika Bhattachan
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suman Bahadur Singh
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nilambar Jha
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Paras K Pokharel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Tessema RA. Assessment of the implementation of community-led total sanitation, hygiene, and associated factors in Diretiyara district, Eastern Ethiopia. PLoS One 2017; 12:e0175233. [PMID: 28407003 PMCID: PMC5390995 DOI: 10.1371/journal.pone.0175233] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 03/22/2017] [Indexed: 11/19/2022] Open
Abstract
Based on the sustainable development goals, the United Nations plans to achieve equitable sanitation and hygiene for all and to end open defecation by 2030. In Ethiopia, 60% to 80% of health problems are due to communicable diseases attributable to unsafe water supply, unhygienic and unsanitary waste management, which are directly linked to the practice of open defecation. This study has aimed at assessing the implementation of community-led total sanitation and hygiene (CLTSH) and associated factors. A community-based cross-sectional study design involving 420 of the 7,225 households found in Diretiyara district was conducted in June 2014. Both quantitative and qualitative data were collected. Using Logistic Regressions, bivariate and multivariate analyses were computed. This study showed that 66% of the respondents have knowledge of CLTSH. Eighty-nine percent of the respondents have latrine, of which 78% were constructed after the introduction of CLTSH. Eleven percent of the respondents reported to have defected in the open field and 15% of them reported that they had been recently exposed to diarrhea diseases. The occurrence of diarrheal disease was significantly associated with the extent of latrine ownership [AOR = 2.48; 95% CI 1.00, 6.12]. Attitude and perception parameters were significantly associated with consistent latrine utilization. Respondents who agreed that "Open defecation is preferred due to the unpleasant smell and heat from the Latrine'' [COR = 0.58; 95% CI 0.34, 0.99] were 58% less likely to use the latrine consistently. In conclusion, CLTSH has increased the extent of latrine ownership and decreased practice of open defecation, and yet, intermittent latrine use and poor hygienic practice were reported. Although some fundamental misconceptions were reported, the majority of the respondents have accepted CLTSH approach as a means to ending open defecation in their village. Health extension workers and local authorities should give emphasis to achieving sustainable behavioral change on improved sanitation and good hygiene practices.
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Affiliation(s)
- Roba Argaw Tessema
- Department of Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
- * E-mail:
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Aluko OO, Afolabi OT, Olaoye EA, Adebayo AD, Oyetola SO, Abegunde OO. The management of the faeces passed by under five children: an exploratory, cross-sectional research in an urban community in Southwest Nigeria. BMC Public Health 2017; 17:178. [PMID: 28178955 PMCID: PMC5299761 DOI: 10.1186/s12889-017-4078-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 01/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background Safe management of faeces (SMoF) and environmental contamination by faecal pathogens have been extensively researched although the SMoF in under-five children has been perennially neglected perhaps due to the misconception that it is harmless. This research, therefore, studied the situation, to determine the magnitude and dimensions of the problem aimed at making policy level stakeholders aware of child faeces management systems and so, inform evidence-based implementation of child and health-related programmes in Nigeria. Methods The study utilized an exploratory cross-sectional design and a multi-stage sampling technique to identify 300 respondents from 12 randomly selected streets from 4 wards in Ife central local government area. The study collected data with a pretested questionnaire which included direct observations of child defecation practices and existing toilet facilities. Cleaned data were analyzed by IBM-SPSS version 20 with child faeces management outcomes as the dependent variable. Results The mean age of respondents’ and monthly income (mode) were 30.8 ± 7.5 years and ₦10,000.00 ($28.60). Most respondents were mothers to the under five children (84.7%), had a secondary education (72.0%) and were semi-skilled (57.0%). The caregivers had access to improved water sources (93.7%), improved toilets (64.3%), with 64% and 53.7% having above average scores in knowledge and attitudes, respectively. In the study, 19.7% and 69.0% of caregivers practiced safe disposal of faeces passed by the under five child during the day and at night respectively, though most caregivers (94.3%) omitted steps in the safe management of child faeces chain. The under five diarrhoea prevalence rate was 13.7% and unsanitary passage of child faeces is associated with four folds likelihood of having diarrhoea (p = 0.001). The caregivers whose under five children practiced safe sanitation were rich (p = 0.009) and knowledge was significantly associated with ownership of household toilet (P = 0.037), night faeces management chain practice (P < 0.001) and disposal of anal cleaning materials (P = 0.002). Handwashing was significantly associated with household toilet (P < 0.001), wealth (P < 0.001), under five child defecation preferences during the day (P < 0.001) and at night (P = 0.008). Conclusion The high knowledge and positive attitudes exhibited by the caregivers were at variance with practice. Where under five children defecate during the day were influenced by the disposal of their anal cleaning materials, distance to the toilet and caregivers’ education. The findings highlight the dangers of unsanitary disposal of child faeces and the need to strengthen the related policies that can increase caregivers awareness and practice at all levels and in all livelihood domains. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4078-1) contains supplementary material, which is available to authorized users.
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Bawankule R, Singh A, Kumar K, Pedgaonkar S. Disposal of children's stools and its association with childhood diarrhea in India. BMC Public Health 2017; 17:12. [PMID: 28056888 PMCID: PMC5217632 DOI: 10.1186/s12889-016-3948-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children's stool disposal is often overlooked in sanitation programs of any country. Unsafe disposal of children's stool makes children susceptible to many diseases that transmit through faecal-oral route. Therefore, the study aims to examine the magnitude of unsafe disposal of children's stools in India, the factors associated with it and finally its association with childhood diarrhea. METHODS Data from the third round of the National Family Health Survey (NFHS-3) conducted in 2005-06 is used to carry out the analysis. The binary logistic regression model is used to examine the factors associated with unsafe disposal of children's stool. Binary logistic regression is also used to examine the association between unsafe disposal of children's stool and childhood diarrhea. RESULT Overall, stools of 79% of children in India were disposed of unsafely. The urban-rural gap in the unsafe disposal of children's stool was wide. Mother's illiteracy and lack of exposure to media, the age of the child, religion and caste/tribe of the household head, wealth index, access to toilet facility and urban-rural residence were statistically associated with unsafe disposal of stool. The odds of diarrhea in children whose stools were disposed of unsafely was estimated to be 11% higher (95% CI: 1.01-1.21) than that of children whose stools were disposed of safely. An increase in the unsafe disposal of children's stool in the community also increased the risk of diarrhea in children. CONCLUSION We found significant statistical association between children's stool disposal and diarrhea. Therefore, gains in reduction of childhood diarrhea can be achieved in India through the complete elimination of unsafe disposal of children's stools. The sanitation programmes currently being run in India must also focus on safe disposal of children's stool.
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Affiliation(s)
- Rahul Bawankule
- International Institute for Population Sciences, Mumbai, India
| | - Abhishek Singh
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Kaushalendra Kumar
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India.
| | - Sarang Pedgaonkar
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
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Ps P, Sahoo SK, Biswas D, Dasgupta A. Unsafe Disposal of Child Faeces: A Community-based Study in a Rural Block in West Bengal, India. J Prev Med Public Health 2016; 49:323-328. [PMID: 27744673 PMCID: PMC5066419 DOI: 10.3961/jpmph.16.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 09/08/2016] [Indexed: 11/09/2022] Open
Abstract
Objectives A clean India is the responsibility of all Indians. One of the objectives of the Swachh Bharat Abhiyan (Clean India Initiative) is to bring about behavioural changes regarding healthy sanitation practices. While large-scale programs in India have increased latrine coverage, they have to some extent failed to bring behavioural changes ensuring optimal latrine use, including the safe disposal of child faeces, which is a significant source of exposure to faecal pathogens. Hence, this study was done to explore child faeces disposal practices in rural West Bengal and to elicit the determinants of unhygienic faeces disposal. Methods Data collection was done using an interview method among the mothers of 502 under-5 children, following a pre-designed, semi-structured schedule during house-to-house visits in a set of villages in the Hooghly district of West Bengal. Results The prevalence of unsafe disposal of child faeces was 72.4%, and maternal education, per capita income, and water source were found to be significantly associated with unsafe child faeces disposal. Conclusions This study draws attention to the unsafe disposal of child faeces in this area of India and raises questions about the efficiency of sanitation campaigns in rural India that focus on expanding coverage rather than emphasizing behavioural changes, which are crucial to ensure the safe disposal of child faeces. Thus, it is urgently necessary to strengthen efforts focusing on behavioural changes regarding the safe disposal of child faeces in order to minimise adverse health outcomes.
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Affiliation(s)
- Preeti Ps
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, West Bengal, India
| | - Sanjaya Kumar Sahoo
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, West Bengal, India
| | - Dhiraj Biswas
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, West Bengal, India
| | - Aparajita Dasgupta
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, West Bengal, India
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Baker KK, O’Reilly CE, Levine MM, Kotloff KL, Nataro JP, Ayers TL, Farag TH, Nasrin D, Blackwelder WC, Wu Y, Alonso PL, Breiman RF, Omore R, Faruque ASG, Das SK, Ahmed S, Saha D, Sow SO, Sur D, Zaidi AKM, Quadri F, Mintz ED. Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007-2011: Case-Control Study. PLoS Med 2016; 13:e1002010. [PMID: 27138888 PMCID: PMC4854459 DOI: 10.1371/journal.pmed.1002010] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 03/21/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child's risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age. METHODS/FINDINGS The GEMS matched case-control study was conducted between December 1, 2007, and March 3, 2011, at seven sites in Basse, The Gambia; Nyanza Province, Kenya; Bamako, Mali; Manhiça, Mozambique; Mirzapur, Bangladesh; Kolkata, India; and Karachi, Pakistan. Data was collected for 8,592 case children aged <5 y old experiencing MSD and for 12,390 asymptomatic age, gender, and neighborhood-matched controls. An MSD case was defined as a child with a diarrheal illness <7 d duration comprising ≥3 loose stools in 24 h and ≥1 of the following: sunken eyes, skin tenting, dysentery, intravenous (IV) rehydration, or hospitalization. Site-specific conditional logistic regression models were used to explore the association between sanitation and hygiene exposures and MSD. Most households at six sites (>93%) had access to a sanitation facility, while 70% of households in rural Kenya had access to a facility. Practicing open defecation was a risk factor for MSD in children <5 y old in Kenya. Sharing sanitation facilities with 1-2 or ≥3 other households was a statistically significant risk factor for MSD in Kenya, Mali, Mozambique, and Pakistan. Among those with a designated handwashing area near the home, soap or ash were more frequently observed at control households and were significantly protective against MSD in Mozambique and India. CONCLUSIONS This study suggests that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. These findings support the current World Health Organization/ United Nations Children's Emergency Fund (UNICEF) system that categorizes shared sanitation as unimproved.
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Affiliation(s)
- Kelly K. Baker
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Occupational and Environmental Health, The University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
| | - Ciara E. O’Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Myron M. Levine
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - James P. Nataro
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Tracy L. Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tamer H. Farag
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Gates Foundation, Seattle, Washington, United States of America
| | - Dilruba Nasrin
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - William C. Blackwelder
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Yukun Wu
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Emergent BioSolutions, Gaithersburg, Maryland, United States of America
| | - Pedro L. Alonso
- Centre de Recerca en Salut Internacional de Barcelona, Hospital Clinic (CRESIB), Universitat de Barcelona, Barcelona, Spain, and Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- World Health Organization, Geneva, Switzerland
| | - Robert F. Breiman
- US Centers for Disease Control and Prevention, Nairobi, Kenya
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Richard Omore
- Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC), Kisumu, Kenya
| | - Abu S. G. Faruque
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Sumon Kumar Das
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
- The University of Queensland, Brisbane, Australia
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Debasish Saha
- Medical Research Council (United Kingdom), Fajara, The Gambia
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
- India Public Health Association and PATH India Office, New Delhi, India
| | - Anita K. M. Zaidi
- Gates Foundation, Seattle, Washington, United States of America
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan; Gates Foundation, Seattle, Washington, United States of America
| | - Fahreen Quadri
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan; Gates Foundation, Seattle, Washington, United States of America
| | - Eric D. Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Cronin AA, Sebayang SK, Torlesse H, Nandy R. Association of Safe Disposal of Child Feces and Reported Diarrhea in Indonesia: Need for Stronger Focus on a Neglected Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E310. [PMID: 26978379 PMCID: PMC4808973 DOI: 10.3390/ijerph13030310] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 11/17/2022]
Abstract
Indonesia still faces several challenges in the areas of water, sanitation, and hygiene (WASH). Diarrhea remains a major killer of children and it is important to understand the local diarrhea transmission pathways to prioritise appropriate WASH interventions to reduce diarrhea burden. This study used a cross-sectional data set from a recent national household survey (the 2012 Indonesia Demographic and Health Survey) to examine the associations between diarrhea in children aged less than 24 months with WASH interventions and population characteristics. Unsafe disposal of child feces was strongly associated with an increased odds of child diarrhea (OR: 1.46; 95% CI: 1.18-1.82, p = 0.001). However, other WASH practices were not found to be associated. The findings underline the dangers of unsafe disposal of child feces and highlight the need for strengthening the related policies and program strategies and their implementation.
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Affiliation(s)
- Aidan A Cronin
- UNICEF Indonesia, World Trade Center 6, Jalan Jenderal Sudirman Kav. 31, Jakarta 12920, Indonesia.
| | - Susy Katikana Sebayang
- Faculty of Public Health, Universitas Airlangga, Banyuwangi Campus, Jalan Wijaya Kusuma No 113, Banyuwangi 68414, Indonesia.
| | - Harriet Torlesse
- UNICEF Indonesia, World Trade Center 6, Jalan Jenderal Sudirman Kav. 31, Jakarta 12920, Indonesia.
| | - Robin Nandy
- UNICEF Indonesia, World Trade Center 6, Jalan Jenderal Sudirman Kav. 31, Jakarta 12920, Indonesia.
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