Date Published: August 02, 2017
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Faruqe Hussain, Stephen P. Luby, Leanne Unicomb, Elli Leontsini, Tania Naushin, Audrey J. Buckland, Peter J. Winch.
Indiscriminate defecation among young children and the unsafe disposal of their feces increases fecal contamination in the household environment and the risk of diarrheal disease transmission. Improved sanitary technology for children too young to use a latrine may facilitate safe feces disposal and reduce fecal contamination in the household environment. We assessed the acceptability and feasibility of child potties in rural Bangladesh in 2010. Our team introduced child potties into 26 households for 30 days, and conducted semistructured interviews, group discussions, and observations to assess the acceptability and feasibility of their use for parents and children. Residents of this rural Bangladeshi community accepted the child potties and caregivers found them to be a feasible means of managing child feces. The color, shape, design, and size of the potty influenced its acceptability and use. These residents reported that regular use of the potty improved the household’s physical environment and caregiver and child personal hygiene. Regular potty use also reduced caregivers’ work load by making feces collection and disposal easier. Primary caregivers viewed 4–6 months as the appropriate age to initiate potty training. Sanitation interventions should integrate and emphasize potties for children’s feces management to reduce household environmental contamination.
Globally, diarrheal illness is a leading cause of childhood morbidity and mortality.1,2 Open defecation and unsafe disposal of feces increases the risk of disease transmission.3–6 An improved sanitary environment may reduce childhood diarrheal incidence substantially by interrupting fecal–oral transmission.7–10 Safe disposal of children’s feces was associated with reduction in helminth infestation in children under 2 years of age in rural Bangladesh.11
In our rural Bangladesh study site, caregivers accepted potty training for young children and we found locally available potty models that were feasible to use. Defecating in a potty was a new practice for young children and the disposal of feces from a potty was a new behavior for their caregivers. We identified factors that influenced child defecation behaviors and the adoption of safe disposal practices for child feces within the contextual, psychosocial, and technological dimensions of IBM-WASH.32 We summarize the results according to these dimensions below.
Effective sanitation programs need behavior change interventions accompanied by an appropriate enabling technology. Ownership of a household latrine is a contributing factor to enable safe child feces disposal practices,12 but is not sufficient to ensure hygienic feces disposal practices. Four behaviors should be promoted in a child potty behavior change intervention for safe disposal of children’s feces: 1) acquisition of a potty, 2) potty training, 3) regular emptying of the potty into a latrine or safe burial of feces, and 4) cleaning and maintenance for continued use.