Date Published: September 07, 2017
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Fiona Majorin, Belen Torondel, Parimita Routray, Manaswini Rout, Thomas Clasen.
Child feces represent a particular health risk to children due to increased prevalence of enteric agents and a higher risk of exposure owing to exploratory behaviors of young children. The safe management of such feces presents a significant challenge, not only for the 2.4 billion who lack access to improved sanitation, but also due to unhygienic feces collection and disposal and poor subsequent handwashing practices. We assessed potential sources of fecal exposure by documenting child feces management practices in a cross-sectional study of 851 children < 5 years of age from 694 households in 42 slums in two cities in Odisha, India. No preambulatory children and only 27.4% of ambulatory children defecated directly in the latrine. Children that did not defecate in a latrine mainly defecated on the ground, whether they were preambulatory or ambulatory. Use of diapers (1.2%) or potties (2.8%) was low. If the feces were removed from the ground, the defecation area was usually cleaned, if at all, only with water. Most children’s feces were disposed of in surrounding environment, with only 6.5% deposited into any kind of latrine, including unimproved. Handwashing with soap of the caregiver after child feces disposal and child anal cleaning with soap after defecation was also uncommon. While proper disposal of child feces in an improved latrine still represents a major challenge, control of the risks presented requires attention to the full range of exposures associated to the management of child feces, and not simply the place of disposal.
Worldwide 2.4 billion people did not have access to improved sanitation in 2015, including nearly 1 billion people that practiced open defecation.1 India represents a particular challenge, as 44% of its population practiced open defecation and only 40% used improved facilities.1
A total of 694 households, with 852 children < 5 years of age, were enrolled from 42 slums. There was an average of 16.5 respondents per slum (range: 3–20). The primary caregiver of the youngest child in the household who was the respondent for the survey, was mostly the mother of the child (96.3%) (Table 1) and most were not engaged in income generation (self-reported as housewives, 90.9%, data not shown). In this article, we describe defecation and feces disposal practices of children living in slums in Bhubaneswar and Cuttack. We attempted to describe the child feces management process to show the multiple pathways in which child feces may enter the environment. There may be other behaviors that were not quantified in our research or were not captured accurately, for example, handwashing of the children after defecation, which has been found to be poor in rural Bangladesh.24 This aspect should be investigated for children being trained to use the toilet. We did not collect data on whether the tool used for child feces disposal/removal was cleaned afterwards, which is also a step of child feces management that may create a potential risk for exposure.44 What happens with the water when the main disposal was washed with water or with water and soap is unclear, but it is assumed to end up in the environment where the cloth/ nappy, etc. is washed. Future research should quantify where the water ends up, as well as the other feces management steps. While we collected data on the consistency of the feces the last time the child defecated this does not indicate whether the child was sick with diarrhea but it was used to understand whether there were differences in disposal when feces are more liquid. This is, however, an important research question as presumably diarrhea feces may pose a more significant threat as they may contain more pathogens, thus the disposal of diarrhea feces may be an important question to ask. The temporality of events was not captured in the questionnaire and it may be relevant to know how long child feces remain at the defecation place before being disposed of etc. How consistent the disposal behavior is, would also be interesting as this has not been found to be the case in other studies.26,44 Source: http://doi.org/10.4269/ajtmh.16-0688