Abstract
BackgroundUnsafe disposal of child faeces is persistent and may lead to considerable impact on the health of young children. Research is limited on the impact of sanitation or hygiene interventions to improve child faeces disposal practices.MethodsIn the context of a randomised controlled trial to assess the health impact of a programme in Odisha, India, to promote rural sanitation under the Government of India's Total Sanitation Campaign, we explored whether the intervention affected the safe disposal of faeces of children under-5 years of age.ResultsAt baseline, 1.1% of households practised ‘safe’ disposal of child faeces, either disposing it in a toilet or by burial. The intervention increased safe disposal of child faeces to 10.4% in intervention households, compared to 3.1% in the control households (RR 3.34; 95% CI 1.99–5.59). This increase in safe disposal is attributable to increases in latrine presence in the intervention communities; the intervention did not change safe disposal practices above and beyond the increase in latrine coverage.ConclusionsThe very modest increase in safe disposal, while statistically significant, is not likely to have consequential health benefit. To achieve open defecation free communities, sanitation interventions will need to develop behaviour change approaches to explicitly target safe disposal behaviours.
Highlights
1 billion people still practise open defecation globally, and a further 1.4 billion use unimproved toilet facilities.[1]
The Government of India launched a series of initiatives, including the Total Sanitation Campaign (TSC) (1999–2012), Nirmal Bharat Abhiyan (2012–2014) and most recently Swachh Bharat Abhiyan.[2,3]
Despite evidence of the positive health impact of improved sanitation generally,[8,9] rigorous evaluation programmes implementing the TSC have shown no effect on diarrhoea, soil-transmitted helminth infection or nutritional status.[4,7]
Summary
1 billion people still practise open defecation globally, and a further 1.4 billion use unimproved toilet facilities.[1]. Compounding the low use among adolescents and adults is that even among households with access to improved sanitation, the faeces of children may not end up in the latrine.[10] In the latest demographic health survey in India, just 20% of child faeces ended in latrines—either the child defecated in the latrine, or it was placed there by a caregiver—the last time the child defecated.[11] Less than 1% was buried, a method currently characterised by the WHO/UNICEF Joint Monitoring Programme on Water Supply and Sanitation (JMP) as safe disposal.[12]. Unsafe disposal of child faeces is persistent and may lead to considerable impact on the health of young children. Research is limited on the impact of sanitation or hygiene interventions to improve child faeces disposal practices
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