Abstract
BackgroundYoung 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.MethodsWe 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.ResultsUnsafe 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.ConclusionDespite 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.
Highlights
One billion people worldwide (18% of the global population) practice open defecation and in low-income countries nine out of the ten residents who defecate in the open live in rural areas [1]
Unsafe disposal of feces of children
The presence of observed human feces was associated with these household characteristics
Summary
One billion people worldwide (18% of the global population) practice open defecation and in low-income countries nine out of the ten residents who defecate in the open live in rural areas [1]. In Bangladesh, reported open defecation decreased from 42% in 2003 to 1% in 2015, measured as access to a toilet [2]; the nationally representative Bangladesh National Hygiene Baseline Survey, conducted in 2013, 2% of households had no access to a toilet and 4% lacked access in rural areas [3] These figure based on latrine access could underestimate the actual practice of open defecation. While Bangladesh has a very high rate of latrine access (96%), it has the second lowest levels of reported safe disposal of child feces in the South Central Asia region [4]. This could be because child potties and diapers are rarely used in Bangladesh [6]. 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
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