A multilevel analysis of individual and contextual factors associated with the practice of safe disposal of children’s faeces in sub-Saharan Africa

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.

Safe stool disposal and associated factors among mothers of children under-two age in Gambia: Evidence from Gambia Demographic Health Survey 2019/20

“…The nding of the study is higher than studies done in Eswatini, Ethiopia, Bangladesh, India, and Orissa (3,15,20,23,24). On the other hands, the nding of the current study is lower than the study conducted in Malawi, Cambodia and Sub-Saharan Africa (19,25,26). The possible reason for the discrepancies might be differences in sample size, sampling technique, method of analysis and differences in population characteristics.…”

“…The study conducted in Sub-Saharan Africa used large sample size and it incorporates individual and contextual factors of different countries that might affect safe stool disposal practice. With-in and across-country contextual variations and commonalities might affect safe disposal of children's faeces (19,27).…”

“…Safe child stool disposal was the outcome variable of this study which was obtained after categorizing child stool disposal in to two as safe (Flush or pour-ush toilet/latrine to( piped sewer system, septic tank, pit latrine ), Ventilated improved pit (VIP) latrine and Pit latrine with slab ) and unsafe(pit latrines without a slab or platform, hanging latrines and bucket latrines) Independent Variables Age of the mother, religion, region, educational level, occupation, residence, wealth index, media exposure (yes, no), age of the child, toilet facility(improved, unimproved), sex of the child, birth order, visited a health facility in the last 12 months (yes, no), history of diarrhea in the last 2 weeks preceding the survey (yes, no), source of drinking water(improved, unimproved) and the number of living children were included in the study. Those variables were identi ed after reviewing different literature (5,15,18,19,22).…”

“…Different studies have been done on safe child stool disposal and associated factors among children but there is no study done in Gambia. Among the studies that investigated child feces disposal, most found that the age of the child, maternal age, maternal education, household wealth index, number of children, number of children,sex of the child, availability of toilet facility, improved drinking water, number of living under-ve children and history of diarrhea (18) (19) (20). According to the Gambia Demographic Health Survey (GDHS) 2019/20, safe child stool disposal among children under the age of 2 years has been decreased from 82% in 2013 to 56% in 2019-20.…”

A Rapid Assessment of Knowledge, Attitudes and Practices of Mothers Admitted with Diarrhoea Suffering Children in West Urban Region of Unguja-Zanzibar

“…A number of key determinants of diarrhoea among under-ve morbidity and mortality in sub-Saharan Africa and Southeast Asia have been documented [9]. Some of them includes individual factors like unemployment status, education and age of mothers/caretakers [10,11] and others related to knowledge, attitude and practice of mothers and caregivers in Water, Sanitation and Hygiene (WASH) practices that resulted in inappropriate waste disposal [12], poor hygiene and sanitation [13], limited treatment of stored drinking water [14,15].and little awareness of ORS provision to children that led to admission of children with dehydraton.…”