Geographical variation and factors associated with unsafe child stool disposal in Ethiopia: A spatial and multilevel analysis

Abstract

Background Unsafe disposal of children’s stool makes children susceptible to fecal-oral diseases and children remain vulnerable till the stools of all children are disposed of safely. There is a paucity of data on spatial distribution and factors associated with unsafe child stool disposal in Ethiopia. Previous estimates, however, do not include information regarding individual and community-level factors associated with unsafe child stool disposal. Hence, the current study aimed (i) to explore the spatial distribution and (ii) to identify factors associated with unsafe child stool disposal in Ethiopia. Methods A secondary data analysis was conducted using the recent 2016 Ethiopian demographic and health survey data. A total of 4145 children aged 0–23 months with their mother were included in this analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of unsafe child stool disposal. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant spatial clusters. A multilevel multivariable logistic regression model was fitted to identify factors associated with unsafe child stool disposal. Results Unsafe child stool disposal was spatially clustered in Ethiopia (Moran’s Index = 0.211, p-value< 0.0001), and significant spatial SaTScan clusters of areas with a high rate of unsafe child stool disposal were detected. The most likely primary SaTScan cluster was detected in Tigray, Amhara, Afar (north), and Benishangul-Gumuz (north) regions (LLR: 41.62, p<0.0001). Unsafe child stool disposal is more prevalent among households that had unimproved toilet facility (AOR = 1.54, 95%CI: 1.17–2.02) and those with high community poorer level (AOR: 1.74, 95%CI: 1.23–2.46). Higher prevalence of unsafe child stool disposal was also found in households with poor wealth quintiles. Children belong to agrarian regions (AOR: 0.62, 95%CI 0.42–0.91), children 6–11 months of age (AOR: 0.65, 95%CI: 0.52–0.83), 12–17 months of age (AOR: 0.68, 95%CI: 0.54–0.86), and 18–23 months of age (AOR: 0.58, 95%CI: 0.45–0.75) had lower odds of unsafe child stool disposal. Conclusions Unsafe child stool disposal was spatially clustered. Higher odds of unsafe child stool disposal were found in households with high community poverty level, poor, unimproved toilet facility, and with the youngest children. Hence, the health authorities could tailor effective child stool management programs to mitigate the inequalities identified in this study. It is also better to consider child stool management intervention in existing sanitation activities considering the identified factors.

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

“…The odds of safe stool disposal increases with increasing child age. This is finding is consistent with the studies done in Malawi, Ethiopia, Eswatini and Ghana [ 17 , 20 , 26 , 30 ]. The possible reason might be that as children get older especially starting from 6 months as they start complementary feeding their stool becomes offensive which increases the likelihood of safe stool disposal in older children as compared to younger children less than 6 month whose stool is not offensive making it favorable to defecate on clothes/diapers.…”

Hygienic Disposal of Children’s Stools Practices Among Women of Children With Diarrhoea in Sub-Saharan Africa

“…Consistent with earlier studies in Ethiopia 51 and Cambodia, 50 geographic variation in stool disposal practices was observed in which the odds of hygienic stool practice increased in the Eastern and Southern Regions when compared to women in the West. A possible explanation for the observed geographic variation in stool disposal practice might be differences in the availability of toilet and water facilities, as well as policies guiding sanitation in the sub-regions.…”

“…The study revealed that women from households with unimproved toilet and water facilities were less likely to practice hygienic stool disposal compared to those with improved toilet and water facilities consistent with previous studies. 44,51,52 Compared to those living in homes that rely on public restrooms, people in low-income urban households having access to within-compound toilet facilities are more likely to utilise latrines for child defecation and stool disposal. 53 Stool disposal practices seem to improve with the availability of water resources on the compound.…”

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

“…The odds of safe stool disposal increases with increasing child age. This is nding is consistent with the studies done in Malawi, Ethiopia, Eswatini and Ghana (15,18,25,29) .The possible reason might be that as children get older especially starting from 6 months as they start complementary feeding their stool becomes offensive which increases the likelihood of safe stool disposal in older children as compared to younger children less than 6 month whose stool is not offensive making it favorable to defecate on clothes/diapers.…”