Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection

Abstract

BackgroundDiarrhoea and soil‐transmitted helminth (STH) infections represent a large disease burden worldwide, particularly in low‐income countries. As the aetiological agents associated with diarrhoea and STHs are transmitted through faeces, the safe containment and management of human excreta has the potential to reduce exposure and disease. Child faeces may be an important source of exposure even among households with improved sanitation.ObjectivesTo assess the effectiveness of interventions to improve the disposal of child faeces for preventing diarrhoea and STH infections.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, and 10 other databases. We also searched relevant conference proceedings, contacted researchers, searched websites for organizations, and checked references from identified studies. The date of last search was 27 September 2018.Selection criteriaWe included randomized controlled trials (RCTs) and non‐randomized controlled studies (NRS) that compared interventions aiming to improve the disposal of faeces of children aged below five years in order to decrease direct or indirect human contact with such faeces with no intervention or a different intervention in children and adults.Data collection and analysisTwo review authors selected eligible studies, extracted data, and assessed the risk of bias. We used meta‐analyses to estimate pooled measures of effect where appropriate, or described the study results narratively. We assessed the certainty of the evidence using the GRADE approach.Main resultsSixty‐three studies covering more than 222,800 participants met the inclusion criteria. Twenty‐two studies were cluster RCTs, four were controlled before‐and‐after studies (CBA), and 37 were NRS (27 case‐control studies (one that included seven study sites), three controlled cohort studies, and seven controlled cross‐sectional studies). Most study sites (56/69) were in low‐ or lower middle‐income settings. Among studies using experimental study designs, most interventions included child faeces disposal messages along with other health education messages or other water, sanitation, and hygiene (WASH) hardware and software components. Among observational studies, the main risk factors relevant to this review were safe disposal of faeces in the latrine or defecation of children under five years of age in a latrine.Education and hygiene promotion interventions, including child faeces disposal messages (no hardware provision)Four RCTs found that diarrhoea incidence was lower, reducing the risk by an estimated 30% in children under six years old (rate ratio 0.71, 95% confidence interval (CI) 0.59 to 0.86; 2 trials, low‐certainty evidence). Diarrhoea prevalence measured in two other RCTs in children under five years of age was lower, but evidence was low‐certainty (risk ratio (RR) 0.93, 95% CI 0.84 to 1.04; low‐certainty evidence).Two controlled cohort studies that evaluated such an intervention in Bangladesh did not detect a difference on diarrhoe...

Sanitation practices and perceptions in Kakuma refugee camp, Kenya: Comparing the status quo with a novel service-based approach

“…Open defecation increases the risk of diarrheal disease transmission, whereas access to private, improved sanitation facilities can reduce the risk of exposure to the others’ feces, and is thus, safer. [ 31 ][ 32 ][ 33 ]…”

Sanitation and Hygiene Practices in Small Towns in Tanzania: The Case of Babati District, Manyara Region

“…Studies have estimated that the unsanitary disposal of child feces may result in a 63% increase in diarrhea. 24 Poor child feces disposal practices have also been found to be associated with a heightened risk of undernutrition, intestinal worms, environmental enteropathy, and death. 25 , 26 Child feces are often poorly disposed of because toilets are not designed for, or indeed used by, small children.…”

Toward a Model of Situations and Their Context

“…I take an example from public health, where such understanding is crucial to the ability to exchange undesirable behaviors for healthier ones. The situation chosen for this example may seem trivial-washing hands with soap-but is actually instrumental to reducing a wide variety of diseases that are major causes of mortality in less developed countries, from diarrhea to helminth infection, and respiratory illnesses-including controlling the viruses that cause some pandemics (Freeman et al, 2014(Freeman et al, , 2016.…”