Toys and toilets: cross‐sectional study using children's toys to evaluate environmental faecal contamination in rural Bangladeshi households with different sanitation facilities and practices

Abstract

Abstractobjective To evaluate household faecal contamination using children's toys among 100 rural Bangladeshi households categorised as 'cleaner' (toilet that reliably separates faeces from the environment and no human faeces in/around living space) or 'less clean' (no toilet or toilet that does not reliably separate faeces from the environment and human faeces in/around living space).methods We distributed toy balls to each household and rinsed each study toy and a toy already owned by the household in 200 ml of Ringer's solution. We enumerated faecal coliforms and faecal streptococci from each rinse using membrane filtration methods.results Study toys from 39 cleaner households had lower mean faecal coliform contamination than toys from 61 less clean households (2.4 log 10 colony-forming units (CFU)/200 ml vs. 3.2 log 10 CFU/ 200 ml, P = 0.03). However, wealth measures explained a portion of this relationship. Repeat measures were moderately variable [coefficient of variation (CV) = 6.5 between two toys in the household at the same time, CV = 37.6 between toys in the household at two different times 3-4 days apart]. Too few households owned a non-porous toy to compare groups without risk of bias.conclusion In rural Bangladesh, improved sanitation facilities and practices were associated with less environmental contamination. Whether this association is independent of household wealth and whether the difference in contamination improves child health merit further study. The variation found was typical for measures of environmental contamination, and requires large sample sizes to ascertain differences between groups with statistical significance.

Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection and malnutrition in India

“…Furthermore, we provided sterile balls to children younger than five years from the same 360 households, encouraged them to play with the toys in their household settings for one day, rinsed them in 300 ml of sterile water and assayed the water for thermotolerant coliforms (Vujcic et al 2014).…”

Effect of Neighborhood Sanitation Coverage on Fecal Contamination of the Household Environment in Rural Bangladesh

“…be associated with lower contamination of toy balls and hands. 26,41,42 Second, there are other routes of contamination, such as poor latrine cleanliness, presence of animal feces, or unsafe disposal of children's feces, that neither target household nor neighborhood sanitation access can prevent. There may also be important community-level social, geographical, cultural, and/or environmental factors that we did not capture in our study because we found that sentinel toys in Narshingdi district had a higher level of contamination compared with children's toys in Mymensingh district even after adjusting for potential confounding factors.…”

“…25 Sentinel toy ball rinse: Standard-sized (20 cm circumference) sentinel toy balls ( Figure 1) given to children to play with were collected after 24 hours and rinsed in a Whirl-Pak bag (19 × 38 cm) filled with 200 mL of Ringer's solution for 30 seconds following the methods used previously. 26 All samples were transported in a cool box to the icddr,b Environmental Microbiology Laboratory within 15-18 hours of collection, maintaining a temperature of 4-10°C.…”

Systematic review of evidence on the effectiveness of safe child faeces disposal interventions

“…Despite the pervasive belief that child faeces are safe , unsafe disposal of child faeces increases exposure to faecal pathogens in the domestic environment . Infants and young children in LMIC are particularly vulnerable to microbial contamination in their environment through childhood mouthing behaviours during their exploratory stage of development and through contaminated outdoor play spaces . These exposures to faecal pathogens make them more susceptible to enteric infections resulting in diarrhoeal diseases .…”

“…Infants and young children in LMIC are particularly vulnerable to microbial contamination in their environment through childhood mouthing behaviours during their exploratory stage of development and through contaminated outdoor play spaces . These exposures to faecal pathogens make them more susceptible to enteric infections resulting in diarrhoeal diseases . A global meta‐analysis of child faeces disposal practices found that unsafe child faeces disposal was associated with a 23% increased risk of childhood diarrhoea , the second leading cause of death in children under 5 years of age .…”