Unsafe disposal of feces of children <3 years among households with latrine access in rural Bangladesh: Association with household characteristics, fly presence and child diarrhea

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.

Prevalence of soil-transmitted helminthiases among pre-school age children (12-59 months) and WASH condition in Mkuranga, Tanzania: a cross-sectional study

“…This gure is higher than the national average where proportion of safe disposal of child faeces was 72% (15). Our ndings disagree with the results from rural Bangladesh which reported 80% unsafe disposal of children faeces (34). Safe disposal of children faeces in our study is due to availability of pit and ush latrine which allow caretakers to throw or rinse faeces easily.…”

Animal Feces Contribute to Domestic Fecal Contamination: Evidence from E. coli Measured in Water, Hands, Food, Flies, and Soil in Bangladesh

“…Indeed, other work in our study area indicated that, among households where child feces are not disposed of in a latrine, 64% reported disposing of them in the bushes surrounding the compound, 18% in open waste heaps and 13% in drains while only 11% left the feces on the ground. 44 However, human feces likely contribute to domestic fecal contamination through other routes, such as latrines draining into ponds/canals or pits leaking into the environment. Indeed, ponds with a latrine within 10 m and ponds receiving latrine effluent had higher E. coli levels in our study, consistent with previous evidence from rural Bangladesh.…”

Cost and effectiveness of water, sanitation and hygiene promotion intervention in Ghana: the case of four communities in the Brong Ahafo region

“…Our modifications were: inclusion of infant and new born faecal management (thus making it more explicit as part of the principle of all inclusive household faecal containment); restricting ourselves to hand washing with soap only but not soap substitutes; and finally defining an overall hygiene behaviour indicator by combining all the three key hygiene behaviour indicators. Infant and new born faecal management (now explicit in our framework) is key in the reduction of incidence of diarrheal disease amongst infants ( Godana and Mengiste, 2013 ; Islam et al., 2018 ). Although soap substitutes could be as good as soap itself ( Potter et al., 2011 ), however, they stand the risk of becoming contaminated and being disease reservoirs themselves ( Bloomfield and Kumar, 2009 ), hence soap substitutes are not regarded as adequate in this study.…”