Despite clear evidence of the adverse health impacts of unsafe child feces disposal (CFD), there is little evidence of the effectiveness of interventions targeting the improvement of unsafe CFD practices in this region. A systematic review of the literature was conducted to identify and evaluate the quality of both behavior change and hardware interventions targeting the improvement of CFD practices in the Asia-Pacific region. A total of 695 articles were screened, and 11 studies were included. The combined hardware and behavior change interventions reported the highest rates of safe CFD (SCFD) post-intervention; however, these interventions were of lower quality. Four interventions focused specifically on improving SCFD practices, while the remaining seven studies evaluated the impacts of large-scale interventions, such as India's MANTRA and Total Sanitation Campaign programs, on unsafe CFD practices. Large-scale programs and hardware interventions are important for providing communities with the infrastructure necessary to improve unsafe CFD practices, but such interventions may be improved by the addition of a behavioral change component. With little evidence available on the effectiveness of behavioral interventions on reducing unsafe CFD in the Asia-Pacific region, future work should focus on how behavior change models combined with hardware interventions impact unsafe CFD.
In 2016, nearly 60% of the population of India practiced open defecation (OD), which was 4 times the global rate, and reducing OD in India will be essential in meeting Sustainable Development Goal (SDG) 6.2 and improving global public health. The government of India launched the Swachh Bharat Mission (SBM) in 2014 with one key goal for all Indian states to achieve OD-free (ODF) status by 2019. Despite reports from the Government of India on the success of SBM, the true ODF status of Indian states is still unknown. A systematic review of peer-reviewed literature was conducted to assess the impact of SBM on OD in India, evaluate the barriers to reducing OD, and provide recommendations for future interventions to reduce or eliminate OD in India. A total of 237 publications were screened, and 22 were selected for inclusion. While the Prime Minister declared India ODF in 2019, studies suggest that the government monitoring system overestimates numbers of ODF villages and toilet coverage. Reasons for households’ continued OD practice include financial constraints, lack of water supply, governmental mistrust, cultural beliefs, and personal preference. Community incentives and penalties have been used to encourage proper sanitation practices with varying success. Overarching strategies and approaches that have worked well across study districts to reduce OD include high involvement of district leadership and innovative behavior-change and local community mobilization campaigns.
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