Contextual and psychosocial factors influencing caregiver safe disposal of child feces and child latrine training in rural Odisha, India

Abstract

Child feces are an important source of fecal exposure in household environments. Typically, one of two behaviors is necessary to mitigate this risk: either caregivers dispose of their children’s feces into a latrine or children learn how to use a latrine. Although past studies have examined factors associated with these two behaviors collectively (i.e. “safe disposal”), there is a need to separately analyze these distinctive practices to better inform programming. This study aims to quantitatively examine contextual and psychosocial factors influencing caregiver safe disposal and, separately, child latrine training. We surveyed 791 primary female caregivers, who reported on 906 children <5 years old, across 74 villages in rural Odisha, India. At their last defecation event, 38% of children used the latrine and another 10% had their feces safely disposed of into the latrine. Since caregiver safe disposal was rare, we instead assessed safe disposal intention. We used linear regression and multilevel mixed effects models to examine contextual and psychosocial factors. For contextual factors, we found caregivers had stronger safe disposal intention when they came from wealthier households and had greater informational support, but weaker intention when their latrine was near the household. Caregivers more intensely practiced latrine training with their child when they themselves used the latrine for defecation, the latrine was fully intact, and they had greater instrumental support. For psychosocial factors, caregivers had stronger safe disposal intention when their households expected them to practice safe disposal, they felt strongly committed to the behavior, and had a plan for what to do when faced with a water shortage. Caregivers more intensely taught their child how to use the latrine when they believed their child was at risk of becoming sick if they practiced open defecation (OD); viewed child OD as unbeneficial; liked teaching their child; personally felt it was important for the child’s father to help; felt confident in their ability to teach their child; and had greater action control over their training practice. Interestingly, caregivers put less effort into latrine training when they felt more concerned for their child’s safety when the child defecated outside. These findings underscore the critical need to separately assess unique child feces management (CFM) practices and also provide a road map for practitioners on the types of behavior change strategies to consider in their CFM programming.

Decomposing rural-urban gap in unsafe disposal practice of child stool in India using nationwide sample survey data

“…Subsequently, the existing studies scientifically predicted the significant predictors of unsafe disposal practices of child stool at the national context but overlooked to contextualize rural–urban variation in these predictors 4 , 5 . In addition, a considerable number of prior studies have delved into the predictors of unsafe child stool disposal practices at the rural level in India 23 – 25 . Nevertheless, these studies, being micro-level analyses, fall short in providing insights into the broader macro-level context 23 – 25 .…”

“…In addition, a considerable number of prior studies have delved into the predictors of unsafe child stool disposal practices at the rural level in India 23 – 25 . Nevertheless, these studies, being micro-level analyses, fall short in providing insights into the broader macro-level context 23 – 25 . Therefore, the present study findings will be helpful to the research community, academia, and public health interest groups to understand the rural–urban dichotomy in prevalence, predictors of unsafe disposal practices of child stool, and associated contributors in India from the perspective of selected study participants.…”

“…The first and foremost finding of this study reveals a significant rural–urban gap in the prevalence of unsafe disposal practices of child stool observed in India, aligning with consistent trends identified in prior research 4 , 5 . While earlier studies acknowledged this gap 4 , 5 , 23 – 25 , they inadequately explicated the key contributing factors to the rural–urban gap in unsafe child stool disposal practices. In contrast, the present study systematically identifies household wealth quintile, household sanitation facilities, water availability on household premises, and women's education as pivotal contributors to this specific rural–urban gap.…”

Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program

“…Both the CFIR and RANAS model have been applied in previous water, sanitation, and hygiene (WaSH) research to describe the factors that influence implementation [24][25][26] and behavior change [27][28][29][30][31][32]. These frameworks are specifically designed to examine these factors for public health interventions.…”

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

“…26 Hygienic or safe disposal of children's stools is influenced by individual and contextual variables and has been demonstrated in a handful of studies. [27][28][29][30] In most of these studies, the practices of safe disposal of children's stools were low. In a recent survey of 15 SSA countries, it was found that only 58.73% of childbearing women safely disposed of their children's stools which varied from 26.38% in Chad to 85.90% in Rwanda.…”