Identifying Potential Sources of Exposure Along the Child Feces Management Pathway: A Cross-Sectional Study Among Urban Slums in Odisha, India

Abstract

Abstract.Child feces represent a particular health risk to children due to increased prevalence of enteric agents and a higher risk of exposure owing to exploratory behaviors of young children. The safe management of such feces presents a significant challenge, not only for the 2.4 billion who lack access to improved sanitation, but also due to unhygienic feces collection and disposal and poor subsequent handwashing practices. We assessed potential sources of fecal exposure by documenting child feces management practices in a cross-sectional study of 851 children < 5 years of age from 694 households in 42 slums in two cities in Odisha, India. No preambulatory children and only 27.4% of ambulatory children defecated directly in the latrine. Children that did not defecate in a latrine mainly defecated on the ground, whether they were preambulatory or ambulatory. Use of diapers (1.2%) or potties (2.8%) was low. If the feces were removed from the ground, the defecation area was usually cleaned, if at all, only with water. Most children’s feces were disposed of in surrounding environment, with only 6.5% deposited into any kind of latrine, including unimproved. Handwashing with soap of the caregiver after child feces disposal and child anal cleaning with soap after defecation was also uncommon. While proper disposal of child feces in an improved latrine still represents a major challenge, control of the risks presented requires attention to the full range of exposures associated to the management of child feces, and not simply the place of disposal.

Unsafe child feces disposal status in Ethiopia: what factors matter? Analysis of pooled data from four demographic and health surveys

“…Despite the evidence to the contrary, the feces of children are less likely to be safely disposed of in a toilet than those of the general population, and poor disposal of children's feces is drowning the open defecation free (ODF) progress throughout the globe [1][2][3][17][18][19][20][21]. According to the United Nations Child Fund (UNICEF) and the World Bank Global Water Practice's (WSP), over 50% of households with children under age three reported that the feces of their children were unsafely disposed of [3,22].…”

Unsafe child feces disposal status in Ethiopia: what factors matter? analysis of pooled data from four demographic and health surveys

“…Despite the evidence to the contrary, the feces of children are less likely to be safely disposed of in a toilet than those of the general population, and poor disposal of children feces is drowning the open defecation free (ODF) progress throughout the globe [1,3,[17][18][19][20][21][22][23]. According to the United Nations Child Fund (UNICEF) and the World Bank Global Water Practice's (WSP), over 50 percent of households with children under age three reported that the feces of their children were unsafely disposed of [3,24].…”

Child Defecation and Feces Disposal Practices and Determinants among Households after a Combined Household-Level Piped Water and Sanitation Intervention in Rural Odisha, India

“…1 In addition, many households with access to sanitation facilities do not dispose of their young children’s feces in the latrine. 2–4 Poor child feces management (CFM) presents a particular health risk because young children often have the highest incidence of enteric infections 5 and poorly developed immune systems, so their feces likely contain higher quantities of transmissible pathogens. 6 Young children also tend to defecate in areas closer to households, where susceptible children could be exposed, 7 because young children spend large amounts of time on the ground and commonly engage in exploratory behaviors that include putting fingers, fomites, and soil in their mouths.…”

“…16–18 There is also evidence that children’s feces are not commonly disposed of in a latrine, with previous studies in Odisha, India, finding that only about a quarter of households with latrines safely disposed of children’s feces into the latrine in rural study areas 19 and in urban slum study areas. 4…”

“…To safely manage child feces, all potential points of exposure to pathogens from child feces must be eliminated, including exposure at the sites of defecation, anal cleansing, and feces disposal, as well as the proper cleaning of tools used to assist with defecation or feces disposal, and proper handwashing with soap after feces handling. 4 However, although recent guidelines on sanitation and health released by the World Health Organization (WHO) note the importance of child defecation, feces disposal, and wash water disposal locations, 20 current international monitoring focuses solely on the disposal site of child feces. Specifically, the WHO/United Nations International Children’s Emergency Fund (UNICEF) Joint Monitoring Program (JMP) on Water, Sanitation, and Hygiene (WASH) defines “safe” child feces disposal as a child using a toilet facility or the child’s feces being put into a toilet/latrine (regardless of the type of toilet/latrine) or buried.…”