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

Abstract

Abstractobjectives To review and synthesise the available evidence on the effectiveness of interventions targeting unsafe child faeces disposal in reducing this behaviour and improving child health in lowand middle-income countries.methods PubMed and EMBASE were systematically searched. Studies meeting the inclusion criteria were reviewed and key information on study methodologies and outcomes were extracted.results A total of 1048 articles were screened, and eight studies representing five countries were included for the review. Three were randomised controlled trials, and five were prospective cohort studies. There was wide variability across studies in the definition of 'safe disposal' of child faeces. Six studies reported the change in child faeces disposal practices associated with safe child faeces disposal interventions. However, only one study found a significant improvement in this behaviour. Two of the six studies that evaluated the health impact of delivered interventions found significant reductions in childhood diarrhoea associated with safe faeces disposal practices, and one study reported a positive effect on child growth and ascariasis. Only one study was identified that delivered a single intervention solely focused on safe child faeces disposal. Unfortunately, this study did not investigate the impact of this intervention on child health.conclusions There are major methodological limitations in studies that assessed the impact of safe child faeces disposal interventions. The health impact of these interventions is inconclusive because the quality of the current evidence is poor. Randomised controlled trials are urgently needed to assess the impact of safe faeces disposal interventions on child health.

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

“…Even among households with improved sanitation, unsafe child feces disposal behavior was frequently reported [18,25,26]. So far, efforts to combat open defecation (OD) have mainly targeted adults, with only a limited focus on the management of child feces in lowand middle-income countries (LMIC) and how children's feces are being disposed of, in general, has remained a neglected area of research, policy, and program intervention [2,3,6,15,[27][28][29][30][31][32][33]. Still, in many settings, toilets are not designed for or used by children, and young children tend to defecate in environments around the house where susceptible children could be exposed to fecal pathogens [27,34].…”

“…Further, there is a widespread wrong perception and cultural beliefs towards child feces management in many communities [2,35]. It is therefore very important to implement educational interventions to enhance the behavior of the children's mothers/caregivers towards child feces disposal practice in many societies since they are responsible for disposing of their children's feces and shaping the child's toilet training [15,30,32,35].…”

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

“…A study in Bangladesh found that disposal of child feces into improved latrines was associated with a decreased risk of helminthiasis by 35% in children <2 years [ 19 ]. However, a recent meta-analysis found an association between unsafe child feces disposal and child diarrhea in only two out of five studies reviewed [ 20 ].…”

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

“…Another recent systematic review also found a lack of evidence on the effectiveness of interventions to improve child feces disposal. 23 Recent evidence from a cohort study in rural Bangladesh found that children from households that disposed of their children’s feces unsafely had higher scores of enteropathy, a disorder of the small intestine which is thought to lead to undernutrition and growth faltering, and greater odds of being wasted. 24 The same study found that households that practiced unsafe child feces disposal had more than five times greater odds of having pathogenic Escherichia coli in the soil of the areas where study children played compared with households that practiced safe child feces disposal, supporting the hypothesis that unsafe child feces disposal may increase the risk of exposure to enteric pathogens.…”