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Child feces disposal practices in humanitarian and non-humanitarian settings across 34 low- and middle-income
Rachel Beardsley1, Sarah Lebu2, Carmen Anthonj3
1Department of Health Behavior, University of North Carolina at Chapel Hill, USA.
Insights
Safe disposal of child feces remains a global challenge, with over half of households in non-humanitarian settings and over a third in humanitarian settings practicing unsafe methods. Key factors for safe child feces disposal include wealth, education, and access to sanitation.
Area of Science:
- Public Health
- Environmental Health
- Global Health
Background:
- Unsafe child feces disposal (CFD) poses significant infectious disease risks, particularly in low- and middle-income countries and humanitarian settings.
- Understanding the drivers of CFD practices is crucial for developing effective interventions.
Purpose of the Study:
- To investigate child feces disposal (CFD) practices and associated factors in low- and middle-income countries, including humanitarian contexts.
- To analyze trends in safe CFD over time and space.
Main Methods:
- Utilized data from 352,173 women across 34 countries (2012-2021) from Demographic and Health Surveys (DHS).
- Employed multivariate logistic regression, time series analysis, and spatial autocorrelation analysis, incorporating UNHCR refugee camp data.
- Assessed CFD practices for children under two years old.
Main Results:
- Minimal improvement in safe CFD observed over the decade; 55.6% improper disposal in non-humanitarian and 38.1% in humanitarian settings.
- Improper CFD correlated with increased diarrhea odds in non-humanitarian settings (OR 1.09).
- Safe CFD associated with higher wealth quintiles, basic education, children eating solids, improved sanitation, and radio access.
Conclusions:
- Safe child feces disposal requires targeted interventions, especially in humanitarian settings.
- Policies and programs must prioritize household sanitation investments and caregiver education on safe CFD.
- Addressing socioeconomic and educational disparities is key to improving CFD practices.
Abstract:
Globally, safe sanitation has improved significantly in the last two decades, but unsafe child feces disposal remains a growing challenge in many regions, exposing household members and communities to infectious pathogens. The drivers associated with child feces disposal in several contexts including humanitarian settings are not well understood. This study investigated child feces disposal (CFD) practices and associated factors in low- and middle-income countries, including in humanitarian settings. Data from 352,173 women in 34 countries, collected between 2012 and 2021 through Demographic and Health Surveys (DHS), were used. We utilized multivariate logistic regression to assess CFD practices among children under two years old and the factors linked to these practices. We incorporated data from the United Nations High Commissioner for Refugees (UNHCR) regarding refugee camps' locations in the analysis. Time series and local spatial autocorrelation analyses were run to examine changes in safe CFD practices over time and space, respectively. Results showed minimal improvement in safe child feces disposal over the past decade, with 55.6 % of respondents in non-humanitarian settings and 38.1 % in humanitarian settings improperly disposing of feces. Improper CFD significantly correlated with increased odds of diarrhea in non-humanitarian settings (OR 1.09 95 % CI: 1.05-1.13) but not in humanitarian settings (OR 1.14 95 % CI: 0.53-2.49). The most significant factors (p < 0.05) associated with safe CFD included being in the richest wealth quintile (OR 3.27 95 % CI: 3.06-3.49), having basic education (OR 1.28 95 % CI: 1.22-1.33), children eating solid food (OR 1.53 95 % CI: 1.48-1.57), improved sanitation access (OR 1.88 95 % CI: 1.81-1.96), and listening to radio at least weekly (OR 1.40 95 % CI: 135-1.46). Policymakers and development partners must include safe CFD guidelines in national policies and programs, as well as prioritize investments in household-level sanitation and educate caregivers about safe CFD practices.
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