Child feces management practices and fecal contamination: A cross-sectional study in rural Odisha, India

• Authors: Valerie Bauza, Emory University; Fiona Majorin, London School of Hygiene & Tropical Medicine; Parimita Routray, Independent Consultant, Bhubaneswar, Odisha, India; Gloria D. Sclar, Emory University; Bethany Caruso, Emory University; Thomas CLASEN, Emory University
• Journal Title: The Science of the Total Environment
• Volume: Volume 709
• Publisher: Elsevier | 2020-03-20, Pages 136169-136169
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.scitotenv.2019.136169
• Subjects: Health Sciences, Hygiene; Health Sciences, Public Health; Environmental Sciences
• Keywords: Science & Technology; Life Sciences & Biomedicine; Environmental Sciences; Environmental Sciences & Ecology; Child feces; Fecal contamination; Sanitation; Hygiene; Open defecation; Sanitation program; Hygiene behaviors; Young children; Disposal; Diarrhea; Impact; Exposure; Interventions; Growth; Kenya

Abstract

Safe child feces management (CFM) is likely critical for reducing exposure to fecal pathogens in and around the home, but the effectiveness of different CFM practices in reducing fecal contamination is not well understood. We conducted a cross-sectional study of households with children <6 years in rural Odisha, India, using household surveys (188 households), environmental sample analysis (373 samples for 80 child defecation events), and unstructured observation (33 households) to characterize practices and measure fecal contamination resulting from CFM-related practices, including defecation, feces handling and disposal, defecation area or tool cleaning, anal cleansing, and handwashing. For environmental sampling, we developed a sampling strategy that involved collecting samples at the time and place of child defecation to capture activity-level fecal contamination for CFM practices. Defecating on the floor or ground, which was practiced by 63.7% of children <6 years, was found to increase E. coli contamination on finished floors (p < 0.001) or earthen ground surfaces (p = 0.008) after feces were removed, even if paper was laid down prior to defecation. Use of unsafe tools (e.g., paper, plastic bag, straw/hay) to pick up child feces increased E. coli contamination on caregiver hands after feces handling (p < 0.0001), whereas the use of safe tools (e.g., potty, hoe, scoop) did not increase hand contamination. Points of contamination from cleaning CFM hardware and anal cleansing were also identified. The most common disposal location for feces of children <6 years was to throw feces into an open field (41.6%), with only 32.3% disposed in a latrine. Several households owned scoops or potties, but use was low and we identified shortcomings of these CFM tools and proposed alternative interventions that may be more effective. Overall, our results demonstrate the need for CFM interventions that move beyond focusing solely on feces disposal to address CFM as a holistic set of practices.