Disposal of child faeces: practices, determinants and health effects.

An estimated 2.4 billion people worldwide lack access to improved sanitation. This includes nearly 1 billion people practicing open defecation, of which around 60% reside in India. Even among households with access to improved sanitation, children’s faeces—a potentially important source of disease transmission—are not always disposed of safely (disposal of faeces or defecation into latrine). In India only 20% of child faeces were reportedly disposed of safely in the latest National Family Health Survey (2006). This research has two overall aims. The first is to summarize existing knowledge of the health impact of safely disposing child faeces. The second is to advance our understanding of the scope and possible reasons for unsafe disposal of child faeces among a population in Eastern India. To achieve these aims a systematic review and cross-sectional study were conducted. The systematic review summarized the evidence on the effectiveness of interventions to improve child faeces disposal for preventing diarrhoea and soiltransmitted helminth (STH) infections from 46 studies. The evidence suggested that safe child faeces disposal may reduce diarrhoea. However, the evidence was limited and of low quality. Only 2 studies measured effects on STH, neither found a protective effect. Findings from the cross-sectional study in slums in Odisha, India, were divided into two papers. The first described child faeces management practices and identified potential sources of faecal exposure, highlighting the importance of considering other steps of child faeces management rather than just the place of disposal. The second paper investigated factors associated with being a safe disposal household, where the faeces of all children <5 ended up in a latrine. Significant risk factors were: education and religion of the primary caregiver, number and mobility of children <5 in the household, wealth, type and location of latrine, and defecation behaviours of household members >5.