Child feces disposal practices in humanitarian and non-humanitarian settings across 34 low- and middle-income countries.

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.

Factors associated with safe child feces disposal in Ethiopia, India, and Zambia.

Safe child feces disposal (CFD) is defined as a child or caregiver placing or rinsing child feces into an improved sanitation facility. In low- and middle-income countries (LMICs), 48% of households with children under five report that child feces were safely disposed. Despite its widespread prevalence and harmful health effects, little is known about the determinants of safe CFD. We analyzed determinants of CFD across three countries that differently address safe CFD in their policies. We used data from a cross-sectional survey of 3737 households in rural areas of Ethiopia, India, and Zambia. Multivariable logistic regression models were used to identify factors associated with safe child feces disposal (CFD) in these countries. Safe CFD was positively associated with whether a female head of household attended primary school in Zambia and India, whether someone spoke to households about cleanliness in Ethiopia, and whether a community had a WaSH committee that met in the past year in Ethiopia. In all three countries, households with a member who practiced open defecation were significantly less likely to practice safe CFD. Increasing the education level of female head of households, reducing open defecation, speaking to a household, and having an active WaSH committee are important programmatic considerations for actors who seek to address CFD in low resource settings. Unsafe CFD is a substantial challenge to transformative WaSH, and more studies should be conducted to evaluate the causes, determinants, and behaviors of CFD.