Background: According to the WHO/UNICEF Joint Monitoring Programme (JMP) for water supply and Sanitation definition, safe child feces disposal practices include: children defecation into a latrine, disposal of child stools in a latrine or burial. Inappropriate disposal of human feces including unsafe child feces disposal facilitates the transmission of pathogens. However, the factors associated with safe child feces disposal practices have not been yet well explored in Ethiopia. This study aimed to identify factors associated with safe child feces disposal practices in Ethiopia. Methods: This study analyzed data from Ethiopian Demographic and Health Survey (EDHS) 2011. The practice of child’s feces disposal was categorized into ‘safe’ and ‘unsafe’ based on the WHO/ UNICEF JMP for water supply & Sanitation definition. Binary and multivariable logistic regression models were employed to identify factors associated with safe child feces disposal practices. Result: The prevalence of safe child feces disposal was 33.68 % (95 % CI: 32.82-34.55). In the final multivariable logistic regression model, the practice of safe disposal of child feces was significantly associated with urban residency (AOR = 1.25, 95 % CI: 1.01-1.55) and having access to an improved latrine (AOR = 1.92, 95 % CI: 1.56-2.36). Households found in the poorer, middle, richer and richest wealth quintile had (AOR = 2.22, 95 % CI: 1.70-2.89), (AOR = 2.94, 95 % CI: 2.27-3.81), (AOR = 4.20, 95 % CI: 3.42-5.72) and (AOR = 8.06, 95 % CI: 5.91-10.99) times higher odds to practice safe child feces disposal respectively as compared households from poorest wealth quintile. Mothers/caregivers with primary, secondary and higher educational status had (AOR = 1.29, 95 % CI: 1.10-1.50), (AOR = 1. 64, 95 % CI: 1.12-2.41) and (AOR = 2.16, 95 % CI: 1.25-3.72) times higher odds to practice safe child feces disposal respectively than those mothers who had no education. Those mothers/caregivers whose child was 48-59 months old had (AOR = 2.21, 95 % CI: 1.82-2.68) times higher odds to practice safe child feces disposal as compared to mothers/caregivers who had a child with age less than 12 months old. The odds of safe child feces disposal among households who had one two and three under five years old children were (AOR = 3.11, 95 % CI: 1.87-5.19),(AOR = 2.55, 95 % CI: 1.53-4.24) and (AOR = 1.92, 95 % CI: 1.13-3.24) times higher respectively than households with four and more children of under five years old. Conclusion: Only one third of the mothers practiced safe child feces disposal in Ethiopia. Being an urban resident, having a higher wealth quintile, high levels of maternal education, older child age, having a lower number of under five years old children, and the presence of an improved latrine were factors associated with safe child feces disposal practices. Therefore interventions designed to improve safe child feces disposal practices should consider those factors identified. Further research is also needed to design intervention that will aim to improve safe child feces disposal.
This study was an in-depth secondary data analysis of a population-based cross-sectional survey of EDHS in 2011. EDHS was designed to provide population and health indicators at the national (urban and rural) and regional levels. The EDHS samples were drawn through two stages stratified clustered sampling from a total of 624 clusters (187 in urban areas and 437 in rural areas) in nine regional states in the country. Design effect was used to reduce the sampling error due to the use of a more complex and less statistically efficient design, such as multistage and cluster selection. Data from a total of 11, 654 respondents were collected and all respondents who responded for the outcome variable were included in the analysis for this study. The detailed methodology is found elsewhere [22]. Independent variables from EDHS data set such as mother/caregiver educational level, partner educational level, age of the mother, place of residence (urban or rural), age of child, number of under five years old children, marital status, religion, and wealth index were included. The wealth index was measured using principal component analysis. Variables included in the construction of the wealth index were ownership of selected household assets, size of agricultural land, quantity of livestock and materials used for house construction. Other factors such as exposure to mass media (radio, television and newspapers), environmental health (latrine availability, drinking water supply), child diarrhea morbidity in the past two week preceding the survey, and health service related factors (visited by health workers in the past one year, visit health institution in the past one year) were included. The outcome variable for this study was child feces disposal practices. Child feces disposal practices was assessed using WHO/UNICEF Joint Monitoring Program(JMP) for water supply and Sanitation definition by asking “The last time child passed stools (indexed for youngest under five years old child), what was done to dispose of the stools?” The list of disposal options include: did the child use the toilet or latrine, were the feces put/rinsed into the toilet or latrine, put/rinsed into a drain or ditch, thrown into garbage, buried and left in the open. Finally, child feces disposal practices were recoded into a binary outcome, “safe” (defecation into a latrine, disposal of stools in a latrine or buried) and “unsafe”(put/rinsed into a drain or ditch, thrown into garbage, and left in the open) based on WHO/UNICEF Joint Monitoring Program(JMP) for water supply & Sanitation definition [13]. Data were analyzed by using STATA version 12 (Stata Corp, College Station, Texas, United States). We used “svy” in STATA version 12 to weight the survey data to adjust for the cluster sampling design. These sample weights were also used in order to compensate for the unequal probability of selection between the strata that has been geographically defined as well as for non-responses. A detailed explanation of the weighting procedure with all specification can be found in 2011 EDHS report page 278–279 [22]. Weighted prevalence of safe child feces disposal practice with 95 % confidence interval was done based on background characteristics of respondents. Binary and multivariable logistic regressions models were employed to determine the factors associated with safe child feces disposal practices. A multi-collinearity test was done and variables with variance inflation factors (VIF) of greater than 10 were excluded from the multivariable analysis [23]. Those respondents with missing data were not included in the regression analysis. All variables with p-value <0.05 in binary logistic regression analysis were entered into the multivariable logistic regression model. Those variables with a p value < 0.05 in the final multivariable logistic regression model were considered as associated factors for safe child feces disposal. Both crude (COR) and adjusted odds ratios (AOR) were calculated with a 95 % confidence interval. The data were downloaded and used after the purpose of the analysis was communicated and approved by Measure DHS. The original DHS data were collected in conformity with international and national ethical guidelines. Ethical clearance was provided by the Ethiopian Public Health Institute (EPHI) former Ethiopian Health and Nutrition Research Institute (EHNRI) Review Board, the National Research Ethics Review Committee (NRERC) at the Ministry of Science and Technology, the Institutional Review Board of ICF International, and the CDC. Written consent was obtained from mothers/caregivers and data were recorded anonymously.
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