Factors associated with safe child feces disposal practices in Ethiopia: Evidence from demographic and health survey

Archives of Public Health, Volume 73, No. 1, Year 2015

Interpretação

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.

AI Digest

Study Justification:

This study aimed to explore the factors associated with safe child feces disposal practices in Ethiopia. Safe disposal of child feces is important for preventing the transmission of pathogens. However, there is limited research on this topic in Ethiopia. Understanding the factors that influence safe child feces disposal can inform interventions and policies to improve hygiene practices and reduce the risk of disease transmission.

Highlights:

– The prevalence of safe child feces disposal in Ethiopia was found to be 33.68%.
– Factors associated with safe child feces disposal included urban residency, access to an improved latrine, higher wealth quintile, higher maternal education, older child age, and fewer under five years old children in the household.
– Interventions to improve safe child feces disposal should consider these factors identified in the study.

Recommendations:

Based on the findings of this study, the following recommendations can be made:

1. Increase access to improved latrines in both urban and rural areas.
2. Implement hygiene education programs that target households in lower wealth quintiles and with lower levels of maternal education.
3. Focus on households with younger children and those with a higher number of under five years old children, as they may have lower rates of safe child feces disposal.
4. Conduct further research to design interventions that specifically address the barriers to safe child feces disposal in Ethiopia.

Key Role Players:

1. Ministry of Health: Responsible for developing and implementing policies and programs related to sanitation and hygiene.
2. Non-governmental organizations (NGOs): Involved in implementing hygiene education programs and providing support for improving sanitation facilities.
3. Community health workers: Play a crucial role in disseminating information and educating households about safe child feces disposal practices.
4. Local government authorities: Responsible for ensuring access to improved latrines and promoting hygiene practices in their respective areas.

Cost Items for Planning Recommendations:

1. Construction and maintenance of improved latrines: Includes materials, labor, and ongoing maintenance costs.
2. Hygiene education programs: Costs associated with developing educational materials, training facilitators, and conducting awareness campaigns.
3. Capacity building for community health workers: Training programs and ongoing support for community health workers to effectively promote safe child feces disposal.
4. Monitoring and evaluation: Costs for data collection, analysis, and reporting to assess the impact of interventions and make necessary adjustments.
Please note that the cost estimates provided are not actual costs but represent budget items that need to be considered when planning interventions and policies related to safe child feces disposal in Ethiopia.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a secondary data analysis of a population-based cross-sectional survey, which provides a moderate level of evidence. The study used a large sample size and employed binary and multivariable logistic regression models to identify factors associated with safe child feces disposal practices. However, the study design is cross-sectional, which limits the ability to establish causality. To improve the strength of the evidence, future research could consider using a longitudinal design to examine the temporal relationship between the identified factors and safe child feces disposal practices.

Resumo

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.

Materiais

N/A

Inovações

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Education and awareness campaigns: Implementing targeted education and awareness campaigns to educate mothers and caregivers about the importance of safe child feces disposal practices. This could include providing information on the health risks associated with improper disposal and promoting the use of latrines or proper burial.

2. Infrastructure improvement: Investing in the construction and maintenance of improved latrines in both urban and rural areas. This could involve providing financial support or subsidies to households to facilitate the installation of latrines, especially in poorer communities.

3. Behavior change interventions: Developing behavior change interventions that focus on promoting safe child feces disposal practices. This could involve using community health workers or peer educators to provide information, demonstrations, and support to mothers and caregivers.

4. Access to sanitation facilities: Improving access to sanitation facilities, particularly in rural areas, by increasing the number of latrines available and ensuring their proper functioning. This could involve working with local governments and organizations to prioritize sanitation infrastructure development.

5. Targeted interventions for vulnerable populations: Designing interventions that specifically target vulnerable populations, such as those in poorer wealth quintiles or with lower levels of education. This could involve providing additional support, resources, or incentives to encourage safe child feces disposal practices.

6. Integration with existing health services: Integrating safe child feces disposal practices into existing maternal and child health services. This could involve training healthcare providers to include discussions on safe disposal during antenatal and postnatal care visits, as well as providing educational materials and resources to mothers and caregivers.

It is important to note that these recommendations are based on the specific context of the study in Ethiopia. When implementing innovations to improve access to maternal health, it is crucial to consider the local context, cultural norms, and resources available in each setting.

AI Innovations Description

Based on the study titled “Factors associated with safe child feces disposal practices in Ethiopia: Evidence from demographic and health survey,” the following recommendations can be developed into an innovation to improve access to maternal health:

1. Education and Awareness Campaigns: Develop and implement targeted education and awareness campaigns to educate mothers and caregivers about the importance of safe child feces disposal practices. These campaigns should emphasize the health risks associated with improper disposal and provide information on proper disposal methods.

2. Community Engagement: Engage local communities, including community leaders, health workers, and volunteers, to promote safe child feces disposal practices. This can be done through community meetings, workshops, and door-to-door outreach programs.

3. Infrastructure Improvement: Improve access to improved latrines in both urban and rural areas. This can be achieved through government initiatives, partnerships with NGOs, and community-led sanitation projects. Providing access to improved latrines will encourage safe disposal practices.

4. Financial Support: Provide financial support or incentives to households in poorer wealth quintiles to improve their access to improved latrines. This can help overcome financial barriers and ensure that all households have access to safe disposal facilities.

5. Maternal Education: Promote maternal education by providing opportunities for mothers and caregivers to improve their educational status. This can be done through adult education programs, vocational training, and scholarships. Educated mothers are more likely to adopt safe child feces disposal practices.

6. Monitoring and Evaluation: Establish a monitoring and evaluation system to track the progress of safe child feces disposal practices. This will help identify areas that need improvement and measure the effectiveness of interventions.

By implementing these recommendations, access to maternal health can be improved by reducing the transmission of pathogens through safe child feces disposal practices.

AI Innovations Methodology

Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement educational programs and campaigns to raise awareness about safe child feces disposal practices among mothers, caregivers, and communities. This can include providing information on the health risks associated with improper disposal and promoting the use of latrines or proper burial methods.

2. Improve access to improved latrines: Increase the availability and accessibility of improved latrines in both urban and rural areas. This can be achieved through infrastructure development initiatives and collaborations with local communities, government agencies, and non-governmental organizations.

3. Address socioeconomic disparities: Develop interventions that target households in lower wealth quintiles to improve their access to safe child feces disposal practices. This can include providing financial support or incentives to upgrade sanitation facilities and promoting behavior change through community engagement.

4. Enhance maternal education: Implement programs that focus on improving maternal education levels, particularly in rural areas. This can be done through adult literacy programs, vocational training, and community-based education initiatives.

5. Strengthen health service delivery: Integrate safe child feces disposal practices into existing maternal health programs and services. This can include training healthcare providers on the importance of safe disposal and incorporating it into antenatal and postnatal care consultations.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify specific indicators that can measure the impact of the recommendations, such as the percentage increase in safe child feces disposal practices, the number of improved latrines constructed, or the increase in maternal education levels.

2. Collect baseline data: Gather baseline data on the current status of safe child feces disposal practices, access to improved latrines, maternal education levels, and other relevant factors. This can be done through surveys, interviews, or existing data sources.

3. Develop a simulation model: Create a simulation model that incorporates the identified indicators and factors. This model should be able to simulate the potential impact of the recommendations over a specific time period.

4. Input data and parameters: Input the baseline data and set the parameters for the simulation model. This can include the expected increase in access to improved latrines, the percentage increase in maternal education levels, and the targeted population.

5. Run the simulation: Run the simulation model to generate projections of the potential impact of the recommendations on improving access to maternal health. This can include estimating the increase in safe child feces disposal practices, the number of improved latrines constructed, or the improvement in maternal education levels.

6. Analyze the results: Analyze the results of the simulation to assess the potential impact of the recommendations. This can include comparing the projected outcomes with the baseline data and identifying any trends or patterns.

7. Refine and adjust: Based on the analysis of the simulation results, refine and adjust the recommendations as needed. This can include modifying the parameters of the simulation model or revising the strategies and interventions proposed.

8. Monitor and evaluate: Continuously monitor and evaluate the implementation of the recommendations to assess their effectiveness and make further adjustments if necessary. This can include collecting data on the actual outcomes and comparing them with the projected results from the simulation model.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of the recommendations on improving access to maternal health and make informed decisions on resource allocation and program implementation.

Autores & Coautores

Statistics:

Citations: 44

Authors: 2

Identifiers:

DOI: 10.1186/s13690-015-0090-z

ISSN: 07787367

Research Areas:

Community Interventions, Disparities, Environmental, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Technology and Innovations

Study Countries:

Ethiopia

Study Design:

Cross Sectional Study, randomised-control-trial

Study Approach:

Mixed-methods, Qualitative, Quantitative

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