Yeager B A, Huttly S R, Bartolini R, Rojas M, Lanata C F
Instituto de Investigación Nutricional, Lima, Peru.
Soc Sci Med. 1999 Aug;49(4):531-41. doi: 10.1016/s0277-9536(99)00119-7.
Little is known about feces disposal practices, their determinants and feasibility for change, despite their importance in the control of diarrheal diseases. We report here the results of formative research for the development of an intervention to promote sanitary disposal of feces of young children. The study was conducted in a densely populated shanty town area of Lima, where water and sanitation systems are scarce. In-depth interviews were undertaken with mothers, husbands and community leaders. Group discussions were held with mothers in order to validate findings from the interviews, investigate particular topics further and explore reactions to possible intervention strategies. The principal defecation sites for young children were diapers, potties, the ground in or near the home, the hill, latrines and flush toilets. The main determinants found were the age of the child, the effort required by the method, perceptions of dirtiness and the availability of resources. Almost all children under one year of age use diapers but the high resource cost of diaper washing is a strong motivation for mothers to move their children on as early as possible. Potties were considered the most socially acceptable and 'hygienic' defecation method for children between one and three years of age. Nevertheless, defecation directly onto the ground is common at this age. Potty training is deemed to be quite difficult and the long term achievements are determined by the initial training success. In most cases, the training process is authoritative and inconsistent. The use of latrines and flush toilets is not considered appropriate for children until they are three to four years old. Based on these initial findings, a micro-trial was conducted to assess the feasibility and acceptability of promoting greater use of potties and associated practices. The results of the trial were very encouraging and provided valuable information for the design of a community-wide intervention. Our findings help explain why the emphasis given in most sanitation projects, where efforts have been concentrated on the promotion of latrines, has failed to induce their utilization by small children. Sanitation projects should incorporate interventions that will promote hygienic defecation and stool clearance practices for infants and small children.
尽管粪便处理方式及其决定因素和改变的可行性在控制腹泻疾病方面具有重要意义，但人们对此了解甚少。我们在此报告一项形成性研究的结果，该研究旨在开发一项促进幼儿粪便卫生处理的干预措施。该研究在利马一个人口密集的棚户区进行，那里的水和卫生系统匮乏。我们对母亲、丈夫和社区领袖进行了深入访谈。与母亲们进行了小组讨论，以验证访谈结果、进一步调查特定主题并探讨对可能的干预策略的反应。幼儿的主要排便地点是尿布、便盆、家中或家附近的地面、山坡、旱厕和冲水马桶。发现的主要决定因素包括孩子的年龄、方法所需的努力、对脏污的认知以及资源的可用性。几乎所有一岁以下的儿童都使用尿布，但洗尿布的高资源成本促使母亲们尽早让孩子改用其他方式。对于一到三岁的儿童，便盆被认为是社会上最可接受且“卫生”的排便方式。然而，这个年龄段直接在地上排便的情况很常见。便盆训练被认为相当困难，长期效果取决于初始训练的成功与否。在大多数情况下，训练过程具有权威性且不一致。直到孩子三到四岁，使用旱厕和冲水马桶才被认为是合适的。基于这些初步发现，我们进行了一项微型试验，以评估推广更多使用便盆及相关做法的可行性和可接受性。试验结果非常令人鼓舞，并为设计一项全社区范围的干预措施提供了有价值的信息。我们的研究结果有助于解释为什么大多数卫生项目将重点集中在推广旱厕上，但却未能促使幼儿使用这些设施。卫生项目应纳入促进婴儿和幼儿卫生排便及粪便清理做法的干预措施。
