Aluko Olufemi Oludare, Afolabi Olusegun Temitope, Olaoye Emmanuel Abiodun, Adebayo Adeyinka Daniel, Oyetola Seun Oladele, Abegunde Oluwaseun Olamide
Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
BMC Public Health. 2017 Feb 8;17(1):178. doi: 10.1186/s12889-017-4078-1.
Safe management of faeces (SMoF) and environmental contamination by faecal pathogens have been extensively researched although the SMoF in under-five children has been perennially neglected perhaps due to the misconception that it is harmless. This research, therefore, studied the situation, to determine the magnitude and dimensions of the problem aimed at making policy level stakeholders aware of child faeces management systems and so, inform evidence-based implementation of child and health-related programmes in Nigeria.
The study utilized an exploratory cross-sectional design and a multi-stage sampling technique to identify 300 respondents from 12 randomly selected streets from 4 wards in Ife central local government area. The study collected data with a pretested questionnaire which included direct observations of child defecation practices and existing toilet facilities. Cleaned data were analyzed by IBM-SPSS version 20 with child faeces management outcomes as the dependent variable.
The mean age of respondents' and monthly income (mode) were 30.8 ± 7.5 years and ₦10,000.00 ($28.60). Most respondents were mothers to the under five children (84.7%), had a secondary education (72.0%) and were semi-skilled (57.0%). The caregivers had access to improved water sources (93.7%), improved toilets (64.3%), with 64% and 53.7% having above average scores in knowledge and attitudes, respectively. In the study, 19.7% and 69.0% of caregivers practiced safe disposal of faeces passed by the under five child during the day and at night respectively, though most caregivers (94.3%) omitted steps in the safe management of child faeces chain. The under five diarrhoea prevalence rate was 13.7% and unsanitary passage of child faeces is associated with four folds likelihood of having diarrhoea (p = 0.001). The caregivers whose under five children practiced safe sanitation were rich (p = 0.009) and knowledge was significantly associated with ownership of household toilet (P = 0.037), night faeces management chain practice (P < 0.001) and disposal of anal cleaning materials (P = 0.002). Handwashing was significantly associated with household toilet (P < 0.001), wealth (P < 0.001), under five child defecation preferences during the day (P < 0.001) and at night (P = 0.008).
The high knowledge and positive attitudes exhibited by the caregivers were at variance with practice. Where under five children defecate during the day were influenced by the disposal of their anal cleaning materials, distance to the toilet and caregivers' education. The findings highlight the dangers of unsanitary disposal of child faeces and the need to strengthen the related policies that can increase caregivers awareness and practice at all levels and in all livelihood domains.
粪便的安全管理（SMoF）以及粪便病原体对环境污染的问题已得到广泛研究，尽管五岁以下儿童的粪便安全管理长期以来一直被忽视，这可能是因为人们误以为这并无危害。因此，本研究对该情况进行了调查，以确定问题的严重程度和范围，旨在让政策层面的利益相关者了解儿童粪便管理系统，从而为尼日利亚儿童及健康相关项目的循证实施提供参考依据。
本研究采用探索性横断面设计和多阶段抽样技术，从伊费中央地方政府辖区4个行政区的12条随机选取的街道中确定300名受访者。研究通过一份经过预测试的问卷收集数据，该问卷包括对儿童排便习惯和现有厕所设施的直接观察。清理后的数据由IBM-SPSS 20版软件进行分析，以儿童粪便管理结果作为因变量。
受访者的平均年龄为30.8±7.5岁，月收入（众数）为10,000.00奈拉（28.60美元）。大多数受访者是五岁以下儿童的母亲（84.7%），接受过中等教育（72.0%），且为半熟练劳动力（57.0%）。照料者能够使用改良水源（93.7%）、改良厕所（64.3%），在知识和态度方面得分高于平均水平的分别占64%和53.7%。在该研究中，分别有19.7%和69.0%的照料者在白天和夜间对五岁以下儿童排出的粪便进行安全处理，不过大多数照料者（94.3%）在儿童粪便安全管理环节中省略了一些步骤。五岁以下儿童腹泻患病率为13.7%，儿童粪便不卫生排放导致腹泻的可能性增加四倍（p = 0.001）。其五岁以下儿童实行安全卫生措施的照料者较为富裕（p = 0.009），知识水平与家庭厕所拥有情况（P = 0.037）、夜间粪便管理环节实践（P < 0.001）以及肛门清洁用品处理方式（P = 0.002）显著相关。洗手行为与家庭厕所（P < 0.001）、财富状况（P < 0.001）、五岁以下儿童白天（P < 0.001）和夜间（P = 0.008）的排便偏好显著相关。
照料者表现出的高知识水平和积极态度与实际行为不一致。五岁以下儿童白天排便地点受肛门清洁用品处理方式、与厕所距离以及照料者教育程度的影响。研究结果凸显了儿童粪便不卫生处理的危险性，以及加强相关政策以提高各层面和各生活领域照料者意识与实践的必要性。
