Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
Sci Total Environ. 2020 Mar 20;709:136169. doi: 10.1016/j.scitotenv.2019.136169. Epub 2019 Dec 18.
Safe child feces management (CFM) is likely critical for reducing exposure to fecal pathogens in and around the home, but the effectiveness of different CFM practices in reducing fecal contamination is not well understood. We conducted a cross-sectional study of households with children <6 years in rural Odisha, India, using household surveys (188 households), environmental sample analysis (373 samples for 80 child defecation events), and unstructured observation (33 households) to characterize practices and measure fecal contamination resulting from CFM-related practices, including defecation, feces handling and disposal, defecation area or tool cleaning, anal cleansing, and handwashing. For environmental sampling, we developed a sampling strategy that involved collecting samples at the time and place of child defecation to capture activity-level fecal contamination for CFM practices. Defecating on the floor or ground, which was practiced by 63.7% of children <6 years, was found to increase E. coli contamination on finished floors (p < 0.001) or earthen ground surfaces (p = 0.008) after feces were removed, even if paper was laid down prior to defecation. Use of unsafe tools (e.g., paper, plastic bag, straw/hay) to pick up child feces increased E. coli contamination on caregiver hands after feces handling (p < 0.0001), whereas the use of safe tools (e.g., potty, hoe, scoop) did not increase hand contamination. Points of contamination from cleaning CFM hardware and anal cleansing were also identified. The most common disposal location for feces of children <6 years was to throw feces into an open field (41.6%), with only 32.3% disposed in a latrine. Several households owned scoops or potties, but use was low and we identified shortcomings of these CFM tools and proposed alternative interventions that may be more effective. Overall, our results demonstrate the need for CFM interventions that move beyond focusing solely on feces disposal to address CFM as a holistic set of practices.
安全的儿童粪便管理（CFM）对于减少家庭内外粪便病原体的暴露可能至关重要，但不同 CFM 实践在减少粪便污染方面的有效性尚不清楚。我们在印度奥里萨邦的农村地区对 6 岁以下儿童的家庭进行了一项横断面研究，使用家庭调查（188 户家庭）、环境样本分析（80 次儿童排便事件的 373 个样本）和非结构化观察（33 户家庭）来描述做法，并衡量与 CFM 相关做法导致的粪便污染，包括排便、粪便处理和处置、排便区或工具清洁、肛门清洁和洗手。对于环境采样，我们制定了一项采样策略，包括在儿童排便的时间和地点收集样本，以捕获与 CFM 实践相关的活动水平粪便污染。在地板或地面上排便，这是 63.7%的 6 岁以下儿童的做法，结果发现，即使在排便前铺上了纸，粪便清除后，在完成的地板（p < 0.001）或泥土地面（p = 0.008）上，会增加大肠杆菌的污染。使用不安全的工具（例如纸、塑料袋、吸管/干草）来捡拾儿童粪便，会增加粪便处理后手的大肠杆菌污染（p < 0.0001），而使用安全的工具（例如便盆、锄头、勺子）则不会增加手部污染。还确定了清洁 CFM 硬件和肛门清洁的污染点。6 岁以下儿童粪便的最常见处置地点是将粪便扔进开阔地（41.6%），只有 32.3%的粪便被扔进厕所。一些家庭拥有勺子或便盆，但使用率较低，我们发现这些 CFM 工具存在缺陷，并提出了可能更有效的替代干预措施。总的来说，我们的研究结果表明，需要采取 CFM 干预措施，不仅要关注粪便处置，还要将 CFM 作为一套整体实践来解决。
