Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
PLoS One. 2021 Aug 2;16(8):e0254774. doi: 10.1371/journal.pone.0254774. eCollection 2021.
Over the years, sanitation programs over the world have focused more on household sanitation, with limited attention towards the disposal of children's stools. This lack of attention could be due to the misconception that children's stools are harmless. The current study examined the individual and contextual predictors of safe disposal of children's faeces among women in sub-Saharan Africa (SSA).
The study used secondary data involving 128,096 mother-child pairs of under-five children from the current Demographic and Health Surveys (DHS) in 15 sub-Saharan African countries from 2015 to 2018. Multilevel logistic analysis was used to assess the individual and contextual factors associated with the practice of safe disposal of children's faeces. We presented the results as adjusted odds ratios (aOR) at a statistical significance of p< 0.05.
The results show that 58.73% (57.79-59.68) of childbearing women in the 15 countries in SSA included in our study safely disposed off their children's stools. This varied from as high as 85.90% (84.57-87.14) in Rwanda to as low as 26.38% (24.01-28.91) in Chad. At the individual level, the practice of safe disposal of children's stools was more likely to occur among children aged 1, compared to those aged 0 [aOR = 1.74; 95% CI: 1.68-1.80] and those with diarrhoea compared to those without diarrhoea [aOR = 1.17, 95% CI: 1.13-1.21]. Mothers with primary level of education [aOR = 1.42, 95% CI: 1.30-1.5], those aged 35-39 [aOR = 1.20, 95% CI: 1.12-1.28], and those exposed to radio [aOR = 1.23, 95% CI: 1.20-1.27] were more likely to practice safe disposal of children's stools. Conversely, the odds of safe disposal of children's stool were lower among mothers who were married [aOR = 0.74, 95% CI: 0.69-0.80] and those who belonged to the Traditional African Religion [aOR = 0.64, 95% CI: 0.51-0.80]. With the contextual factors, women with improved water [aOR = 1.13, 95% CI: 1.10-1.16] and improved toilet facility [aOR = 5.75 95% CI: 5.55-5.95] had higher odds of safe disposal of children's stool. On the other hand, mothers who lived in households with 5 or more children [aOR = 0.89, 95% CI: 0.86-0.93], those in rural areas [aOR = 0.86, 95% CI: 0.82-0.89], and those who lived in Central Africa [aOR = 0.19, 95% CI: 0.18-0.21] were less likely to practice safe disposal of children's stools.
The findings indicate that between- and within-country contextual variations and commonalities need to be acknowledged in designing interventions to enhance safe disposal of children's faeces. Audio-visual education on safe faecal disposal among rural women and large households can help enhance safe disposal. In light of the strong association between safe stool disposal and improved latrine use in SSA, governments need to develop feasible and cost-effective strategies to increase the number of households with access to improved toilet facilities.
多年来，世界各地的卫生计划更加注重家庭卫生，而对儿童粪便的处理关注有限。这种关注不足可能是因为人们错误地认为儿童的粪便没有危害。本研究考察了撒哈拉以南非洲（SSA）地区妇女安全处理儿童粪便的个人和背景预测因素。
本研究使用了来自 2015 年至 2018 年期间 15 个撒哈拉以南非洲国家的当前人口与健康调查（DHS）中 128096 名 5 岁以下儿童的母子对的二级数据。多水平逻辑分析用于评估与安全处理儿童粪便相关的个人和背景因素。我们以统计学意义为 p<0.05 的调整优势比（aOR）呈现结果。
研究结果表明，在所研究的 15 个撒哈拉以南非洲国家中，58.73%（57.79-59.68）的生育妇女安全处理了她们孩子的粪便。这一比例从卢旺达的 85.90%（84.57-87.14）到乍得的 26.38%（24.01-28.91）不等。在个人层面上，与 0 岁的儿童相比，1 岁的儿童更有可能安全处理他们的粪便[aOR=1.74；95%CI：1.68-1.80]，与没有腹泻的儿童相比，腹泻的儿童更有可能安全处理他们的粪便[aOR=1.17，95%CI：1.13-1.21]。具有小学教育水平的母亲[aOR=1.42，95%CI：1.30-1.5]、年龄在 35-39 岁的母亲[aOR=1.20，95%CI：1.12-1.28]和接触广播的母亲[aOR=1.23，95%CI：1.20-1.27]更有可能安全处理儿童的粪便。相反，已婚母亲[aOR=0.74，95%CI：0.69-0.80]和属于传统非洲宗教的母亲[aOR=0.64，95%CI：0.51-0.80]安全处理儿童粪便的可能性较低。在背景因素方面，改善用水的妇女[aOR=1.13，95%CI：1.10-1.16]和改善卫生设施的妇女[aOR=5.75，95%CI：5.55-5.95]安全处理儿童粪便的可能性更高。另一方面，有 5 个或更多孩子的家庭的母亲[aOR=0.89，95%CI：0.86-0.93]、居住在农村地区的母亲[aOR=0.86，95%CI：0.82-0.89]和居住在中非地区的母亲[aOR=0.19，95%CI：0.18-0.21]不太可能安全处理儿童的粪便。
研究结果表明，在设计增强儿童粪便安全处理措施时，需要承认国家内部和国家之间的背景差异和共性。对农村妇女和大家庭进行安全粪便处理的视听教育可以帮助提高安全处理。鉴于安全粪便处理与改善 SSA 地区厕所使用之间的强烈关联，政府需要制定可行且具有成本效益的战略，以增加获得改良厕所设施的家庭数量。
