Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
Department of Psychology, University of Zürich, Zürich, Switzerland.
PLoS One. 2022 Sep 9;17(9):e0274069. doi: 10.1371/journal.pone.0274069. eCollection 2022.
Child feces are an important source of fecal exposure in household environments. Typically, one of two behaviors is necessary to mitigate this risk: either caregivers dispose of their children's feces into a latrine or children learn how to use a latrine. Although past studies have examined factors associated with these two behaviors collectively (i.e. "safe disposal"), there is a need to separately analyze these distinctive practices to better inform programming. This study aims to quantitatively examine contextual and psychosocial factors influencing caregiver safe disposal and, separately, child latrine training. We surveyed 791 primary female caregivers, who reported on 906 children <5 years old, across 74 villages in rural Odisha, India. At their last defecation event, 38% of children used the latrine and another 10% had their feces safely disposed of into the latrine. Since caregiver safe disposal was rare, we instead assessed safe disposal intention. We used linear regression and multilevel mixed effects models to examine contextual and psychosocial factors. For contextual factors, we found caregivers had stronger safe disposal intention when they came from wealthier households and had greater informational support, but weaker intention when their latrine was near the household. Caregivers more intensely practiced latrine training with their child when they themselves used the latrine for defecation, the latrine was fully intact, and they had greater instrumental support. For psychosocial factors, caregivers had stronger safe disposal intention when their households expected them to practice safe disposal, they felt strongly committed to the behavior, and had a plan for what to do when faced with a water shortage. Caregivers more intensely taught their child how to use the latrine when they believed their child was at risk of becoming sick if they practiced open defecation (OD); viewed child OD as unbeneficial; liked teaching their child; personally felt it was important for the child's father to help; felt confident in their ability to teach their child; and had greater action control over their training practice. Interestingly, caregivers put less effort into latrine training when they felt more concerned for their child's safety when the child defecated outside. These findings underscore the critical need to separately assess unique child feces management (CFM) practices and also provide a road map for practitioners on the types of behavior change strategies to consider in their CFM programming.
儿童粪便在家居环境中是粪便暴露的重要来源。通常，要降低这种风险，需要采取两种行为之一：照顾者将儿童的粪便处理到厕所中，或者儿童学会使用厕所。尽管过去的研究已经检查了与这两种行为相关的因素（即“安全处置”），但需要分别分析这些独特的做法，以便更好地为规划提供信息。本研究旨在定量检查影响照顾者安全处置以及单独的儿童厕所培训的背景和心理社会因素。我们调查了印度奥里萨邦 74 个村庄的 791 名主要女性照顾者，他们报告了 906 名 5 岁以下的儿童。在他们的最后一次排便事件中，38%的儿童使用了厕所，另有 10%的儿童将粪便安全地处理到厕所中。由于照顾者安全处置的情况很少见，因此我们评估了安全处置的意图。我们使用线性回归和多层次混合效应模型来检查背景和心理社会因素。对于背景因素，我们发现来自较富裕家庭的照顾者和获得更多信息支持的照顾者更倾向于进行安全处置，而当他们的厕所靠近家庭时，他们的意图较弱。当照顾者自己使用厕所排便时，厕所完全完好无损，并且他们得到更多的工具支持时，他们会更强烈地与孩子一起进行厕所培训。对于心理社会因素，当照顾者的家庭期望他们进行安全处置时，当他们强烈致力于该行为时，当他们有计划应对缺水情况时，他们对安全处置的意图更强。当照顾者认为如果孩子进行露天排便（OD），孩子有生病的风险时，他们更强烈地教导孩子如何使用厕所；认为儿童 OD 没有好处；喜欢教导他们的孩子；个人认为孩子的父亲帮助很重要；对教导孩子的能力有信心；并且对他们的培训实践有更大的行动控制。有趣的是，当照顾者在孩子在户外排便时更担心孩子的安全时，他们会在厕所培训上投入更少的精力。这些发现强调了单独评估独特的儿童粪便管理（CFM）实践的迫切需要，并为实践者提供了在其 CFM 规划中考虑的行为改变策略类型的路线图。
