Department of Health Behavior, University of North Carolina at Chapel Hill, USA.
Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, USA.
Sci Total Environ. 2024 Aug 25;940:173547. doi: 10.1016/j.scitotenv.2024.173547. Epub 2024 May 25.
Globally, safe sanitation has improved significantly in the last two decades, but unsafe child feces disposal remains a growing challenge in many regions, exposing household members and communities to infectious pathogens. The drivers associated with child feces disposal in several contexts including humanitarian settings are not well understood. This study investigated child feces disposal (CFD) practices and associated factors in low- and middle-income countries, including in humanitarian settings. Data from 352,173 women in 34 countries, collected between 2012 and 2021 through Demographic and Health Surveys (DHS), were used. We utilized multivariate logistic regression to assess CFD practices among children under two years old and the factors linked to these practices. We incorporated data from the United Nations High Commissioner for Refugees (UNHCR) regarding refugee camps' locations in the analysis. Time series and local spatial autocorrelation analyses were run to examine changes in safe CFD practices over time and space, respectively. Results showed minimal improvement in safe child feces disposal over the past decade, with 55.6 % of respondents in non-humanitarian settings and 38.1 % in humanitarian settings improperly disposing of feces. Improper CFD significantly correlated with increased odds of diarrhea in non-humanitarian settings (OR 1.09 95 % CI: 1.05-1.13) but not in humanitarian settings (OR 1.14 95 % CI: 0.53-2.49). The most significant factors (p < 0.05) associated with safe CFD included being in the richest wealth quintile (OR 3.27 95 % CI: 3.06-3.49), having basic education (OR 1.28 95 % CI: 1.22-1.33), children eating solid food (OR 1.53 95 % CI: 1.48-1.57), improved sanitation access (OR 1.88 95 % CI: 1.81-1.96), and listening to radio at least weekly (OR 1.40 95 % CI: 135-1.46). Policymakers and development partners must include safe CFD guidelines in national policies and programs, as well as prioritize investments in household-level sanitation and educate caregivers about safe CFD practices.
全球范围内，过去二十年中安全卫生设施得到了显著改善，但在许多地区，不安全的儿童粪便处理仍然是一个日益严峻的挑战，这使家庭成员和社区面临感染病原体的风险。在包括人道主义环境在内的多个背景下，导致儿童粪便处理的因素尚未得到充分理解。本研究调查了低收入和中等收入国家（包括人道主义环境）中的儿童粪便处理（CFD）实践及其相关因素。该研究使用了 2012 年至 2021 年期间通过人口与健康调查（DHS）在 34 个国家收集的 352173 名妇女的数据。我们利用多变量逻辑回归评估了两岁以下儿童的 CFD 实践以及与这些实践相关的因素。我们将联合国难民署（UNHCR）有关难民营位置的数据纳入分析。我们进行了时间序列和局部空间自相关分析，以分别检查过去十年中安全 CFD 实践的变化和空间变化。结果表明，在过去十年中，安全处理儿童粪便的做法几乎没有改善，55.6%的非人道主义环境受访者和 38.1%的人道主义环境受访者不当处理粪便。不当的 CFD 与非人道主义环境中腹泻的几率增加显著相关（OR 1.09，95%CI：1.05-1.13），但与人道主义环境中腹泻的几率增加不相关（OR 1.14，95%CI：0.53-2.49）。与安全 CFD 最显著相关的因素（p<0.05）包括处于最富裕的五分之一（OR 3.27，95%CI：3.06-3.49）、受过基本教育（OR 1.28，95%CI：1.22-1.33）、儿童食用固体食物（OR 1.53，95%CI：1.48-1.57）、改善卫生设施的获取（OR 1.88，95%CI：1.81-1.96）和每周至少听一次广播（OR 1.40，95%CI：135-1.46）。政策制定者和发展伙伴必须将安全 CFD 准则纳入国家政策和方案，并优先投资于家庭一级的卫生设施，并教育照顾者有关安全 CFD 的实践。
