A UNICEF/WSP brochure on child feces disposal practices in Balochistan and Punjab (Pakistan), available at www.wsp.org/sites/wsp.org/files/publicat...stan-CFD-Profile.pdf, gives the following key messages:

1. In 2011, 32 percent of households surveyed in Punjab, and, in 2010, 78 percent of households surveyed in Balochistan reported unsafe disposal of the feces of their youngest child under age three.

2. Even among households with improved toilets or latrines, 15 percent in Punjab and 73 percent in Balochistan reported unsafe child feces disposal behavior.

3. Unsafe child feces disposal is more prevalent among households that defecate in the open, those in rural areas, those that are poorer, and those with younger children.

In the rural areas of Sindh province, Pakistan, it is common to see the child feces being buried in the ground, or just put on the ground covered by a handful of the surrounding topsoil material, or, to a lesser extent, being disposed of as a part of garbage.

It can be seen that these practices are not proper, but the problem is that the rural women consider child feces as harmless. The rural women do not wash their hands with soap after cleaning the infants. At the same time, it is also a fact that these poor village women do not have proper latrine facilities. Most resort to open defecation, at night.

The brochure defines the safe disposal of child feces as:

The safest way to dispose of a child’s feces is to help the child use a toilet or latrine or, for very young children, to put or rinse their feces into a toilet or latrine. For the purposes of this brief, these disposal methods are referred to as “safe,” whereas other methods are considered “unsafe.” By definition, “safe disposal” is only possible where there is access to a toilet or latrine. When a child’s feces is put or rinsed into an “improved” toilet or latrine, this is termed “improved child feces disposal.”

While the above contention is correct, the brochure does not give guidelines as to what to do, when these latrine facilities are not available with the rural women, due to poverty.

The brochure answers the interesting question: What Is the Impact of Unsafe Disposal of Children’s Feces?
The answer is:

There is widespread belief that the feces of infants and young children are not harmful, but this is untrue. In fact, there is evidence that children’s feces could be more risky than adult feces, due to a higher prevalence of diarrhea and pathogens— such as hepatitis A, rotavirus, and E. coli—in children than in adults. Therefore, children’s feces should be treated with the same concern as adults’ feces, using safe disposal methods that ensure separation from human contact and household contamination.

In particular, the unsafe disposal of children’s feces may be an important contaminant in household environments, posing a high risk of exposure to young infants. Poor sanitation can result in substantial health impacts in children, including a higher prevalence of diarrheal disease, intestinal worms, enteropathy, malnutrition, and death. According to the World Health Organization (WHO), most diarrheal deaths in the world (88 percent) are caused by unsafe water, sanitation, or hygiene. More than 99 percent of these deaths are in developing countries, and about eight in every 10 deaths are children. Diarrhea obliges households to spend significant sums on medicine, transportation, health facility fees, and more, and can mean lost work, wages, and productivity among working household members. Stunting and worm infestation can reduce children’s intellectual capacity, which affects productivity later in life. The WHO estimates that the average IQ loss per worm infection is around 3.75 points.”

A June 2015 brief by WSP on Management of Child Feces: Current Disposal Practices, available at:
www.wsp.org/sites/wsp.org/files/publicat...FD-Summary-Brief.pdf, gives key findings as:

1. In most countries analyzed, over 50 percent of households with children under age three reported that the feces of their children were unsafely disposed.
2. Even among households with improved toilets or latrines, some unsafe child feces disposal behavior was reported.
3. In almost every country, feces of children under age three are less likely to be safely disposed of than those of the general population.
4. Higher rates of unsafe child feces disposal were found in poor, rural households with the youngest children and where other household members defecate in the open.
5. Although there is a common belief that children’s feces are not harmful, exposure to children’s feces could be more risky than exposure to adults’ feces.

A paper (Are burial or disposal with garbage safe forms of child faeces disposal? An expert consultation
ROB BAIN and ROLF LUYENDIJK) correctly says that the household surveys demonstrate that the burying of child faeces (‘dig-and-bury’) is common in several countries, especially in sub-Saharan Africa and South-east Asia.

The paper’s contention that “Disposal with garbage is widely practised in middle- and high-income countries and is becoming increasingly common in urban areas of low-income countries,” may be correct in respect of some developing countries.

The interesting point in the paper is that the authors sought opinion of experts in the field of sanitation on the safety of these two child faeces disposal methods (burial and disposal with garbage). The paper concludes: There was almost unanimous agreement these should be considered neither safe nor improved. A range of arguments was provided to support this position, including proximity of solid waste and burial sites to the home and children’s play areas and that neither practice would be acceptable for adults.

Child feces disposal practices in most developing countries are, no doubt, improper. However, no way-out is given on what the poor rural women can do, in view of non-available of the latrine facilities, due to poverty.


F H Mughal

Do you know of any programs to improve feces disposal of children under five that we might have missed when creating these profiles outlining the current practices of caregivers?


Should you want more of the background on the profiles, here it is:

Although the impact of poor sanitation and hygiene is often measured by the effects on children, most sanitation and hygiene interventions target adults. Safe disposal of children’s feces is as essential as the safe disposal of adults’ feces and yet, in general, sanitation for children has been a neglected area of research. Significant knowledge gaps must be filled before comprehensive, practical, evidence based policy and program guidance can be made available.

To improve the evidence base, the Global Water Practice’s Water and Sanitation Program (WSP) and the United Nations Children’s Fund (UNICEF) partnered to develop profiles outlining the current child feces disposal practices of caregivers and existing interventions to improve those practices.

The analysis found that in most countries investigated, over 50 percent of households with children under age three reported that the feces of their children were unsafely disposed of. Even among households with improved toilets or latrines, some unsafe child feces disposal behavior was reported by caregivers. In almost every country analyzed, the feces of children under age three are less likely to be safely disposed of than those of the general population. Furthermore, the burden of child feces management is usually left to women.

· Read a new blog: “ What Happens When the Playground Is Also the Potty? ”
· See the individual country profiles at Ensuring Safe Sanitation for Children
· Check out the summary brief compiling the country level profile practices: Management of Child Feces: Current Disposal Practices

A very recent paper by Fiona Majorin et al. (Majorin F, Freeman MC, Barnard S, Routray P, Boisson S, et al. (2014) Child Feces Disposal Practices in Rural Orissa: A Cross Sectional Study. PLoS ONE 9(2): e89551. doi:10.1371/journal.pone.0089551), gives an interesting overview and discussion on child feces disposal in Orissa, India.

The paper notes that in many low-income settings, nappies (i.e. diapers or cloth) and potties are rarely available or used, making the hygienic collection of young children's feces difficult; if collected, such feces are often disposed of in a manner that does not prevent further exposure to household members or contamination of water sources.

This is almost a similar situation that we have here in the rural areas of Sindh province of Pakistan. Since, it is the job of rural women to clean the child, they do so in most irresponsible manner. A woman would hold infant on her feet, such that the feet act as a channel. The feces are poorly dispersed with few mugs of water. Children, on the other hand, defecate in open channels (if they exist), or just outside the house.

This is serious, when read in conjunction with what the paper says: “the unsanitary disposal of child feces may present a greater health risk than that of adults. First, young children represent the highest incidence of enteric infections, and their feces are most likely to contain agents. Second, young children tend to defecate in areas where susceptible children could be exposed. Third, young children who are also most at risk of mortality and the serious sequelae associated with enteric infection are most likely to be exposed to these ambient agents due to the time they spend on the ground, their tendency to put fingers and fomites in their mouths, and common behaviors such as geophagia.”

The authors, and the forum colleagues, would be surprised to know that, in the rural areas here, the rural women still consider infants’ feces as harmless, and consequently, do not wash their hands with soap, after cleaning the infants.

There is one important conclusion in the paper. The paper says: “the Total Sanitation Campaign has not led to high levels of safe disposal of child feces.” Total Sanitation Campaign, now known as Nirmal Bharat Abhiyan, is India’s largest rural sanitation campaign. It is “a subsidy-based approach that seeks to create demand and provide subsidies to below the poverty line households towards construction of individual household latrines.”

This is in line with what I have stated in the forum’s another post, that a country should use a sanitation strategy that delivers in that particular settings; and, this may, or may not be, a flagship program.

The paper is attached. Enjoy!

F H Mughal