Everyone Poops (But Where?): Assessing Feces Disposal Practices for Children Under-Five in Low- and Middle-Income Countries Open Access

Abstract

Background: Sanitation is a global priority, with estimated 2.6 billion worldwide lacking
access to improved sanitation. This estimate is solely based on surveys of adults though a
key argument for the focus on improving sanitation is the potential reduction in child deaths
attributable to diarrheal disease. Children are at greater risk in both contraction and the
severity of diarrheal diseases than adults, representing 68% of the diarrheal disease burden.
Given that over 9% of the world's population of 7 billion is under-five years old, there is a need to
systematically assess sanitation for children under-five in the same way that adult sanitation is
being analyzed.
Objective: This study aims to expand the knowledge base for feces disposal
behavior for children under-five in low- and middle-income countries, focusing on whether
children's feces are disposed of in an improved method and regional variations in disposal method.
Methods: DHS and MICS data from 78 low- and middle-income countries was extracted to estimate sanitation statistics and to develop an exploratory model for improved disposal, defined as use of a toilet/latrine or feces put or rinsed into a toilet/latrine.
Results: Globally, an estimated 47.0% of households report using an improved method to
dispose of children's feces, with urban dwellers more likely to use an improved method than
rural dwellers (51.8% v. 44.7%, p<0.01). The practice is highly variable by world region and
urban/rural residence within a given country. Using disposable diapers or throwing feces in
garbage is the dominant practice for children 6 months old and younger (30.4%). Putting or
rinsing feces into a toilet or latrine is the most common disposal method for children 7-60
months old (31.0-34.8%). Unsurprisingly, since by definition improved disposal requires access
to a toilet/latrine the strongest predictor of improved disposal is access to an
improved toilet/latrine.
Discussion: Although children under 6 months and rural residents are at increased risk of
diarrheal disease, these caregivers are less likely to use improved disposal. Further analysis of
will help to focus on improving coverage of sanitation solutions that are effective for
children under-five and to better target those populations who do not practice improved
disposal of children's feces.

Table of Contents

Contents Introduction...1 Background...7

Impact of Improved Sanitation...7

Disposal of Children's Feces...9

Comparison of Methodologies for Analysis of Sanitation Practices...11

Methods...13 Data Sources...13 Data Management...15 Analysis...17 Results...19 Data Management...19

Reported Disposal by Country and Region...20

Reported Disposal by Household Wealth...24

Reported Disposal by Developmental Age of Child...25

Modeling Improved Disposal of Children's Feces...26

Discussion and Conclusion...27

Appendix: Tables and Figures...30

Tables...30

Table 1. Selected surveys by survey year, country, and survey type...30

Table 2. Regional distribution of country surveys included in analysis...32

Table 3. Standardization of indicator for disposal of children's feces...33

Table 4. Standardization of indicator for household access to toilet/latrine...34

Table 5. Demographics of population by world region...35

Table 6. Urban (U), rural (R), and total (T) percent disposal of children's feces by country and world region...36

Table 7. Percent disposal of child's feces by developmental age of the child...39

Table 8. Exploratory multivariate regression models for improved disposal of children's feces...40

Figures...41

Figure 1. Percent prevalence of improved disposal of children's feces by country...41

Figure 2. Percent improved disposal of child's feces by household wealth quintile for each world region...42

Figure 3. Percent improved disposal of child's feces by developmental age of child for each world region...42

References...43

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	MICS sanitation children under-five feces disposal DHS
Committee Chair / Thesis Advisor	Null, Clair, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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