Implications of the Latrine Training Mat for Improving the Defecation Practices of Children Under Five in Rural Western Kenya Open Access

Van Schoyck, Gabriella Annmarie (2012)

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Kenya's Western province has the country's second highest prevalence of diarrheal disease among children under five. In 2010, formative research conducted in this region by Innovations for Poverty Action's (IPA) WASH-Benefits Project indicated that children under five often do not use their mud floor latrine due to fear of its large hole and unsanitary conditions. WASH-Benefits staff hypothesized that this lack of latrine use could be contributing to the region's high prevalence of diarrheal disease, and they developed a tool that they hoped would facilitate latrine use among children under five.

This prototype, the "Latrine Training Mat," was a small, lightweight wooden mat with a hole appropriately sized for a child. It could be placed over a latrine's existing hole and would make using a latrine a safer, less threatening, and more sanitary activity for young children. Made of wood or plastic, the training mat could be cleaned with a few rinses of water directly into the latrine hole, and then stored inside the latrine until its next use.

Three versions of the latrine training mat were piloted in the summer of 2011 among 12 households in rural Western Kenya. Each household contained a pit latrine with a mud floor, and had at least one child between the ages of 2 and 5 years old. Qualitative research methods were utilized to understand current local practices surrounding child defecation, feces disposal, and toilet training. In-depth interviews were administered and the training mats distributed to the twelve study households for one week. Focus group discussions were then conducted with participating mothers to understand their experiences with and perceptions of the training mat. The data were analyzed using a Grounded Theory approach with MAXQDA version 10 software.

Results from the study indicate that the concept of a latrine training mat was an effective tool for facilitating latrine use within this study population, and is potentially feasible for scale-up in rural Western Kenya because it accommodates local practices surrounding child defecation, feces disposal, and toilet training. This paper discusses these findings, and makes recommendations for modifications to future training mat designs and delivery methods.

Table of Contents

Table of Contents
Chapter 1: Introduction and Aims...1

1.1. Introduction...1
1.2 Context of Research Project...2
1.3 The Latrine Training Mat...4
1.4 Research Aims...5

Chapter 2: Literature Review...7

2.1 Diarrheal Diseases and Sanitation...7
2.3 Child Defecation Practices in the Developing World...13
2.4 Children's Feces Disposal Practices in the Developing World...16
2.5 Toilet Training Practices...18

2.5.1 Toilet Training in the Developed World...18
2.5.2 Toilet Training in the Developing World...20

2.6 Conclusion...22

Chapter 3: Methods...23

3.1 Data Collection Methods...23
3.2 Study Site...26
3.3 Study Site and Participant Selection...27
3.4 Development and Implementation of Research Instruments...28
3.5 Revisiting Participants from Summer 2010 Pilot...29

3.5.1 Phase 1: Understanding Current Practices...30
3.5.2 Phase 2: In-home LTM Intervention...31
3.5.3 Phase 3: Follow-Up...33

3.6 Summary of Data Collected...34
3.7 Data Quality...34
3.8 Qualitative Data Analysis Methods...35

Chapter 4: Results...38

4.1 Introduction...38
4.2 Local Practices...39

4.2.1 Children's Defecation Practices...39
4.2.2 Feces Disposal Practices...44
4.2.3 Toilet Training...46
4.2.4 Pride...59

4.3 Participants' Experiences with and Perceptions of the Latrine Training Mat...60

4.3.1 LTM Training Process...61
4.3.2 Children's Use...64
4.3.3 Changes in Defecation Practices and Household Behaviors Due to LTM...65
4.3.4 Cleaning...67
4.3.5 Storage...69
4.3.6 Perceived Benefits and Limitations...72
4.3.7 Key Features...75
4.3.8 Perceived Age of LTM Initiation...78
4.3.9 Overall Preference...79

4.4 Conceptual Diagrams...80

4.4.1 Explanation of Diagram 1...80

Diagram 1: The Influence of the Latrine Training Mat on the Progression of Children's Defecation Practices...82

4.4.2 Explanation of Diagram 2...83

Diagram 2: Facilitators and Barriers to LTM Effectiveness...85

Chapter 5: Discussion...86

5.1 Introduction...86
5.2 Local Behaviors, Practices, and Perceptions Surrounding Child Defecation...86

5.2.1 Advantages and Risks of Using Designated Defecation Spots...86
5.2.2 Mothers' Perception of Feces and Disease Transmission...87
5.2.3 Toilet Training...90

5.3 Feasibility and Effectiveness of the Latrine Training Mat...91

5.3.1 Potential for Integrating LTM into Toilet Training Process...91
5.3.2 Influence of Behavior Change Messaging...94
5.3.3 Cleaning and Storage...95
5.3.4 The Link Between Cleaning and Storage, and Its Implications for Behavior Messaging...96
5.3.5 LTM Use at Night...98
5.3.6 Mothers' Overall Preference for Latrine Training Mat Design...98
5.3.7 Limitations of the Study...99

Chapter 6: Recommendations and Conclusions...101

6.1 Contribution to the Literature...101
6.2 Implications and Recommendations for Future LTM Promotion and Marketing Efforts...101

6.2.1 Improved Behavior Messaging...101
6.2.2 Modifications to the LTM Design...103
6.2.3 Targeting Mothers...103
6.2.4 Summary of Recommendations for the WASH-LTM Project...105
6.2.5 Further Research...106

6.3 Conclusions...106


Appendix A: Visual Summary of the Defecation Practices of Children Under Five in Rural Western Kenya...113
Appendix B: IDI Guide...115
Appendix C: Messaging Scripts for Village 1 (no-messaging)...123
Appendix D: Messaging Scripts for Village 2 (messaging)...125
Appendix E: FGD2 Guide for Village 1 (non-messaging)...131
Appendix F: FGD2 Guide for Village 2 (messaging)...142

Table of Images and Diagrams
Images 1 and 2: Mud Floor Latrines in Western Kenya...2
Image 3: Original Latrine Training Mat Prototype, Piloted in Summer 2010...24
Image 4: LTM Prototype #1...31
Image 5: LTM Prototype #2...31
Image 6: LTM Prototype #3...32
Image 7: The mother places the #3 LTM...61
Image 8: The mother teaches the child how to use the LTM...61
Image 9: The child is comfortable using the LTM...62
Image 10: The child is introduced to the #2 LTM outside...63
Image 11: The child then practices using the LTM inside the latrine...63
Diagram 1: The Influence of the Latrine Training Mat on the Progression of Children's Defecation Practices...82
Diagram 2: Facilitators and Barriers to LTM Effectiveness...85
Image 12: A child begins to demonstrate using the #1 LTM...92
Image 13: The #2 LTM covers the latrine's larger hole...93

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