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Laney Graduate School

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Excreta Disposal and Hygiene Practices Following Child Defecation among Peri-Urban Households in Western Kenya

Rush, Rosalyn (2011)
Master's Thesis (81 pages)
Committee Chair / Thesis Adviser: Dreibelbis, Robert
Committee Members: Rheingans, Richard
Research Fields: Health Sciences, Hygiene; Health Sciences, Public Health
Partnering Agencies: Emory University schools, faculty or affiliated programs
Keywords: excreta disposal; hygiene; Kenya; peri-urban; mixed methods
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url: http://pid.emory.edu/ark:/25593/93sdj

Abstract

Background: Diarrhea is one of the leading causes of childhood morbidity and mortality in Kenya. The World Health Organization has identified the safe disposal of feces and handwashing as two key behaviors that could result in significant reductions in diarrheal disease. In order to successfully promote these behaviors, it is first essential to understand the local practices and contextual factors that might act as barriers and enablers of change.

Objective: This study examines child excreta disposal practices and associated hygiene practices among peri-urban caretakers of children under the age of two. In addition, this study explores the barriers to and facilitators of safe excreta disposal and hygiene-related practices of caretakers at the household level.

Methods: Semi-structured observations were conducted in 30 compounds to document key hygiene behaviors of caretakers and household latrine conditions. A short hygiene questionnaire was administered to each caretaker under observation. Three focus group discussions were conducted with different caretakers to identify beliefs, motivations, and barriers relevant to stool disposal and associated hygiene practices.

Results: Observation data reveal a wide range of defecation sites, cleaning methods, disposal sites, handwashing practices, and latrine conditions in the peri-urban community. Comparison of observed and reported behaviors shows poor agreement for feces disposal and caretaker handwashing practices. Caretakers tend to over-report "good" hygiene practices such as the disposal of child stools in a latrine and subsequent handwashing with soap. Qualitative data suggest that the decision of where to dispose of child feces may depend on numerous factors, including the child's defecation site, availability of sanitation, and characteristics of latrines. Handwashing behavior may also be influenced by several factors, such as perceived contact with feces and the task in which the caretaker will participate after contact.

Discussion: Promotion of safe excreta disposal and handwashing practices at the individual level may not be successful if larger external factors are not first addressed. Of particular note, households must have continuous access to a clean and well-maintained latrine before they will properly dispose of feces. Findings from this research can be used to inform the development of an intervention to improve feces disposal and handwashing practices.

Table of Contents


CHAPTER 1: INTRODUCTION ............................................................................................... 1
Aim and objectives ........................................................................................................... 2
Significance .....................................................................................................................2
CHAPTER 2: LITERATURE REVIEW ....................................................................................... 3
Overview of transmission routes and epidemiologic evidence ...................................... 3
F-Diagram .................................................................................................................... 3
Hygiene interventions and health outcomes ............................................................. 4
Sanitation interventions and diarrheal disease .......................................................... 5
Specific behaviors and practices related to child defecation ......................................... 6
Defecation sites .......................................................................................................... 6
Disposal sites ............................................................................................................... 9
Feces near the home ................................................................................................ 11
Anal cleansing ........................................................................................................... 13
Handwashing ............................................................................................................. 14
Interventions for behavior change ............................................................................... 16
Methodological issues in hygiene research .................................................................. 18
Conclusion ..................................................................................................................... 20
CHAPTER 3: PROJECT CONTENT ........................................................................................ 21
Study site ....................................................................................................................... 21
Methods ........................................................................................................................ 21
Data collection .......................................................................................................... 21
Observations and questionnaires .......................................................................... 22
Focus group discussions ......................................................................................... 24
Data analysis ............................................................................................................. 25
Results ........................................................................................................................... 26
Quantitative results .................................................................................................. 26
Household observations ........................................................................................ 27
Latrine observations .............................................................................................. 30
Qualitative results ..................................................................................................... 31
Defecation site ....................................................................................................... 32

Cleaning methods .................................................................................................. 34
Disposal site ........................................................................................................... 35
Handwashing .......................................................................................................... 38
CHAPTER 4: DISCUSSION, RECOMMENDATIONS, AND CONCLUSION .............................. 40
Disposal of child feces ................................................................................................... 40
Handwashing after contact with child feces ................................................................. 44
Methodological issues .................................................................................................. 45
Conclusion ..................................................................................................................... 47
REFERENCES ...................................................................................................................... 48
FIGURES AND TABLES ........................................................................................................ 52
Figure 1. F-Diagram, adapted from Curtis 2000 ........................................................... 52
Figure 2. Map of informal settlements in Kisumu ........................................................ 52
Figure 3. Compound observations ................................................................................ 53
Table 1. Observed hygiene behaviors surrounding child defecation ........................... 54
Table 2. Comparison of observed versus reported behaviors for feces disposal and
handwashing practices ................................................................................................. 55
Table 3. Associations between latrine characteristics and disposing of child stools in a
latrine ............................................................................................................................ 55
APPENDICES ...................................................................................................................... 56
Appendix A. Consent forms .......................................................................................... 56
Appendix B. Compound and latrine observation tools ................................................ 58
Appendix C. Caregiver questionnaire ........................................................................... 62
Appendix D. Focus group discussion guide ................................................................... 64
Appendix E. IRB documentation ................................................................................... 72

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