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The Global Handwashing Partnership

Webinar summary: The forgotten juncture? Handwashing and safe management of child feces

September 7, 2018

On August 22nd, 2018 at 6pm ET, the Global Handwashing Partnership, in conjunction with USAID, the International Water Center, the Water and Engineering Center for Development, and UNICEF hosted a discussion on the intersection of handwashing and the safe management of child feces.

Safe disposal of children’s feces is a critical practice, and programs often under-emphasize critical times for handwashing related to infant and child feces. This webinar aimed to:
• Discuss the present status and impact of child feces disposal practices and handwashing,
• Highlight case studies, interventions and evidence,
• Share experiences across regions; and
• Review key considerations for practitioners.

Nga Nguyen, Senior WASH and Social Behavior Change Adviser at USAID, introduced the status of child feces disposal practices and handwashing, and the role of this webinar in highlighting evidence and interventions and providing an open forum for implementers to review key considerations.

Emily Christensen Rand, UNICEF Vanuatu WASH Specialist, presented a global overview of the status of evidence on child feces management and handwashing. Evidence was captured from regional studies, with the earliest evidence from the 1980s. This review opened with the 2015 UNICEF and World Bank research into the child feces disposal practices in 24 countries in different regions. In most countries analyzed, over 50 percent of households with children under age three reported that the feces of their children were unsafely disposed. These findings were corroborated by studies in subsequent years, with some evidence suggesting a correlation between health impacts and safe disposal of child’s feces. Research also showed that caregivers don’t always include handwashing as a part of child feces management. A variety of factors which affect this behavior were explored in different regions, including economic status, beliefs, and culture.

In the next presentation, Edith Kamundi, Project Officer at the International Water Centre, described a behavior change campaign on infant feces management in East Sepik Province in Papua New Guinea (PNG). The campaign findings revealed that the key motivators for improved hand hygiene behavior at this key instance were nurture, community status and competing household priorities during the sequence of events in child feces handling. This led the innovation of the 5 Star Mama behavior change campaign, with a focus on the sequence of steps in safe infant feces management, and the collective community responsibility towards this behavior. The team found that culture and gender heavily influence this behavior in PNG. The campaign implementation further revealed it is critical that practitioners work through other sectors beyond WASH, such as nutrition, which address the same target audience. The need for integration was the strongest takeaway from this intervention.

Jake Pitts, a WEDC Water and Waste Engineering MSc student, presented recent formative research on child feces management in the Rhino Refugee Settlement in Uganda. This research highlighted that household child feces management strategies vary with children age groups and status of health. Caregivers adopted coping strategies for child feces management to overcome economic barriers, such as improvised diapers from bedding. Further, caretakers behaved differently when children had diarrhea; including increased washing and disposal. Understanding these differences, along with the process that households use for managing child feces, is very useful for targeted programming. Further, in low resource contexts, even with adequate knowledge and consistent child feces disposal, there are still other risks for fecal contamination.

Following these short presentations, all participants engaged in an active discussion focused on evidence and interventions across regions, motivators for hand hygiene behavior during child feces management and recommendations from participants. Some key points from this discussion included comparing child feces practices in other regions, such as community buy-ins into potty purchases, and creating child-focused latrine systems. The discussion was moderated by Nga Nguyen, and Carolyn Moore, Secretariat Director at the Global Handwashing Partnership.

A recording of the webinar is available here. If you have questions or feedback about the webinar; or if you have resources related to safe management of child feces as a critical time for handwashing, please email contact@globalhandwashing.org.

Learn more: If you are interested in learning more about child feces disposal practices, please see the list of resources below. This list is adapted from a list prepared by Dan Campbell of the Water CKM Project.
WSP – Ensuring Safe Sanitation for Children – This series of country profiles provides an overview of the available data on child feces disposal.
Within-Compound Versus Public Latrine Access and Child Feces Disposal Practices in Low-Income Neighborhoods of Accra, Ghana. American Society of Tropical Medicine and Hygiene, May 2018.
Unsafe disposal of feces of children <3 years among households with latrine access in rural Bangladesh: Association with household characteristics, fly presence and child diarrhea. PLoS One, April 2018.
Piloting a low-cost hardware intervention to reduce improper disposal of solid waste in communal toilets in low-income settlements in Dhaka, Bangladesh. BMC Public Health, August 2017.
Identifying Potential Sources of Exposure Along the Child Feces Management Pathway: A Cross-Sectional Study Among Urban Slums in Odisha, India. Am. J. Trop. Med. Hyg., 97(3), 2017.
The impact of a rural sanitation program on safe disposal of child feces: a cluster randomised trial in Odisha, India. Transactions of the Royal Society of Tropical Medicine and Hygiene, 110 (7), 2016.
Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth. Journal of Pediatrics, September 2016.
Management of Child Feces: Current Disposal Practices. WSP, June 2015.

 

Photo credit: International Water Centre

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