Decomposing rural-urban gap in unsafe disposal practice of child stool in India using nationwide sample survey data
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ABSTRACT:
SUBMITTER: Roy A
PROVIDER: S-EPMC10950857 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundDisposal of children's stools is often neglected in Indian sanitation programs, putting them at higher risk of diseases transmitted through the fecal-oral route. Therefore, the current study aims to identify the socioeconomic and demographic factors associated with the unsafe disposal of child stool in India and to estimate the geographical variation in unsafe disposal.MethodsThe study used 78,074 births under two years from the fifth round of the National Family Health Survey (2019-21). Descriptive statistics, bivariate analysis with the chi-square test, and a four-level hierarchical logistic regression model were applied to accomplish the study objectives.ResultsFindings revealed a 61.3% prevalence of unsafe stool disposal nationwide, significantly varying between rural (45%) and urban (67%) areas. Multilevel logistic regression highlighted that mother's education, wealth quintile, and sanitation facility were significant predictors of unsafe disposal of child stools. Random intercept statistics revealed a substantial geographical unit-level variance in unsafe stool practice in India.ConclusionThe study emphasizes the widespread unsafe disposal of child stool among Indian mothers with young children below two years, and the study underscores a range of contributing factors, including education, media exposure, prosperity, water availability, and sanitation. It also accentuates the significance of the geographical variance in the unsafe disposal of child stool in India, particularly at the household level, followed by the community level. Hence, the findings underscore the importance of focused interventions, including targeted household-level poverty alleviation programs, initiatives to enhance sanitation and water facilities, and community-level public health awareness programs.
| S-EPMC10947681 | biostudies-literature
Project description:BackgroundUnsafe disposal of children's stool makes children susceptible to fecal-oral diseases and children remain vulnerable till the stools of all children are disposed of safely. There is a paucity of data on spatial distribution and factors associated with unsafe child stool disposal in Ethiopia. Previous estimates, however, do not include information regarding individual and community-level factors associated with unsafe child stool disposal. Hence, the current study aimed (i) to explore the spatial distribution and (ii) to identify factors associated with unsafe child stool disposal in Ethiopia.MethodsA secondary data analysis was conducted using the recent 2016 Ethiopian demographic and health survey data. A total of 4145 children aged 0-23 months with their mother were included in this analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of unsafe child stool disposal. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant spatial clusters. A multilevel multivariable logistic regression model was fitted to identify factors associated with unsafe child stool disposal.ResultsUnsafe child stool disposal was spatially clustered in Ethiopia (Moran's Index = 0.211, p-value< 0.0001), and significant spatial SaTScan clusters of areas with a high rate of unsafe child stool disposal were detected. The most likely primary SaTScan cluster was detected in Tigray, Amhara, Afar (north), and Benishangul-Gumuz (north) regions (LLR: 41.62, p<0.0001). Unsafe child stool disposal is more prevalent among households that had unimproved toilet facility (AOR = 1.54, 95%CI: 1.17-2.02) and those with high community poorer level (AOR: 1.74, 95%CI: 1.23-2.46). Higher prevalence of unsafe child stool disposal was also found in households with poor wealth quintiles. Children belong to agrarian regions (AOR: 0.62, 95%CI 0.42-0.91), children 6-11 months of age (AOR: 0.65, 95%CI: 0.52-0.83), 12-17 months of age (AOR: 0.68, 95%CI: 0.54-0.86), and 18-23 months of age (AOR: 0.58, 95%CI: 0.45-0.75) had lower odds of unsafe child stool disposal.ConclusionsUnsafe child stool disposal was spatially clustered. Higher odds of unsafe child stool disposal were found in households with high community poverty level, poor, unimproved toilet facility, and with the youngest children. Hence, the health authorities could tailor effective child stool management programs to mitigate the inequalities identified in this study. It is also better to consider child stool management intervention in existing sanitation activities considering the identified factors.
| S-EPMC8084221 | biostudies-literature
Project description:BackgroundDespite the growing evidence from other developing countries, intra-urban inequality in childhood undernutrition is poorly researched in India. Additionally, the factors contributing to the poor/non-poor gap in childhood undernutrition have not been explored. This study aims to quantify the contribution of factors that explain the poor/non-poor gap in underweight, stunting, and wasting among children aged less than five years in urban India.MethodsWe used cross-sectional data from the third round of the National Family Health Survey conducted during 2005-06. Descriptive statistics were used to understand the gap in childhood undernutrition between the urban poor and non-poor, and across the selected covariates. Blinder-Oaxaca decomposition technique was used to explain the factors contributing to the average gap in undernutrition between poor and non-poor children in urban India.ResultConsiderable proportions of urban children were found to be underweight (33%), stunted (40%), and wasted (17%) in 2005-06. The undernutrition gap between the poor and non-poor was stark in urban India. For all the three indicators, the main contributing factors were underutilization of health care services, poor body mass index of the mothers, and lower level of parental education among those living in poverty.ConclusionsThe findings indicate that children belonging to poor households are undernourished due to limited use of health care services, poor health of mothers, and poor educational status of their parents. Based on the findings the study suggests that improving the public services such as basic health care and the education level of the mothers among urban poor can ameliorate the negative impact of poverty on childhood undernutrition.
| S-EPMC3666977 | biostudies-literature
Project description:The use of hygienic materials (sanitary napkins, locally prepared napkins, tampons, and menstrual cups) during menstruation among adolescent women in India has improved over the years, yet a significant rural-urban gap in the usage persists at the national level. This study investigates how this rural-urabn gap varies across different states and union territories (UTs) of India and uses Fairlie decomposition to quantify the contribution of various factors to this gap. The study uses data on 114,805 adolescent women (aged 15-19 years) from the fifith round of National Family Health Survey (2019-21). The utilization of hygienic materials during menstruation among adolescent women in rural India stood at 43%, whereas in urban areas, it was 68%, indicating a significant 25 percentage point (pp) difference between the two. The rural-urban gap in the hygienic material use varied significantly across Indian states and UTs. The gap exceeded 20 pp in Madhya Pradesh (36 pp), Odisha (26 pp), Jammu and Kashmir (25 pp), Assam (25 pp), Uttar Pradesh (23 pp), Jharkhand (22 pp), Chhattisgarh (21 pp), and Rajasthan (21 pp). In contrast, the gap in Tamil Nadu, Himachal Pradesh, and Telangana was less than 10 pp. The decomposition analysis of the rural-urban gap (25 pp) revealed that the variables included in the anlaysis explained about 70% of the gap. The difference in the household wealth between rural and urban areas contributed about 69% of the explained gap. Other significant contributors to the explained gap were 'transportation to health facility' (5.6%), 'mass-media exposure' (4.9%), and 'level of education (4.4%). The findings underscore the necessity for state-specific interventions aimed at vulnerable groups, particularly individuals from economically disadvantaged backgrounds, those with lower levels of education, and limited exposure to mass media, in order to reduce the existing rural-urban disparity in hygienic material use among adolescent women.
| S-EPMC10725416 | biostudies-literature
Project description:BackgroundEven among households that have access to improved sanitation, children's faeces often do not end up in a latrine, the international criterion for safe disposal of child faeces.MethodsWe collected data on possible determinants of safe child faeces disposal in a cross-sectional study of 851 children <5 y of age from 694 households in 42 slums in two cities in Odisha, India. Caregivers were asked about defecation and faeces disposal practices for all the children <5 y of age in the household.ResultsOnly a quarter (25.5%) of the 851 children's faeces were reported to be disposed of in a latrine. Even fewer (22.3%) of the 694 households reported that the faeces of all children <5 y of age in the home ended up in the latrine the last time the child defecated. In multivariate analysis, factors associated with being a safe disposal household were education and religion of the primary caregiver, number of children <5 y of age in the household, wealth, type and location of the latrine used by the household, household members >5 y of age using the latrine for defecation and mobility of children <5 y of age in the household.ConclusionsFew households reported disposing of all of their children's faeces in a latrine. Improving latrine access and specific behaviour change interventions may improve this practice.
| S-EPMC6515899 | biostudies-literature
Project description:BACKGROUND:The only safest way to dispose of a child's feces is to help the child use a toilet or, for very young children, to put or rinse their feces into a toilet, whereas other methods are considered unsafe. This study aimed to determine the magnitude and factors associated with unsafe child feces disposal in Ethiopia. METHODS:This was a cross-sectional study using pooled data from the four rounds of Demographic and Health Surveys (DHS) conducted in Ethiopia (2000, 2005, 2011, and 2016). Data on child feces disposal practice was collected for all children born during the 5 years preceding survey. Mothers were asked for the youngest child born, "The last time child passed stools, what was done to dispose of the stools?".Descriptive statistics were computed to illustrate the given data. Multivariable logistic regression was performed to identify factors associated with unsafe child feces disposal. RESULTS:The pooled dataset contains data for 40,520 children younger than 5 years, male accounts 20,629 (50.9%). Overall, 77.7% (95%CI: 76.3-79.0) of children feces disposed of unsafely. In the multivariable logistic regression model, those mothers whose child was 13-24 months [AOR: 0.68, 95% CI: (0.60-0.78)] and ≥ 25 months [AOR: 0.66, 95% CI: (0.60-0.72)] were lower odds of unsafe child's feces disposal. Children born into households having two or fewer children were 33% lower [AOR: 0.67, 95% CI: (0.56-0.79)] odds of unsafe child's feces disposal than their counterparts. The odds of disposing of feces unsafely among households having improved toilet facility was 76% lower [AOR: 0.24, 95% CI: (0.19-0.29)] that of households lacking such facilities. Further, being an urban resident, having improved drinking water facility, a high level of maternal and paternal education, paternal occupational status (work in non-agriculture), and maternal age (25-34 and ≥ 35 years) were factors that associated with lower odds of unsafe child's feces disposal. CONCLUSIONS:Three in four Ethiopian children feces disposed of unsafely. Household and socio-demographic factors, such as access to improved toilet facility, the child's age (older age), and both higher maternal and paternal education levels were important factors that significantly associated with lower odds of unsafe child feces disposal.
| S-EPMC7254708 | biostudies-literature
Project description:: Background: To examine the knowledge, attitudes, and practice gap of yoga across India based on implicit perceptions. Methods: The present study is a nationwide door-to-door survey conducted using a questionnaire/screening form. The data were collected from a national survey conducted under the Niyantrit Madhumeh Bharat (NMB) program initiated by The Ministry of Ayurveda, Yoga, Unani, Siddha, Homeopathy (AYUSH), Government of India, from all major zones of the country. A total of 162,330 participants who joined the NMB program were recruited in our study. Results: Out of the total respondents to the survey, it was observed that 11.8% [13,336/112,735] practice yoga, which was highest in the north zone [4,567/112,735] and lowest in the east zone [971/112,735]. Out of 101,643 respondents, 94,135 of the individuals who participated in the survey believed that yoga improved their lifestyle, and 90,102/98,518 believed that yoga prevented diabetes, revealing a huge knowledge-practice gap. Conclusions: The scale of the knowledge-practice gap coupled with the general acceptability of yoga calls for a change in the conventional healthcare provisions by its integration with modern medicine. The population-wide positive perceptions about yoga as a preventive health tool can not only catalyze consensus disease-specific yoga modules but also bridge the knowledge-practice gap that exists because of limited yoga centers and professionals.
| S-EPMC7168227 | biostudies-literature
Project description:Child feces are an important source of fecal exposure in household environments. Typically, one of two behaviors is necessary to mitigate this risk: either caregivers dispose of their children's feces into a latrine or children learn how to use a latrine. Although past studies have examined factors associated with these two behaviors collectively (i.e. "safe disposal"), there is a need to separately analyze these distinctive practices to better inform programming. This study aims to quantitatively examine contextual and psychosocial factors influencing caregiver safe disposal and, separately, child latrine training. We surveyed 791 primary female caregivers, who reported on 906 children <5 years old, across 74 villages in rural Odisha, India. At their last defecation event, 38% of children used the latrine and another 10% had their feces safely disposed of into the latrine. Since caregiver safe disposal was rare, we instead assessed safe disposal intention. We used linear regression and multilevel mixed effects models to examine contextual and psychosocial factors. For contextual factors, we found caregivers had stronger safe disposal intention when they came from wealthier households and had greater informational support, but weaker intention when their latrine was near the household. Caregivers more intensely practiced latrine training with their child when they themselves used the latrine for defecation, the latrine was fully intact, and they had greater instrumental support. For psychosocial factors, caregivers had stronger safe disposal intention when their households expected them to practice safe disposal, they felt strongly committed to the behavior, and had a plan for what to do when faced with a water shortage. Caregivers more intensely taught their child how to use the latrine when they believed their child was at risk of becoming sick if they practiced open defecation (OD); viewed child OD as unbeneficial; liked teaching their child; personally felt it was important for the child's father to help; felt confident in their ability to teach their child; and had greater action control over their training practice. Interestingly, caregivers put less effort into latrine training when they felt more concerned for their child's safety when the child defecated outside. These findings underscore the critical need to separately assess unique child feces management (CFM) practices and also provide a road map for practitioners on the types of behavior change strategies to consider in their CFM programming.
| S-EPMC9462565 | biostudies-literature
Project description:Helicobacter fennelliae (H. fennelliae) is associated with human gastroenteritis; however, H. fennelliae was isolated and confirmed by phenotypic and genotypic identification from a non-diarrheal child stool sample in Cambodia. Antimicrobial susceptibility testing demonstrated that this isolate had a high minimal inhibitory concentration against macrolides and quinolones, which are first-line antibiotic treatment choices for Campylobacter infections. Consequently, macrolides and quinolones were likewise expected to be ineffective against Campylobacter-like organisms such as H. fennelliae. This isolate warranted further genetic characterization to better understand associated antibiotic resistance mechanisms. Resistant pathogens from asymptomatic diarrheal cases are likely underestimated, and as such colonized individuals may spread resistant organisms to local community members and the environment.
| S-EPMC5975586 | biostudies-literature