Infant and Young Child Faeces Management: Potential enabling products for their hygienic collection, transport, and disposal in Cambodia Authors: Molly Miller-Petrie, Lindsay Voigt, Lyn McLennan, Sandy Cairncross, Marion Jenkins Table of contents Table of contents ................................................................................................................... I List of tables and figures ....................................................................................................... II Acknowledgements .............................................................................................................. III Acknowledgement of academic support ........................................................................... III Acknowledgement of other support .................................................................................. IV Abstract................................................................................................................................. V Background ....................................................................................................................... V Methods ............................................................................................................................ V Results .............................................................................................................................. V Discussion ......................................................................................................................... V Introduction ........................................................................................................................... 1 The diarrheal disease burden ............................................................................................ 1 Faeces management for infants and young children ......................................................... 1 Enabling products for faeces management ....................................................................... 3 The Cambodian context .................................................................................................... 4 Aims and objectives: ............................................................................................................. 6 Project aim ........................................................................................................................ 6 Project objectives .............................................................................................................. 6 Materials and Methods .......................................................................................................... 7 Stage one recruitment and data collection......................................................................... 7 Stage two recruitment and data collection ......................................................................... 9 Stage one data analysis .................................................................................................... 9 Stage two data analysis .................................................................................................. 10 Global product inventory ................................................................................................. 10 Results ................................................................................................................................ 11 Stage one: Household surveys ........................................................................................ 11 Participant and household characteristics ................................................................... 11 Characteristics of children under five ........................................................................... 13 Village characteristics .................................................................................................. 14 Attitudes and perceptions on hygiene .......................................................................... 14 Children’s latrine use ................................................................................................... 15 Child cleaning and hand washing ................................................................................ 15 Children’s faeces management practices .................................................................... 17 Tools for children’s sanitation ...................................................................................... 21 Predictors of hygienic child faeces disposal................................................................. 23 Stage two: Focus group discussions ............................................................................... 24 Summary ..................................................................................................................... 24 Global inventory of children’s sanitation products ............................................................ 25 Cambodian products ................................................................................................... 26 Discussion .......................................................................................................................... 27 Explaining hygienic disposal practices ............................................................................ 27 Perceptions and attitudes ................................................................................................ 27 Consumer interest and product design ............................................................................ 28 Latrines ....................................................................................................................... 29 Scoops and shovels .................................................................................................... 29 Potties and reusable diapers ....................................................................................... 30 Hygiene practices in the faeces management process .................................................... 31 Conclusions .................................................................................................................... 32 Limitations & Recommendations ......................................................................................... 35 Study limitations .............................................................................................................. 35 Recommendations .......................................................................................................... 35 References ......................................................................................................................... 37 Annexes .............................................................................................................................. 39 1 – Complete focus group discussion report .................................................................... 39 2 – Global inventory of faeces management products ..................................................... 39 3 – Household survey questionnaire ............................................................................... 39 3.1 – Village survey questionnaire ................................................................................... 39 4 – Household survey consent form ................................................................................ 39 5 – Focus group discussion question guide ..................................................................... 39 6 – Focus group discussion oral consent form ................................................................ 39 7 – Local ethics approval ................................................................................................. 39 8 – CARE form ................................................................................................................ 39 9 – Student’s questionnaire ............................................................................................. 39 List of tables and figures Table 1 Children's faeces management steps and related hygiene behaviours ..................... 2 Table 2 Participant and household characteristics (N=129) ................................................. 11 Table 3 Characteristics of children under-five (N=145) ........................................................ 13 Table 4 Village characteristics (N=21) ................................................................................. 14 Table 5 Attitudes and perceptions on hygiene ..................................................................... 15 Table 6 Odds of hygienic child faeces disposal by child age, 95%Confidence interval (CI), and p-values ................................................................................................................ 23 Table 7 Explanatory variables and age-adjusted odds of practicing hygienic child faeces disposal, 95%CI, and adjusted p-values ...................................................................... 24 Table 8 Focus group discussion theme matrix .................................................................... 25 Table 9 Faeces management steps and potential tools to facilitate hygienic practice in Cambodia .................................................................................................................... 32 Table 10 Recommended tools to facilitate hygienic faeces management in Cambodia by child age .....................................................................................................................