The association of child feces disposal, and Water, Sanitation, and Hygiene (WASH) toward child health in the urban slum, Indonesia

Agestika, Lina (2019) The association of child feces disposal, and Water, Sanitation, and Hygiene (WASH) toward child health in the urban slum, Indonesia. Masters thesis, Hokkaido University.

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Abstract

Indonesia is one of low-middle income country that intended to resolve the problem about access to sanitation and hygiene as well as child malnutrition. Achieving goal for the provision of basic sanitation, Indonesia still face increasing number of households that performing unsafe child feces disposal. Furthermore, from the Indonesian Health Report in 2013, that proper handwashing rates at critical times in Indonesia only reached 47% even though handwashing facilities were found to cover more than 90% of the population. We involved 41 elementary school children and 183 mothers as main caregivers with under-five children living in an urban slum of Indonesia for study participants. The master thesis devided into two studies; (1) handwashing skill, hand bacteria reduction and child nutritional status of elementary school children and; (2) unsafe child feces disposal as the risk factor of child stunting in an urban slum of Indonesia. The measures for the first study were: 1) handwashing skill observation using a checklist, 2) hand bacteria assessment before and after handwashing using a swab, and 3) child anthropometry (height and weight measurement). Moreover, we conducted an in-depth interview, measuring child’s height and observing child feces disposal and WASH for each household for the second study. The relationships between handwashing skill, bacterial assessment, and child nutritional status were analyzed using bivariate Spearman’s correlation tests and differences were studied using paired t-tests for the first study. On the other hand, we performed binary and multivariable logistic regression analysis for the contributing factors related unsafe child feces disposal and child stunting for the second study. iii From the first study we aimed to evaluate elementary school children’s awareness of handwashing skills based on WHO hand hygiene guidelines and their effectiveness in reducing total hand bacteria. We also aimed to analyze the relationship between handwashing skills and child nutritional status. Then for the second study, focusing on manifestation of socio-economic factors, child characteristic and environmental factors, this recent study tried to investigate the prevalence of unsafe child feces disposal, the risk factors of mother on performing unsafe child feces disposal and its effect to child stunting. The result showed that handwashing reduced total bacteria by 0.70 log CFU/hand. Allocating time specifically to pouring water before lathering significantly lowered total bacteria after handwashing. Moreover, neglecting hand drying was identified as a potential factor that caused hand contamination and lowered child nutritional status. As the result form the second study, forty-five percent of mothers performed unsafe child faeces disposal. A multivariate logistic regression analysis revealed that unsafe child faeces disposal increased the risk of child stunting (AOR: 2.56; 95% CI: 1.10-5.96). Having a lower than secondary school education level (AOR: 2.85; 95% CI: 1.38-5.89) and using a shared toilet (AOR: 14.74; 95% CI: 2.49-87.17) increased the mothers’ odds of performing unsafe child faeces disposal, as did children’s age of lower than 2 years (AOR: 2.51; 95% CI: 1.25-4.99). The conclusion of the first study are factors that affect total bacteria reduction after handwashing are: (1) time duration for handwashing, especially for wetting hands before lathering; and (2) performing comprehensive handwashing skills including drying hands with a single paper towel. In addition, improper hand drying which results in hand contamination may lead to a lowering of child nutritional status. Moreover, in the second study, low prevalence of unsafe child faeces disposal was insufficient preventing stunting. The provision of adequate sanitation systems for each household and using washable diaper or toilet training in an early age for young children might eliminate potential sources of faecal contamination that lead to child stunting.

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