title: The impact of a rural sanitation programme on safe disposal of child faeces: a cluster randomised trial in Odisha, India.
abstract: Unsafe disposal of child faeces is persistent and may lead to considerable impact on the health of young children. Research is limited on the impact of sanitation or hygiene interventions to improve child faeces disposal practices.
  
  
  
  In the context of a randomised controlled trial to assess the health impact of a programme in Odisha, India, to promote rural sanitation under the Government of India's Total Sanitation Campaign, we explored whether the intervention affected the safe disposal of faeces of children under-5 years of age.
  
  
  
  At baseline, 1.1% of households practised 'safe' disposal of child faeces, either disposing it in a toilet or by burial. The intervention increased safe disposal of child faeces to 10.4% in intervention households, compared to 3.1% in the control households (RR 3.34; 95% CI 1.99-5.59). This increase in safe disposal is attributable to increases in latrine presence in the intervention communities; the intervention did not change safe disposal practices above and beyond the increase in latrine coverage.
  
  
  
  The very modest increase in safe disposal, while statistically significant, is not likely to have consequential health benefit. To achieve open defecation free communities, sanitation interventions will need to develop behaviour change approaches to explicitly target safe disposal behaviours.
authors: Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, Georgia 30322, USA matthew.freeman@emory.edu.
authors: Matthew C
authors: MC
authors: Freeman
authors: Department of Disease Control, Faculty of Infectious and Tropical Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors: Fiona
authors: F
authors: Majorin
authors: Department of Disease Control, Faculty of Infectious and Tropical Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors: Sophie
authors: S
authors: Boisson
authors: Department of Disease Control, Faculty of Infectious and Tropical Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors: Parimita
authors: P
authors: Routray
authors: Department of Disease Control, Faculty of Infectious and Tropical Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors: Belen
authors: B
authors: Torondel
authors: Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, Georgia 30322, USA Department of Disease Control, Faculty of Infectious and Tropical Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors: Thomas
authors: T
authors: Clasen
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005191:Family Characteristics; D005243:Feces; D005260:Female; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D006920:Hygiene; D007194:India; D007223:Infant; D008297:Male; D011247:Pregnancy; D015397:Program Evaluation; D012424:Rural Population; D012499:Sanitation; D014038:Toilet Facilities
keywords: Child faeces; Diarrhoea; Faecal exposure; India; Sanitation; WASH