title: Systematic review of evidence on the effectiveness of safe child faeces disposal interventions.
abstract: OBJECTIVE
  To review and synthesise the available evidence on the effectiveness of interventions targeting unsafe child faeces disposal in reducing this behaviour and improving child health in low- and middle-income countries.
  
  
  METHODS
  PubMed and EMBASE were systematically searched. Studies meeting the inclusion criteria were reviewed and key information on study methodologies and outcomes were extracted.
  
  
  RESULTS
  A total of 1048 articles were screened, and eight studies representing five countries were included for the review. Three were randomised controlled trials, and five were prospective cohort studies. There was wide variability across studies in the definition of 'safe disposal' of child faeces. Six studies reported the change in child faeces disposal practices associated with safe child faeces disposal interventions. However, only one study found a significant improvement in this behaviour. Two of the six studies that evaluated the health impact of delivered interventions found significant reductions in childhood diarrhoea associated with safe faeces disposal practices, and one study reported a positive effect on child growth and ascariasis. Only one study was identified that delivered a single intervention solely focused on safe child faeces disposal. Unfortunately, this study did not investigate the impact of this intervention on child health.
  
  
  CONCLUSIONS
  There are major methodological limitations in studies that assessed the impact of safe child faeces disposal interventions. The health impact of these interventions is inconclusive because the quality of the current evidence is poor. Randomised controlled trials are urgently needed to assess the impact of safe faeces disposal interventions on child health.
authors.affiliation: Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Morita
authors.affiliation: Water, Sanitation and Hygiene Section, UNICEF Ethiopia, Addis Ababa, Ethiopia.
authors.forename: Samuel
authors.initials: S
authors.lastname: Godfrey
authors.affiliation: Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. cmgeorge@jhsph.edu.
authors.forename: Christine Marie
authors.initials: CM
authors.lastname: George
mesh_terms: D002648:Child; D003906:Developing Countries; D005243:Feces; D006801:Humans; D012499:Sanitation / Q000379:methods*
keywords: child growth; children; crecimiento infantil; croissance de l'enfant; diarrea; diarrhoea; diarrhée; eliminación segura de heces infantiles; enfants; low- and middle-income countries; niños; pays à revenus faibles ou intermédiaires (PRFI); países con ingresos bajos y medios; revisión sistemática; revue systématique; safe child faeces disposal; systematic review; élimination sûre des excréments d'enfants