Defecation practices of young children in a Peruvian shanty town

Little is known about feces disposal practices, their determinants and feas ibility for change, despite their importance in the control of diarrheal di seases. We report here the results of formative research for the developmen t of an intervention to promote sanitary disposal of feces of young childre n. The study was conducted in a densely populated shanty town area of Lima, where water and sanitation systems are scarce. In-depth interviews were un dertaken with mothers, husbands and community leaders. Group discussions we re held with mothers in order to validate findings from the interviews, inv estigate particular topics further and explore reactions to possible interv ention strategies. The principal defecation sites for young children were d iapers, potties, the ground in or near the home, the hill, latrines and flu sh toilets. The main determinants found were the age of the child, the effo rt required by the method, perceptions of dirtiness and the availability of resources. Almost all children under one year of age use diapers but the h igh resource cost of diaper washing is a strong motivation for mothers to m ove their children on as early as possible. Potties were considered the mos t socially acceptable and 'hygienic' defecation method for children between one and three years of age. Nevertheless, defecation directly onto the gro und is common at this age. Potty training is deemed to be quite difficult a nd the long term achievements are determined by the initial training succes s. In most cases, the training process is authoritative and inconsistent. T he use of latrines and flush toilets is not considered appropriate for chil dren until they are three to four years old. Based on these initial findings, a micro-trial was conducted to assess the feasibility and acceptability of promoting greater use of potties and assoc iated practices. The results of the trial were very encouraging and provide d valuable information for the design of a community-wide intervention. Our findings help explain why the emphasis given in most sanitation project s, where efforts have been concentrated on the promotion of latrines, has f ailed to induce their utilization by small children. Sanitation projects sh ould incorporate interventions that will promote hygienic defecation and st ool clearance practices for infants and small children. (C) 1999 Elsevier S cience Ltd. All rights reserved.