Promoting Safe Child Faeces Management in Solomon Islands

Purpose

The lack of safe infant and child (U/5) faeces management (CFM) is a critical issue in Solomon Islands, as it is in many countries¹. Unsafe CFM, or the failure to separate and contain the faeces of young children, causes significant human health risks to Solomon Islanders, because of a confluence of situational factors which exacerbate unsafe CFM. These include low rates of access to safe sanitation facilities, varying knowledge and beliefs around the safety of the faeces of children, and the higher potential for transmission of pathogens from infants’ faeces to children because of their playing behaviours in their environment, which brings them in contact with contaminated surfaces and objects.

A complicating factor for improving child faeces management is that currently, it is likely that women and older children, usually siblings, have responsibility for similar childcare activities, and an improvement in CFM practices could further increase the burden or work and responsibility on women and children. However, challenging entrenched gender norms is a long and slow process and in some instances can create risk of harmful backlash to women and children, if not done safely. Serious backlash – rejection by others that the responsibility for safe CFM should be shared with them and which results in abuse – could be exhibited by some men, but also by other women, who may reject modernisation of gender roles.

Recent advances globally in designing behaviour change intentions for sanitation and hygiene have replaced or complemented educational approaches with a systematic consideration of technological, psychosocial and contextual determinants. But the lack of consideration of epistemologies, or local-ways-of-knowing, and the missed opportunity to disrupt gender inequitable CFM roles, through CFM interventions, has been criticised^2,3.

Solomon Islands Government is committed to improving sanitation across all rural areas, and is implementing demand-based approaches, in particular CLTS. At present the Solomon Islands CLTS approach doesn’t explicitly address CFM and there is an opportunity to incorporate a CFM component, or implement a subsequent intervention that complements CLTS with the aim to explicitly address CFM.

The safety of CFM is particularly relevant in the Solomon Islands (SI) because:

• Diarrhoea is a leading cause of childhood mortality, causing ~25% childhood deaths⁴
• Child malnutrition and stunting affects 33% children⁴
• 80% population are rural, where there is 80% open-defecation, and 16% have a handwashing facility with soap⁴

The National Sanitation Plan⁵ and community engagement guidelines outline the approach to improve sanitation and hygiene. However, they don’t currently address CFM despite young children comprising 15% of the population⁶. There are no local communication materials for CFM.

Research approach

The overall approach of the research involves two phases of research:

• Phase 1: formative research to develop a CFM behaviour change intervention, with pretesting of elements of the CFM intervention
• Phase 2: piloting of CFM intervention using a randomised control trial to assess potential outcomes (effects on targeted determinants, and effects on improving CFM and gender-inequitable CFM), implementation processes, and inform refinement of the intervention.

The formative research will be conducted in two provinces, where there has been CLTS intervention recently. The intervention will be trialled in two provinces where CLTS implementation is ongoing. These provinces will most likely be Guadalcanal, and Malaita or Isabel.

Image Credit: Diana Gonzalez Botero