Child Faeces Management Project moves to next phase

The partnership between the International Water Centre (IWC), Solomon Islands National University (SINU) and London School of Hygiene and Tropical Medicine partnerships reached an exciting milestone this month with the release of their Phase 1 Research Report on safe Child Faeces Management (CFM) in the Solomon Islands.

The safety of CFM is particularly relevant in the Solomon Island where diarrhoea is a leading cause of childhood mortality, causing almost 25% of childhood deaths. Child malnutrition and stunting affects 33% of children, and of the 80% of the population living in rural areas, there is still 80% open defecation and only 16% have a handwashing facility with soap.

According to IWC Project Officer, Water Sanitation and Hygiene, Rosie Sanderson, the formative research helped the team to better understand the knowns and unknowns of CFM in five selected villages from provinces where Community-led Total Sanitation (CLTS) implementation had occurred previously.

“Child faeces management is a routine behaviour, and often undertaken by parents without much conscious and planned thought, “Rosie explains.

“Rather, parents are motivated by a desire to look after their children (nurture) and for them to be happy and healthy. Parents tended to be disgusted by the poo of others and by the thought of their child (or a dog) coming into contact with the poo, but not so much specifically having to deal with the poo of their own children.”

“From a behavioural perspective, this meant parents tended to move the poo from the ground where the child defecated, to somewhere else out of the way – though that “out of the way” place was not always safe – the mangroves, the beach, the stream, or at the base of the bananas in the garden.”

While it is acknowledged that hygiene practices, including handwashing, are an important part of safe CFM, the target behaviour for this project was for child faeces, where possible, be moved to a latrine or toilet. This option is considered to be the safest by the World Health Organisation (WHO) and have broad consensus with experts globally.

“Some parents already practice safe CFM, and our challenge is to motivate more parents to do this and to normalise this behaviour,” Rosie said.

The formative research also explored how fathers were involved in CFM and what sorts of social, environmental, and epistemological barriers might hinder their involvement.

The project explicitly recognised that promoting changes to how families manage their children’s sanitation could, if not appropriately considered and enacted, increase women’s domestic workloads and/or contribute to the risk of Gender-Based Violence perpetrated by men if domestic gender norms are challenged.

Rosie said the team conducted the research activities separately with mothers and with fathers and determined that safe CFM can be promoted as an issue for parents because nurturing and looking after their children were considered a high priority for both mothers and fathers.

The formative research has revealed there are several levers that could be employed to support behaviour change in safe faeces disposal as part of safe CFM, including:

• Removing barriers and addressing convenience (for example location and accessibility of latrines, tools to move poo etc)
• Rewarding and amplifying the relevant motives for safe CFM behaviours
• Supporting the formation of safe CFM habits (by helping parents plan and normalising the behaviours)
• Filling knowledge and awareness gaps (for example that children’s faeces can be as harmful as adults)

The findings have already been shared with the Solomon Islands Sanitation Working Group convened by UNICEF and RWASH (Rural Water, Sanitation and Hygiene, under the Ministry of Health and Medical Services), and the feedback was great with the working group members discussing the gap in the sanitation approach related to CFM and what could be done about it.

“There was broad support for incorporating the findings of our research into their community engagement approach, and we are currently preparing an integrated package of activities that use the behavioural levers.”

The team will be presenting their findings at the UNC’s Water and Health conference in October.

A picture is worth a thousand words – collecting data using picture cards in Solomon Islands

The failure to separate and contain the faeces of infants and young children, causes significant human health risks to Solomon Islanders. Many situational factors influence the way in which child faeces is managed, including low rates of access to safe sanitation facilities, varying knowledge and beliefs around children’s faeces, and the higher potential for transmission of pathogens from child faeces to children because of hand-to-mouth behaviours. While there is increasing focus on trying to close the sanitation gap for people living in the Solomon Islands, the safe management of children’s faeces is seldom considered. 

The project aims to develop a behaviour change intervention that promotes safe child faeces management in rural Solomon Islands villages. To do so, the research team is conducting formative research to learn about current child faeces management practices, attitudes, motives (what makes people do or not do certain things related to child faeces management), and the different roles of men and women in childcare activities.

One of the picture cards given to the community. Photo: IWC.

The research project Promoting Safe Child Faeces Management in Solomon Islands led by the International WaterCentre at Griffith University in partnership with the Solomon Islands National University and the London School of Hygiene & Tropical Medicine, addressees this issue.

The project aims to develop a behaviour change intervention that promotes safe child faeces management in rural Solomon Islands villages. To do so, the research team is conducting formative research to learn about current child faeces management practices, attitudes, motives (what makes people do or not do certain things related to child faeces management), and the different roles of men and women in childcare activities.

Talking about faeces and sanitationcan be uncomfortable for most people. Likewise, identifying your own motives for doing something that is normally a habit and talking about gender roles and norms can be difficult and complex. To overcome these difficulties, the research team opted to base the research interviews around pictures instead. Sometimes finding words to talk about difficult or complex and abstract topics can be daunting for participants, which is why the picture cards method is appropriate. Using picture cards means respondents can be prompted visually and externalise their replies, which helps to add richness to their responses.

Community members discussing the image cards. Photo: IWC.

It was important to the team that the picture cards we used were contextually relevant and culturally appropriate, which is why we engaged Solomon Islands artists to capture different situations related to daily household activities and child faeces management in rural Solomon Islands.

The picture cards tool is available to download and use from the project website here

If you would like to know more about the research project, please visit our project website.

Community members discussing the image cards. Photo: IWC.

CFM: The Solomon Islands Infant and Child Faeces Management project is managed by the International WaterCentre at the Australian Rivers Institute within Griffith University and delivered with our research partners Solomon Islands National University, and London School of Hygiene and Tropical Medicine. The research is funded by the Australian Aid’s Water for Women Fund. https://watercentre.org/research/research-impacts/promoting-safe-child-faeces-management-in-solomon-islands/

Community members receive research findings reports

By Senior Project Officer Diana Gonzalez Botero

During the first phase of the Pacific Community Water Management Plus (PaCWaM+) research, the teams in Solomon Islands and Fiji spent a week in each study community collecting data about community water management, household water, sanitation, hygiene (WASH) and health situations, water quality, sanitary risk assessment and the socio-economic context. 

After completing the data collection and analysis, the PaCWaM+ team delivered summary reports and posters back to these communities to inform them of the research findings.The four-page summary reporthighlights the key findings related to the WASH situation, strengths and weaknesses of the village water system management, people’s perceptions of the main issues in the community, and the key water management challenges experienced by residents. The report also includes key recommendations that community members and leaders can implement to improve their water services, as well as information about hand hygiene in the context of COVID-19.

The report also includes key recommendations that community members and leaders can implement to improve their water services, as well as information about hand hygiene in the context of COVID-19.

Copies of the village reports were presented to the Village Chief, the Water Committee, and the village nurse in each community. Additionally, posters were displayed in public places where all the community members could see them. 

The water committee members who received thesereports thanked the research team for conducting the research in their community and for bringing back the results. A water committee chairman from one of the communities said, “the report shares a very powerful message to the village”and noted that they have started planning how the committee can work together with the community to improve their water supply system and management practices based on the research findings. 

The PaCWaM+ project is managed by the International WaterCentre at Griffith University and delivered with our research partners, Solomon Islands National University and the University of South Pacific. The research is funded by the Australian Aid’s Water for Women Fund, and is supported by Plan International Australia, Live & Learn Solomon Islands, Habitat for Humanity Australia and Fiji. 

To learn more, visit: www.watercentre.org/research/pcwm 

As the COVID-19 pandemic continues to unfold, governments are focussed on hospital and intensive care unit (ICU) capacity and securing enough PPE for their health workers. In the emergency stages of response the focus on clinical and health sector responses dominated preventative measures. This prompted water, sanitation and hygiene (WASH) focussed multilateral platforms such as Sanitation and Water for All (SWA) and UNICEF to lobby for a great focus on WASH as the first line of defence for this and future epidemics. SWA’s Call to Action highlights that WASH should be available to everyone, and, in line with the Sustainable Development Goals, eliminate inequalities and leave no-one behind.

Of all the elements of WASH, handwashing with soap is a particularly critical one. SARS-CoV-2 is a virus with a lipid layer broken down by soap, and so washing hands with soap has never been more important for preventative health. Changing human behaviours is notoriously difficult: shifting hygiene and handwashing behaviours has been one of the toughest nuts to crack in WASH, and equally hard to measure. As videos of handwashing with soap (HWWS) go viral in social media and signs are plastered in public places more than ever, are we witnessing a renaissance for handwashing? If we are, it will have benefits for not only preventing the spread of covid-19 but also other water-borne diseases with high morbidity and mortality rates like diarrhoea.

Yet so many communities lack the facilities to enact this barrier of defence, as currently highlighted by the WHO/UNICEF Joint Monitoring Program. Globally 1 in 3 people do not have basic handwashing facilities at home (WSSCC), the bulk of them in lower and middle income countries.  The situation in healthcare facilities is particularly alarming: 1 in 4 have no clean water on site; and 1 in 5 have no decent toilets (WaterAid). Of Australia’s nearest neighbours Timor Leste, only 28% of households have access to basic handwashing facilities (with water and soap). In Indonesia, 38% of the rural population (45 million) and 22% of the urban population (31 million) have no handwashing facility at all in their household (JMP 2017). Indonesia has registered 22,000 cases as of May but health specialists suggest this is probably an underestimate due to low levels of testing. In many instances even if households want to increase handwashing they are constrained by inequitable water access.

In the five months since covid-19 started it has spread to more than 180 countries and 5 million people in that short space of time. From where I sit (at home in Australia), the data being presented in global press overwhelmingly emphasises the case loads of developed or middle income countries (e.g. US, Russia, South Korea, Italy, Brazil). Cases reported in countries with less robust healthcare and monitoring systems are less represented. Is this because they have fewer cases, or are less able to accurately measure them? It may be years before we know the answer to this, and this itself represents the possible inequitable toll the virus may take.

The impacts of the COVID-19 pandemic on equity will take time to be revealed. In Australia, restrictions are having gendered impacts in essential services on women who are over-represented as nurses, carers and teachers, in access to paid work where more women have left employment due to economic downturn, and in the household where studies are showing women have taken on more of the domestic load. In contexts where access to WASH services is already challenging there are already well documented gender and social inclusion issues. How are covid-19 risks and restrictions altering or exacerbating existing inequalities in accessing WASH? What about in densely populated areas or in water scarce or flood-prone areas? WASH professionals need to consider intra- and inter-household equity issues within a do-no-harm framework.

Covid-19 is highlighting inequalities within households and societies and between countries. There is no doubt that WASH is a first line of defence against this pandemic and there cannot be adequate responses without adequate WASH. We must understand the complexities and nuances of delivering adequate WASH as we continue to work towards improving these services and decreasing inequalities as we do so.

The blog author, Bronwyn Powell is also a Water and WASH Specialist with over 20 years’ experience in the Asia-Pacific.  

Inadequate water, sanitation and hygiene (WASH) services impact on the health, livelihoods and wellbeing of many families around the world. Learn more in our Introduction to WASH Development Online Training Program. Details here. 

Read more about IWC’s work in addressing social and gender inclusion issues in Fiji and Indonesia via the Australia government supported grant Engaging corporate actors for inclusive WASH-at-work linked to the Water for Women Fund.

Banner image courtesy of Clear Water.