Child Feces Disposal in 96436 NIGER Key messages: • In 2012, four in five households (81 percent) surveyed in Niger reported unsafe disposal of the feces of their youngest child under age three. • Even among households with improved toilets or latrines, 23 percent reported unsafe child feces disposal behavior. • Unsafe child feces disposal is more prevalent among households that defecate in the open, those in rural areas, and those that are poorer.1 OVERVIEW Among households with children in their first year of life, 19 percent Safe disposal of children’s feces is as essential as the safe disposal of reported safe disposal, compared to 23 percent of those with children adults’ feces. This brief provides an overview of the available data on aged four (48 to 59 months). A small shift is seen as children grow child feces disposal in Niger and concludes with ideas to strengthen (Figure 3): children are increasingly likely to have their feces left in safe disposal practices, based on emerging good practice. the open or not disposed of. Once children reach four years of age, children are slightly more likely to use a toilet/latrine themselves, The Joint Monitoring Programme for Water Supply and Sanitation or have their feces put or rinsed into one. At these young ages, the (JMP) tracks progress toward the Millennium Development Goal 7 behavior of the child’s caregiver is critical to dispose of their feces target to halve, by 2015, the proportion of people without sustainable safely and shape the child’s toilet training. The main shift by age access to safe drinking water and basic sanitation. The JMP in Niger, however, is for an increase in the percentage of youngest standardized definition for an improved sanitation facility is one that children whose feces are left in the open—which essentially is open hygienically separates human excreta from human contact.2 defecation. In the latest JMP report, only 9 percent of Niger’s population had In the poorest quintile in Niger, only 2 percent of households reported access to improved sanitation in 2012.3 This means that 16 million safe feces disposal for their youngest children under age three, individuals in Niger lacked improved sanitation in 2012, of which compared to three quarters (74 percent) of the richest households 13  million practice open defecation. However, these estimates are (Figure 4). Widening the perspective to all individuals living in based on the household’s primary sanitation facility, and may overlook households with children under age three, 0 percent of members in the sanitation practices of young children. In many cases, children the poorest quintile used a toilet/latrine of any kind, compared to may not be able to use an improved toilet or latrine—because of their 88 percent in the richest quintile. age and stage of physical development or the safety concerns of their caregivers—even if their household has access to one. Between 2006 and 2012, reported safe disposal of child feces increased in Niger, from covering 14 percent of the youngest children per household nationally in 2006, to 20 percent of them in 2012. SUMMARY OF CHILD FECES However, the prevalence of safe disposal in rural areas remained eight DISPOSAL DATA times lower than in urban areas (see Figure 5). While 19 percent of households in Niger reported safe disposal of What Is “Safe Disposal” of a Child’s Feces? their youngest child’s feces, only 7 percent of households reported that their youngest child’s feces were disposed of into an improved The safest way to dispose of a child’s feces is to help the sanitation facility (see Figure 1). This low percentage of households child use a toilet or latrine or, for very young children, to put reporting improved child feces disposal suggests that children under or rinse their feces into a toilet or latrine. For the purposes age three have slightly worse sanitation than the country’s broader of this brief, these disposal methods are referred to as population, where 9 percent use improved sanitation. Virtually all “safe,” whereas other methods are considered “unsafe.” By households (98 percent) practicing open defecation reported unsafe definition, “safe disposal” is only possible where there is child feces disposal (Figure 2). Niger ranked fifth worst (number 34) access to a toilet or latrine. When a child’s feces is put for the proportion of children whose feces are safely disposed, out of or rinsed into an “improved” toilet or latrine, this is termed 38 African countries with available Multiple Indicator Cluster Survey “improved child feces disposal.” (MICS) or Demographic and Health Survey (DHS) data. December 2014 1 FIGURE 1  In 2012, only one-fifth (19 percent) of households in Niger reported that the feces of their youngest child under age three were safely disposed. Percentage of households reporting each feces disposal practice for their youngest child under age three, Niger, 2012 Unsafe Disposal Safe Disposal Left in the open, 7% Put/rinsed into drain or ditch, 1% Child used toilet/latrine Buried, 2% and household (HH) used improved sanitation, 0% Improved Other, 1% Child feces put/rinsed disposal = 7% Missing, 0% in toilet/latrine and HH used improved Safe sanitation, 7% disposal = 19% Thrown into Child used toilet/latrine, garbage, 70% but HH used unimproved sanitation, 0% Child feces put/rinsed in toilet/latrine but HH used unimproved sanitation, 12% FIGURE 2  Even among households with improved FIGURE 3  Child feces disposal behaviors differ sanitation, 23 percent reported unsafe child feces across child age groups. Reported feces disposal practice disposal behaviors. Reported feces disposal practice for children of different ages, Niger, 2012. for households’ youngest child under age 3, by household sanitation facility type, Niger, 2012. 100 5% 7% 10% 2% 2% 1% 2% 16% 20% 80 2% 100 8% 6% 1% 1% 1% 1% 1% % of children 2% 1% 1% 16% 20% 60 80 70% 71% 66% 57% 49% % of children 48% 40 60 85% 78% 76% 20 40 14% 19% 19% 19% 19% 0 1% 2% 9% 20 42% 0 1 2 3 4 2% 1% 1% 1% Child age (years) 0 Open Unimproved Shared Improved defecation (9% of (9% of (9% of Other Thrown into garbage (74% of households) households) households) Left in the open/not disposed of Put/rinsed into toilet/latrine Put/rinsed into drain or ditch Child used toilet/latrine households) Buried Type of sanitation facility used by household (HH) Other Thrown into garbage Left in the open/not disposed of Put/rinsed into toilet/latrine Put/rinsed into drain or ditch Child used toilet/latrine Buried IDEAS FOR CONSIDERATION In Niger, UNICEF has promoted safe disposal of children’s feces since 2012, particularly in cholera-affected areas.4 However, there are few other interventions in Niger aimed at the safe disposal of children’s Behind this national-level data, there is wide variation in child feces feces during the first years of life. The national evaluation criteria and disposal practices, with a greater prevalence of unsafe practices forms used for verification of open defecation free (ODF) villages in among households without access to improved sanitation, in rural Niger do not explicitly consider sanitation for children.5 The major areas, and those that are poorer. For example, unsafe disposal in known barrier to safe child feces disposal in Niger is household rural areas and among the poorest 40 percent of households is worse access to a toilet/latrine, which is a prerequisite of safe child feces than among children overall. Although this brief only focuses on one disposal. Only 9 percent of the population uses improved sanitation, socioeconomic indicator at a time, applying multiple lenses would so it is imperative that household and child sanitation be addressed show even greater extremes of disparity—with the poorest rural simultaneously. In general, sanitation for children under age three has households reporting the greatest prevalence of unsafe disposal. been a neglected area of policy and program intervention in Niger. 2 FIGURE 4  Safe disposal differs across the wealth asset quintiles: safe disposal is almost nonexistent What Is the Impact of Unsafe Disposal among the poorest 60 percent of households, but of Child Feces? reported by 74 percent of the richest households.6 There is widespread belief that the feces of infants and young Reported feces disposal practice for households’ youngest children are not harmful, but this is untrue. In fact, there is child under age 3, by household wealth quintile, Niger, 2012. evidence that children’s feces could be more risky than adult feces, due to a higher prevalence of diarrhea and pathogens— 100 2% 1% such as hepatitis A, rotavirus, and E. coli—in children than in 8% 9% 8% 6% 2% 2% 2% 1% 21% adults.8 Therefore, children’s feces should be treated with the 80 same concern as adult feces, using safe disposal methods % of children 60 that ensure separation from human contact and household 70% 85% 84% 84% contamination. 40 73% In particular, the unsafe disposal of children’s feces may be 20 an important contaminant in household environments, posing 20% a high risk of exposure to young infants.9 Poor sanitation can 0 2% 2% 3% 1% 1% result in substantial health impacts in children, including a Poorest Poorer Middle Richer Richest Wealth quintile of child’s household higher prevalence of diarrheal disease, intestinal worms, enteropathy, malnutrition, and death. The Niger 2012 directory Other Thrown into garbage of health statistics reported that 1.3 million Nigeriens suffer Left in the open/not disposed of Put/rinsed into toilet/latrine from diarrheal disease, of which 1.1 million are children under Put/rinsed into drain or ditch Child used toilet/latrine age four.10 According to the World Health Organization Buried (WHO), most diarrheal deaths in the world (88 percent) are caused by unsafe water, sanitation, or hygiene. More than 99 percent of these deaths are in developing countries, FIGURE 5  Safe disposal remains lower among rural and about eight in every 10 deaths are children.11 Diarrhea households than urban households. Percentage of obliges households to spend significant sums on medicine, households reporting safe feces disposal for their youngest child transportation, health facility fees, and more, and can mean under age three, by urban and rural residence, Niger, 20127 lost work, wages, and productivity among working household members.12 Stunting and worm infestation can reduce children’s intellectual capacity, which affects productivity 100 later in life. The WHO estimates that the average IQ loss per 81% worm infection is around 3.75 points.13 80 65% 60 % of children 40 including key messages in antenatal/newborn care materials and infant and young child feeding guidance provided to parents, 20 ensuring that midwives’ training includes information on safe child 10% 4% feces disposal, and integrating child sanitation information into 0 Urban Rural Urban Rural early childhood development materials and preschool programs • Partnering with the private sector to improve feces management 2006 2012 tools, such as potties, diapers, tools for retrofitting latrines for child use, and scoopers • Improving the enabling environment for management of Given the relatively few programs focusing on children’s sanitation children’s feces, by including specific child feces related criteria in Niger and globally, there is not a strong evidence base of effective in ODF verification protocols and in national sanitation policies, strategies for increasing the safe disposal of children’s feces. Significant strategies, or monitoring mechanisms. knowledge gaps must be filled before comprehensive, practical evidence-based policy and program guidance will be available. Nevertheless, organizations and governments interested in improving DATA SOURCES the management of children’s feces could consider: Unless otherwise specified, all analysis in this brief is based on households’ • Conducting formative research to understand the behavioral self-reported behavior for disposing of child feces, as collected in the 2012 drivers and barriers to safe child feces disposal Niger DHS, which is the latest MICS/DHS available for Niger that records • Strengthening efforts to change the behavior of caregivers through child feces disposal behavior. programs that encourage cleaning children after defecation, potty The MICS and DHS collect data in a generally harmonized manner and hence training children, and using appropriate methods to transport are the basis for this country profile series. However, whereas the DHS collects feces to a toilet/latrine as well as handwashing with soap after fecal data on the youngest child under age five living with the mother for each contact and before preparing food or feeding a child household, the MICS collects data on all children under age three who live • Exploring opportunities to integrate child sanitation into existing with the respondent (mother or caretaker). To maximize comparability, we interventions that target caregivers of young children, such as restricted all analysis to children under age three in all figures, except Figure 3. 3 10 Niger Ministry of Health. 2012. Annuaire des Statistiques Sanitaires du Niger: 2012. Niger: Niger MOH. 11 WHO. 2009. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva: World Health Organization, 23. 12 Favin, M., Naimoli, G., and Sherburne, L. 2004. Improving Health Through Behavior Change: A Process Guide on Hygiene Promotion. Joint Publication 7. Washington, DC: Environmental Health Project (EHP). 13 WHO. 2005. Report of the Third Global Meeting of the Partners for Parasite Control: Deworming for Health and Development. Geneva: World Health Organization, 15. 14 Stanton, B., J. Clemens, K. Azis, and M. Rahamanr. 1987. “Twenty-Four- Hour Recall, Knowledge-Attitude-Practice Questionnaires and Direct Observations of Sanitary Practices: A Comparative Study.” Bulletin of the World Health Organization. Geneva: World Health Organization. 15 Akhtaruzzaman, M. N, and S. N. Islam. 2011. Nutrition, Health and Demographic Survey of Bangladesh—2011: A Preliminary Report. Bangladesh: University of Dhaka, 19. It is likely that self-reports overestimate safe disposal.14 In Bangladesh, for example, although 22 percent of children reportedly either used a toilet/ NOTES latrine or their feces were put or rinsed into the toilet/latrine (according to We’re interested in your thoughts. Have you found different evidence MICS 2006), a structured observation of behavior conducted under UNICEF’s of what works through your own programming? If you have thoughts to Sanitation, Hygiene Education and Water Supply in Bangladesh (SHEWA-B) share, or know of a program that is encouraging the safe disposal of child program in 2007 found only 9 percent of subjects disposed of child feces into a feces, please contact WSP at worldbankwater@worldbank.org or UNICEF toilet/specific pit.15 Regardless of this issue, self-reports are currently regarded at WASH@unicef.org so that we can integrate your information into future as the most efficient method for gauging safe disposal of children’s feces. program guidance. REFERENCES ACKNOWLEDGEMENTS This brief was developed jointly by WSP and the United Nations Children’s 1 Institut National de la Statistique (INS) and ICF International. 2013. Fund (UNICEF) as part of a series of country profiles about sanitation for Enquéte Démographique et de Santé et à Indicateurs Multiples du Niger children under age three. 2012. Niger: INS, and Calverton, Maryland: ICF International. Please see the “Data Sources” section. The findings, interpretations, and conclusions expressed herein are those of 2 The JMP has established a set of standardized definitions to categorize the author(s), and do not necessarily reflect the views of the International improved sanitation, which are used to track progress toward Millennium Bank for Reconstruction and Development / The World Bank and its affiliated Development Goal 7. However, these definitions are not always the same organizations, or those of the Executive Directors of The World Bank or the as those used by national governments. See Progress on Drinking Water governments they represent, or of UNICEF. and Sanitation: Update 2014. 3 WHO/UNICEF Joint Monitoring Programme, 2014. Progress on Drinking © 2015 by International Bank for Reconstruction and Development / The Water and Sanitation: Update 2014. Geneva: World Health Organization. World Bank and UNICEF. 4 Maiga, Taibou Adamou. 2014. Email correspondence. 5 Critères d’évaluation des performances et de certification des villages Photo Credits : © UNICEF/UKLA2012-01117/Kurzen (page 1); © UNICEF/ ATPC (Niger). n.d. http://www.communityledtotalsanitation.org/resource/ UKLA2012-01118/Kurzen (page 4, left); © UNICEF/UNI164943/Terdjman national-protocols-and-guidelines-verification-and-certification. (page 4, right) (Downloaded July 20, 2014.) 6 These asset indices used to classify households into wealth quintiles have not been adjusted to remove drinking water or sanitation variables. 7 Institut National de la Statistique (INS) and ICF International. 2013. Enquête Démographique et de Santé et à Indicateurs Multiples du Niger 2012. Niger: INS, and Calverton, Maryland: ICF International; and Institut National de la Statistique (INS) and Macro International Inc. 2007. Enquête Démographique et de Santé et à Indicateurs Multiples du Niger 2006. Niger: INS, and Calverton, Maryland: Macro International Inc. 8 Feachem, R., D. Bradley, H. Garelick, et al. 1983.  Sanitation and Disease: Health Aspects of Excreta and Wastewater Management. World Bank Studies in Water Supply and Sanitation 3. Chichester, UK: John Wiley & Sons. 9 Gil, A., C. Lanata, E. Kleinau, and M. Penny. 2004. Children’s Feces Disposal Practices in Developing Countries and Interventions to Prevent Diarrheal Diseases: A Literature Review. Strategic Report 11. Peru: Environmental Health Project (EHP). 4