Effect of Positive Deviance Approach on Promotion of Safe Disposal of Child’s Faeces in Rural Tamil Nadu: A Community-Based Quasi-Experimental Study

S Nancy; Gayathri S; Udhayakumar U; Thirumeni S; Govindarajan PK; Mujibur Rahman K

doi:10.55489/njcm.140920233237

Authors

S Nancy Vinayaka Mission’s Medical College and Hospital, Vinayaka Mission’s Research Foundation – Deemed to be University (VMRF-DU), Karaikal, Puducherry, India https://orcid.org/0000-0001-5825-1126
Gayathri S Vinayaka Mission’s Medical College and Hospital, Vinayaka Mission’s Research Foundation – Deemed to be University (VMRF-DU), Karaikal, Puducherry, India
Udhayakumar U Vinayaka Mission’s Medical College and Hospital, Vinayaka Mission’s Research Foundation – Deemed to be University (VMRF-DU), Karaikal, Puducherry, India
Thirumeni S Vinayaka Mission’s Medical College and Hospital, Vinayaka Mission’s Research Foundation – Deemed to be University (VMRF-DU), Karaikal, Puducherry, India
Govindarajan PK Vinayaka Mission’s Medical College and Hospital, Vinayaka Mission’s Research Foundation – Deemed to be University (VMRF-DU), Karaikal, Puducherry, India
Mujibur Rahman K Vinayaka Mission’s Medical College and Hospital, Vinayaka Mission’s Research Foundation – Deemed to be University (VMRF-DU), Karaikal, Puducherry, India

DOI:

https://doi.org/10.55489/njcm.140920233237

Keywords:

child’s faeces, safe disposal, toilet usage, positive deviance, quasi-experimental

Abstract

Background: Unsafe disposal of child’s faeces plays a crucial role in disease transmission and environmental pollution. These areas are overlooked by many sanitation promotion interventions. The objective was to determine the effect of Positive Deviance (PD) approach on safe disposal of child’s faeces among households who owned a toilet.

Methodology: A community-based quasi-experimental study was carried out in the four field practice villages of UHTC, Villupuram for 18 months. Households who owned a toilet and had a child <5 years were included. After IEC clearance, information was collected from a representative sample of 100 households before intervention and another 100 households after intervention. PD approach was applied for six months to promote safe disposal practices. Data was analyzed in SPSS 24 software. Chi square test and Effect size (Cramer’s V) were employed.

Results: Before intervention, only 3% households disposed the faeces into a toilet. While, after intervention, almost 38% households disposed in the toilet (c²=37.39; df=1; p=0.001). Effect size was found to be 0.43.

Conclusion: PD approach demonstrated considerable improvements in safe disposal of child’s faeces in rural settings. Further, in order to sustain the behaviour, change frequent reinforcement of key messages at frequent intervals need to emphasized.

References

World Health Organization and United Nations Children's Fund. Core Questions on Drinking-Water and Sanitation for Household Surveys. Geneva, Switzerland; 2006. Available from: http://www.who.int/water_sanitation_health/moni-toring/oms_brochure_core_questionsfinal24608.pdf. [Last accessed on 2023 Jun 15].

Bawankule R, Singh A, Kumar K, Pedgaonkar S. Disposal of children's stools and its association with childhood diarrhea in India. BMC Public Health 2017;17:12. Doi: https://doi.org/10.1186/s12889-016-3948-2 PMid:28056888 PMCid:PMC5217632

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4). Mumbai; 2016. Available from: http://rchiips.org/nfhs/NFHS-4Report.shtml. [Last accessed on 2023 Jun 15].

Brown J, Cairncross S, Ensink JH. Water, sanitation, hygiene and enteric infections in children. Arch Dis Child. 2013;98(8):629-34. Doi: https://doi.org/10.1136/archdischild-2011-301528 PMid:23761692 PMCid:PMC3717778

WSP, UNICEF. Part 1 of 2: Child Feces Disposal in Bangladesh: World Sanitation Program; 2014:1 - 4. Available from: http:// www.wsp.org/sites/wsp.org/files/publications/WSP-Child-Feces-Disposal-Bangladesh-Part1.pdf. [Last accessed on 2023 Jun 15].

Majorin F, Torondel B, Chan GKS, Clasen T. Interventions to improve disposal of child faeces for preventing diarrhea and soil-transmitted helminth infection. Cochrane Database Syst Rev 2019;9(9):CD011055. Doi: https://doi.org/10.1002/14651858.CD011055.pub2 PMid:31549742

Tufts University. Basic field guide to the Positive Deviance Approach; 2010. Available from: https://static1.squarespace. com/static/5a1eeb26fe54ef288246a688/t/5a6eca16c83025f9bac2eeff/1517210135326/FINALguide10072010.pdf. [Last accessed on 2023 Jun 15].

Baxter R, Taylor N, Kellar I, Lawton R. Learnings from posi-tively deviant wards to improve patient safety: an observa-tional study protocol. BMJ Open 2015;5:1-7. Doi: https://doi.org/10.1136/bmjopen-2015-009650 PMid:26656985 PMCid:PMC4680003

Chamber R. Rapid Appraisal: rapid, relaxed and participatory. Patna: Institute for Participatory Practices (PRAXIS); 2001. p.17-23.

Saha I, Paul B. Essentials of Biostatistics. 2nd ed. Kolkata: Aca-demic Publishers; 2017.p.63-74.

Preeti PS, Sahoo SK, Biswas D, Dasgupta A. Unsafe disposal of child faeces: a community-based study in a rural block in West Bengal, India. J Prev Med Public Health 2016;49(5):323-8. Doi: https://doi.org/10.3961/jpmph.16.020 PMid:27744673 PMCid:PMC5066419

Majorin F, Nagel CL, Torondel B, Routray P, Rout M, Clasen TF. Determinants of disposal of child faeces in latrines in ur-ban slums of Odisha, India: a cross-sectional study. Trans R Soc Trop Med Hyg 2019;113(5):263-72. Doi: https://doi.org/10.1093/trstmh/try142 PMid:30668852 PMCid:PMC6515899

Islam M, Ercumen A, Ashraf S, Rahman M, Shoab AK, Luby SP et al. unsafe disposal of feces of children < 3 years among households with latrine access in rural Bangladesh: Associa-tion with household characteristics, fly presence and child diarrhea. Plos One 2018;13(4):e0195218. Doi: https://doi.org/10.1371/journal.pone.0195218 PMid:29621289 PMCid:PMC5886761

Aliyu AA, Dahiru T. Factors associated with safe disposal practices of child's faeces in Nigeria: Evidence from 2013 Ni-geria demographic and health survey. Niger Med J 2019;60(4):198-204. Doi: https://doi.org/10.4103/nmj.NMJ_3_19 PMid:31831940 PMCid:PMC6892328

Freeman MC, Majorin F, Boisson S, Routray P, Torondel B, Clasen T. The impact of a rural sanitation programme on safe disposal of child faeces: a cluster randomized trial in Orissa, India. Trans R Soc Trop Med Hyg 2016;110:386-92. Doi: https://doi.org/10.1093/trstmh/trw043 PMid:27496512 PMCid:PMC5916378

Caruso BA, Sclar GD, Routray P, Nagel CL, Majorin F, Sola S et al. Effect of a low-cost, behaviour-change intervention on la-trine use and safe disposal of child faeces in rural Odisha, In-dia: a cluster-randomised controlled trial. Lancet Planet 2022;6(2):110-21. Doi: https://doi.org/10.1016/S2542-5196(21)00324-7 PMid:35150621

Abalo J. The positive deviance approach as a behavior change strategy for promoting sustainable sanitation practices in-cluding eliminating open defecation. In: Handbook of Re-search on Urban Governance and Management in the Devel-oping World. 1st ed. Uganda: University of Begen; 2018.p.13. Doi: https://doi.org/10.4018/978-1-5225-4165-3.ch021

Swachh Bharat Mission - Gramin. Department of Drinking Water and Sanitation. Ministry of Jal Shakti; 2017. Available on: http://swachhbharatmission.gov.in/sbmcms/index.htm. [Last accessed on 2023 Jun 15].