The impact of a rural sanitation programme on safe disposal of child faeces: a cluster randomised trial in Odisha, India

Background: Unsafe disposal of child faeces is persistent and may lead to considerable impact on the health of young children. Research is limited on the impact of sanitation or hygiene interventions to improve child faeces disposal practices. Methods: In the context of a randomised controlled trial to assess the health impact of a programme in Odisha, India, to promote rural sanitation under the Government of India's Total Sanitation Campaign, we explored whether the intervention affected the safe disposal of faeces of children under05 years of age. Results: At baseline, 1.1% of households practised 'safe' disposal of child faeces, either disposing it in a toilet or by burial. The intervention increased safe disposal of child faeces to 10.4% in intervention households, compared to 3.1% in the control households (RR 3.34; 95% CI 1.9905.59). This increase in safe disposal is attributable to increases in latrine presence in the intervention communities; the intervention did not change safe disposal practices above and beyond the increase in latrine coverage. Conclusions: The very modest increase in safe disposal, while statistically significant, is not likely to have consequential health benefit. To achieve open defecation free communities, sanitation interventions will need to develop behaviour change approaches to explicitly target safe disposal behaviours.