The importance of safe handling and disposal of child faeces given its potential role in disease transmission are increasingly recognized. Household surveys demonstrate that the burying of child faeces (‘dig-and-bury’) is common in several countries, especially in sub-Saharan Africa and South-east Asia. Disposal with garbage is widely practised in middle- and high-income countries and is becoming increasingly common in urban areas of low-income countries. The safety of these two approaches is difficult to assess given the limited evidence available and we therefore sought the opinion of experts in the field of sanitation to support advocacy around the topic. We report the findings of an anonymous expert (Delphi) consultation on the safety of these two child faeces disposal methods. There was almost unanimous agreement these should be considered neither safe nor improved. A range of arguments was provided to support this position, including proximity of solid waste and burial sites to the home and children’s play areas and that neither practice would be acceptable for adults. The consultation also highlighted gaps in the current evidence base that should be addressed to gain a fuller insight into the risks involved in these two forms of sanitation with a view to providing both programmatic and normative guidance. In particular further work is needed to assess the potential for exposure to faecal matter in solid waste in low- and middle-income countries and to elucidate the predominant practices of child faeces burial including proximity to the home or infant play areas as well as depth of burial.
Half of the global population menstruate as part of their life cycle. This involves water, sanitation, and hygiene (WASH) needs that are often overlooked. Experience from the Millennium Development Goals shows that states focus on targets that are measured globally. Data and indicators on menstrual hygiene management (MHM) for women and girls can have a positive impact on raising awareness, national policy making, and in finding sustainable WASH sector solutions. With this paper, we explore the possible use of Joint Monitoring Programme for Water Supply and Sanitation estimates for representing women and girls’ unique WASH experience, through a focus on MHM. We reviewed definitions of MHM alongside indicators monitored by the JMP and calculated estimates for 18 case-study low- and middle-income countries. Consultation with a broad range of experts identified open defecation and handwashing indicators as the best proxy indicators for inadequate MHM. Globally around half a billion women (13 per cent) defecate in the open and likely lack privacy for MHM. Data on handwashing suggest that a lack of cleansing materials is a particular challenge for MHM. In six of 10 study countries with data, over three-quarters of women lacked handwashing facilities with water and soap. Further research is needed to establish the validity of various aspects of these proxies and to gain greater understanding of the principal WASH-related challenges and barriers faced by women. Nevertheless, it seems clear that interventions among communities with highest open defecation rates and lowest handwashing levels are needed to address barriers to MHM.