Summer Project: Working in Cambodia

For her summer project, winner of our student photo competition Molly Miller-Petrie is investigating the the management of children’s waste and interest in new hygienic disposal products. Molly’s research has taken her to the Kampong Speu province in Cambodia.

The leaves of the banana trees lining the road begin to blow sideways in the wind, and the temperature takes a merciful plunge below 95 for the first time all day. Soon after, the afternoon rainstorm begins, low lying grey clouds dumping down, turning the red dirt road to mud and making a roaring din on the tin roof over our heads. The din makes it difficult to hear our interviewee, a 24 year old who raises pigs and takes care of her 2 month old and 3 year old children, as she tells us why her children can’t yet use the latrine when they go to the bathroom.

“He’s too small and doesn’t know how to squat”, she tells us, motioning to the three year old. The baby, who she is rocking to sleep in a low lying hammock, only uses disposable diapers, which she tells us are expensive but very easy for her to manage. The used diapers are thrown into a trash pit among the banana trees behind the house. Sometimes, she tells us, she can convince her older child to use a potty which she empties directly into the latrine, a process she demonstrates for us in spite of the rain, her flip-flops squelching in the mud as she shows us how she rinses the potty afterward and stores it upside-down near the round, cement water jars lined up along the house.

This demonstration makes up a part of the more than 120 household surveys I have conducted this summer in Battambang and Kampong Speu provinces in Cambodia. In collaboration with WaterSHED Asia, a local NGO, I am conducting formative research on how people manage their young children’s feces. In particular, I hope to identify the barriers and motivators to using hygienic methods – in which the feces are disposed of in the latrine – for collecting, transporting, and disposing of children’s feces, and the potential interest of Cambodian families in purchasing products to assist with this process.

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Children’s feces disposal has been a relatively neglected area in public health research. When looking at latrine usage, sanitation coverage is often much lower for young children than for adults, in part because many people feel that children’s feces are harmless. In fact, children’s feces are often more infective than that of adults, with a high prevalence of enteric pathogens affecting children under five. Even in households that do own a latrine, children under-five are generally considered to small to use it. As a result, many people dispose of children’s feces by throwing them into a garbage pit, burying them in the yard, or by burning used diapers or paper towels. Hygienic methods of disposing of feces include having the child use a latrine or a potty, which can be rinsed directly into the latrine.

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As the rain lets up the local enumerator and I thank our last interviewee (perhaps the word in Khmer I now know best) and make our way back to the main road. Beyond it, we can see families harvesting the long lines of green rice stalks from the fields behind their houses, which are perched up on stilts in case of flooding, while the ubiquitous Cambodian water buffalo grazes beside them. For these families, it is important that a sanitation solution be quick, easy, and affordable, as well as available in a local market that may be a costly motorcycle ride away.

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We will return to this village in several weeks to run a focus discussion group with the houses we interviewed, bringing samples of new products such as toy shaped latrines with grips that allow children to sit without assistance; reusable diapers with removable inserts; and a locally made version of the Safe Squat, a latrine training mat recently trialed in Kenya which allows smaller children to use a latrine. By gauging participant’s reactions to these products, we hope to identify which ones have the greatest chance of being purchased and to identify the industries or behaviors that will need to be targeted to achieve the greatest impact in improving sanitation for children under five. No in-depth research has been conducted on children’s hygiene practices in Cambodia before, and our findings will hopefully provide valuable information to any working in the WASH sector.

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Our findings are particularly important as improving feces management for children under five has the potential to make a great impact on the health of those children and their families. Diarrheal disease is responsible for 4% of all deaths worldwide, primarily in Southeast Asia and Sub-Saharan Africa, and is the second greatest cause of death for children under five. 88% of all diarrheal deaths are attributable to water, sanitation, and hygiene (WASH) related factors (WHO). We hope our findings will be able to contribute to programs which decrease the disease burden of diarrheal diseases, in Cambodia and elsewhere.

Please feel free to contact the author at: mmpetrie@gmail.com

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