What motivates open defecation? A qualitative study from a rural setting in Nepal.

INTRODUCTION: Open defecation is ongoing in Nepal despite the rise in efforts for increasing latrine coverage and its use. Understanding the reasons for open defecation would complement the ongoing efforts to achieve the 'open defecation free' status in Nepal. This study aimed at exploring different motivations of people who practice open defecation in a village in Nepal. METHODS: This study was conducted among the people from the Hattimudha village in Morang district of eastern Nepal, who practiced open defecation. Maximum variation sampling method was used to recruit participants for 20 in-depth interviews and 2 focus group discussions. We adopted a content analysis approach to analyze the data. RESULTS: We categorized different reasons for open defecation as motivation by choice and motivation by compulsion. Open defecation by choice as is expressed as a medium for socializing, a habit and an enjoyable outdoor activity that complies with spiritual and religious norms. Open defecation by compulsion include reasons such as not having a latrine at home or having an alternative use for the latrine structures. Despite having a private latrine at home or access to a public latrine, people were compelled to practice open defecation due to constraints of norms restricting latrine use and hygiene issues in general. For women the issues with privacy and issues refraining women to use the same latrine as men compelled women to look for open defecation places. CONCLUSION: Open defecation is either a voluntary choice or a compulsion. This choice is closely linked with personal preferences, cultural and traditional norms with special concerns for privacy for women and girls in different communities. The ongoing campaigns to promote latrine construction and its use needs to carefully consider these factors in order to reduce the open defecation practices and increase the use of sanitary latrines.

Eco-social and behavioural determinants of diarrhoea in under-five children of Nepal: a framework analysis of the existing literature.

BACKGROUND: While diarrhoea is the second major killer among the under-five children in the world with an estimation of 760,000 deaths annually, it stands as a major killer in Nepal with an annual incidence of 500 per 1000 under-five children with diarrhoea. Diarrhoea is responsible for a wide range of morbidity and mortality among children in Nepal. The objective of this review work is to identify the eco-social and behavioural determinants of diarrhoea among the under-five children of Nepal. METHODS: A literature review was conducted using the Dahlgren and Whitehead model (1991) between June and October 2015. PubMed, Nepal Journals online and Google Scholar were used to search for literature published between 1989 and July 2015 using defined keywords. RESULTS: Children of age group 6-23 months are at higher risk, as supplementary diets are introduced to the children from the age of 6 months. Male children have better access to healthcare services. Malnourished children also have a higher chance of developing persistent diarrhoea. Provision of safe water and sanitation has direct link with the prevention and control of diarrhoea. Male gender with high income positively influences the treatment-seeking behaviour. Mother's education and hand-washing practice have direct influence in child health. Hand-washing practices with soap which are protective are influenced by the cultural beliefs. Involvement of community health volunteers increases the access to the health system, thereby reducing the diarrhoeal burden in the community. CONCLUSION: Age, gender, hand-washing behaviour, nutritional status of children, education of mothers, water and sanitation, healthcare services, cultural and societal values and income of the household were identified determinants for diarrhoea in under-five children of Nepal.