Mothers’ Perception of Feces and Disease Transmission. The fact that mothers encourage the use of designated defecation spots, which carry the risk of fecal contamination, may be surprising when one considers that most of the study participants indicated an awareness of the link between feces and diarrheal disease. There was a common awareness among participants that feces are dirty and can lead to a variety of diseases including diarrheal illness. Many of them seemed to have an understanding of fecal-oral pathways and the importance of keeping feces away from water sources and flies. This awareness positively influences behaviors among mothers in this context, particularly related to their consistent feces disposal immediately after a child’s defecation, or as soon as possible. It also impacts their desire for a clean household and compound and their distaste for open defecation. It sometimes leads to mothers’ decision to keep their young children away from the latrine because the conditions inside – namely, feces and urine on the floor surrounding the hole – are considered too unsanitary. (This is an interesting paradox: mothers’ fear of their children encountering germs in the latrine leads to alternative defecation practices that introduce germs to the household environment). Finally, during the LTM intervention, this understanding of fecal contamination was evidenced by mothers’ emphasis on the necessity of cleaning the LTMs thoroughly before storing them in the home so as not to introduce fecal contamination into the house. However, despite their knowledge of diarrheal disease transmission through fecal contamination, mothers in this context still exhibit some risky behaviors. First, the common practice of allowing young children – even those who are already latrine trained – to defecate on the ground during the night instead of going to the latrine ignores the fecal contamination that can be introduced into the compound through this behavior. The same applies to the overall absence of explicitly-mentioned hand-washing behaviors following the defecation, feces disposal, or cleaning the child’s bottom. During the LTM study, the decision that many mothers made to store their removable mats inside the home (even though they did wash them first) is a cause for concern, because it is still unknown exactly how effectively the pathogens on the mats are killed through washing. Also related to washing, all eight mothers who received removable mats chose to wash them outside of the latrine; this is a risky behav...
