Disposable diaper use and perception of health and environmental risks in a rural community from Bushbuckridge, South Africa

Abstract

Littering of disposable diapers is a problem with One Health implications and has been identified as an issue within the Mnisi community, a rural area within Bushbuckridge, South Africa. Several environmental and public health related concerns arise from this, including contamination of waterways used by animals and people with human waste, scavenging by domestic and wild animals, and the aesthetic impact on the environment. The aim of this study was to gain an understanding of the use and sanitation practices associated with disposable diapers, with the ultimate goal of identifying possible community-led initiatives and solutions which can be used for training and education. Focus group discussions were conducted within the community which included a participatory mapping exercise used to map general diaper disposal sites. Focus group data was analyzed according to three themes: decisions and factors around diaper use and disposal, perceptions of impact and health risk of diaper use for people and animals, and barriers and solutions for proper disposal. Most participants used disposable diapers and disposed of them within the environment because they lacked access to municipal waste collection. Regarding decisions around diaper use, common factors discussed were convenience, social perception and beliefs, cost, water access, and diaper disposal logistics. Convenience and societal perception and beliefs were determined as key factors behind diapering choices, and both a gender and a generational divide was revealed. Participants express general understanding of negative impacts associated with diaper disposal, but knowledge gaps exist, notably regarding water pollution and pathogen spread, that could be a focus of educational campaigns. Regarding solutions, participants proposed the provision of a central collection point as well a return to reusable diapers, each of which has its own considerations and hurdles. Any interventions should retain the perceived convenience factor of disposable diapers and be implemented on a community rather than individual basis. Solutions should be multifaceted, involve opportunities for community collaboration amongst all ages and genders, and should also engage local leadership. Focus groups should be considered as the first steps towards continued discussions amongst stakeholders.