Local Perceptions, Cultural Beliefs, Practices and Changing Perspectives of Handling Infant Feces: A Case Study in a Rural Geita District, North-Western Tanzania

We report on the management of infant feces in a rural village in Geita region, Tanzania. Findings discussed here emerged incidentally from a qualitative study aimed at investigating vulnerability and resilience to health challenges in rural settings. Data was gathered through semi-structured focus group discussions (FDGs) with women (n = 4; 32 participants), men (n = 2; 16 participants), and community leaders (n = 1; 8 participants). All FDGs were audio recorded, transcribed verbatim and thematically analyzed using Atlas.ti. Respondents reported feces of a child under the age of six months were considered pure compared to those of older children. Infant feces were seen as transitioning to harmful at the point when the child began to eat solid food, resulting in their stool visually changing in appearance. Caregivers reportedly used soft implements to handle infant feces due to the belief that tools with hard surfaces would physically harm the child. Infant feces were disposed in environments around the house due to the belief that disposal in latrines would prevent developmental milestones and result in other perceived negative health outcomes for the child. Changing views expressed by participants suggest a window of opportunity to implement evidence-based and culturally relevant interventions to encourage the safe disposal of infant feces.


S3
Problem formulation Description and significance of the problem/phenomenon studied; review of relevant theory and empirical work; problem statement 2-3

S4
Purpose or research question Purpose of the study and specific objectives or questions 3 Methods

S5
Qualitative approach and research paradigm Qualitative approach (e.g., ethnography, grounded theory, case study, phenomenology, narrative research) and guiding theory if appropriate; identifying the research paradigm (e.g., postpositivist, constructivist/ interpretivist) is also recommended; rationale b 3

S6 Researcher characteristics and reflexivity
Researchers' characteristics that may influence the research, including personal attributes, qualifications/experience, relationship with participants, assumptions, and/or presuppositions; potential or actual interaction between researchers' characteristics and the research questions, approach, methods, results, and/or transferability 4 S7 Context Setting/site and salient contextual factors; rationale b 3 S8 Sampling strategy How and why research participants, documents, or events were selected; criteria for deciding when no further sampling was necessary (e.g., sampling saturation); rationale b 4 S9 Ethical issues pertaining to human subjects Documentation of approval by an appropriate ethics review board and participant consent, or explanation for lack thereof; other confidentiality and data security issues 5 S10 Data collection methods Types of data collected; details of data collection procedures including (as appropriate) start and stop dates of data collection and analysis, iterative process, triangulation of sources/methods, and modification of procedures in response to evolving study findings; rationale b 4-5 S11

Data collection instruments and technologies
Description of instruments (e.g., interview guides, questionnaires) and devices (e.g., audio recorders) used for data collection; if/how the instrument(s) changed over the course of the study 3-4 S12 Units of study Number and relevant characteristics of participants, documents, or events included in the study; level of participation (could be reported in results) 4 and 5 S13 Data processing Methods for processing data prior to and during analysis, including transcription, data entry, data management and security, verification of data integrity, data coding, and anonymization/deidentification of excerpts 5 S14 Data analysis Process by which inferences, themes, etc., were identified and developed, including the researchers involved in data analysis; usually references a specific paradigm or approach; rationale b 5 S15 Techniques to enhance trustworthiness Techniques to enhance trustworthiness and credibility of data analysis (e.g., member checking, audit trail, triangulation); rationale b 4 Results/findings S16 Synthesis and interpretation Main findings (e.g., interpretations, inferences, and themes); might include development of a theory or model, or integration with prior research or theory 5-10 S17 Links to empirical data Evidence (e.g., quotes, field notes, text excerpts, photographs) to substantiate analytic findings 5-10 Discussion S18 Integration with prior work, implications, transferability, and contribution(s) to the field Short summary of main findings; explanation of how findings and conclusions connect to, support, elaborate on, or challenge conclusions of earlier scholarship; discussion of scope of application/ generalizability; identification of unique contribution(s) to scholarship in a discipline or field 11-12 S19 Limitations Trustworthiness and limitations of findings 12 Other S20 Conflicts of interest Potential sources of influence or perceived influence on study conduct and conclusions; how these were managed 13 S21 Funding Sources of funding and other support; role of funders in data collection, interpretation, and reporting 13 a The authors created the SRQR by searching the literature to identify guidelines, reporting standards, and critical appraisal criteria for qualitative research; reviewing the reference lists of retrieved sources; and contacting experts to gain feedback. The SRQR aims to improve the transparency of all aspects of qualitative research by providing clear standards for reporting qualitative research. b The rationale should briefly discuss the justification for choosing that theory, approach, method, or technique rather than other options available, the assumptions and limitations implicit in those choices, and how those choices influence study conclusions and transferability. As appropriate, the rationale for several items might be discussed together.