I recently visited Kisumu, Kenya, where Practical Action is working with two local partner organisations (KUAP and Umande Trust) in a five-year project to transform the sanitation situation for 64,200 residents of the city’s informal settlements.

We visited families to understand the extreme challenges faced by parents and carers looking after Children under 5 years. As a Mum of two, the youngest of whom turns 6 next month, I could easily make comparisons. There are so many different stages babies, toddlers and children go through in those years, and so many challenges to keeping them healthy and happy. This area has been acknowledged as a blind spot within the already blind spot of understanding how to make progress on sanitation.

If my children catch one of those nasty ‘winter vomiting bugs’ I know I’m in for a hard time. All that extra washing and cleaning up, and trying to bleach every surface I might have inadvertently contaminated.

Now imagine dealing with 10 month-old twins with diarrhoea and vomiting with cloth nappies which have to be washed by hand, and where you can’t afford expensive cleaning products. No wonder the whole family got sick.

Children are generally taken out of nappies far earlier in developing countries than in the UK – and it seems that can mean more accidents, that can be hard to clean up where floors are not just mud or concrete and not easily wiped.

And when children are old enough to manage their own toileting, the pit latrines adults use are not places for children. They are often filthy with excrement on various surfaces, and not designed to be used with little legs. Parents would rather put down old newspapers for children, or get them to use a potty, with the contents disposed in the toilet. But then again, sometimes children have to be left while the parent is at work in which case they are more inclined to just use an open space outside.

This is not uncommon. In a global study in countries with poor sanitation, UNICEF found that over 50 percent of households with children under age three reported that the faeces of their children were unsafely disposed of. Even among households with improved toilets or latrines, some unsafe child faeces disposal behavior was reported by caregivers.

Every time these children and carers want to wash their hands they need to get the basin, soap and container of water out separately. It’s enough of a struggle to remind my children to always wash their hands and that’s when the basin is right there with soap on hand.

Practical Action is working to transform the situation – using a combination of school-led and community-led total sanitation, which uses visual demonstrations to explain how an environment polluted with so much faeces is damaging everyone’s health. Encouraging handwashing and making it easier is also an important focus. We’ve been running the programme for a little over a year with good results so far, and action will be ramping up in the coming year. With the support of Public Health Officers and a cadre of amazingly motivated ‘natural leaders’ from the community we think the collective behaviour change needed will be ignited.

As one Public Health Officer told me: “it’s one thing to force people to build toilets, but that’s not the answer. What matters is that they are used by everyone all the time.” And that’s the change we’re aiming for: a shit-free environment and a healthy future for Kisumu’s children.