Effect of Environmental Sanitation on Preparing and Maintaining of Suck Away of Toilet
OBJECTIVE OF THE STUDY
The overall objective of the assessment study is to evaluate the community sanitation and hygiene practices and implementation challenges of suck away of toilets and provide valuable remedial inputs for the improvement of the projects in Ikot Ekpene.
- To assess the conditions of suck away toilet in households.
- To assess the gaps in knowledge in relation to usage of sanitation facilities and hygiene management
- To investigate challenges related to implementation of suck away of toilets.
- To evaluate the implementer’s participation in monitoring and evaluation of suck away of toilets?
- To review the government sanitation and hygiene policies and guidelines in the implementation of sanitation and hygiene project in the study Ikot Ekpene?
- To analyze the relationship exists between the usage of suck away and family health in Ikot Ekpene.
Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and faeces (Melosi, 2000).Generally, sanitation in the world is below standard with up to 2.4 billion people globally lacking proper sanitation (Elizabeth & steve, 2004). The sanitation problem is worst in sub Saharan Africa and south Asia where about 30% still open defecate while another 44% have unimproved suck away (WHO, 2014). Different studies indicate lower suck away coverage in communities as compared to the general suck away coverage in the same areas (WHO, 2008).A study in China for example revealed that despite a 59% improvement in general sanitation coverage, less than 10% of 15,000 rural communities had adequate suck away and hand-washing facilities (WHO, 2008). Recent research on the Nigerian situation indicates that approximately 27% urban and 32% rural Nigerians have access to private improved sanitation (UNICEF, 2010). In the urban areas an additional 51% of the population use shared suck away while in the rural areas, open defecation was estimated to be still practised by 18% of the population (UNICEF, 2012).By the year 2012, sanitation coverage in Transzoia county stood at 24.2% with pit suck away leading as the main mode of waste disposal (81.2%) (MOD, 2013). There was no specific data on sanitation coverage in communities in Transnzoia County.
Suck away quality
Suck away quality is determined by a number of factors such as suck away to pupil ratio, privacy of the suck away, cleanliness of the suck away among others (Rutega, 1999). In Nigeria, Suck away coverage has always been grossly inadequate with an average of 30.5% urban population and 21.6% rural population having access to any form of suck away (KNBS, 2015)as opposed to the community health policy requirement of suck away to population ratio of 4 suck away for the first 30 boys/girls, the next 270 boys/girls to have a ratio of 1:30 boys/girls and 1:50 for the remaining boys/girls. At the same time, a third of the suck away for boys should be urinals (GOK, 2012) .Universal free primary education was introduced in 2003 in Nigeria leading to an increase in pupil enrolment from 5,900,000 in the year 2002 to 7,200,000 in the year 2003 and 8,200,000 in the year 2007 (KNBS & Macro, 2010). Akwa Ibom was also affected by the increase in enrolment with the number of pupils enrolled increasing from 39,869 in 2001 to about 54,880 in 2011 (MOE, 2011).This increase in the population of pupils in Nigerian communities was not commensurate with the increase in suck away in the communities leading to over strained suck away facilities in public communities (UNDP, 2006).
In Nigeria, hand washing is low with research indicating that only 1 percent of pupils wash their hands with soap and water and about 28% wash their hands without soap (Mooijman & Snel, 2010).To improve sanitation in communities; provision of adequate suck away and hand washing facilities and health education on sanitation is key (Mooijman & Snel, 2010).In this study the focus was on the provision of ventilated improved suck away. Ventilated improved suck away had been recommended by the Local government Health Management Team in its annual operation plan (MOPHS, 2010).
Importance of quality suck away
Community suck away are subject to high sanitation usage and thus making them potential zones for transmitting faecal related diseases with a positive association between a high number of suck away users to a low disease prevalence with odds ratio of 1.63 (Migele & Ombeki, 2007). Provision of quality suck away may lead to increased usage of the suck away among the community going children and this may lead to reduction of morbidity (Vernon & lundblad, 2003). Studies have shown that adequate provision of suck away in communities has led to reduction of diarrhoea incidences by up to 36% (Esrey & Potash, 1990).More recent studies have also linked provision of adequate water and suck away in communities to upto 50% reduction in incidences of upper respiratory diseases (UNICEF, 2010). Washing hands with soap at the right times can reduce instances of diarrhoea by between 35 to50 percent. Evidence also suggests that hand washing with soap can actually reduce acute respiratory infections by up to 30 percent (WSP& UNICEF & GOK, 2012). Provision of adequate suck away facilities also leads to reduction of health problems such as renal problems caused by urine back flow and stress associated with an over stretched bladder (Migele & Ombeki, 2007).
MATERIALS AND METHODS
This chapter presents the study area, study design and methodology, data collection techniques, data analysis, criteria for interpretation of results and ethical considerations applied in the study.
This was a descriptive cross-sectional study seeking to establish environment and leaders determinants affecting the suck away quality in communities in Akwa Ibom. This study design was carried out to ensure that the results would not be influenced by the time factor.
The study population were leaders in communities in Akwa Ibom. They were a total of 1370 leaders in the City at the time of study (DEO, 2011). To check on the quality of suck away a sample was obtained as explained in the sampling from the study population of 120 communities.
Social demographic characteristics of the study population
The study analysis as shown in table 4.1 indicated that majority of the leaders that participated in the study were aged between 30-39 years (39.6%) while a few of the respondents were between the ages of 20-29 years (8.5%). The age distribution was statistically significant at a (p-value of <0.001). There was an insignificant statistical difference (p value <0.905) in the gender of respondents with the male taking up 49.5% and female 50.5%. Looking at the respondents marital status, majority of them were married (89.4%) and the marital status was statistically significant at (p value <0.001).
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
Suck away quality
The present study has examined the communities suck away quality in respect to the standards set by the community health policy. In Akwa Ibom, the suck away to pupil’s ratio stood at 1:34 which is higher than that recommended by the policy of about 1 suck away to every 25 pupils (Joshua & Saboori, 2013) and thus the City stakeholders need to work on improving the suck away adequacy. The stakeholders should involve the leaders so that they understand the rationale behind the need for suck away adequacy. Inadequate suck away facilities lead to health problems such as typhoid which was a major health concern in the City (Christian & Bartram, 2012).
Provision of quality suck away is important in ensuring maximum usage of the same by the pupils (Hutton & Haller, 2004). A national study in Nigeria gave a significance association between suck away state and suck away usage in Nigeria at a p value of 0.01 (Joshua & Saboori, 2013). From the study 64.3% of the suck away in the City were categorized as quality while 35.7% were not of the standard quality and thus needed improvement so that they could conform to the community health policy requirement.
Key to ensuring quality suck away is the provision of privacy in the suck away by complete separation of the boys from girls suck away, ensuring the doors are intact and lockable and ensuring that the walls are not worn out (MOE & MOH, 2009).About 18.9% of the communities did not provide adequate privacy in the suck away which is against the communities health policy requirement. Lack of adequate privacy in community suck away leads to pupils’ absenteeism of up to 10% especially so in female pupils (Freeman & Muga, 2011). Provision of a vent pipe is key in the control of foul smell while provision and use of a suck away cover is important in control of flies (winblad & kilama, 1985).About 79.5% of the sampled communities had a vent pipe against the City annual work plan that required all the suck away in communities to have vent pipes(MOPHS, 2010). The leaders should also be trained on this so that they appreciate the need to have good suck away structures. Hand washing for pupils is important in the control of illnesses such as typhoid (Christian & Bartram, 2012) which was a main problem in Akwa Ibom. The sampled communities had the ratio of about 1functional hand washing facility to 1189 pupils which is way higher than findings of a similar study done in Nairobi that gave the ratio of 1 hand washing facility to about 330 pupils (UNICEF, 2012).This had the implication that few pupils got to wash their hands.
Difference between HECA participating communities and HECA nonparticipating communities
HECA was supposed to provide a sustainable way of dealing with sanitation issues in the communities by engaging the community in the sustainability of adequate and quality suck away in the communities. It was however noted that there was no significant difference in suck away quality between HECA participating communities and HECA non participating communities (p value=0.280). This was due to the fact that there were no measures to sustain HECA activities put into place (52% of respondents indicating this). The rate of availability of suck away with acceptable levels of suck away fill-ups significantly differed between HECA and Non-HECA communities (Mann Whitney U test p-value = 0.024).
HECA communities had a lower rate of availability of suck away with acceptable suck away fill-ups as compared to Non-HECA communities and this could be, by way of hypothesis, attributed to the fact that no more effort was put on sanitation after the conclusion of the HECA program. Non-HECA communities had an average lockable suck away door rate of 79.9% while HECA communities had an average lockable suck away door rate of 41.0%. Non-HECA communities had a higher rate of lockable doors as compared to HECA communities (Mann Whitney U test p-value = 0.004). The difference in acceptable suck away holes between HECA and Non-HECA communities was statistically significant (Mann Whitney U test p-value=0.002) meaning Non-HECA communities had higher proportion of suck away with acceptable suck away holes compared to HECA communities. The leaders were asked to outline any issues that they would want included in future HECA programs and they suggested that all the leaders should be trained on HECA so that in case a leader was transferred to another communities the program would continue to run and that HECA implementers should involve the community health clubs actively and at all levels. The issues raised by the leaders could be hypothesised to have contributed to the results of the suck away qualities.
Association between environmental factors and quality of suck away.
Most of the environmental factors studied did not have a significant association with suck away quality. Availability of building materials (p value=0.0466) was the only environmental factor which influenced suck away quality. Ease of availability of building material is important in any development and availability of bricks in the City seemed to influence the building of permanent suck away made of bricks. Ease of availability of materials was influenced by local availability of the materials. Type of soil did not significantly affect the suck away quality and this could be explained by the fact that most leaders had experience in dealing with problems related to soil structure and that there were experts to consult. It is also important to develop ways of ensuring adequate supply of hand washing water or better still develop ways of hand washing using minimum water.
Based on the results of this study the following conclusions were drawn: there was no significant difference in the suck away quality between HECA and non HECA communities.
Leader’s knowledge on the national community health policy is a significant factor affecting the quality of suck away. The type of materials available within or near the community influences the suck away quality.
As a recommendation future HECA projects should be implemented and sustainability measures put in place. Some of the measures suggested by the leaders include: ensuring that more leaders are trained on HECA in order to ensure continuity in case a leader is transferred, retires or dies. The leaders also suggested that the HECA activities be anchored in the community health clubs to ensure continuity of the program.
It is important to put measures in place to ensure continuous training of leaders on the community health policy for example by ensuring that training on community health policy is incorporated in the leaders training curriculum or seminars on the same be organised. Leaders should be empowered by the stakeholders such as the community management to ensure that they improve on their good sanitation practice and on their understanding concerning the quality of suck away.
The community management should also be encouraged to utilize the locally available materials to increase suck away quality and also develop ways of acquiring adequate water for hand washing.
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