Cross sectional study on household sanitation, hygiene and water access level in Debay Tilat Gin Woreda, East Gojjam, Ethiopia Abstract Introduction An estimated.6 billion people lack access to improved facilities for the disposal of human excreta, and more than 1.1 billion people in the world, lack access to safe drinking water sources which represented 39% and17% of the global population respectively. According to JMP 1 update in Ethiopia improved access to sanitation and drinking water is 1% and 38% of the respectively. Objective To assess sanitation, hygiene and water access level in households and to identify the available resources, partners and commitment at woreda level. Methods A community based cross- sectional study was carried out on 3/18 - /1 in Debay Tilat Gin woreda, East Gojjam, Ethiopia using pre designed questionnaire and observational check list of mapping the context to observe the current condition of water handling and treatment, sanitation and hand washing facilities accessibility at household level. Result The study result revealed that among types of water collection container most mothers commonly preferred was Jerrican and in 9 (1%) households drinking water storage was jerrican which was narrow necked. Regarding the solid waste management practices of the respondents majority, twenty four (8.8%) disposed their solid wastes (mostly garbage) on their back yard pit. All households visited have latrine of these 7 (93%) were with separated squatting holes for male and female. All of them full fill privacy, comfort and dignity for users and with good maintenance. Almost all old latrines replaced by new and 18 of them roofs constructed by corrugated Iron sheet and 11 were good condition of thatch roof, 6 pit latrines superstructure were clean but only 11 were with squatting hole cover. Moreover, All 96.6% of households pit latrine had been with hand washing facilities, made from locally available materials, and with adequate water. Of these households 3 of them placed soap nearby latrines and 6 were availed ash for hand washing purpose. All 8 HHs were observed with wet lands beneath HWFs indicating that they are practicing hand washing after visiting latrines currently at the time of observation. Conclusion Even though JMP criteria for improved water and sanitation is not viable option for our rural community, the study result revealed that the woreda is on track to unfold sanitation, hygiene and households water handling and treatment system. 1
1. INTRODUCTION An estimated.6 billion people or 39% of the world s population lack access to improved facilities for the disposal of human excreta, such as a basic pit latrine, a toilet connected to a septic tank or piped sewer system, or a composting toilet and more than 1.1 billion people in the world, lack access to safe drinking water sources which represented 17% of the global population (1). In low-income regions, where people are most vulnerable to infection and disease, only one in two people is covered by improved sanitation. More than one billion people still practice open defecation. In sub- Saharan Africa and southern Asia coverage is just 31% and 33%, respectively. While the global population in 6 is about equally divided between urban and rural dwellers, more than seven out of 1 people living without improved sanitation are rural inhabitants (1). According to JMP 1 update in Ethiopia the urban and rural improved access to sanitation is 9% and 8% respectively and the country average improved sanitation coverage is 1% and only 38% of the country population accessed with improved drinking water. The shortfall in sanitation coverage is not the result of a failure to recognize the need for it or declare goals to meet this need at the highest international level. The 1977 Mar del Plata Declaration by the United Nations expressed the goal of providing safe water and sanitation for all by 199, launching the Water and Sanitation Decade (1981 to 199). In 199 the United Nations renewed the call and extended the deadline to the end of the th century. While sanitation was first omitted from the United Nations Millennium Development Goals (MDGs), it was added to the water target at the Johannesburg World Summit on Sustainable Development in. Target 1 of Goal 7 is less ambitious than its predecessors, seeking only to reduce by half the portion of the population without access to basic sanitation. Even so, the evidence suggests that current efforts will fall far short of even this scaled down target. At the current rate, the world will miss the MDG sanitation target by 13 percentage points; in 15, the number of people without basic sanitation will actually rise to.7 billion (1). In sub-saharan Africa, where only 31% of people have access to improved sanitation, current efforts will actually result in an increase in the number who do not by 91 million (,3). Even if the MDG target could be met, it would still leave well more than 1.7 billion without such access. Mean while the government of Ethiopia developed an ambitious plan for universal access to sanitation by the year 15. Even though the criteria for improved sanitation seat by JMP is so complex in the country context the government of Ethiopia with its partners works to achieve the universal access plan. The government uses fundamental primary health care service approach using health extension program. In Amhara region, East Gojjem zone, Debay Tilat Gin woreda graduated from all 16 health packages in 9/1 and the woreda is in line with MDGs on at scale sanitation and hygiene. Thus, this paper is aimed to assess the household scale up sanitation, hygiene and water access level and to identify the available resources, partners and commitment at woreda level.
. OBJECTIVES.1. General Objective To assess sanitation, hygiene and water access level in households and to identify the available resources, partners and commitment at woreda level... Specific Objectives To examine the availability of sanitation, hygiene and water access at house hold level To assess the knowledge and hygienic practice of the community To ensure the effectiveness of waste disposal system in the rural community To identify the available resources, partners and commitment for scale up sanitation and hygiene at woreda level 3
3.1. Study design 3. METHODS AND MATERIALS A community based cross- sectional study was carried out on 3/18 - /11 using pre designed questionnaire and observational check list of mapping the context to observe the current condition of water handling and treatment, sanitation and hand washing facilities accessibility at household level. 3.. Study area Debay Tilat Gin woreda, one of the twenty Woredas found in East Gojjam Zone, is located in the southern of the capital city of Amhara, Bahir Dar, at a distance of 6 and 95 kilometers rth of Addis Ababa. From 7 National Housing & Population Census, the projected population of the Woreda for the year 11 is 135,81 of which 68579 are males & 6731 are females. The woreda comprises Kebeles, urban and rural, having 315 residential houses with an average household size of 4.4 persons per house. In the woreda there are five health centers and health posts and the health service coverage is reached to 1%. The human resource available in the woredas, who are working at scale sanitation and hygiene, are 5 environmental health workers, 36 health extension workers, 3 health extension worker supervisors and 1 health extension coordinators. In addition to that, there are 5 schools in the woreda of these 4 are alternative basic education, 3 are grade 1-8, 18 are grade 1-4 and are secondary schools (1 preparatory and 1 from grade 11 1). 3.3. Source and study population The Source populations for this study were households found in Debay Tilat Gin Woreda which found in kebeles and households in Nabira Micheal, Nabira Yebalat and Kidist kebeles were study units. In this study units one village/gott from each kebele sampled by convenience sampling technique and in these villages 1% the households (n=9) sampled by systematic random sampling to interview and visit their latrines, hygiene and household water handling and treatment practice and respondents especially mothers were considered to explore knowledge and practices of hand washing, household water handling and treatment and available latrine utilization. 3.4. Sampling Methods In the Namira Michea, Namira Yebalat and Kidista kebeles, Gedamu, Tach Borobor, and Kidsta villages were purposefully selected for the study. The reason for selection of these kebeles was the woreda graduated in 9/1 by achieving 1% of all 16 primarily health care packages. Thus by considering that and to check how much their achievement in scale up sanitation and hygiene practice the study team select to observe the by far kebeles/villages from the woreda capital, Kuy town. Using systematic random sampling method 1% representative sample of households were selected from each three villages to assess the sanitation, hygiene and water access level using behavior indicators at household level. 4
3.5. Data collection Pre designed questionnaire and mapping the context check list were used for the purpose of data collection. Two data collectors, WSP-AF Amhara region short term consultant and counterpart from RHB, environmental health case team, were involved in data collection. Available data regarding water, sanitation and hygiene facilities at house hold level collected using observational check list and water, sanitation and hygiene relevant information collected from mothers in each household by interviewing questionnaire. 5
4. RESULTS 4.1. Knowledge of the respondents about water and sanitation Assessment of knowledge was done among 15 households and the respondents were all mothers. Of these majority of the study subjects 13(86.7%) knew that water can transmit diarrheal diseases and the same respondent believed feacally contaminated water was responsible to cause diarrheal diseases. The main sources of information about the relationship of water and diarrheal diseases among 11(73.3%) respondents were hygiene education given by the health extension workers, followed by health professionals 3(%). All respondents believed that the purpose of having latrine is to prevention feco-oral diseases transimtion (Table1). Table1. Knowledge about water and sanitation of the study households of Namira Micheal, Namira Yabalat, and Kidista kebeles, Debay Tilatign woreda, Amhara, March 11. Characteristics Number(n=15) Percent Can water transmit diarrheal diseases 13 Sources of information Broad casting agency Health professional Health extension workers 3 11 86.7% 13.3% 13.3%.% 73.3% Do you get information about water handling Sources of information Broad casting agency Health professional Health extension workers Purpose of having a latrine Health Privacy Convenience dignity Social Pressure Others 15 15 15 13 1 9 1% 13.3% 13.3% 1% 1% 86.7% 8% 6% 6
4.. Water handling practices related to collection, transportation and storage Majority (69%) of the respondents were found to collect water from two protected sources found in the nearby Gedamu and Tach Borobor villages. The water supply of these springs was distributed through pipe line working gravity system. Among 9 households 9 (31%) used water from the river found near by the Kidista village. The average time required to fetch water in the study area was below 3 minutes. The study result revealed that most mothers commonly preferred type of water collection container was Jerrican and in 9 (1%) households drinking water storage was jerrican. Moreover, 1% of the respondents cleaned their containers before collection and refill. Similarly all households of the study subject had cover for their collection container during transportation and stored in their household (Table 4). All interviewed and observed households used method for drawing drinking water from their storage materials was pour but the cleanness of storage containers in 6 (.7%) households were poor. Table. Water handling practices of study households of Namira Micheal, Namira Yabalat, and Kidista kebeles, Debay Tilatign woreda, Amhara, March 11. Characteristics Number (n=9) Percent Sources of water spring River Time required to fetch water < 3 minutes 31-6 minutes Container rinsing before collection Households used narrow necked drinking water storage Method of water treatment in the household Boiling Chlorine products UV radiation Neither Cover of the storage containers Sanitation of the storage areas Good Poor 9 6 3 9 9 6 3 9 3 6 69% 31% 89.7% 1.3% 1% % 1% %.7% 79.3% 1% 79.3%.7% 7
4.3. Practices related to liquid and solid waste management and personal hygiene All visited households had latrine facilities and majority, 7(93%), of them had separated rooms for male and female.. All of them full fill privacy, comfort and dignity for users and with good maintenance. The woreda was in the track to sustain sanitation and hygiene services and facilities in all kebeles. Almost all old latrines replaced by new and 18 of them roofs constructed by corrugated Iron sheet and 11 were in good condition of thatch roof. 6 pit latrines superstructure were clean but only 11 were with squatting hole cover (Table3). Regarding the solid waste management practices of the respondents majority, 4 households (8.8%) disposed their solid wastes (mostly garbage) on their back yard pit and the remain 5 (17.) of them disposed in the open field and concerning liquid waste management, all wastewater produced in 5 households disposed in the infiltration pit constructed in the nearby dwellings. Concerning personal hygiene the majority 3 (79.3%) of the respondents took shower every week and most of the respondents took baths near the spring and river which accounted 44.8% and 55.% respectively. All respondents wash their clothes near the water sources (Table3). Table3. Practices related to liquid and solid waste management and personal hygiene in households of Namira Micheal, Namira Yabalat, and Kidista kebeles, Debay Tilatign woreda, Amhara, March 11. Characteristics Number Percent Latrine availability 9 1% Separate squatting holes for male and female Sanitation of the latrine Good Poor Squat hole cover Cleanness of latrine Good Fair Poor Latrine doors, walls etc available ensuring privacy 7 6 3 11 18 3 6 7 93% 7% 89.7% 1.3% 37.9% 6.1% 79.3%.7% 93% 7% 8
Good latrine maintenance Solid waste disposal system(n=4) Pit Open field Farm field as fertilizers Waste water disposal system. Infiltration Pit Simple pit Open field Frequency of tacking bath Once a week Once a month t known Where do you take bath? In the house Near spring In the river 9 4 5 5 4 3 5 1 13 16 1% 8.8% 17.8% 86.% 13.8% 79.3% 17.% 3.5% % 44.8% 55.% The availability of Hand washing facilities near to latrines All 8 out of 9 households pit latrine had been with hand washing facilities, made from locally available materials, with adequate water. Of these households 3 of them placed soap and ash in the nearby of the latrines and all 8 were availed with ash only for hand washing purpose. All 8 latrines beneath hand washing materials were wet. Table4. Availability of hand washing facilities with its item in the nearby latrine in households of Namira Micheal, Namira Yabalat, and Kidista kebeles, Debay Tilatign woreda, Amhara, March 11. Item available Remark Hand washing container 8 1 One latrine is under Adequate water in the container 8 1 Soap in the near by 3 6 Ash in the near by 8 1 Wet land under hand washing facility 8 1 construction for upgrade the old one to new using CIS roof. Of the interviewed 15 household mothers in those study areas hand washing practiced in the morning and before contact with food and food equipments accounted 1%, after using latrine, after managing child bottom and after contact with solid as well as wastewater accounted 89%,73% and 6% respectively (Figure1). 9
Figure1. Hand washing practices coverage at critical times in Debay Tilatigin woreda, Amhara, 4.4. Distribution of diseases in the woreda As can be seen in the figure among the ten top diseases in woreda intestinal parasites account 6.64% and Diarrheal diseases 8.9% and other gastro intestinal diseases is 5.73%. Among all ten top diseases in the woreda, seven of them are water, sanitation and hygiene induced health problem this might be due to open defecation practice since the woreda was not open defecation free, poor hand washing practice at critical times or poor household water management.. Figure. Distribution of ten top diseases in Debay Tilatigin woreda, Amhara, March 11 1
4.5. Schools WASH coverage According to woreda education bureau head information among the available 5 schools in the woreda only 7 of them have adequate latrine facility and 1 of these 7 schools have separate squatting holes for males and females in the same structure. Moreover, 14 schools were with safe and adequate water supply but none of 5 schools was with hand washing facilities (figure3). Figure3. WASH coverage in schools in Debay Tilatigin woreda, Amhara, March 11. 4.6. Indentified resources The followings are indentified resources, commitment and partnership in the woreda: There is political commitment and involvement of woreda cadre in planning and mainly in the continuous follow up of development works in the woreda including health extension activities The woreda was rich in wooden materials and other resources for the construction of latrine, hand washing facilities, wastewater infiltration jar, ground water and surface water, etc All technical and supportive staffs in all public health facilities had established system to support the health extension program and at scale sanitation and hygiene activities. Front line farmers commitment and contribution were good input in WASH coverage The community involvement at scale up sanitation and hygiene in planning and implementation, follow up was significant Woreda WASH team commitment in the achievement of at scale sanitation and hygiene including water supply provision contribution was satisfactory All WWT member sector staffs integrated sanitation, hygiene and other health extension activities for the achieved coverage was significant. Their contribution was 11
not one time work they were involved in plan implementation, follow up and evaluation. All woreda government stakeholders mainly woreda education staffs, water resource office staffs, health office staffs, and other water, sanitation and hygiene related sectors staffs involved for 1% coverage of health extension packages Community empowerment was the main resource, commitment and partnership that the woreda used. 5. DISCUSSION AND CONCLUSION Safe drinking water, sanitation and good hygiene practices are fundamental to health, survival, growth and development for poor communities in countries like Ethiopia. Over 48.9 million (6%) of our fellow citizens in Ethiopia do not use drinking water from improved sources, while 69.5 million (88%) lack basic sanitation(1). Safe drinking water and basic sanitation are so obviously essential to health that they risk being taken for granted. Efforts to prevent morbidity and mortality from diarrhoea or to reduce the burden of such diseases as ascaris, dracunculiasis, hookworm, schistosomiasis and trachoma are destined to failure unless people have access to safe drinking water and basic sanitation. The Millennium Development Goals (MDGs) have set us on a common course to push back poverty, inequality, hunger and illness. The world has pledged to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation. Achieving the MDG drinking water and sanitation target poses different challenges (4). But Debay Tilat Gin woreda tends to be on tack to MDGs goals in scale up sanitation and hygiene. In the woreda at scale sanitation and hygiene coverage reached 1% even though it is difficult to say the woreda is free of open defecation, and hygiene and sanitation induced health problems such as intestinal parasites and Diarrhea. The woreda reached to this coverage through concerted efforts of all technical and supportive staffs of woreda health office, community involvement mainly front line farmers, woreda WASH team members, woreda executive members and their commitment. Even though JMP criteria for improved water and sanitation is not viable for our rural community the study result revealed that the woreda is on track to unfold sanitation, hygiene and households water handling and treatment system. 1
References 1. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Progress on Drinking Water and Sanitation: 1 Update. Geneva and New York: World Health Organization and United Nations Children s Fund, 1.. World Health Organization, United Nations Childrens Fund. Progress towards the Millennium Development Goals, 199-5. Geneva: World Health Organization, 5. 3. United Nations Development Programme. Human Development Report 7: Power, Poverty and the Global Water Crisis. New York: United Nations Development Programme, 7. 4. World Health Organization and UNICEF 6; meeting the MDG drinking targets for water and sanitation: the urban and rural challenges of the decade. Acknowledgements First and foremost, I would like to express my deepest appreciation to Regional health bureau and in the bureau environmental health case team members for its invaluable input in transportation facilities and for their unreserved help throughout the work of this study. My sincere thanks goes to Ato Dires Alemu, Debay Tilat Gin woreda health office head, and his partners in the woreda and kebeles council for their facilitation, coordination and commitment for the successful data collection of the study. Finally, it is also my pleasure to acknowledge the study team, data collectors and all study participants for their fruitful efforts in conducting this study. 13