INVESTIGATION OF LATRINE COVERAGE AND ASSOCIATED RISK FACTORS AMONG THE SWAHILI COMMUNITY IN MAJENGO VILLAGE, KITUI TOWN, KITUI COUNTY.
BRIAN KAITHYA JOSHUA
A RESEARCH PROPOSAL SUBMITTED IN PARTIAL FULFILLMENT FOR THE AWARD OF BACHELOR OF SCIENCE IN PUBLIC HEALTH DEGREE IN THE SCHOOL OF HEALTH SCIENCES IN KISII UNIVERSITY.
2019
DECLARATION
I declare that this study is an independent investigation research conducted by myself for the award for academic qualification in Kisii University. This report has never been submitted to any institution for any reason whatever.
Signature…………………………………… Date…………………………………….
Name Brian Kaithya Joshua
Reg. No: HE15/40025/14
This research proposal has been submitted for examination with my approval as the university Supervisor.
Signature………………………………………. Date…………………
Mr.Agasa.
Kisii University.
DEDICATION
This research proposal is dedicated to Mr. Justus Kameya Mwetu who has been supportive throughout the course duration. I also dedicate this research proposal to my course mates who have been of great support to me.
ACKNOWLEDGEMENT
First and foremost, I would like to thank my Almighty God for giving me life and strength to write this report. I am also very grateful to supervisor Mr.Lameck Agasa for the tiredness support and advice throughout the study process which has enabled me to write this report. I also wish to thank Joshua’s family for their positive criticism, support, and encouragement during the time of writing this report.
LIST OF ABBREVIATIONS AND ACRONYMS
KITWASCO Kitui Water and Sanitation Company
CBA Cost Benefit Analysis
CD ROM Compact Disk Read Only Memory
CHV Community Health Volunteers
DALS Distributed Adaptive Learning System (web-based learning system)
DHIS District Health Information System
GDP Gross Domestic Product
GOK Government of Kenya
KDHS Kenya Demographic Health System Survey
MDG Millennium Development Goal
MoH Ministry of Health
ODF Open Defecation Free
UNICEF United Nations Child Emergency Fund
USD United State Dollars
VIP Ventilated Improved Pit latrine
W.H.O World Health Organization
TABLE OF CONTENTS
Contents
LIST OF ABBREVIATIONS AND ACRONYMS. iv
1.5 General objective of the study. 4
1.8 Significance of the study. 5
1.9Scope of the study. 5
CHAPTER TWO: LITERATURE REVIEW… 7
2.4 Socio-cultural and behavioral factors. 13
2.5 Measures to increase latrine coverage. 15
CHAPTER THREE: METHODOGY.. 18
3.1 Study design. 18
3.2 Study population. 18
3.4 Sample size determinant 18
3.6 Data collection Technique. 20
3.8 Ethical Issues Involved. 21
CHAPTER FOUR: RESULTS AND FINDINGS. 24
4.2 Respondents’ demographic factors. 24
4.2.2. Age of household head. 25
4.2.3. Occupation of household heads. 25
4.3.1. Benefits of using latrines. 28
4.3.2. Sources of knowledge. 28
4.3.3. Main disease transmitted through faeces. 28
4.3.4. Main reason why people don’t have latrines. 29
4.3.5. Effects of open defecation. 29
4.3.6. Relationships in diseases between children’s and adults feces. 30
4.3.7. Hand washing with soap and water for prevention of diarrhea diseases. 30
4.3.8. If there is any effect if neighbors don’t use latrine. 30
4.4 Measures to increase latrine coverage. 30
The table below shows a summary. 31
4.5.1. Estimate cost of simple latrine. 31
4.5.2. How the latrines were financed (source of finance for the contribution of these latrines). 32
4.5.3 Motivation of latrine use in the village. 32
4.6.1. Factors negatively influencing latrine use. 34
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS. 35
5.1.1: Demographic Information. 35
5.1.4 Measures to increase latrine coverage. 36
GANT CHART SCHEDULE FOR RESEARCH ACTIVITY.. 46
ABSTRACT
Latrine coverage and associated factors remain an important issue in many parts of the world especially developing and underdeveloped countries. Globally 2.5 billion people lack improved latrine facilities while in Kenya 8 million lack the facilities. Kenya being a developing country, still 5.8 million people lack access to latrines whereby they practice open defecation. This has caused sanitation related diseases to rise in prevalence. Diseases such as diarrhea, cholera etc is very common in Kenya causing high mortality rates. This study aimed at studying latrine coverage and associated factors among the Swahili community in Majengo village in Kitui town, Kitui County, Kenya. A cross section study was used for the research. The reason for selecting Majengo village was due to the reports received from Kitui Water and Sanitation Company and the community health workers’ household registers (MOHS) which indicate very low latrine coverage in the area. Despite the intervention of The Water Service Trust Fund through Kitui Water and Sanitation company to provide subsidy latrines to the community, there was need to establish the real challenge/obstacle for effective dealing with the problem of low latrine coverage as a first hand solution in the control of fecal related diseases. The study was aimed at establishing the main reason as to why there was low latrine coverage in Majengo village, whether it was due to culture, religion, poverty, space and the like. This could help in the application of the most appropriate approach in solving the problem. Two Community Health Workers from the area were used as research assistants. They were trained and pre-testing done to determine the accuracy of data collection. Systematic random sampling of households was conducted using the CHVs household register whereby each third household was interviewed using a structured questionnaires per household. The structured household questionnaire included an observation checklist for filling the observation made on latrine use, cleanliness and a result of the transect walk. Qualitative data was collected through key informant interviews for filling the survey finding. All questionnaires were collected, checked for the required quantity/numbers, completion, coded, entered into SPSS and cleaned before data analysis. Findings which were collected in descriptive nature were presented as numerical summaries and tables (charts).From the study it was concluded that joint effort from every sector(especially KITWASCO in reducing the severe construction fee, county government funds and other well-wishers for subsidies, health for sensitization) to deal with these barriers as a way of up scaling latrine coverage. Socio-economic factors were found to be the main barrier as compared to other factors. Continued sensitizing and health education to the community should be emphasized and continued by all stakeholders who include the KITWASCO, National and County governments and any other interested party for the achievement of the government’s national sanitation target.
CHAPTER ONE : INTRODUCTION
1.1 Background information
Latrine coverage is defined as the proportion of households in a community with access to latrine or with connection to latrine (Benard S. et al, 2013). It is one of the most important measure ofdealing with fecal related diseases like fecal contaminated disease such as diarrhea, bacillary dysentery, amoeba, cholera, poliomyelitis, food poisoning, acute gastroenteritis, giardiasis, acute and viral hepatitis, and also helminthic diseases such as ascariasis, taeniasis, trichinosis and hookworms, (Kingondu T. et al,2007). Fecal related diseases can be prevented by use of improved sanitation. Improved sanitation refers to safe methods for excreta disposal such as use of flush or pours flush latrines, piped sewer system, septic tanks, pit latrines, cess-pits, ventilated improved pit (VIP), pit latrines with slabs, composting toilets among others. According to WHO these are among the methods of excreta disposal terms as un improved sanitation (poor or unsafe methods ) and they includes flush/pour flush to elsewhere, a pit latrine without a slab, a bucket latrine, a hanging toilet or hanging latrine, no facilities or bush or field, street gutters, among other methods,( WHO and UNICEF,2012).
Improved sanitation protects the environment and improves people’s health translating into social economic development and poverty reduction. Lack of sanitation is a major health problem around the world. Billions of people around the world especially the low class, who are either poor, disadvantaged or with little health education are being affected by these diseases.Open defecation which is practiced in many parts of the world is due to lack of sanitation facilities. This practice increases the risk of fecal related disease transmissions. The disease burden associated with poor sanitation and hygiene, account for 4.0% of all deaths and 5.7% of the total disease burden worldwide (DALYS). Improved sanitation is considered equally important as in access to clean water.
About 1.8 million people die every year globally due to diarrhea disease whereby children under 5 years account for 90% of diarrhea deaths. 88% of diarrhea diseases are attributed to water supply, inadequate sanitation and poor hygiene. Regions with the poorest water supply coverage are Oceania (53%), Southern Asia (36%) and Sub-Saharan Africa (31%), (WHO, 2015).
In Southern Asia, 47% of the population was using improved latrine facilities in 2015 as compared to 22% in1990, while the Sub Sahara Africa made slower progress in the same period by rising from 24% to only 30%. Despite progress, the 2015 Millennium Development Goal (MDG) to half the population of the people within access to improved sanitation facilities was missed by almost 700 million people. 47 countries have less than half the population accessible to toilet and improved latrine.
In the Sub-Sahara Africa, 2/3 of the population lack access to improved sanitation facilities (WHO/UNICEF, 2006). Sub-Southern Africa and Southern Asia are the lowest worldwide in sanitation coverage. Usage of septic tanks stands at 5% of the population of Sub Saharan Africa. Challenges with the septic tanks are mostly high construction cost, space limitations, lack of water and blockages that result from use of bulky materials for anal cleansing.
Diarrhea is a highly preventable disease but kills 1.5 million children annually, more than Malaria, Measles and AIDS combined. It is a second leading cause of deaths among children under five years (UNICEF and WHO, 2009). Diarrhea disease is a direct cause of 11% of under-five mortality with developing countries especially Sub-Sahara Africa bearing the most consequence (UNICEF, 2012).
According to world health organization (WHO) fact sheet on sanitation of July 2014, 68% of global population use improved sanitation and 2.1% billion people have gained access to improved sanitation facilities since 1990. 2.4 billion people still don’t have basic sanitary facilities such as toilets and latrines, of these, 946 million still defecate in the open for example in street gutters, behind bushes or into open bodies of water. The proportion of people practicing open defecation globally has fallen almost by half from 24% to 13%. At least 10% of the world’s population is thought to consume food irrigated by waste water. Inadequate sanitation is estimated to cause 280,000 diarrhea deaths annually and is a major factor in several neglected tropical diseases.
In 2010, the UN General Assembly recognized access to safe and clean water and sanitation as a human right and called for international effort to help countries to provide safe, clean, accessible and affordable drinking water and sanitation.13% 0f global population defecate in the open, where of these, 9 out of 10 live in rural areas. Better sanitation, water and hygiene could prevent the deaths of 361,000 children aged under 5years each year. Countries where open defecation is mostly practiced have the highest number of deaths of children below 5 years as well as high level of malnutrition and poverty, and by disparities of wealth.
In Kenya, over 8 million people lack proper toilets (Dr. Hussein, Daily Nation, and Friday 18th December 2015). Following the benchmark done by the Ministry of Health, Nyeri County was ranked the best in sanitation out of the 47 counties, followed by Nakuru County. On 19th November each year, is marked the world toilet day, meant to raise global awareness on the struggle faced by close to 2.5 million people living without access to proper sanitation.
Diarrhea prevalence for children under 5 years remains at 17% nationally, but disproportionally affects the poorest people in the population, (KDHS, 2010). Diarrhea is ranked 3rd most prevalent cases or mortality in Kenya resulting in 7% of all deaths in a year. According to the ministry of health, about 80% of all the disease attendance in Kenya is sanitation and hygienic related (GOK, 2010). Approximately 19,500 Kenyans, including 17,500 children under 5 years die each year from diarrhea (GOK, 2012).According to Ministry of Health (MoH, 2015) statistics, 55% of Kenyans have no access to toilets and only 5% of Kenyans wash their hands using soap. The percentage of people without access to improved sanitation is 39%.
According to the Ministry of Health Vision report, Kenya projects to be Open Defecation Free (ODF) by the year 2020. Nationally, Busia county is the only region which has attained 100% ODF followed by Kisumu Nyando Sub county. Kitui county projects to be ODF by 2020.In Kitui County, 64% of the residents use improved sanitation, while the rest use unimproved sanitation. Kitui Central has the highest share of residences using improved sanitation at 74%, while Kitui-West being the lowest.
1.2 Problem statement
According to a survey done by The Kitui Water and Sanitation Company (KITWASCO) in 2017, and the Ministry of Health in 2018, it was established that this community is lagging behind, otherwise the lowest of all the communities in Kitui County in hygiene situation. Majority of the pit latrines in use are substandard, and don’t even provide enough privacy to the users. The community depends of river water and earth dams for domestic water. Despite the efforts put up by Kitui County Government with collaboration with Kitui-Central Sub-County PHOs and CHVs, the community has a low latrine coverage whereby most residents defecates in streams which channel the rain water to the rivers and dams which is later used for drinking and other domestic work.
1.3 Justification
Fecal related diseases in Kitui-Central Sub-County related to poor sanitation were 12,723 in the year 2016. Diarrhea and Amoeba diseases recorded 11,255 and 1,011 respectively (DHIS, 2016). If this is not properly investigated and verified on time, the prevalence of diarrhea diseases is likely to rise at a rate of 22%. This would definitely increase the negative health indicator in KituiCounty.A survey done by KITWASCO and MoH indicated that more than 75% of households in Majengo village being located within outskirts of Kitui town did not have proper sanitation facilities (KITWASCO, 2017).
1.4Aim of the study
The study is aimed at investigating latrine coverage and associated factors among the Swahili community in Majengo village.
1.5 General objective of the study
The objective of the study is to investigate latrine coverage and associated factors among the Swahili community in Majengo village in Kitui town, Kitui County, Kenya.
1.6 Specific objectives
- To investigate socio-economic factors affecting latrine coverage among the Swahili community of Majengo village in Kitui-central Sub-County, Kitui County, Kenya.
- To investigate the knowledge factors affecting latrine coverage among the Swahili community of Majendo village in Kitui-Central Sub-County,Kitui County.
- To investigate cultural and behavioral factors affecting latrine coverage among the Swahili community of Majengo village in Kitui-Central Sub-County,Kitui County.
- To come up with measures that will increase latrine coverage among the Swahili community of Majengo village in Kitui-Central Sub-County, Kitui County.
1.7 Research questions
- What are the socio-economic factors effecting latrine coverage among the Swahili community of Majengo village Kitui-Central Sub-County, Kitui County?
- What are the knowledge factors affecting latrine coverage among the Swahili community of Majengo village in Kitui town, Kitui County, Kenya?
- What are the cultural and behavioral factors affecting latrine coverage among the Swahili community of Majengo village in Kitui town?
- What measures can be implemented to increase latrine coverage among the Swahili community of Majengo village in Kitui town, Kitui County?
1.8 Significance of the study
To investigate latrine coverage and the associated factors in Majengo village. The gaps identified may be used in finding solutions for promoting latrine coverage in the area as a first hand solution in the control of fecal related diseases.
1.9Scope of the study
This study will be carried out on the house-hold heads of Majengo village in Kitui township ward in Kitui-Central Sub-County. It will be carried in the months of June and August 2019. Household heads in the age bracket 18- 65 years will be targeted for the study.
1.10 Definition of terms
Latrine –it is a facility simpler than a toilet usually consisting of a hole in the ground, a slab with an aperture hole and a superstructure which by family to defecate or to urinate. It is practiced as a safe excreta disposal point within household or emergency camps.
Latrine coverage– this is the proportion of number of latrines within a given locality or community compared to its population and number of households within that area.it is expressed as a percentage. Latrine coverage is defined as the proportion of households in a community with access to latrine or with connection to latrine.
Risk factor-it is any attribute, characteristic or exposure of an individual which increases his/her likelihood of developing a disease(WHO).It is a factor associated with an increased occurrence of a particular problem which is associated or contributed by a practice among a particular group.
Association-it is a statistical dependence between two variables. It is a state which two attributes can occur together either more or less than expected by chance.
Sanitation- Sanitation refers to the provision of facilities and services for the safe management of excreta disposal from toilets or latrines to the containment and storage and treatment onsite or conveyance, treatment and eventually safe end use or disposal.(WHO).
CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
The treatment and disposal of human waste is becoming an important matter of concern asthe world population is growing at a high rate. The main source of diarrheal infection is human excreta (Elisa R. et al, 2012). It seems clear therefore, that human excreta should be managed as a potentially dangerous material. The construction of latrines is a relatively simple technology that may be used to control the spread of infectious diseases. Studies have shown that latrine coverage has to reach 90% of a population to have an impact on community health (Ikin et al, 1994). Improvements in sanitation coverage are one of the key elements to improve health around the world.
Despite the huge potential benefits of improved sanitation, large-scale latrine promotion around the world has been very disappointing. The percentage of latrine coverage has increased by 5% during twenty years of sanitation promotion, however the number of people lacking sanitation services remain practically the same (WHO, 2000). Current sanitation promotion tactics need to be reevaluated in order to develop new techniques that meet with the wide public appeal. Considering the reasons behind the non- adoption and the results of case studies can provide the necessary information to create a successful sanitation program.
There are several reasons associated with non-adoption of latrines use. The most common are related to poverty, socio-cultural issues, and technical difficulties. The most commonly identified reason for the lack of a household toilet is the high cost, followed by “use public latrines”, ‘lack of space’, and ‘difficult to operate and maintain’ (Cotton A. et al, 1998).
Another frequent barrier to latrine adoption is difficulties in operation and maintenance. Odor and insect problems are often quoted as deterrents to use, however only 11% of users reported these as nuisance problems (Ababa A, 2004). The large numbers of maintenance problems are related to emptying. Emptying may require extra costs that are difficult for families to afford. There are also concerns with hygiene during emptying and the frequency with which it must be done.
The other reasons for lack of household toilet are less of a concern on designing a sanitation promotion program. If people lack a household latrine because they are using public latrines the ultimate goal of managing human excreta is still met. In this case, there is always the possibility that the family may construct their own latrine when it becomes financially affordable. Lack of space for latrine construction may be a concern in urban areas, but studies have not shown a link between plot size and the absence of a latrine (Cotton A. et al, 1998). In considering all of the socio-cultural reasons for non- adoption it is also important to realize that communities are not uniform and not all of these issues will be problematic for everyone. The goal of a successful promotion program will be to identify the site-specific problem areas and work to overcome the barriers on accepted sanitation.
2.2 Socio-economic factors
Latrine coverage involves resources. Availability and type of latrine in a society depends on the financial resources of the society among other factors. Latrine requires maintenance. The availability of latrine is higher in households with high income as compared with those households with low income. Also areas near to urban centers and health facilities tend to have high number of latrine coverage than those located in the district areas (Awoke W. et al, 2013).
Poverty and indebtedness limits the spread of latrine coverage. Some people are very poor such that they survive on subsistence incomes. At this level of poverty, income is primarily spent on food and goods, with other items being given low priority. It is difficult to convince these people to use their limited finances on sanitation when they have lived their entire life without it. Even when they are convinced that sanitation will be beneficial, the perceived high cost of installation keeps many people from adopting latrines and toilets. (Conville J.M.2003). According to the national hygiene and sanitation strategy of the ministry of health of Ethiopia, persistent drought conditions worsen poverty, increase indebtedness, and reduce funds available for water, latrine and soap. As a result the spread of latrine coverage is highly confronted.
According to an estimate by the WHO and UNICEF, initial investment cost (year 2000) per capita ranges from a simple pit latrine at US$ 26 in Asia to aseptic at US$ 160 in Latin America and the Caribbean. Scientific evidence has demonstrated that the economic cost associated with poor sanitation is substantial. At the global level, failure to meet the MDG water and sanitation target would have ramifications in the area of US$ 38 billion whereby sanitation accounts for 92% of this amount (US, 2005).Benefit analysis has not been commonly used to justify increased spending programs. Until now, both policy makers and the general public have not been presented with comprehensive evidence on the economic impact that sanitation has on the economy, the environment and population welfare.
Poor sanitation is expensive; Kenya loses an estimate ofKsh. 27 billion (365 USD) each year which is 1% of the national (GDP), due to poor sanitation. Open defecation costs Kenya US$ 88 million for years (WSP 2012). Inadequate sanitation continue to strain the health care system with the economic burden of poor sanitation falling heavily on poorest who constitute nearly a half of all Kenyans (WHO, 2008).
Improved sanitation brings multiple economic benefits, which include; direct economic benefits of avoiding illness thus averting health care costs (the amount of money that is saved from health care expenses), indirect economic benefits, which include a decrease in work days lost to illness and a long lifespan, because these benefits enables people to work more and non- health benefits such as time, productivity gains associate morbidity and mortality, (Bwire B, et al 2009).
Good sanitation contributes largely to poverty reduction and enhances the security, dignity, and wellbeing of women and girls, since poor sanitation hits them the hardest due to their vulnerability. (Singh P, 2017)The rich have greater access to improved sanitation as compared to the poor. Lack of latrine at times could be due to lack of cash income on part of economically poor families, thus at some places prompting subsidized latrines (Singh P.2017).
Although sanitation services seems to be expensive, evidence has demonstrated that investing in sanitation is socially and economically worthwhile, (Hunt C, et al 2001). Benefits outweigh the cost. Furthermore, improved sanitation has great positive impact on children’s health, gender equality, environmental sustainability, and water resources (clean drinking water). Improved sanitation will contribute to lifting populations out of poverty as well as preventing them from slipping back into poverty, (Podja A. et al, 2010).
Different studies have demonstrated that sanitation is fundamental to social and economic development, and fiscal gain from improved sanitation services are substantial (Dolla D. et al, 1999), for example, reported that for every 10% increase in female literacy (due to increased school attendance where proper sanitation facilities exist), a country’s economy could grow by 0.3%.
Cost and benefit analysis available on global scale have frequently concluded that the benefit outweigh the costs regardless of which scenario is being considered. Cost benefit analysis (CBA) is an economic evaluation method used to determine if a project is worth for a community. It comprises the value of the benefit gained from a specific policy or intervention to the corresponding costs.Poor sanitation has shown to cause a wide range of advanced impact on population health as well as national economies. The magnitude of economic losses associated with poor sanitation in developing countries has been substantial, (Podja A. et al, 2010).
Sanitation also has socio economic equity implications. Vulnerable groups (the poor, children, women, the disabled and the elderly) have suffered the most from the economic impact on poor sanitation, (Podja A. et al, 2010).
Diseases associated with poor sanitation have been closely associated with poverty and infancy which accounts up to 10% of the global burden of diseases,( Ngowi H. et al, 2004).There is lack of recognition of actual drivers for sanitation improvement and complexities in the provision of sanitation services in the cortex of sanitation services in urban slums with mix of tenants and landlords, (Isunju J.et al, 2011)
Improved sanitation has been shown to have great impact on people’s health and economy. However, the program of achieving the Millennium Development Goal (MDG) on halving the promotion of people without access to clean water and basic sanitation by 2015 has far been delayed. One reason for the slow progress is that policy makers as well as general public halves not fully understanding the importance of the improved sanitation solutions, (EHI, 2011).
The governments in the developing countries tend not to see improved sanitation as a necessary condition of economic development or source of improved welfare, and cost benefit.
It may be difficult for extension agents to understand what is considered ‘high cost’ in a developing country. It is often useful to consider the cost of latrines as a percent of the household income. For example, a Mozambique program targeted latrine construction in the poorest sections of the peri – urban communities. The average household income in these areas was $22 per month. The program introduced domed concrete slabs that were subsidized to a user cost of $1.16. This one-time cost represents 5% of the average monthly income. The extra costs of transportation and construction were borne by the users. A survey of residents indicated that the majority of people viewed the total costs of the latrine as a medium cost (Cotton A, at al, 1998).
2.3 The knowledge factors
Low latrine coverage is associated with illiteracy, lack of knowledge on latrine coverage and its importance. A campaign which lasted for 1- 2 months was undertaken in each of the 20 villages in Bhadrak, rural Orissa India. This was done to ensure that social mobilization was conducted with sensitivity to local customs in each village by a local community based organization. The implementing agency helped the community to establish system of fines or social sanctions to punish those who contributed to defecate in the open. The local government helped these organizations to establish sanitation marts, produce sanitation components in the village and provide know how on latrine engineering.
WHO global assessment of sanitation and drinking water in 2013 highlights the lack of policies for improving water, sanitation and hygiene in health care facilities. The MDG for sanitation and water are almost exclusively focusing on households and communities, while outside the home where a significant amount of time is spent, institutions such as schools and health-care facilities are ignored (Sigh P., 2017)
The National Environment Sanitation and Hygiene Policy (2007) provide direction on planning and implementing policies. Policy provides direction on planning and implementing sanitation objectives in Kenya. The policy envisions, creating and enhancing an enabling environment, in which all Kenyans will be motivated to improve the hygienic behavior and environmental sanitation. According to the policy, all Kenyans will be educated and made aware of the importance and need for improved Environmental Sanitation and hygiene practices for improved health resulting in positive change in behavior.
This policy was developed to make contribution to the dignity, health, welfare, social wellbeing and general prosperity of all Kenyans. It recognizes that healthy and hygienic behavior and practices begins at individual level. Implementation of the policy is aimed at the increasing demand for sanitation at the household level and encourages communities to take responsibility for improving sanitary conditions of their environment (GOK 2007 b).
Communities with high level of education have better access to sanitation than illiterates ones (Singh P. 2017).
The public health act cap 242 requires every premise to have adequate sanitary facilities. The Food Drug and Chemical substance act cap 254 requires every food premise to have adequate sanitary facilities. The building code requires anybody commencing a construction work to start with sanitary facilities. There are many acts which enforce the provision of sanitary facilities but the most important thing is to make the public aware of the importance of latrine use in order to create a demand. The National Health sector strategic plan aims to increase sanitation coverage from 46% to 60% (GOK 208-2012a).
The new constitution of Kenya of 2010 chapter 43, part 20,1b outlines the result of every Kenyan including the minorities and marginalized groups have a right to the highest standards of health; which includes the right to health care services, accessible, adequate and reasonable standards of sanitation.
Improved sanitation is not limited to physical structured aspects but also includes having the correct knowledge on importance of using latrines, proper use and maintenance of latrine facilities as well as behavior change towards more hygienic practices.
As per the MDG, by the year 2015 every household could have been made aware of the importance of improved environmental sanitation and hygienic practices for improved health; 90% of household would have access to hygienic, affordable and sustainable toilet facilities; and every school would have had hygienic toilets and hand- washing facilities (GOK 2010b).
Approximately 19,500 Kenyans, including 17,100 children under 5years die each year from diarrhea (GOK 2012c). Diarrhea prevalence for children under the age of 5years remains 17%nationaly, but disproportionately affects the poorest people in the population (KDHS 2014).Lack of awareness on the health adversities caused by unsafe fecal disposal is a pressing challenge o provision and use of latrine (MDWSI 2015).
Various promotion methods have been used to promote latrine coverage. Some of these methods include radio broadcasts, local extension agents, school programs, subsidized costs, house to house visits and guided tours of latrines.
2.4 Socio-cultural and behavioral factors
There are several socio-cultural issues that can influence the acceptance of on-plot sanitation. The concept of dirty and clean can vary from culture to culture. In many places children’s feces are considered harmless and therefore are not disposed in latrines. Latrines themselves may be viewed as dirty and evil places. It may be considered more sanitary to defecate in the fields away from the house. Existing traditions and beliefs also play a part in the reception of latrines. It is difficult to change long ingrained behaviors dictating defecation practices and without proper reinforcing, people will revert to old habits. In some cultures religious beliefs may influence latrine use as well. For example, a latrine construction project in India placed the toilets in the northeast corner of the plot. According to the local Hindi beliefs this is an inauspicious location to place a toilet, so the people refused to use them (Cotton A. at al, 1998).
Gender issues are an important consideration in sanitation projects. In many cultures women need separate facilities from men. This may be especially important for menstruating women. Women often require more privacy and will boycott facilities that they feel they give inadequate protection (UK DFID, 2013)
Cultures may be resistant or reluctant to change. This is especially true when foreign aid workers are responsible for promoting change. There may be feelings of resentment and/or fear of outsiders and their ideas. Community leaders may fear the loss of authority as foreign ideas begin to spread. There have been reports of leaders sabotaging sanitation projects or redirecting sanitation funds into their own pockets.
Feces have been considered ritually impure as well as physically filthy and water as the necessary medium of purification and ritual cleansing in Indian society (Laungani P, 2007)
Beliefs in India that feces are impure also caused a few participants to consider the practice of containing feces in the latrine pit in the home as a sin, because idols and pictures of god that are revered are kept and worshiped in every house; having toilets within or next to the house makes the entire home impure. These kinds of strong tradition beliefs can hold back people from adopting the new practice of defecating safely inside latrines (Sing P. et al, 2013). The importance of considering cultural beliefs however, has long held time for changing the globe.
In some parts of rural India, people who had not been involved in choosing their sanitation technology persisted in their habit of open defecation (WSP, 2010), and has been confirmed in a quantitative study showing individuals in households that had been involved in the choice of their latrine design.
Lack and provision of water supply in the latrines emerged as major factor for non-use in the design of facilities, given the quantities of water needed for anal cleansing, flushing and sanitation purification rituals. Usage would increase among latrine with provision of water in the latrine (O’Relly K. 2010)
Absence of water at the latrine for post defecation and anal cleansing and bathing (which is crucial to accomplish customary sanitation purification rituals), reduce latrine uptake and use. In places where the distance of water supply points is more than 500 meters from the latrine, villagers have shown unwillingness to fetch water (Singh P. at el, 2013).
Some communities have negative attitude towards excreta disposal. They claim that latrine smells thus better to go to the bush because it is fresh. Others claim that sharing of latrines with children is a big issue which is not good. Some people don’t want to be seen going to the latrine.
In some of the communities son in-laws don’t share latrines with their mother in-laws because of that fear that they might meet when one is naked in the latrine. Also, there is fear that if one accidentally shits on the side of the latrine, the other person will be able to connect the feces to the person who shits it there, exposing the quantity, type, color, how often one is seen going to defecate among other things (Dittmer A et al, 2009).
Siting of latrines may also affect its usage. In some community people don’t feel comfortable going to use a latrine while others are seeing or watching, for example when a latrine is sited in front of the house. In such a case others may opt to use any other alternative available including bushes rather than being seen openly going to the latrine.
2.5 Measures to increase latrine coverage
People are more likely to use latrine when they are functional, well maintained, accessible, clean, private, and amenities for practicing hygienic behaviors like anal cleaning and menstrual management.
Even with high latrine coverage levels achieved, open defecation is still often practiced, (Benard S. et al, 2013). Users may choose to openly defecate and that decision is likely influenced by a number of technological and behavioral factors, (Coffey et al 2014, Hulland et al, 2015) and (Rontray et al, 2015) behavior and strategy matters.
For centuries, agricultural regions in China have used night soil as fertilizer for field crops. The introductions of latrines in these areas has posed the difficulty of convincing famers that the health benefits of latrines outweighs the loss or natural fertilization. The initial programs advocating sanitation reform prior to the 1970s met with little success. This program lacked community involvement, offered few benefits to the famers and were ill received by people resistance to change, (Slinger et al, 2000)
Kenyan governments initiate programs that promote latrine construction. A combination of local advocacy meetings and mass media were used to spread the key message of reform. The government provides subsides and low interest loans but most of the cost of construction maybe the responsibility of the families. Another key element was setting up demonstration sites where people could learn how the system actually works, the program also trained local leaders as technicians and reform promoters to ensure community involvement, (Shugen A. et al, 2000).
A survey done in Bhadrad rural Orissa in India indicated that many households lack access to private water sources, latrines, roads and village dispensaries. Most households reported using public wells and surface water source for their daily water supply and covering their stored water at home, with some few reported treating their water. Most adults reportedly washed their own hands and their children’s after defecating and before eating, but they rarely used soap or ash. Responded reported limited access to latrines, and more than 90% of the households reported open defecation. Most people dispose their waste directly outside the house.
Some communities defecate outside in the periphery of their villages in open fields or bushy areas of hide themselves and avoid being seen by others. Availabilities of bushes encourage open defecation because it becomes safe and convenient place where they could hide themselves from sight of other people as they don’t like to be seen by others during the act. Sometimes in farm where there are no latrines, farmers defecate at unused sites somewhere close to their agricultural fields.
Ownership of latrine facility doesnot guarantee health benefits unless the said facility is utilized effectively (Antezeh K. et al, 2010). However, many factors have been shown to promote latrine use such as behavioral, demographic, geographic, climatic, economic, supportive supervisory visits by health personnel, presence of school going children, peer pressure, social learning and living in close proximity to health institutions have also been found to promote latrine use (Shakya et al, 2012).
Many factors hinder use of latrine i.e. weak national strategies and policies, inadequate financial and low privatization of latrine by the government, global misunderstanding on linkage between sanitation and health, social taboo, inadequate funding (WSP 2004) Other factors promoting latrine use include street theatre, appropriate technology, government/NGO support, mass media, community involvement, demonstration site, household visits, women involvement and others.
2.6 Conceptual framework
The study will adopt conceptual framework to show the relationship between the depended and independent variables as shown below.
| LATRINE COVERAGE |
| Practices
· Availability of latrines · Availability of other disposal methods/sites · Illiteracy · Hand washing · Sharing of latrine · Cleanliness · Maintenance |
| Attitude
· Taboo · Belief · Culture · Religious beliefs |
| Socio-economic
· Poverty · Labour · Employment |
| Knowledge
· Knowledge of importance of latrine usage · Knowledge of hygiene practices · Illiteracy · Law enforcement · Effects of poor sanitation · Causes and prevention of diseases · |
Dependent variables Independent variables
CHAPTER THREE: METHODOGY
3.1 Study design
A cross section descriptive study design will be applied by the use of systematic random sampling to study the latrine coverage and associated factors among the Swahili community in Majengo village, Kitui town, Kitui County.
3.2 Study population
The study population will consist of household heads or their representative from the study area of Majengo village. The village has a total population of 1,763 people. It has 253 households based on the Household Register, MOH 2017.
3.3 Study Area
The study will be conducted in Majengo village, Kitui Township ward, Kitui-Central sub countyKitui County, Kenya. It lies at latitude -1.37508 and the longitude of 37.9952, GPS coordinates of 10 22’’ 30.2916’’ S and 370 59’’ 42.7668’’ E. It is located 180 kms east of Nairobi, 105 kms east of Machakos, 4225 kms from Prime meridian and 152 Kms from equator.
3.4 Sample size determinant
Sample size will be determined using Fisher’s method (Fisher’s et al 1998) as shown below
When population is more than 10,000
Where n=sample size
z=standard normal deviation (1.96) which corresponds to 95% confidence level
p=expected prevalence (because no prevalence is given, we use 50%) latrine coverage in Kitui -Municipality Ward.
d=degree of accuracy
D= Study design effect (usually 1) when it is not a comparison study.
Therefore:
= 384.16
Since the population of Majengo is less than 10,000, a second formula of Fisher’s et al will be used.
Where = The desired sample size of the population when the population is less than 10,000
= The desired sample size calculated using the first formula.
The estimated population size = 253 households
Therefore:
= 154
Attributes 20% of the calculation = = 31
154+31= 185
The above sample size is the minimal for statistical significance calculations.
3.5 Sampling techniques
The area was selected purposely due to the previous survey done by KITWASCO and also MOH through the community health volunteers (CHV) who identified the poor sanitation in the area. KITWASCO came out with the project subsidizing the construction of latrines called Eco toilets (ECOSAN). They came up with their design and color for the purpose of identification of these toilets.
3.6 Data collection Technique
A questionnaire will be designed in a structural manner for the collection of data. Data collection will be in line with relevant objectives of the study from the respondent. The research questionnaire will be written in English language which will be translated to Kiswahili language and then back to English for filling the forms precisely. Some questions can be asked by the research assistant while others can be left for the principal investigator depending on the technicality required/ involved .Informed consent will be obtained from all relevant respondents before data collection. No respondent will be forced to give any data.
Observation method will also be used during the study whereby latrines will be observed of their existence, cleanness, privacy, type (improved or unimproved), hygiene practices, hand washing facilities etc. Any observation made will be recorded with guidance of the checklist.
A transect walk will be conducted systematically across the study area to explore the sanitary conditions of the area by observing, asking, listening and looking. CHV of the study area will be recruited as a research assistant; he/she will be trained to assist the researcher in the area. The training will be conducted regardless of the primary training in case of undertaking similar studies. The training will cover the purpose and objectives of the study tools, methods of data collection, general interviewing and note taking techniques.
3.7 Data Management
Data will be cleaned, coded keyed punched to the computer and analyzed.
3.7.1 Data Entry
Data cleaning will be done by detecting and correcting or removal of corrupt or inaccurate records from a record set, table or database.
3.7.2 Data analysis
Data obtained from the field will be cleaned, coded, key-punched into the computer and analyzed. The descriptive findings for the study will be presented in form of numerical summaries, tables and charts.
3.7.3 Data Presentation
Data presentation can be done by publicizing the article, charts, graphs, histograms.
3.7.4 Data dissemination
Data will be disseminated either by electronic format, CD ROM and paper publication such as pdf file based on aggregate data; internet protocols (open system)
3.8 Ethical Issues Involved
Ethical issues will be observed not to have participants as a result of their participations. Majorethical issues will include informal consent, beneficence (do not harm), respect for anonymity and confidentiality, respect for privacy.
3.9 Pilot study
Pilot study which is a small study carried out before a large-scale study, will be conducted in order to evaluate feasibility, time, cost, adverse events, and variability in an attempt to predict an appropriate sample size and improvement of study design prior to performance of full scale research project.
3.10 Study feasibility
Analysis and evaluation of the proposed project will be conducted to determine whether the study is feasible within the estimated cost, whether it is technically feasible and if it will be profitable.
3.11 Reliability
This involves problem solving skills and techniques to prevent recurrence of failure or adverse events. A way of accessing the quality of the measurement procedures used to collect data in order for the results from a study to be considered valid.
CHAPTER FOUR: RESULTS AND FINDINGS
4.1 Introduction
This section discusses what was found during the study. The study was aimed at investigating latrine coverage and associated risk factors among the Swahili community in Majengo village, Kitui town, Kitui County, Kenya. The specific objectives of the study were; to assess socio-economic factors affecting latrine coverage, to investigate cultural and behavioral factors affecting latrine coverage and to determine measures that be put to increase latrine coverage among the Swahili community of Majengo village in Kitui town, Kitui County.
4.2 Respondents’ demographic factors
A total number of 160 respondents participated in the study whereby Seven demographic variables were investigated. They included gender, age, occupation, level of education, people permanently residing in the household, religion and average income of the respondents (as shown below).
Table 4.1. Demographic findings
| GENDER | Demographics | N | %age |
| Female | 98 | 61.25% | |
| Male | 62 | 38.75% | |
| AGE | Less-24 years | 18 | 11.25% |
| 24-40 years | 96 | 60% | |
| 41-60 years | 46 | 28.75% | |
| OCCUPATION | Formal employment (salaried) | 4 | 2.5% |
| Informal employment(casual) | 16 | 10% | |
| Business persons | 88 | 55% | |
| Farming | 52 | 32.5% | |
| Others | 0 | 0 | |
| LEVEL OF EDUCATION | No formal education | 14 | 8.75% |
| Primary | 84 | 52.5% | |
| Secondary | 54 | 33.75% | |
| Tertiary | 8 | 5% | |
| PERMANENT RESIDENT | 1-4 | 48 | 30% |
| 5-8 | 104 | 65% | |
| 9-12 | 8 | 5% | |
| RELIGION | Muslim | 118 | 73.75% |
| Christian | 42 | 26.25% | |
| Hindu | 0 | 0%% | |
| Other | 0 | 0% | |
| MONTHLY INCOME | Less 5000 | 86 | 53.75% |
| 6000-10000 | 72 | 45% | |
| 11000-15000 | 0 | 0% | |
| 16000-20000 | 2 | 1.25% | |
| Over 20000 | 0 | 0% |
4.2.1. Gender
The number of female headed households who participated were more (61.25%) as compared to male headed households (38.75%).
4.2.2. Age of household head
It was found out that most of the household heads who participated in the study were in the age bracket of 24-40years (60%), followed by 41-60years (28.75%) then lastly less 24years old (11.25%).
4.2.3. Occupation of household heads
Most of the household heads were small business persons (55%), followed by peasant farmers (32.5%), informed employment (10%) and lastly formal employed persons who were 2.5%.
4.2.4. Level of education
Most of the household heads were primary school dropouts (52.5%), followed by secondary school leavers (33.75%). Those with no formal education were 8.75% while tertiary level of education were 5%.
4.2.5. Household sizes
The study found out that most of the families had a size of 5-8 persons (65%), followed by 1-4 persons (48%). The households with 9-12 persons were 8%.
4.2.6. Religion
From the study, it was found that most of the residents were Muslim (73.75%) while a small number comprised of Christians (26.25%).
4.2.7. Monthly Income
The monthly income of most people is below Ksh. 5000 (53.75%). Those whose income ranged between Ksh.6000- Ksh.10,000 was 45%. Only 1.25% received between Ksh 16,000 to Ksh.20,000.
4.3.0 Knowledge
The following table shows the knowledge outcome for the study population; Table 4.2. Knowledge factors affecting latrine coverage
| KNOWLEDGE | KNOWLEDGE | N | %age |
| BENEFITS OF USING A LATRINE | No benefit | 0 | 0% |
| Disease prevention | 158 | 98.75% | |
| Privacy | 2 | 1.25% | |
| Others | 0 | 0% | |
| SOURCE OF KNOWLEDGE ON IMPORTANCE OF LATRINE | Through barazas | 22 | 13.75% |
| Though health workers | 122 | 76.25% | |
| Learned in school | 16 | 10% | |
| Others | 0 | 0% | |
| NAMING DISEASE TRANSMITTED THROUGH FEACES | Cholera | 152 | 95% |
| Diarrhea | 8 | 5% | |
| Others | 0 | 0% | |
| MAIN REASON WHY SOME HOUSEHOLD LACKED A LATRINE | Had a latrine | 140 | 87.5% |
| Lacked construction material | 6 | 3.75% | |
| Lack of enough space | 4 | 2.5% | |
| Lack of enough money | 10 | 6.25% | |
| Others | 0 | 0% | |
| ATTRIBUTES OF LACK OF LATRINE | None | 48 | 30% |
| Diseases | 104 | 65% | |
| Medical expenses | 4 | 2.5% | |
| Did not know | 2 | 1.25% | |
| Shame | 2 | 1.25% | |
| EFFECTS OF OPEN DEFECATION | Shame and disgust | 106 | 66.25% |
| Cause diseases | 54 | 33.75% | |
| Others | 0 | 0% | |
| IF CHILDREN’S FEACES CAN CAUSE DISEADES | Yes | 158 | 98.75% |
| No | 2 | 1.25% | |
| Don’t know | 0 | 0% | |
| IF HUMAN FEACES ARE PRINCIPLE CAUSE OF DIARRHOEA DISEASE | Yes | 158 | 98.75% |
| No | 2 | 1.25% | |
| IF WASHING HANDS WITH SOAP COULD PREVENT DISEASES | Yes | 160 | 100% |
| No | 0 | 0% | |
| IF ONE IS AT RISK OF GETTING DIARRHOEA IF NEIGHBOUR DOESN’T USE A LATRINE | Yes | 160 | 100% |
| No | 0 | 0% |
4.3.1. Benefits of using latrines
The study found out that almost all respondents n=158 (98.75%) believed that the main benefit of using latrines is disease prevention.
4.3.2. Sources of knowledge
Respondents received the knowledge of importance of latrines from different sources. Most of the knowledge was received from health workers n=122 (76.25%), barazas n=22 (13.75%) and schools at 10%.
4.3.3. Main disease transmitted through faeces
It was found out that almost all respondents (95%) believed that cholera is the main disease transmitted through faeces. 5% believed in diarrheal diseases.
4.3.4. Main reason why people don’t have latrines
87.5% of the respondents have/ use latrines. The study discloses that those who do not have latrines is due to finance (6.25%), lack of construction materials (3.75%) and lack of space at 2.5% of the residents.
4.3.5. Effects of open defecation.
It was discovered that the major effect of open defecation was shame and disgust at 66.25% ,and disease causation at 33.75%.
4.3.6. Relationships in diseases between children’s and adults feces
The community believes that both children’s and adult’s feces are equally responsible in causing diseases. This established from the respondents at 98.75% with only 1.25% without knowledge of any effects of children’s and adult’s feces.
4.3.7. Hand washing with soap and water for prevention of diarrhea diseases
The entire village believed that diarrhea diseases can be prevented by the use of soap and water for washing hands.
4.3.8. If there is any effect if neighbors don’t use latrine
All the respondents (100%) believed that if a neighbor doesn’t have a latrine then there is a possibility of this other neighbor getting exposed to the fecal borne and fecal related effects.
4.4 Measures to increase latrine coverage
From the study, it was established that most people suggested to punish those don’t construct latrines in the community 46.25%. Other supported the idea of helping members of the community of don’t have latrines in their households 28%, others suggested the government to subsidize latrines construction in the community (13.75%) others did not suggest any of the above12% .
4.5. SOCIO-ECONOMIC
The table below shows a summary of the social economic findings for the community.
Table 4.4. Socio economic factors.
| SOCIO-ECONOMIC | N | %age | |
| ESTIMATE COST OF LATRINE CONSTRUCTION | 10000-15000 | 22 | 13.75% |
| 16000-20000 | 96 | 60% | |
| 21000-25000 | 10 | 6.25% | |
| 26000-30000 | 2 | 1.25% | |
| 31000-33000 | 2 | 1.25% | |
| 36000-40000 | 4 | 2.5% | |
| Don’t know | 24 | 15% | |
| HOW THE CURRENT LATRINES WERE FINANCED | Loan | 58 | 36.25% |
| Own | 86 | 53.75% | |
| Assisted | 16 | 10% | |
| WHAT WAS THE MAIN MOTIVATION TO LATRINE USE | Health education | 94 | 58.75% |
| Disease prevention | 62 | 38.75% | |
| Don’t know | 4 | 2.5% | |
| ANY PEOPLE OR GROUP OF PEOPLE WHO PROMOTE LATRINE USE IN THE AREA | KITWASCO | 148 | 92.5% |
| Neighbours | 4 | 2.5% | |
| Community volunteer | 8 | 5% |
4.5.1. Estimate cost of simple latrine.
From the study, it was found that most people in the village (60%), believed that a simple latrine could cost in between Ksh 15,000- Ksh 20,000. 13.5% of the village believed it to cost between Ksh10,000 – Ksh 15,000. A smaller number (11.5%) believed it to cost in between Ksh 21,000-Ksh 25,000.Other people (15%) do not know how much money it can cost.
4.5.2. How the latrines were financed (source of finance for the contribution of these latrines).
Most latrines in the area 53.75% were constructed through personal financing. 36.25% of the existing latrines were due to loans given (one could borrow and construct a latrine, after completion he/she was subsidized by Kitui Water and Sanitation Company (KITWASCO) project at Ksh 30,000 for any one latrine (compartment) constructed and Ksh 15,000 for any renovation of one compartment of the latrine to the satisfactory of the project) 10% of the latrines were constructed through assistance from the villagers.
4.5.3 Motivation of latrine use in the village.
The study revealed that most people in the study area were motivated to use latrines through health education. 38.75% of the population was motivated as a means of preventing fecal related diseases. A small percentage of people didn’t explain how they were motivated to use latrines. They were either born or found latrines in use whereby they continued using them as the rest.
4.5.4. Any people or group of people who promote latrine construction and use in the study area of Majengo village.
From the study, it was found that latrine construction is promoted by KITWASCO at 92.5%.
NOTE: The KITWASCO project comprises the public health department. Other people who promote latrine construction include village volunteers at 5% and lastly neighbors at 2.5%.
4.6. Culture/ beliefs
This section deals with the culture or believes in the village which affects latrine coverage and associated factors in the village. The following table (table 4.5) shows a summary of the finding;
Table 4.5 Culture/ beliefs affecting latrine coverage
| FACTORS | N | %age | |
| FACTORSNEGATIVELY INFLUENCING LATRINE USE IN THE COMMINUTY | Social factors | 138 | 86.25% |
| Religious factors | 12 | 7.5% | |
| Others | 10 | 6.25% | |
| MAJOR OBSTACLES TO LATRINE OWNERSHIP AND UTILIZATION IN THE COMMUNITY | Lack of space | 22 | 13.75% |
| Finance | 138 | 86.2s5% |
4.6.1. Factors negatively influencing latrine use
Factors known to negatively influence latrine use are social factors (86.25%), followed by religious factors (13.75%).
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS
5.1 Introduction
This chapter discusses the findings in chapter four according to specific objectives.
5.1.1: Demographic Information.
Most of the respondents who were found as household heads were women (61.25%) whom most of them (60%) were aged between 24-40 years old. This does not mean that most of the household are headed by women, in most cases men leave their homes to search for labor. This implies that in most cases women are the ones left to take charge of the households as men get out searching for resources for the family.
The study disclosed that many household heads are business people (55%) as the main occupation, whereby formal employment being very minimal in number (2.5%). It was also found that most household sizes (65%) ranges from 5 to 8 persons.
Spiritually, it was found out that most of the community members are Muslims (73.75%).
5.1.2 Knowledge
It was discovered from the study that most of the household heads (52.5%) are primary school leavers which implies that the level of education is very low.
When investigating on the knowledge factors affecting latrine coverage, it was discovered from the study that most people (98.75%) know that the main benefits of using a latrine is to prevent diseases. Most of them when asked the main disease caused by indiscriminate fecal disposal (where there are no latrines) they named cholera (95%).
From the investigation done to establish on how they obtained this knowledge on latrines, it was found that the main source was through health workers (76.25%).
5.1.3 Cultural believes
When investigated on the effects of open defecation, it was discovered that the community believes that apart from disease prevention, it is shameful and disgusting.
It was also discovered that most community members believe that children’s faeces are equally responsible for carrying diseases just like adults’. The study also discovered that almost all the community members (100%) believe that even if one is using a latrine and yet the surrounding neighbors don’t, both of them are at risk of getting infected with fecal borne diseases.
It was discovered that socio- culture and religion affects latrine use in one ways or the other with social factors outnumbering religious factors.
They also believe that home faeces is the main cause(98.75%) of diarrhea diseases, and that washing hands with soap and water can greatly prevent diseases.
5.1.4 Measures to increase latrine coverage
In the study it was established that most people suggested to punish those don’t construct latrines in the community 46.25%. Other supported the idea of helping members of the community of don’t have latrines in their households 28%, others suggested the government to subsidize latrines construction in the community (13.75%) others did not suggest any of the above12%.Other NGOS where to be involved to fund some projects of construction of SAFISAN types of latrines in the community.
5.1.5 Socio Economic
The study found out that most people in the community (60%) believe that the cost of constructing a latrine is 16000-20000 while a small number (15%) unable to estimate the cost.It was discovered that the monthly income for most households (53.75) is below Ksh. 5000.
A larger portion of the latrines constructed was through self-financing (53.75%) followed by through the assistance of the subsidies by Water Service Trust Fund trough KITWASCO (63.25%). At the moment the promotion of latrine construction (92.5%) is done by Kitui Water and Sanitation Company, and the Ministry of Health through Public health department.
The community believes that the main reason people don’t have latrines is because of lack of finance to be used for latrine construction. The study discovered that most people who don’t have latrines is due to lack of finance with a small number of people attributing it to lack of construction materials.
5.2 CONCLUSION
It was found from the study that the main reason for low latrine coverage in Majengo village is due to lack of resources (finance). Most people in the community (98.75%) earn as little as less than Ksh 10000 per month. This was established through the study conducted which revealed that most respondents’ n=86(53.75%) monthly income is below Ksh 5000, and another group of the respondent n=72(45%) with income ranging from Ksh 6000 to Ksh 10000 per month. When subsidized toilets were introduced in the village by Water Service Trust Fund (a programme for Up-scaling Basic Sanitation for the Urban Poor –UBSUP), introduced through GWASCO, almost everybody was willing to benefit from the program. Since there was subsidies for renovation, most latrines were renovated and connected to the sewer line.
It was established that most people have knowledge on the importance of having and using a latrine. Therefor knowledge is not a factor to low latrine coverage in Swahili community of Majengo village in Kituitown,Kitui County.
The study also established that there were no beliefs, culture, nor religious factors that contributed to low latrine coverage in the study area.
5.3 RECOMMENDATION
The community needs to be assisted economically by the Government, NGOs and any other well-wishers through income generating activities.
REFERENCES
- Awoke W. Muche S, (2013), A cross-section study: Latrine coverage and associated factors among rural communities in the district of Bahor Dar Zaria, Ethiopia. BMC Public Health 4.15-99.
- Anteneh A, and Kumie (2010), Assessment of impact of latrine utilization on diarrhoeal diseases in the rural community of HuletEjjul. EnessieWorenda, East Gojjam zone, Amhara region article. Ethiopia J Health Dev. 2010;24(2);14.
- Benard S. et al. impact of indian total sanitation campaign on latrine coverage and use a cross-sectional study in Orissa. Plos One 2013
- Bwire B (2009) Breaking shit taboos: CLTS in Kenya. In: Plan Kenya Country Programme Progress Report. Plan International Kenya, Nairobi. pp. 107.
- UK DFID. Water Sanitation and Hygiene. Evidence paper. UK; Department for International Development; 2013.
- Conville J.M. (2003) How to promote the use of latrine in developing countries. Michigan Technological University, Masters International Program.
- Cotton, Andrew and Saywell Darren, on plot sanitation in low income urban communities. Water engineering and development centre 1998, Loughbrough; UK
- Dittmer A (2009) Towards total sanitation: Socio-cultural barriers abd triggers to total sanitation in West Africa. 0–16.
- Dolla D., Tomales B., Pesticide productivity and food security (1994).
- Drangert J-O (2004) Norms and Attitudes Towards Ecosan and Other Sanitation Systems.
- Druss A, Kay D,Fewtvell L; Estimating The Burden of Disease for Water Sanitation and Hygiene at a Global Level, Environmental Health Perspect 2002, 110(5)
- Dr. Timothy Kingondu, Dr. Eric Nordberg, Dr. Mugambi, Dr. Lucy Mosyoka and Dr. Fred Otieno (2007) Communicable diseases – Amanual for health workers in sub Saharan Africa.
- Dr. PoonamKhatrapal Singh (Regional director WHO South East Asia) – The health and economic cost of poor sanitation. SEARO 2017.
- Elisa R. Isabbele P (2012) Toilets for health, a report by the London school of hygiene and tropical medicine in collaboration with domestics.
- Federal Democratic Republic of Ethiopia (2005) Ministry of health national hygiene and sanitation strategy to enable 100% adoption of improved hygiene and sanitation.
- Gill C. J. Young M, Schroder K., Carvajal-vesez L.,(2013). Bottlenecks barriers, and solutions. A Results from multicountry consultations focused on reduction of childhood pneumonia and diarrhea deaths. The Lancet, 381 (9876), 1487-98.
- Grudens-Schuck N, Allen BL, Larson K (2004) Focus Group Fundamentals. Iowa State University Extension. Available.
- Hesse AA, Nouri A, Hassan HS, Hashish AA (2012) parasitic infestations requiring surgical interventions.
- Hunt C (2001) How Safe is Safe? a Concise Review of the Health Impacts of Water Supply, Sanitation and Hygiene. A WELL study produced under Task 509.
- Iicon, – Derrick Owen. 1994. Demand creation and affordable sanitation and water. Switzerland. WEDC.
- Ikin A.F., Annert W.G, Takei K, De Camilli P., Jan R., Greengard P.,Buxhaum J. D.,(1994), Alzheimer amyloid protein procurs or localized in nerves.
- Isunju J.B, Schwartz .K, Schouten .M.A, Johnson W.P, Van Dijk M.P, Socioeconomic aspect of improved sanitation in slums: A review Public Health. 2011;125(6):368-76
- Kenya National Environmental Policy, (2007).
- Laungani PD. Understanding Cross-Cultural Psychology; Eastern and Western perspectives. New Delhi; Sage; 2007.
- Ministry of Drinking Water and Sanitation, Government of India. Accessed on 20 Jul 2015.
- Murrell K. D., Dorny P., World Health Organization, International Office of Epizootics, and Food and Agriculture Organization of the United Nations (2005) WHO/FAO/OIE guidelines for the surveillance, prevention and control of taeniosis/cysticercosis. OIE (World Organisation for Animal Health).
- Mwape KE, Phiri IK, Praet N, Speybroeck N, Muma JB, Dorny P, Gabriel S (2013) The incidence of human cysticercosis in a rural community of Eastern Zambia. PLoSNegl Trop Dis 7: e2142 doi: 10.1371/journal.pntd.0002142 [PMC free article] [PubMed]
- Ngowi HA, Carabin H, Kassuku AA, Mlozi MRS, Mlangwa JED, Willingham AL (2008) A health-education intervention trial to reduce porcine cysticercosis in Mbule District, Tanzania. Preventive veterinary medicine 85: 52–67. doi: 10.1016/j.prevetmed.2007.12.014 [PubMed]
- Ngowi HA, Kassuku AA, Maeda GEM, Boa ME, Carabin H, Willingham AL (2004) Risk factors for the prevalence of porcine cysticercosis in Mbulu District, Tanzania. Veterinary Parasitology 120: 275–283. [PubMed]
- O’Relly K. Conbing sanitation and Women’s Participation in Water Supply. Dev. Pract. 2010
- Pondja A, Neves L, Mlangwa J, Afonso S, Fafetine J, Willingham AL, Thamsborg SM, Johansen MV (2010) TI—Prevalence and risk factors of porcine cysticercosis in angonia district, mozambique. Plos neglected tropical diseases 4. [PMC free article] [PubMed]
- Robert M, AkiikiKusiima B (1998) Community use of pit-latrines in Mubende district.
- Sanitation and hygiene in Africa. Where do we stand? 2013.D. 161.ISBN-978-178040-541-4 NOTE: shift “in develop to follow Caribbean 15:23)
- Selendy,Jamine M.H (2011) water and sanitation related diseases and the environmental challenges intervention and preventive measures. P.25.ISBN973-1-118-14860
- Shakya G.D. and J.Nepal, – Interstinal parasitic infection among school children. Health research council 10(1) 20-23 1 2012..
- Shuck B, Ghosh R, Zigarmi D, and Nimom K, (2014). The jumgle of employee engagement; Further exploration of the emerging consntruct and implication for workplace learning and performance. Human Resource Development Review 12.11-35
- Singh P, Chavan P; Mathur D. Open Defecation, Policy Brief for Parliamentarians. Policy No.20, Centre for Legislative Research& Advocacy, India, August-Sept 2013.
- The Constitution of Kenya 2010..
- UNICEF and WHO, 2015 – international journal of hygiene and environmental health. April 2017, Vol 220 (2) 25 year program on sanitation and drinking water; 2015 update and MDG assessment, WHO press, Geneva, Switzerland.
- Van Der Geest S (1998) Akan Shit: Getting Rid of Dirt in Ghana. Anthropology today 14: 8–12.
- WHO and UNICEF 2012 –Improved and uniform sanitation facilities. WHO, Geneva and UNICEF, New York access 9 March 2017.
- WHO/10 Facts on Sanitation URL
- World Bank WSP. A decate of TSC; Rapid assessment of progress and outcomes. Delhi, India; Water and Sanitation Programme, The World Bank; 2010.
- World Health Organization/ Facts and Figures: water, sanitation and Hygiene links to health, 2004, URL.
- WSP. Water and sanitation 2004
- Water and sanitation program 2012
APPEDICES
APEDIX 1
- HOUSEHOLD QUESTIONNAIRE.
Interview Initial
Household No………………………….. Date………………………………..
Sub location……………………………… Questionnaire Code No……………
- DEMOGRAPHIC INFORMATION
- Gender of household head Male……………..[ ] Female…………. [ ]
- Age of household head completed… <24 … [ ], 24-40…. [ ], 41-60…. [ ]
- What is the occupation of household head?
Formal employment (salaried)… [ ] Informal employment (casual)… [ ] . Business person……… [ ], Farmer… [ ], Others (specify)…… [ ]
- What is the highest level of education of the household head?
No formal education [ ] Primary…[ ] Secondary [ ] Tertiary[ ]
- How many people are permanently residing in your household (1-4)………[ ],
(5-8) …….[ ], (9-12)……….[ ], (13 and above). .……………[ ]
- Which is your religion? Muslim…[ ] Christian…[ ]Hindu..[ ].Others (specify)……..
- What is the household’s average income per month in Ksh ? (< 5000)… .. [ ]
(6000- 10,000)… [ ] (11000-15000). [ ] (15000-20000). [ ] (over 20000 [ ]
- KNOWLEDGE
- What are the main benefits of using a latrine
No benefit………[ ] Disease prevention…..[ ] Privacy………………… [ ] Convenience…… [ ] Status of prestige…….. [ ] Don’t know……………. [ ] Enhance respect… [ ]
- How did you know the importance of latrines? Through a baraza..[ ] Through health workers…… [ ] Learned in school……[ ] Others(specify)…………..
- Which are some of the diseases transmitted through feces? …………………………….
- If your household doesn’t have a latrine, what are the main reasons why your household doesn’t have a latrine?
Don’t want one [ ] Is not a priority…[ ] Doesn’t have enough money……..…[ ] Don’t know how to construct.[ ] Lack of finance [ ] Do not have enough space .. [ ] It is not part of our culture .[ ] Lack of knowledge and skills ………………… [ ] Lack of construction material.[ ] Other (specify)………………………………………
- In your own opinion, what problem could be attributed to lack of latrine facilities in your community? None…[ ] Diseases…[ ] Stigma…[ ] Shame…[ ]
Medical expenses…….[ ] Absenteeism from school…[ ] Smell…[ ]
Loss of productive time…[ ] Don’t know…[ ] Others (specify)……..………
- What are the effects of open defecation? Shame and disgust …..[ ]
Causes diseases…[ ] Don’t know…[ ] Others (specify)…….…………………
- Do you think children’s feces can cause diarrhea? Yes [ ] No…[ ] Don’t know…[ ]
- Do you think that human feces are the principle causes of diarrheal diseases? . . Yes…………[ ] . No….. …[ ] Don’t know….…[ ]
- Do you think washing your hands with soap and water could prevent diarrheal diseases?
Yes…………[ ] No…..…[ ]
- Don’t you think you are at risk of getting diarrhea if your neighbor does not use a latrine practices open defecation? Yes … .. [ ] No… ….. [ ]
- PRACTICE
- Where do you defecate (observe and confirm)
Ventilated improved pit…[ ] Latrine with slab…[ ] Pour or flush toilet…[ ] . Ecosan type….. [ ] Pit latrine without slab…[ ] Hanging latrine……[ ] Bucket latrine… [ ] Flush/pour flush to elsewhere…[ ] Others…………………..
- Who is responsible for latrine construction in your household? Woman…[ ] .[ ]
FOR THOSE HOUSEHOLDS WITH LATRINE (If no latrine skip)
- How many people use this latrine facility ………. ………………….……..
- Does your household share this latrine with other households? Yes… [ ] No… [ ]
- With how many households do you share your latrine with? (1-4)..[ ] (5-8)..[ ] (9-13..[ ]
- Are there people in your household who don’t use the latrine? Yes… [ ] No… [ ]
- If yes to Q.23, who are they?
Children… [ ] Men… [ ] Women… [ ] Sick people… [ ]
Don’t know…[ ] Others (specify)…………………………………………
- Is the latrine currently being used? (Confirm) Yes… [ ] No… [ ]
- If no to Q.25, why is the latrine not used?
It is defective… [ ] is far… [ ] is full… [ ] smells… [ ] poor privacy [ ]
- Is there a hand wash facility? .. [ ] With soap and water.. [ ] With water only [ ]
With water only… [ ]
- Does latrine present provide adequate conditions of cleanliness (confirm) Yes…….….[ ] No…..[ ]
- Is the latrine clean? Yes… [ ] No… [ ] (Specify)…………………………..……
- Who is responsible for the cleanliness of the latrine? Men… [ ] Women… [ ]
- Does the latrine provide adequate conditions for privacy?
No privacy… [ ] Adequate privacy… [ ] Poor privacy… [ ]
SOCIAL ECONOMIC
- What do you think is the estimate cost of a simple latrine? ……………………………….
- How did you finance the construction of the current latrine?
Own… [ ] Loan… [ ] Assisted… [ ]
- What was the main motivation to using of this latrine?
No motivation… [ ] Disease prevention… [ ] Influence from my neighbor… [ ] Health education received… [ ] Don’t know… [ ] Others (specify)…………………
- Who are some of the people who promote construction of latrines in your community?
None… [ ] Neighbours… [ ] Community volunteer… [ ] Local leaders [ ] NGO… [ ] Don’t know… [ ] GWASCO… [ ] Others (specify)……………
- CULTURAL /BELIEF
- What are some of the factors that are known to negatively influence latrine use in your community? Social factors……[ ]. Religious factors……[ ] Others (specify)…………[ ]
In your own opinion, what are the major obstacles to latrine ownership and utilization in your community? Culture… [ ] Finance… [ ] Unsuitable condition [ ] Lack of skills/knowledge… [ ] Lack of land/space… [ ] Don’t know… [
D.MEASURES TO IMPROVE LATRINE COVERAGE
37.What measures can be put in place to improve latrine coverage in this community?
Punishing those don’t have latrines in the households…………( )
Community to help in the construction of latrines for those don’t have( )
Government to subside latrine construction in the poor communities( )
Others……. ( )
APPEDIX 2
GANT CHART SCHEDULE FOR RESEARCH ACTIVITY
| Activity | June
|
July | August | September | October | November | December |
| Research concept development | |||||||
| Literature review | |||||||
| Proposal writing | |||||||
| Proposal submission | |||||||
| Data collection | |||||||
| Data analysis | |||||||
| Report writing and submission | |||||||
| Report presentation |
APPEDIX 3
BUDGET
| ITEMS | DESCRIPTION | QUANTITY | UNIT/COST | TOTAL |
| Stationery | A 4 plain papers
Ball pens Pencils Erasers |
1 reams
5 2 5 |
500
10 25 10 |
500
50 50 50 |
| Computer services | Typing &
Printing Spiral Binding |
1 copy draft &
2 copies final 2 copies |
250
50 |
750
100 |
| Lunches | Research assistants | 2 | 200/day x7 | 2100 |
| Photocopying | Study tools | 500 | ||
| Transport | 2000 | |||
| Contingencies | 1000 | |||
| Grand Total | 7,100 |
APPEDIX 4
STUDY AREA