KNOWLEDGE, ATTITUDE AND PRACTICES REGARDING CHOLERA OUTBREAK AMONG SECONDARY SCHOOL STUDENTS
Though 89% of the world‘s population had access to drinking water facilities, about 768 million people relied on unimproved drinking water-sources; 83% of them resided in rural areas by the end of 2013 (World Health Organization/ United Nations, 2013). Safe water use is use of water free from water borne diseases. The study assessed the level of knowledge, attitude and practices of students of Oron on safe water use. A sample size of 257 respondents with a response rate of 250(97%) respondents answered the research questions through interviews. These were selected by simple random sampling through a descriptive research design.
Respondents had low knowledge about safe water use; because 210(84%) could not correctly define it. It could be due to the fact that 145(58%) had never had any formal education about safe water use, did not know; 158(63%) safe water sources, 140(56%) the ideal distance between a latrine and a natural water source (between 10 and 20 meters, 90(53%) the major effect of using unsafe water, 185(74%) the water borne diseases, 130(52%) the importance of fetching water in covered containers and 203(81%) that all clear water was unsafe for consumption.
Respondents had negative attitude where, they believed that; 205(82%) that all clear water was safe for consumption, 210(84%) could consume unprocessed water, 233(93%) chemicals were not safe to treat water, 173(69%) filtered water was safe for drinking, 162(65%) could share water sources with animals. However, they recommended 240(96%) boiling as the best way to process water, 200(80%) it was good to cover water for consumption and 183(73%) acknowledge the importance of having an educational program on water use. It was observed that, most of the water containers were unclean, close to latrines, never protected water sources, did not usually cover drinking water, but never shared water sources with animals. About purification, majority of the respondents never left water to settle to use it, never used chemicals, but boiled, filtered and refrigerated water for consumption. All in all, there was poor knowledge, negative attitude and poor practices of students towards safe water use. The researcher therefore recommends that; government and local administrators should promote education and sensitization programs on safe water use , avail safe water sources such as taps at friendly costs, students should; fetch water from safe sources, protect water sources, maintain good hygiene of water containers and purify all water before use.
This chapter includes the background of the study, problem statement, and purpose of the study, specific objectives, research questions, and significance of the study.
1.1 Background to the study
Providing safe water use is a major contributor to improved health. This knowledge, attitudes and practice study/survey aims at enlisting what is known, believed and done in relation to safe water use in Oron. Though 89% of the world‘s population has access to drinking water facilities, about 768 million people rely on unimproved drinking water-sources; 83% of them residing in rural areas (World Health Organization/ United Nations, 2013).
This study is important because in a global study conducted by the United Nations, unsafe water is responsible for around 80% of diseases and 30% of deaths in developing countries throughout the world. In Africa, which accounts for 90% of global cases of malaria, water stress plays an indirect role in curing malaria because it impedes the human recovery process.
When slum dwelling populations such as Oron have limited access to safe water use and present repeated incidences of waterborne diseases. This is a great public health threat which strains health budgets, calls for immediate deployment of health cadres to curb such waterborne diseases (WHO/UNICEF, 2013), and puts stress on the fewer available health facilities through congestion. Providing for safe water use would act as preventive strategy that will lessen public health expenditure (MOH, 2012).
The World Health Organization and other major global public health organizations define safe water access as reasonable access through an improved or an unimproved source (WHO, 2015). An improved source of safe water consists of one of the following: a piped household connection, public standpipe, borehole, protected dug well or spring, and/or rainwater collection. An unimproved source is considered any of the following: vendors, tanker trucks, surface water, bottled water (due to the inability to confirm source and quality), and unprotected dug wells and/or springs. Reasonable access to an improved source is defined as the availability of at least 20 liters a person a day from a source within one kilometer (6 miles) of the dwelling (Global Water, Sanitation and Hygiene, 2012).
Globally, an estimated 1.7 million people die annually of waterborne diseases. Water misuse is responsible for 90% of diarrhea-related mortality more than combined mortality from malaria and HIV/AIDS (UN Water. 2015). Although piped water facility in the rural regions almost doubled in past two decades, 171 million people in rural regions use surface water as the primary source of water (WHO, UNICEF, 2013).Over 783 million people do not have access to clean and safe water worldwide, 37% of those people live in Sub-Saharan Africa, 443 million school days are lost each year due to water-related diseases and 84% of the people who don't have access to improved water, live in rural areas, where they live principally through subsistence agriculture (WHO, 2015).
Coverage of safe water in Eastern Asia increased by 27% points and exceeded the MDG target, with over half a billion people gaining access in China alone. Access in Southern Asia and South-eastern Asia rose by 20% and 19% respectively, and these regions met the target. In Africa about 85% of the water is used in agriculture. Only 10% is used in households and only 5% in the industry. Because of the growing population there will be absolutely used more and more water in agriculture.
In sub-Saharan Africa, 427 million people gained access during the MDG period – an average of
47000 people per day for 25 years, In 2015 only 3 countries – Angola, Equatorial Guinea and
Papua New Guinea – have coverage of less than 50%, compared to 23 countries in 1990.SubSaharan Africa did not meet the MDG target but still achieved a 20% point increase in the use of improved sources of drinking water. There are rural and urban disparities, 96% of the global urban population uses improved drinking water sources, compared with 84% of the rural population, 80% still do not have improved drinking water sources live in rural areas.
The populations without access are mainly in sub-Saharan Africa and Asia; Sub Saharan Africa – 319 million, Southern Asia – 134 million, Eastern Asia – 65 million, South Eastern Asia – 61 million and All other regions – 84 million. 842000 deaths from diarrhoeal diseases each year could be prevented by improved water, sanitation and hygiene
Globally, an estimate of more than 340,000 children under five die annually from diarrheal diseases due to unsafe drinking water – that is almost 1000 per day.
In Africa, 42% of health facilities do not have access to an improved water source within 500 metres. The Joint Monitoring Programme‘s(2012) report, notes that, in a Kenya a population of 46.7 million, 17.3 million lack access to safe water. Access to safe water supplies throughout Kenya is 59%, in Tanzania 23 million people did not have choice but used unsafe water WHO, (2015).
This study assesses the knowledge level of students of Oron on safe water use, assess their attitudes and establish community practices that could improve or hinder access to safe water use.
1.2 Problem statement
Limited access to safe water use can result in water borne diseases which can cause morbidity and loss of a productive population in terms of labour as well as mortalities, a case in point the recent (2015) typhoid outbreak in Oron. Lower Oron Parish is one of the major slums surrounding Oron. Foristance, a total of 560 people were diagnosed with typhoid, just in three days in February 2015 (Nantambi and Waiswa, 2015). Two of 506 died. All the five hundred and sixty patients were admitted at Kisenyi Health Centre IV, Oron. Such an acute outbreak of typhoid and consequently admissions puts a burden on the KCAA health budget.
Communities drain water from unsafe water points especially to low income earners. An estimated 884 million people lack access to safe drinking water and contaminated water is responsible for 1.6 million deaths per year, primarily in children under age 5 (Global Water, Sanitation, 2012). Communities in slums environments are limited in terms of access to safe water provisioning points.
The NWSC has tried to supply piped water across the city, with reports putting access to safe water at 77% (Kagolo, 2012). For one to be considered having access to clean/safe water means that the water source is 250 metres from his home. However, those with the highest access are in upscale city suburbs. According to a report by the Africa Development Bank (AFDB), only about 17% of the population in informal settlements (slums) had safe water access by 2006. Inaccessibility, coupled with poverty and the high tariffs of piped water, have compelled most slums dwellers to rely on spring wells for water. This study intends to assess the knowledge, attitudes and practices of safe water use among students of Oron.
1.3.1 Main objective
The main objective of the study was to determine the knowledge, attitude and practices of safe water use among students of Oron in order to ensure better water harvesting, handling and storage strategies so as to minimize the prevalence of waterborne diseases.
1.3.2 Specific Objectives
The study based on the following specific objectives
- To assess the knowledge on safe water use among the students of Oron.
- To assess the attitudes on safe water use among the students of Oron.
- To establish the practices among the students of Oron on safe water use.
1.4 Research Questions
- What is the knowledge level of students of Oron on safe water use?
- What are the attitudes of the students of Oron on safe water use?
- What are the community practices of members of Oron that are directed towards improving access to safe water use?
Safe water use is a pre-requisite to preventing waterborne related diseases such as typhoid which is caused by salmonella typhi, cholera, shigellosis, amebiasis, among others. Thus this is timely to guide city authorities on promotion of use of safe water among communities of Lower Oron, since outbreak of water borne diseases strains health the public health budget, this research is vital in identifying community practices that hinder access to safe water use, measure their attitudes towards safe water use and suggest measures to Oron Capital City Authority (OCCA) to deal with the challenges of water borne diseases that are of public health interest.
This study was significant to the researcher since it is leading to the award of Bachelor of Science Nursing of International Health Sciences University, Uganda.
The study has generated data for policy makers such as Oron Capital City Authority for proper decision making on safe water provisioning to slum dwellers. It is also an addition to the knowledge base on safe water use especially in slum environment.
The study has further generated ideas to local council authorities on involvement of community leaders in promoting safe water access as a pre-requisite for waterborne disease prevention. This KAP could be essential to help plan, implement and evaluate safe water use in Oron by Oron Capital City Authority (OCCA).
Since this study has identified information that was commonly known and attitudes that are commonly held by students of LowerOron Parish, Oron, it also identified factors influencing behaviour and attitudes that are not known within the communities, the reasons for their attitudes, and how and why communities of Lower Oron Parish practice certain behaviours which are barriers to safe water use.
OCCA could use information on safe water needs, problems and resolve shortcomings to safe water access as well as solutions for improving access to safe water points in Oron. This could provide a lasting solution to the challenge of safe water use and access in Oron.
1.7 Scope of the study
The study assessed the knowledge of students on safe water use, enlisted their attitudes on safe water access and established community‘s practices that hindered accessibility to safe and clean water in Oron.
1.8 Conceptual Framework Independent variable Independent variable
Knowledge about safe Attitude about safe water water use Dependent use
- Source of information Perception about treating about safe water use Practices about safe water
- Level of education and water use A mind-set that all clear sensitization by MoH Cleaning of water water is safe
- Not all clear water is safe Bathing from water A thought that some
- Level of formal education sources animals do not contaminate water
- Awareness about water Water storage A feeling that rain water purification Protection of the water is safe even if not
- Familiarity with water sources purified before use storage methods Method of water
- Intellectual capacity about purification Belief that some people
- safe water sourcesUnderstanding the importance of safe water use Method of water storageSharing of water use unsafe water and do not suffer from water borne diseasesA belief that refrigerated
- Awareness of cheap water sources with animals water is safe
- Knowledge about the distance between a water A mindis safe for drinking even -set that tap water source and latrine if not first purified
Figure 1: Conceptual Framework
Indicators of knowledge were; Source of information about safe water use, Level of education and sensitization by MoH, Having facts about what safe water was, awareness about water purification, familiarity with water storage methods, having right information about safe water sources, understanding the importance of safe water use, awareness of cheap water purification methods, and knowledge about the distance between a water source and latrine.
Indicators of attitude were; perception about treating water, a thought that some animals did not contaminate water, a feeling that rain water was safe even if not purified before use, belief that some people used unsafe water and did not suffer from water borne diseases, a mind-set that tap water was safe for drinking even if not first purified.
Indicators of practices were; maintenance of water containers clean, water storage, protection of the water sources, method of water purification, method of water storage and sharing of water sources with animals.
KNOWLEDGE, ATTITUDE AND PRACTICES REGARDING CHOLERA OUTBREAK AMONG SECONDARY SCHOOL STUDENTS