Abstract

Water, sanitation and hygiene is still a burning issue in the context of developing countries like Cameroon as many diseases related to it and causing significant child’s death. Poor hygienic practices, inadequate water supply, and poor sanitary conditions play a major role in the spread of infectious diseases. Lack of knowledge, attitude, and practices (KAP) on WASH is one of the most imperative causes for transmission of infectious diseases.

This study sought to assessed the knowledge, attitude and practice regarding water, sanitation and hygiene among mothers of under-five children in the Bolifamba Community. To achieve this study objective, a cross-sectional survey with a sample of 100 mothers with children under five years were randomly sampled using a structured-questionnaires.

Collected data from the field were analysed descriptively using SPSS (25.0). Findings revealed that most mothers suffer from low knowledge, poor attitude and undergo poor practices towards WASH.

Therefore, the health extension programs at primary healthcare should be revitalized in a way that can enhance the interventional measures to improve knowledge, attitude, and practice on WASH in the study area.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Water, Sanitation and Hygiene are collectively called WASH and each is a separate field though they are interdependent. The survival and development of a child highly depends on the availability of clean water, improved sanitation facilities and good hygiene practices (Darvesh et al., 2017). Sanitation, as used in this study, refers to the provision of facilities and services for the safe management of human excreta from the toilet to containment and storage and treatment on-site or conveyance (transportation), treatment and eventual safe end use or disposal including also safe management of solid and animal wastes (WHO, 2019).

Globally, in developing countries, the target for sanitation as stipulated in the Sustainable Development Goals (SDGs) of the Agenda 2030 by the United Nations member states has been missed by an estimated 700 million people. About 82% and 51% of the global urban population and rural population respectively use improved sanitation facilities. In rural areas, seven out of ten people are estimated to lack improved sanitation facilities, and nine out of ten people still practising open defecation (WHO, 2018).

UNICEF, (2015), reported that about 2.4 billion people lacked improved sanitation facilities and an estimated 663 million people globally still use unimproved drinking water sources, including unprotected wells springs and surface water. Nearly half of the population with unimproved drinking water sources lives in sub-Saharan Africa and approximately one-fifth live in Southern Asia (UNICEF, 2019).

In Sub-Saharan Africa, especially in rural areas, there is low basic water and sanitation coverage. Thus, people living in those areas are less likely to have access to improved water and sanitation services and infrastructure. A study conducted in rural South Africa reported an increased risk of diarrheal diseases among those households who store water because of a lack of a secure water supply. Diarrhoeal diseases are the major causes of ill health and death among children under 5 years. Diarrhoeal diseases can be prevented through the provision of improved water, sanitation, and hygiene services and practices.

In Cameroon, a paucity of data on diarrhoea morbidity and mortality exists and these epidemiological studies have indicated the community-based prevalence of acute diarrhoea to range from 16% to 23% among under-five under depending on the study site (World Health Organization; 2016). In Cameroon, diarrhoea is a major public health problem and 15% of deaths among children less than 5 years of age are attributable to diarrheal diseases (Chi et al., 2003).

Mothers are the primary caregivers of their children hence the care is mostly dependent on their level of knowledge, attitude, and practice (KAP) in daily life activities. Within the family context children are strongly associated with their parents especially mothers and the careless practices by mothers during the first thousand days have long-term synergic impacts on the physical growth and cognitive development of children (WHO, 2019). Normally mothers play multidimensional roles in their families as the care of family members especially under five children such as maintaining hygienic and sanitary conditions, feeding children, treating their faces, and blowing their nostrils, among others. On the other hand, they are responsible for general housekeeping as preparing meals, cleaning, ensuring healthy food and safe drinking water, and retaining a sanitary and hygienic environment for the family among others (Gizaw et al. 2019). Poor knowledge and practice of water sanitation, and hygiene (WASH) among mothers play a vital role in transmitting infections and respiratory diseases which are the leading cause of morbidity and mortalities in under five children (Yazie et al., 2019). The early years of a child are more sensitive and at risk every time (WHO, 2019). A vicious cycle of diseases related to unhealthy WASH practices can affect and even accelerate mortality, along with health impacts; there is a sensational loss of potential and numerous valuable lives (Hall et al., 2020).

Children under the age of five years generally spend most of their time at home with their guardians, especially mothers, even when they attend preschools or nurseries. These years involve primary socialization including social, physical, and dietary habits along with behaviours and attitudes regarding their daily life activities (Wichaidit et al., 2019). Poor knowledge, attitude and practice of mothers regarding WASH are one of the most imperative causes of transmission of infectious and respiratory diseases (Almas et al., 2020).

The knowledge and practice regarding WASH in families and communities is poor even today (Chauque et al., 2021). Although people around the world claim that they are aware of and adopted improved WASH practices, the empirical evidence (Zywert, 2017; Martinez et al., 2017; Webb et al., 2018; Moreno, 2020; Ghosh et al., 2021) shows the difference in their knowledge and practices. Water and sanitation, hygiene (WASH) related diseases continue to be the major contributors to health issues and stand as the second highest leading cause of global child morbidity and mortality (WHO, 2020).

According to the World Health Organization (WHO) estimated 5.2 million children less than five years old die every year mostly from preventable causes (WHO, 2019). The leading causes of these deaths are infections, diarrhoea, malaria, pneumonia, congenital anomalies and all of which can be prevented with access to simple, affordable interventions including adequate nutrition, safe water and sanitation, improved hygienic and food practices (UNICEF, 2019).

Water and sanitation, hygiene (WASH) related diseases and infections continue to be the major contributors to health problems and stand as the second highest leading cause of mortality & morbidity among children. World Health Organization estimated about 5.2 million children below five years die every year, mostly from preventable viral and infectious diseases. Besides this, globally there are billions of (about 1.7 billion) cases reported only of diarrheal diseases which are responsible for at least 1.9 million under-five deaths reported due to this (WHO, 2019). The leading causes of these deaths are infections during & after birth, diarrhoea, malaria, cholera, hepatitis and typhoid among many others. This chronic condition can be controlled and improved by providing access to adequate nutrition, safe water, sanitation and dietary practices. Water and sanitation, practices (WASH) are also linked to many other diseases including malnutrition and stunting, internal & external infections, polio, trachoma, cholera, arsenicosis, giardiasis, ascariasis, and lead poisoning among others (Saroj et al., 2020).

1.2 Statement of the Problem

Inadequate and unsafe water, poor sanitation, and unsafe hygiene practices are the main causes of diarrhoea, which results in 50 out of a thousand under- 5 child deaths in Bangladesh (WHO, 2019). Water, sanitation and hygiene are also linked to many other diseases that kill children or stunt their development, including helminth infections, trachoma, cholera, fluorosis and arsenicosis. There is also emerging evidence linking better hand-washing practices with reduced incidence of acute respiratory infections.

A significant number of poor households in Bolifamba Community are taking water from ponds because they have limited access to safe water. The sanitation facilities are not so good usually they are using latrines without water seals that are linked with adjacent ponds or water bodies. There is a tradition in that area to keep poultry birds and goats & sheep inside the house because that creates an unhygienic situation for the family members, especially for the under-five children.

Usually, children’s excreta and other household waste are thrown around the kitchen which also creates a worse environmental situation for under five children. Hence, they are playing and moving around the homestead. Personal hygiene condition is also very poor beyond imagining. In that situation, under-five age children usually suffer from different types of diseases and they are living with malnutrition. Limited access to safe drinking water and poor sanitation can lead to undernutrition, waterborne diseases, gastroenteropathy diarrhoea and dysentery. These problems are predominant among preschool children in the Bolifamba Community. Thus, this study sought to assess the knowledge, attitude and practice regarding water, sanitation and hygiene among mothers of under-five children in the Bolifamba Community.

1.3 Rational of the Study

Many people believe that simply providing a fresh, clean water supply will substantially reduce water-borne illnesses. What most people do not know is that safe hygiene practices and access to sanitation are crucial for combating the main health threats to children under five, in particular diarrhoea.

Water, Sanitation and Hygiene are linked in many ways to people’s livelihoods and sustainable development in general; it is an important input not just for Target 10 of Millennium Development Goal 7 but for all of the Goals. It is a key input for the achievement of universal primary education and reductions in child mortality (Goals 2 and 4) and is directly linked to the eradication of poverty and hunger, the empowerment of women, improvements in maternal health and the reduction of diseases (Goals 1, 3, 5 and 6). In addition to coverage disparities between regions, there are significant inequities within the districts: clear rural-urban disparities as well as coverage and service level disparities between richer and poorer households. The urban poor usually have very low access to water and sanitation services, and pockets of people – such as indigenous groups have even lower access.

The provision of sanitation and other public services such as waste collection and disposal is still poor in many parts of Cameroon. The situation is worse in informal settlements such as Bolifamba Community where unsanitary conditions such as traditional pit latrines which are in poor conditions and not connected to a septic tank are a common feature. The study is targeted to the mother groups of under-5 years of age children because the diseases associated with water, sanitation and hygiene are the leading cause of under-5 mortality and morbidity and the mothers are directly linked with the child’s health as they are the one who takes care of their children.

1.4  Research Questions

1. What is the mother’s knowledge regarding WASH practices in the Bolifamba Community?
2. What are the attitudes of mothers of under-five children towards WASH practices in the Bolifamba Community?
3. What are the self-report practices of mothers of under-five children regarding WASH in the Bolifamba Community?

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