Household-Level Water, Sanitation, and Hygiene Behaviors and the Impact on Child Health in the Makungwa Region of the Eastern Province of Zambia
Creators: name: Breithaupt, Lindsay
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2014

description: Background: The United Nations' Millennium Development Goal (MDG) 4 aims to reduce child mortality by two-thirds globally by 2015.1 Clean water, basic sanitation, and hygiene education are some of the most effective ways to prevent child disease and death. 2 Therefore, access to clean water and adequate sanitation are critical in addressing problems related to child morbidity and mortality. While there is a need for physical resources, improved water and sanitation facilities alone do not necessarily result in their appropriate use or adoption of good hygiene behaviors. Therefore, it is important to determine the water, sanitation, and hygiene (WASH) practices as well as the contextual, psychosocial, and technology factors required at various aggregate levels to have a greater potential to address the WASH-related challenges in a community.14 Methods: Key WASH literature and World Vision Zambia's WASH program were reviewed and used to develop a mixed-methods survey which was administered to 100 households in the Makungwa district of the eastern province of Zambia. Communities and community-specific sample sizes were selected using random sampling, and households were selected using random walk sampling. Interpretation was provided by local volunteers. Survey results were compared to other data sources for validation and analyzed using chi square tests and logistic regression. Findings were presented to community members for feedback and district partners to encourage policy and practice changes. A retrospective power analysis revealed that the sample size was not adequately powered to have a 95% confidence level to detect a significant difference between two groups. Findings: Of households interviewed, 87% use improved water sources and use 20.4 L of water/person/day, 54% close/cover drinking water storage containers, 15% use improved sanitation facilities, 28% cover pit latrines, 28% use soap or ash when handwashing, 41% dry hands hygienically, 81% use clotheslines, and 42% use elevated dish racks for drying. Open defecation is estimated to be 24%. Community members identify water-related barriers as consistent borehole breakdowns, congestion at boreholes due to high usage, low commitment to borehole maintenance, and a lack of a Sustainable Operations and Maintenance Program (SOMaP) shop for spare parts. Sanitation-related barriers include unstable sanitation facilities, inconvenient location of latrines, lack of water to clean toilets, animals creating unclean environments, and insufficient rubbish pits. There is a high perceived connection between safe, clean water and improved health as well as between limited water access, poor WASH practices, and poor child health but a low perceived connection between safe sanitation, hygiene practices, and child health. Though none of the individual WASH practices were significantly associated with positive child health outcomes, households categorized as performing many (≥8) positive WASH practices were significantly associated with a lack of underweight status of children under the age of five in the household. Bivariate trends suggest that positive WASH practices have a trending positive impact on child health outcomes. Though not statistically significant, stronger odds ratio associating a lack of diarrhea incidence and covering water storage containers (OR: 1.87; 95% CI: 0.71, 4.93), covering pit latrines (OR: 1.58; 95% CI: 0.50, 5.52), dispensing water sanitarily (OR: 1.46; 95% CI: 0.54, 4.18), and keeping the household environment clean of fecal matter (OR: 1.41; 95% CI: 0.55, 3.69) can help to prioritize implementation programs and messages to encourage positive WASH behaviors. However, these findings may be a result of uncontrolled confounding factors and should be interpreted with prudence. Applying the Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH), the overall findings have implications for practice and policy including the need to harness political support to advocate for and actualize the establishment of a SOMaP shop in the Makungwa district, prioritize funding towards behavior change methods that address contextual and technology factors, and enhance program quality to improve WASH practices. Conclusions: The findings identify the current WASH practices, knowledge, perceived barriers and trends of impact on child health. Specific policy and practice implications are recommended to improve WASH practices and child health through behavior change and quality improvement methodology in the Makungwa district.