This thesis examines the socio-cultural and demographic factors influencing sanitation conditions in Ghana, identifies the presence of Escherichia coli in household drinking water samples and investigates prevalence of diarrhoea among infants. It is based on questionnaire interviews of 120 household heads and 77 caretakers of young children below the age of 5years, direct observation of clues of household sanitation practice as well as analyses of household water samples in six surrounding communities in Bogoso. Data collected was analysed using SPSS and the Pearson Product Moment Correlation Value(R) technique. The findings revealed that the sanitation condition of households improved with high educational attainment and ageing household heads. On the contrary, sanitation deteriorated with overcrowding in the household. Furthermore, in houses where the religion of the head of household was Traditional, sanitation was superior to those of a Christian head and this household also had better sanitary conditions than that with a Moslem head of household. Water quality analysis, indicated that 27 samples out of the 30 representing 90% tested negative for E. Coli bacteria whilst 17(56.7%) samples had acceptable levels of total Escherichia coli. Finally, it was found out that diarrhoea among infants were highly prevalent since 47 (61.04%) out of the 77 child minders admitted their wards had a bout with infant diarrhoea. Massive infrastructural development, supported by behavioural change education focussing on proper usage of sanitary facilities is urgently needed in these communities to reduce the incidence of public health diseases. Intensive health education could also prove vital and such programs must target young heads of household, households with large family size and households whose heads are Christians and Moslems.
CHAPTER ONE - INTRODUCTION
BACKGROUND TO THE STUDY
Efforts to assuage poverty cannot be complete if access to good water and sanitation systems are not part. In 2000, 189 nations adopted the United Nations Millennium Declaration, and from that, the Millennium Development Goals were made. Goal 4, which aims at reducing child mortality by two thirds for children under five, is the focus of this study. Clean water and sanitation considerably lessen water- linked diseases which kill thousands of children every day (United Nations, 2006). According to the World Health Organization (2004), 1.1 billion people lacked access to an enhanced water supply in 2002, and 2.3 billion people got poorly from diseases caused by unhygienic water. Each year 1.8 million people pass away from diarrhoea diseases, and 90% of these deaths are of children under five years (WHO, 2004).
Ghana Water and Sewerage Corporation (GWSC) had traditionally been the major stakeholder in the provision of safe water and sanitation facilities. Since the 1960’s the GWSC has focussed chiefly on urban areas at the peril of rural areas and thus, rural communities in the Wassa West District are no exception. According to the Ghana 2003 Core Welfare Indicators Questionnaire (CWIQ II) Survey Report (GSS, 2005), roughly 78% of all households in the Tamale Metropolis, 97 percent in Accra, 86% in Kumasi and 94% in Sekondi-Takoradi own pipe-borne water. Once more, the report show that a few households do not own any toilet facilities and depend on the bush for their toilet needs, that is 2.1%, 7.3%, and 5% for Accra, Kumasi, and Sekondi-Takoradi correspondingly. Access to safe sanitation, improved water and improved waste disposal systems is more of an urban than rural occurrence. In the rural poor households, only 9.2% have safe sanitation, 21.1% use improved waste disposal method and 63.0% have access to improved water. The major diseases prevalent in Ghana are malaria, yellow fever, schistosomiasis (bilharzias), typhoid and diarrhea. Diarrhea is of precise concern since it has been recognized as the second most universal disease treated at clinics and one of the major contributors to infant mortality (UNICEF, 2004). The infant mortality rate currently stands at about 55 deaths per 1,000 live births (CIA, 2006).
The Wassa West District of Ghana has seen an improvement in water and sanitation facilities during the last decade. Most of the development projects in the district are sponsored by the mining companies, individuals and some non-governmental organisations (NGO’s). Between 2002 and 2008, Goldfields Tarkwa Mine constructed 118 new hand dug wells (77 of which were fitted with hand pumps) and refurbished 48 wells in poor condition. Also, a total of 44 modern style public water closets, were constructed in their catchment areas. The company also donated 19 large refuse collection containers to the District Assembly and built 6 new nurses quarters. The Tarkwa Mine has so far spent 10.5million US dollars of which 26% went into health, water and sanitation projects, 24% into agricultural development, 31% into formal education and the remaining went into other projects like roads and community centre construction ( GGL, 2008). Golden Star Resources (consist of Bogoso/Prestea Mine and Wassa Mine at Damang) also established the community development department in 2005 and has since invested 800 thousand US dollars. Their projects include 22 Acqua-Privy toilets, 10 hand dug wells (all fitted with hand pumps) and supplied potable water to villages with their tanker trucks (BGL, 2007). Other development partners complimenting the efforts of the central government include NGO’s WACAM, Care International and Friends of the Nation (FON). WACAM is an environmentally based NGO which monitors water pollution by large scale mining companies. They have sponsored about 10 hand dug wells for villages in the district. Care International sponsors hygiene and reproductive health programmes in schools and on radio. They have also donated a couple of motor bicycles to public health workers in the district who travel to villages.
The aims of all these projects were to improve hygiene and sanitation so as to reduce disease transmission. Despite efforts by the development partners, water supply and sanitation related diseases are highly prevalent in the district. Data obtained from the Public and Environmental Health Department of the Ministry of Health (M.O.H., 2008) showed that the top ten most prevalent diseases in the district include malaria, acute respiratory infections, skin diseases and diarrhoea. The others are acute eye infection, rheumatism, dental carries, hypertension, pregnancy related complications and home/occupational accidents. A lot more illnesses occur but on a lower scale and these include intestinal worms, coughs and typhoid fever. A complete data on the top ten diseases prevalent in the district is attached as Appendix D but below is a selection of the illnesses that directly result from bad water and sanitation practices.
The number of malaria cases decreased from 350 in 2006 to 300 cases per 1000 population in 2008. Despite the decrease, the values involved are still quite high. The incidence of diarrhoea among infants and acute respiratory infection remained 30 and 60 cases per 1,000 populations respectively. This can be attributed to several reasons, including population boom, lack of uninterrupted services and inadequate functioning facilities. In fact, according to the World Health Organization (WHO, 2004), an estimated 90% of all incidence of diarrhoea among infants can be blamed on inadequate sanitation and unclean water. For example, in a study of 11 countries in Sub-Saharan Africa, only between 35-80% of water systems were operational in the rural areas (Sutton, 2004). Another survey in South Africa recognized that over 70% of the boreholes in the Eastern Cape were not working (Mackintosh and Colvin, 2003). Further examples of sanitation systems in bad condition have also been acknowledged in rural Ghana, where nearly 40% of latrines put up due to the support of a sanitation program were uncompleted or not used (Rodgers et al., 2007). The author had a personal communication with the District Environmental Officer and he estimated that, approximately there are 224 public toilets, 560 hand dug wells, 1,255 public standpipes and 3 well managed waste disposal sites in the district. According to the 2006 projection, the population of the district is expected to reach 295,753 by the end of the year 2009 (WWDA, 2006).
Development partners in the past have concentrated their efforts on facilities provision only. They have not looked well at the possible causes of the persistence of disease transmission despite the effort they are making. Relationships between household’s socio cultural demographic factors and people’s behaviour with respect to the practice of hygiene could prove an essential lead to the solution of the problem. The fact is, merely providing a water closet does not guarantee that it could be adopted by the people and used well to reduce disease transmission. Epidemiological investigations have revealed that even in dearth supply of latrines, diarrhoeal morbidity can be reduced with the implementation of improved hygiene behaviours (IRC, 2001: Morgan, 1990). Access to waste disposal systems, their regular, consistent and hygienic use and adoption of other hygienic behavioural practices that block the transmission of diseases are the most important factors. In quite a lot of studies from different countries, the advancement of personal and domestic hygiene accounted for a decline in diarrhoeal morbidity (Henry and Rahim, 1990). The World Bank, (2003) identifies the demographic characteristics of the household including education of members, occupation, size and composition as influencing the willingness of the household to use an improved water supply and sanitation system. Education, especially for females results in well spaced child birth, greater ability of parents to give better health care which in turn contribute to reduced mortality rates among children under 5years (Grant, 1995). In a study into water resource scarcity in coastal Ghana, Hunter (2004) identified a valid association between household size, the presence of young children and the gender of the household head. It was noted that, female heads were less likely to collect water in larger households. Furthermore, increasing number of young children present increased the odds of female head/spouse being the household water collector. Cultural issues play active part in hygiene and sanitation behaviour especially among members of rural communities. For example, women are hardly seen urinating in public due to a perceived shame in the act but men can be left alone if found doing it. Also, the act of defecation publicly is generally unacceptable except when infants and young children are involved. The reason is that the faeces from young people are allegedly free from pathogens and less offensive (Drangert, 2004). Ismail’s (1999) work on nutritional assessment in Africa, detected that peoples demographic features, socioeconomic and access to basic social services such as food, water and electricity correlate significantly to their health and nutrition status. Specifically, factors such as age, gender, township status and ethnicity, which are basic to demography, can play a role in the quality of life especially of the elderly.
This research assessed people’s practice of personal hygiene in Bogoso and surrounding villages. It also identified the common bacteria present in household stored water sources. Furthermore, the research identified the relationships between some socio-cultural demographic factors of households and the sanitation practice of its members.
THE PROBLEM STATEMENT
The Wassa West District in the Western Region is home to six large scale mining companies and hundreds of small scale and illegal mining units. Towns and villages in the district have been affected by mining, forestry and agricultural activities for over 120 years (BGL EIS, 2005). Because of this development, the local environment has been subjected to varying degrees of degradation. For example, water quality analysis carried out in 1989 by the former Canadian Bogoso Resources (CBR) showed that water samples had Total coliform bacteria in excess of 16 colonies per 100ml (BGL EIS,2005). Most of the water and sanitation programs executed in the district exerted little positive impact and thus, diarrhoeal diseases are still very high in the towns and villages (See Appendix D on page 80).
However, in order to solve any problem it is important to appreciate the issues that contribute to it; after all, identifying the problem in itself is said to be a solution in disguise. Numerous health impact research have evidently recognized that the upgrading of water supply and sanitation alone is generally required but not adequate to attain broad health effects if personal and domestic hygiene are not given equivalent prominence (Scherlenlieb, 2003). The troubles of scarce water and safe sanitation provisions in developing countries have previously been dealt with by researchers for quite some time. However, until recent times they were mostly considered as technical and/or economic problems. Even rural water and sanitation issues are repeatedly dealt with from an entirely engineering point of view, with only a simple reference to social or demographic aspects.
Therefore, relatively not much is proven how the socio-cultural demographic influences impinge on hygiene behaviour which in turn influences the transmission of diseases. The relationship between household socio cultural factors and the sanitation conditions of households in the Wassa West District especially the Bogoso Rural Council area has not been systematically documented or there is inadequate research that investigates such relationship.
THE RESEARCH QUESTIONS
The following research questions were posed to help address the objectives;
- Why are the several sanitation intervention projects failing to achieve desired results?
- Why is the prevalence of malaria and diarrhea diseases so high in the district?
- What types of common bacteria are prevalent in the stored drinking water of households?
The main aim of this research was to investigate people’s awareness and practice of personal hygiene, access to quality water and sanitation and the possible causes of diarrhoeal diseases and suggest ways to reduce the incidence of diseases in the community. The specific objectives were;
- To assess the quality of stored household drinking water
- To establish the extent to which sanitation behaviour is affected by household socio-cultural demographic factors like age and education level of the head.
- To investigate the occurrence of diarrhoea among young children (0-59 months old) in the households.
- To identify and recommend good intervention methods to eliminate or reduce the outbreak of diseases and improve sanitation.
In addition to the above objectives, the following hypotheses were tested;
- Occurrence of infant diarrhoea in the household is independent on the educational attainment of child caretakers.
- There is no relationship between households’ background factors and the sanitation conditions of the household.
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