Factors Influencing Sanitation Conditions
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The United Nations (UN) Sustainable Development Goals, implemented in 2016, have 17 key goals for aiding sustainable development (UN, 2018). Goal 6 is ‘ensure access to water and sanitation for all’ (UN, 2018). Clean water, sanitation and hygiene are intrinsically linked and high standards in all three aspects are necessary to prevent the spread of disease and to ensure good health and well-being (goal 3 of the UN Sustainable Development Goals; UN, 2018). It is estimated that approximately 1.8 billion individuals are utilising water resources that are contaminated by fecal matter and approximately 2.4 billion individuals do not have access to even basic sanitation (UN, 2016). A lack of access to clean water and appropriate sanitation services is predominantly an issue in developing countries (Pruss-Ustun et al., 2014).
The impact of unsafe water and inadequate sanitation is disproportionate, with children under 5 most likely to be adversely affected (Hetherington et al., 2017). It is estimated that more than 800 children under 5 die every day from diseases, predominately diarrhoeal, linked to unsafe water, inadequate sanitation and poor hygiene practices (Liu et al., 2016; UN, 2016). Prior to the UN Sustainable Development Goals, the Millennium Development Goals were implemented with targets aimed to be achieved by 2015 (UN, 2015). Goal 4 of the UN Millennium Development Goals was a reduction in child mortality rates (UN, 2015). Whilst considerable progress was made and substantial reductions in child mortality rates occurred across the globe, the UN fell short of attaining the target reductions (UN, 2015). Follow-up studies have indicated that sanitation services and hygiene practices were the key factors which prevented the attainment of the childhood mortality reduction target (Wolf et al., 2018). Access to clean water is also a key factor; however, progress in access to clean water has been more successful than improved sanitation and hygiene practices (WHO, 2018). It is reported that over 90% of the global population has access to clean water; in comparison, only 68% have access to at least basic sanitation services (WHO, 2018).
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Clean water and sanitation services have been monitored across the globe in the majority of nations for an extended time period, providing large quantities of data on access. Comparatively, there is limited data available regarding hygiene. One measure which has been recorded in 70 countries as a proxy for hygiene is the presence of hand washing facilities (UNICEF, 2017). There were 34 countries from Sub-Saharan Africa for which data on basic hand washing facilities at home is available and it was found that less than 50% of the populations had these basic facilities (UNICEF, 2017). It is evident that sanitation services and hygiene practices must improve if progress is to be made in reducing the spread of water borne diseases and further reducing childhood mortality.
Sub-Saharan Africa has been the focus of numerous studies regarding sanitation and hygiene; this is due to the generally lower rates of improvement in sanitation and hygiene in this area in comparison to other locations (Fuller et al., 2016). When examined in greater depth, it becomes apparent that there is also a high variation in the access to improved water, sanitation and hygiene among the countries of Sub-Saharan Africa (Munamati et al., 2016). Ghana is an example of one of the Sub-Sahara African countries that has experienced very low rates of progress in water, sanitation and hygiene improvements (Roches et al., 2017). In 2012, 13.7% of the Ghanaian population had access to safe toilets; in 2015 this had marginally increased to 14.3% (Centre for Science and Environment, 2018). In contrast, Ghana achieved the access to clean water target under the UN Millennium Development Goals ahead of the 2015 deadline (Monney and Antwi-Agyei, 2018). However, the lack of progress in sanitation and hygiene is threatening the status of the clean water progress (Monney and Antwi-Agyei, 2018). Sanitation and hygiene development strategies have been implemented in Ghana alongside water improvement programmes, yet have not seen the same success; it is therefore suggested that there are underlying influences which need to be understood to enable the development of target strategies to overcome these barriers. Additionally, whilst there has been a downward trend in the child mortality rate, several studies have found that progress has stalled and in recent years there has been no significant decrease in the child mortality rate (Acheampong and Avorgbedor, 2017).
It has been suggested that water borne disease are a partial explanation for the maintaining relatively high child mortality rate (Clasen et al., 2014). It is evident that rapid progress needs to be made in sanitation and hygiene in Ghana to preserve the progress in clean water access and reduce the incidents of water borne diseases and thereby decrease child mortality rates further.
Research Questions and Objectives
The overall aim of the proposed research is to assess the factors that have influenced sanitation conditions in Ghana. There is a clear gap between the progress made in improvement to clean water access and improvement in sanitation services and hygiene in Ghana. These three services have been the prioritised in Ghana, yet only clean water access has successfully increased. This identified gap lead to the development of the research questions for the proposed study:
- Why has there been a lack of progress in sanitation and hygiene improvements in Ghana?
- How are sanitation and hygiene practices in Ghana impacting the child mortality rate?
The answering of these research questions will provide valuable data which can aid in the development of effective action strategies and policies to increase sanitation access and improve hygiene practices in Ghana and similar countries.
In order to develop effective action strategies and supporting policy it is necessary to understand the factors that influence sanitation and hygiene in Ghana. Therefore, it is proposed that a systematic literature review is conducted to identify the influence of socio-cultural and demographic factors on sanitation and hygiene in Ghana. It is proposed that secondary data will be utilised for the conduction of this research study. It is suggested that that the use of secondary data is a suitable approach for this research due to the topic and scope. The use of secondary data will enable multiple studies and sources to be consulted which will provide an overview of the situation in Ghana, an undertaking which would require substantial financial and time inputs if it was to be completed as a primary research study.
It is proposed that a systematic literature review is used as the research approach for this study. The aim of a systematic literature review is to identify, critically evaluate and integrate the findings of all relevant studies (Cooper, 2003). This allows the identification of relationships, contradictions, knowledge gaps and inconsistencies in the published literature (Khan et al., 2003). Thus, this methodology is appropriate for the identification of influencing factors in the sanitation and hygiene issue of Ghana. The scoping of the systematic review is determined by the research questions to be answered, from which the concepts for keyword searches are developed. Keyword searches will be used to collate relevant publications from both public and private databases such as google scholar. The keyword searches will be developed using Boolean operators, to combine search terms to generate relevant search results. Boolean operators are the words AND, OR and NOT, refining the results (DeLuca et al., 2008). Examples of keyword searches which are likely to be used include, ‘Ghana AND sanitation’, ‘Ghana AND hygiene’, ‘Ghana AND child mortality AND sanitation OR hygiene’. Inclusion and exclusion criteria will be developed to ensure that the findings are focused to the topic and scope of the study. This will include a range of publication dates to ensure that the collected data is relevant to the current situation in Ghana.
The next step in the systematic review process will be to screen the search results. This will be undertaken by reading the title and abstract of identified publications to ensure that they meet the inclusion and exclusion criteria. The studies that are identified as eligible for inclusion will then be examined in their entirety to further verify their suitability for inclusion in the study. All the studies which are deemed eligible for inclusion will have all relevant information extracted and collated, at this point any potential limitations of each study will be noted. Due to the nature of the research study, the data which is likely to be extracted will be most suited to qualitative analysis. This is due to the social aspect of the research concerning the behaviour of individuals which is difficult to summarise quantitatively. Therefore, the analysis and findings of this research will be presented in a primarily narrative format. The narrative analysis will be critical and will focus on the overall evidence presented in the literature for how socio-cultural and demographic factors influence sanitation and hygiene conditions in Ghana.
The findings which are the result of this research study will contribute towards addressing knowledge gaps regarding strategies to improve sanitation and hygiene in Ghana and similar nations. The will aid in the development of effective and targeted strategies to improve access to sanitation services and improved hygiene practices globally.
Acheampong, G.K. and Avorgbedor, Y.E., 2017. Determinants of under Five Mortality in Ghana; A Logistic Regression Analysis Using Evidence from the Demographic and Health Survey (1988-2014). American Journal of Public Health, 5(3), pp.70-78.
Centre for Science and Environment. 2018. Bottom to the fore: State of sanitation in Sub-Saharan Africa. Available online at: https://www.cseindia.org/bottom-to-the-fore-8624 (Accessed: 2/9/2018).
Clasen, T., Pruss‐Ustun, A., Mathers, C.D., Cumming, O., Cairncross, S. and Colford Jr, J.M., 2014. Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods. Tropical medicine & international health, 19(8), pp.884-893.
Cooper, H. (2003). Psychological Bulletin: Editorial. Psychological Bulletin, 129(1), 3-9.
DeLuca, J.B., Mullins, M.M., Lyles, C.M., Crepaz, N., Kay, L. and Thadiparthi, S., 2008. Developing a comprehensive search strategy for evidence based systematic reviews. Evidence Based Library and Information Practice, 3(1), pp.3-32.
Fuller, J.A., Goldstick, J., Bartram, J. and Eisenberg, J.N., 2016. Tracking progress towards global drinking water and sanitation targets: a within and among country analysis. Science of the Total Environment, 541, pp.857-864.
Hetherington, E., Eggers, M., Wamoyi, J., Hatfield, J., Manyama, M., Kutz, S. and Bastien, S., 2017. Participatory science and innovation for improved sanitation and hygiene: process and outcome evaluation of project SHINE, a school-based intervention in Rural Tanzania. BMC public health, 17(1), p.172.
Khan, K.S., Kunz, R., Kleijnen, J. and Antes, G., 2003. Five steps to conducting a systematic review. Journal of the royal society of medicine, 96(3), pp.118-121.
Liu, L., Oza, S., Hogan, D., Chu, Y., Perin, J., Zhu, J., Lawn, J.E., Cousens, S., Mathers, C. and Black, R.E., 2016. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. The Lancet, 388(10063), pp.3027-3035.
Monney, I. and Antwi-Agyei, P., 2018. Beyond the MDG water target to universal water coverage in Ghana: the key transformative shifts required. Journal of Water Sanitation and Hygiene for Development, 8(2) p.127-141
Munamati, M., Nhapi, I. and Misi, S., 2016. Exploring the determinants of sanitation success in Sub-Saharan Africa. Water research, 103, pp.435-443.
Prüss‐Ustün, A., Bartram, J., Clasen, T., Colford Jr, J.M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A.D., De France, J., Fewtrell, L. and Freeman, M.C., 2014. Burden of disease from inadequate water, sanitation and hygiene in low‐and middle‐income settings: a retrospective analysis of data from 145 countries. Tropical Medicine & International Health, 19(8), pp.894-905.
Roche, R., Bain, R. and Cumming, O., 2017. A long way to go–Estimates of combined water, sanitation and hygiene coverage for 25 sub-Saharan African countries. PloS one, 12(2), p.e0171783.
UN. 2015. The Millennium Development Goals Report 2015. Available online at: http://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%20(July%201).pdf (Accessed: 2/9/2018).
UN. 2016. Clean Water and Sanitation: Why it matters. Available online at: https://www.un.org/sustainabledevelopment/wp-content/uploads/2016/08/6_Why-it-Matters_Sanitation_2p.pdf (Accessed: 2/9/2018).
UN. 2018. 17 Goals to Transform Our World. Available online at: https://www.un.org/sustainabledevelopment/ (Accessed: 2/9/2018).
UNICEF. 2017. Hygiene. Available online at: https://data.unicef.org/topic/water-and-sanitation/hygiene/ (Accessed: 2/9/2018).
WHO. 2018. Sanitation. Available online at: http://www.who.int/news-room/fact-sheets/detail/sanitation (Accessed: 2/9/2018).
Wolf, J., Hunter, P.R., Freeman, M.C., Cumming, O., Clasen, T., Bartram, J., Higgins, J.P., Johnston, R., Medlicott, K., Boisson, S. and Prüss‐Ustün, A., 2018. Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta‐analysis and meta‐regression. Tropical medicine & international health, 23(5), pp.508-525.
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