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KNOWLEDGE ATTITUDES AND PRACTICES (KAP) END-LINE ASSESSMENT

On Water, Sanitation and Hygiene

LOLKUACH Village, IDPs of Akobo

September-2012

DRC-Gambella WASH Team

Conducted in the frame of an ECHO funded project

“Improving access to short-term food security, safe drinking water, hygiene and basic household items in Ethiopia”

Wanthowa Worda, Gambella, Ethiopia

September 30, 2012

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TABLE OF CONTENTS

1 INTRODUCTION 1

2 SUMMARY OF FINDINGS 2

3 METHODOLOGY 3

3.1 Objectives of the Survey 3

4 FINDINGS 4

4.1 General Background Information 4

5 WATER RELATED INFORMATION 5

5.1 Water Sources 5

5.2 Water collection and storage 9

5.3 Household Water Treatment 11

6 HEALTH AND HYGIENE 12

6.1 Diseases 12

6.2 Washing Hands and Good Hygienic Practices 15

7 SANITATION 18

7.1 Defecation 18

7.2 Waste and Waste Management 20

8 CONCLUSION 23

9 RECOMMENDATIONS 24

10 REFERENCES 25

1

1 Introduction The 2012 report states that as of end of 2010: Over 780 million people are still without access to

improved sources of drinking water and 2.5 billion lack improved sanitation. If current trends continue,

these numbers will remain unacceptably high in 2015: 605 million people will be without an improved

drinking water source and 2.4 billion people will lack access to improved sanitation facilities. An

estimated 801,000 children younger than 5 years of age perish from diarrhea each year, mostly in

developing countries. This amounts to 11% of the 7.6 million deaths of children under the age of five

and means that about 2,200 children are dying every day as a result of diarrheal diseases. Unsafe

drinking water, inadequate availability of water for hygiene, and lack of access to sanitation together

contribute to about 88% of deaths from diarrheal diseases (UNICEF, WHO, 2012: 2; Center of Disease

Control and Prevention, 2012).

As to Andrea Naylor: although worldwide there have been thousands of projects to address water and

sanitation issues as they relate to public health with continued improvements since the 1980’s, research

has shown that due to lack of evaluation surveys on the effectiveness and success of these

interventions, many are not sustainable . To this end, the essence of conducting end-line survey is very

critical to gauge the effectiveness and success of the interventions of DRC-Gambella.

The Gambella Region has an approximately population of 332,600 people, with 49,457 living in Akobo

and Wantawo Woredas. These populations are subjected to water shortage and floods. Moreover the

population is prevalently pastoralist and follows seasonal migration patterns for cattle grazing and

protection of livestock from drought and floods. The perennial attacks by the Murle tribe, coupled with

intra-clan conflicts among the Nuer tribes of Ethiopia and South Sudan, aggravates a situation of chronic

displacement, making populations of bordering areas, especially Akobo, susceptible of massive and

prolonged internal displacements.

Conflicts, drought and floods are the key challenges to the populations in Akobo and in Wantawo. The

consequent perennial movement makes the community vulnerable to food insecurity, disease and

water shortage. It is in view of this that Danish Refugee Council seeks to address in the short term the

basic needs of these populations by providing access to clean drinking water, and tools to improve

hygiene and to build the capacity of the community to respond to these challenges.

2

From the period of July 2011 to June 2012, DRC implemented a Water, Sanitation and Hygiene project,

funded by ECHO, with the goal of rehabilitating 7 hand pumps (and subsequently chlorinating the

water), distributing NFI kits, hygiene kits, and implementing hygiene promotions.

DRC decided to conduct two in-depth KAP surveys (as a baseline and endline) to evaluate the impact

brought by the implementation of the project in the targeted area. The baseline survey was conducted

in the month of May 2012 and the end line survey was conducted in the second week of September

2012. In the period between the two surveys, a number of activities covering water, sanitation and

hygiene were implemented in the frame of the project.

2 Summary of Findings

Project outputs and behaviour and knowledge change (as indicated by the pre and post implementation

KAP surveys) indicate the following key findings:

o Seven hand pumps were rehabilitated/ disinfected

o Hygiene promotion targets were surpassed. (planned: 5,490 beneficiaries; 10,950 reached)

o Hygiene kit distributions were surpassed (planned: 2,250 beneficiaries; 8,870 reached)

o NFI kit distributions were surpassed (planned 6,300 beneficiaries; 7,470 reached)

o The number of respondents who use hand pumps as source of water increased from 4% to 75%

o Knowledge and practice of feasible water purification practices such as boiling, filtration or adding

tablet/sachet has been greatly improved

o Instance of diarrhoea has decreased from 60% to 24% of respondents stating that they had had

diarrhea in during the 3 weeks prior to the survey

o Knowledge that rain water is a safe drinking water source has improved from 24% to 62% of

respondents, however, the use of rain water remains limited.

o Knowledge of the causes of unsafe drinking water (including germs, visible particles and bad taste)

increased from 40% to 81%.

o The practice of open defecation has reduced from 100% to 15% of respondents.

o Hand washing at critical times has increased from 34% to 85% of respondents.

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o Appropriate waste disposal mechanisms improved from 39.2% in baseline to 75% of respondents..

o Although there has been an improvement in the knowledge of respiratory and eye infection

transmission/protection, there is still room for improvement

3 Methodology

A cross sectional, qualitative study was conducted through house to house interviews, taking 150

respondents randomly as study subjects. The sample represents nearly 10% of the total targeted

household 1 in Lolkuach village (1,500 household). The questionnaire (See Annex I) was employed to

collect data on general background information, knowledge, attitude and practices of the IDPs of

Lolkuach village. However the results can also be considered pertinent for the host communities if

considering the cultural and environmental homogeneity. Verbal consent from the respondents was

obtained after explaining the purpose of the study. Data was collected from 13 to 14 September 2012.

The data from the questionnaires was entered into SPSS software (version 13) by the principal

investigators for further analysis.

Data reliability was assured using different techniques such as:

Properly designed questionnaires were prepared and pretested.

Data collectors were hired locally and tested during the training on the contents of the

questionnaire. Constant supervision was done by DRC WASH Team Leader, and problems

encountered at the time of data collection were reported immediately and appropriate actions

taken.

3.1 Objectives of the Survey To identify gaps in knowledge regarding health and hygiene practices and existing practices

leading to negative impact on health.

To describe the socio demographic, cultural information of respondents and villages.

To find out the information on incidence of communicable disease due to unhygienic practice.

1 It is estimated, on the base of IOM Akobo IDPs database, that the number of households currently living in Lolkuach is 1500 and average family size is 5.

4

To assess the effectiveness and impact of the DRC water, sanitation and hygiene promotion

activities.

4 Findings

4.1 General Background Information The beneficiaries of the programme, and KAP survey respondents are all part of the displaced Nuer-

Gajok population from Akobo Woreda now living in Wantawo. Among the KAP survey respondents, the

majority (about 65 %) were female, whereas 35% were male. Females were particularly targeted for the

KAP survey, as they were the primary recipients/participants in the DRC project, and are traditionally

responsible for child care and household WASH issues.

This survey was conducted near the end of the rainy season, in Lolkuach IDP settlement. Respondents

reported moving between the river banks temporary camps and dry land permanent villages according

to seasonal variations. During the dry season, the majority of the respondents live in Dimbierow village

(79%), and Nyawich village (17%), while only 4 % of the respondents indicated that they live in Lolkuach

village throughout all the year. However there are frequent movements among the settlements

throughout all the year.

Most of the respondents (86.2%) indicated that they arrived at Lolkuach between February and June

2009 following a recurrence of conflict with Lou Nuer in Akobo woreda. Minority of the respondents

arrived during the same period of 2008 (12.8%) or 2010 (1 %). Most of the respondents therefore have

been displaced since 2009.

When respondents were asked if they plan to return to their villages of origin, a pronounced number

(55%) indicated that they don’t have any plans to return due to security problems (expressed as ‘war’,

‘conflict’, ‘insecurity’). The remaining 45% of the respondents indicated that they plan to return back in

the future if the security situation is restored and the construction of the road from Mathar to Akobo is

finalized. In this regard, as it can be observed from the baseline survey, no significant difference noted in

the end line survey. However looking in detail at the positive answers (from the 45% of respondents),

21% expressed a plan to go back within six months and the remaining 34% indicated a time longer than

six months. Moreover even the respondents who indicated that they have a plan to return back to

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Kebele of origin also mentioned their fear about the security situation (expressed as ‘if peace come

back’, ‘if cattle raiding ends’, if the construction of the road to Akobo is completed and similar).

5 Water Related Information

5.1 Water Sources Before the project interventions, the baseline data indicated that almost 100% of the respondents were

accessing unsafe drinking water from the river, which is contaminated from the presence of livestock

and open defecation. At the end of the project implementation, the hand pump

maintenance/rehabilitation/water chlorination, coupled with pure sachet distributions, bucket

distributions, and hygiene promotions resulted in a significant positive change.

As you can observe from the Figure 1, the majority of the respondents are now using water from newly

maintained/rehabilitated hand pumps. Due to seasonal movement however, the proportion of

respondents using hand pumps during the dry season reduces, as many of the beneficiaries

move to areas without hand pumps. The following graph outlines both the shift in hand pump

use (pre and post intervention), and also the relation of this use in terms of seasons. There are

still not sufficient hand pumps in Lolkuach area to support the population however, which explains

why 100% of the respondents are not using these protected sources. Considering that the 7500

inhabitants of Lolkuach, Thore and Lolmokoney have only 7 hand-pumps (hand dug wells), this is

insufficient as per SPHERE standards)2 , highlighting the need to construct new hand pumps.

2 Considering the maximum number of users for 1 hand pump should be 500, at least 15 hand pumps would be needed in

Lolkuach

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0102030405060708090

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% o

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Dry Season Rainy Season

Seasons

Seasonal Use of Protected Water Sources - Pre and Post

Intervention

Baseline

Endline

Figure 1: Shift in Use of Protected Water Sources (KAP baseline an d end-line)

Seven hand pumps in Lolkuach and surrounding villages were disinfected and beneficiaries received

pure sachet as well bucket and filter.

From the findings, the graph below states that it is only 27% of the respondents indicated that the main

problems with their water source are water is dirty and it tastes bad. Whereas 40.7% of the respondents

also signified that the water source is far.

0102030405060708090

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% R

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Dirty Water Bad Taste Irregular FlowSource is Dried

Up

Distance to

Source

No problems

Water Source Issues

Problems Related to Water Supply

Baseline

Endline

Figure 2: Main problems related to water supply.

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Consequently 63% of the respondents consider the water they are using is safe for drinking, and 33%

consider it is unsafe instead (Figure 3). This represents a reduction in the proportion of respondents

who stated that they were using unsafe water from 77% in the baseline to 33% in the end-line survey.

Of these 33% of respondents who noted that they were drinking unsafe water, 8% of the respondents

were using hand dug wells (Which were rehabilitated by DRC) as source of water for drinking.

Figure 3: consideration of water safety Figure 4: reasons why 33% declared water is unsafe

In relation to the safety of water, the reason why 33% of respondents declared that they are using

unsafe water is mainly because the water contains germs, is not filtered and not cleaned. This shows

that their understanding about the causes of unsafe water has improved since the baseline (Figure 4).

When it comes to use of rainwater as source, though improvement is registered, much needs to be done

to bring about significant change. Considering the shortage of safe water sources in the area observed

by DRC, and the abundant rain-fall in Gambella region3, reasons for not using the rainwater (which is

almost distilled4) were assessed more closely. Although the number of respondents who believe that

3 The annual rain falls in Gambella region ranges between 800 and 1200mm, but about 85% of rains are concentrated between

May-October (Woube, 1999).

4 In this regards, Dev Sehgal, indicated that rainwater harvesting is an easy method to collect drinking water, and the quality of

the water is almost distilled. First when the water touches the catchment surface it usually gets contaminated (Dev Sehgal, 2005).

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rainwater is unsafe has reduced from 76% to 38% of respondents, more can be done to raise awareness

on this water collection method. Of the 38% of respondents who would not collect rain water given the

choice, the principal reasons were given as follows:

Figure 5: Investigation about unused rain water

When questioned on their knowledge of safe drinking water and water pollution causes, respondents

were given the option of providing more than one answer.

The number of respondents who indicated that drinking water shouldn’t have germs, visible particles

and/or bad taste, increased from 40% at the baseline to 81.3% at the end-line.

The respondents who indicated that the proximity of a latrine to water sources can cause water

contamination increased from 7.2% in the baseline to 15% in the end-line survey. In this regards, water

quality and health council indicated that especially the proximity of latrine to water sources can cause

Removing the first harvested water, so-called first flush, can prevent this. When the rain starts to fall the first water cleans the

catchment surface and fills up the first flush diverter, by the time it is full a ball closes the opening and leads the water to the

main tank. The downside of rainwater harvesting is that it requires double storage, as it is hard to purify water at the same speed

as it rains (Gould, J. & Nissen-Petersen, E., 2005).

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contamination5. The majority of the respondents (85%) also indicated that garbage disposal or animals

feces containers near a water source, or unprotected source can cause water contamination (Figure7).

0

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100%

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Defecation

Nearby

Garbage

Nearby

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Container

Causes of Pollution

Knowledge of Causes of Water Source Pollution

Baseline

Endline

Figure 7: Knowledge of Water Source Pollutants

Although only a small proportion of respondents acknowledge that water can be contaminated through

the ground from a latrine constructed too close to a water source, 95% of respondents are now aware

that defecation near a water source is a pollutant, resulting in a change of behavior in which open

defecation has reduced from 100% in the baseline to 15% in the end-line survey.

5.2 Water collection and storage From the Figure 8, it can be observed that nearly 50% of respondents less than 50 minutes to fetch

water during dry seasons6, meaning that SPHERE standards for these respondents are met for water-

source distance because of the rehabilitations of the hand pump in the vicinity of the village. Concerning

rainy season, it can be observed that respondents spend more time getting water. As it is observed,

respondents need to travel some distance to fetch water and during the dry season respondents also

move to river banks. Hence, this can make the access to hand pump difficult. So besides constructing

5 The causes of water pollution vary and may be both natural and anthropogenic. However, the most common causes of

domestic water pollutions includes : garbage disposal and defecation near water sources, animals feces, sharing the same sources with animals, use of dirty or open water container can affect the safety of our water .Use (Water Quality and Health Councils, 2010; CAWST, 2009; Laurent, P., 2005). 6 According to SPHERE key indicators, the maximum distance from any household to the nearest water point is 500 metres

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new hand pumps, encouraging the community for rain water catchment strategy is very essential at

household at household level.

Figure 8: Average time spent to collect water

Given that water collection requires women and girls to walk distances to find water sources, there may

be heightened protection issues for these family members, although protection was not assessed in the

KAP.

Question posed to respondents on what devices that they are using to store and collect water indicated

that 55% of the respondents are using plastic jerry cans to collect water and 34% of the respondents use

plastic bucket for water collection. For storing water, nearly 33% of the respondents use traditional clay

pot and plastic jerry cans; the rest 36% of the respondents indicated plastic jerry cans or buckets with

lid.

DRC distributed NFI (Contains 2 Jerry cans each 20 litters among others) and Hygiene kits (Contains 2

Buckets each 10 litters among other) to 302 and 283 households respectively living in Lolkuach areas. To

this end, most of the respondents own more than one container. But still those who didn’t receive water

storage and collection device also were among the respondents who took part in the survey, we can

0

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0-50 50-100

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Dry Season

Rainy Season

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observe that 70% of respondents meet the minimum SPHERE7 requirement for water collection

container, and 74% meet the requirement8 for water storage. Whereas in the baseline, it was

noted that only 50% of the respondents met the requirement for water storage and collection

devices.

5.3 Household Water Treatment The knowledge of practical purification methods like boiling, filtration or adding tablet/sachet was

assessed. As it can be observed from Figure 12, there is great leap in knowledge of the basic methods of

household water treatment. For instance, use of purifying sachet/tablet increased from 8% at baseline

to 85% at the end-line survey. The findings also suggested that the majority of the respondents (more

than 75%) know the use of feasible practices like boiling, filtration or adding tablets/sachet for water

treatments9.This figure was only 25% in the baseline survey. After the baseline survey, it is worth to

note that DRC-Gambella has been distributing purifying sachet and providing demonstrations for those

villages with no access to hand pumps.

7 According to SPHERE key indicator: Each household has at least two clean water collecting containers of 10-20 litres, plus

enough clean water storage containers to ensure there is always water in the household. The amount of storage capacity required depends on the size of the household and the consistency of water availability e.g. approximately 4 litres per person would be appropriate for situations where there is a constant daily supply 8 Requirement for storage is calculated according to certain specificities, but considering the minimum of

4lt/person/day, for an average household of 5, should be at least 20 lt. 9 Different researchers suggested some feasible practices like boiling, filtration or adding Figuret/sachet and chlorination for

water treatment (CAWST, 2009; Davis & Lambert, 2002).

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Figure 12: Knowledge of household water treatment methods

6 Health and Hygiene

6.1 Diseases Respondents were asked about the diseases their family experienced during the three weeks before the

interview. The number of respondents who caught diarrhea in the three weeks prior to the interview

reduced from 60% in the baseline to 27.3% in the end-line survey. Hence, you can see from the end-line

survey that hygiene conditions and practices are improving.

When it comes to the causes of diarrhoea, more than 85% of the respondents referenced unsafe

drinking water, children feces, germs/bacteria, open defecation, poor hygienic practices and flies as

causes of diarrhea (Figure 16), indicating that the hygiene promotion has resulted in an increase in

knowledge.

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specialcontainer

Boiling Use ofsachet

Cleaningcontainer

Filteringwith cloth

Covering sunlight

% R

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Knowledge of Household Water Treatment

Baseline

Endline

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Figure 16: Knowledge about diarrhea transmission

Interviewees were asked to indicate in a multiple choice question, which action to be taken to protect

their families from the different diseases that they suffered from.

The respondents who indicated that they can be protected from malaria by sleeping under mosquito net

increased from 40% to 75%. Keeping the environment clean and good hygienic practices also attributed

as a method of prevention of malaria by many respondents (Figure 14).

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Figure 14: knowledge of malaria prevention measures

When it comes to skin diseases, most of the respondents indicated that good hygienic practice as way of

prevention of skin diseases (Figure 15).

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Keeping

environment Clean

Safe water Good

hygienic practice

Use

mosquitonet

Wash cloth Wash hand

% R

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Knowldge of Malaria prevetion measure

Baseline

Endline

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Figure 15: Knowledge of skin diseases prevention measures

Nearly 51.2% of the respondents indicated that good personal hygiene, keeping the environment clean,

use of safe water for drinking, washing hands, washing clothes and hanging them in the sun can protect

their families from respiratory and eye problems.

The above results indicate that the knowledge of the people has improved with regards to respiratory

illness and eye infection transmission and protection, however there is still room for improvement.

6.2 Washing Hands and Good Hygienic Practices General question about hygiene and more specific ones about hand washing were posed.

Keeping food away from flies, bathing regularly, keeping compounds clean, protecting food and washing

hands are considered as good hygienic practices by the majority of the respondents in the end-line

survey. This means that the figure increased from nearly 51% at the baseline to nearly 85% in the end-

line.

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Figure 18: Knowledge about keeping good hygiene

Likewise, when respondents specifically asked if they wash their hands, 89% of the interviewees gave

affirmative answer in the end-line Survey.

People who wash hands reported to be doing it in order to eliminate bad smell and prevent diseases.

Similarly more details of the hand washing practice can be seen from Figure 20, and it can be concluded

that more than three fourth of the population who wash their hands, are doing it at the appropriate

times.

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Figure 20: Frequency of hand washing practice

While the vast majority of the respondents (95%) stated they would like to bathe once a day, when it

comes to practice, 29% of respondents expressed they have problems in taking bath regularly mainly

because of lack of container and soap (Figure 21).

Hygiene practices were also considered to be a major issue by nearly 40.6% of the respondents, these

respondents indicated that poor practices are due to both a lack of access to hygiene items, and a poor

attitude brought on by a lack of knowledge. So the majority of the respondents signified that the

distributed hygiene kits solved some of their problems and they were adhering to good hygienic

practices.

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7 Sanitation

7.1 Defecation Before the DRC intervention, the majority of the adults practiced open defecation. Because changing

habits is not easy, the baseline assessment was designed to understand the risk practices that were

most widespread and identify those that could be changed. From the point of view of controlling

diarrhoea, the priorities for hygiene behavioral change included hand washing at critical times and safe

stool disposal. To this end, the efforts of the organization brought significant behavioral change. From

the end-line survey it is noted that 85% of the respondents use traditional latrines, which is up from 0%.

Similarly, when asked to indicate the best option for defecation, 85% indicated the latrine. On the other

hand, privacy, water pollution, presence of bad smell and flies, as well as spread of disease was reported

as the main problem related to open defecation practices (Figure 23). Respondents were also asked

about post defecation cleansing habits and mostly indicated pieces of paper.

Figure 23: Problems related to defecation practice

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Considering the majority of respondents indicated that a latrine is the best option for defecation, and

that the main issue with defecation is privacy, disease, water pollution, smell and environmental

pollution, it was observed that the traditional latrine which is constructed by the participation of the

communities has been welcomed and used by the community.

In the baseline survey it was found out that inadequate sanitary conditions and poor hygiene practices

played major roles in the increased burden of communicable disease within the village. Similarly, the

baseline information stated that beneficiaries had problems with access to safe water and sanitation

facilities. To this end, DCR Gambella set a strategy to solve the problems through community

participation.

DRC- Gambella inculcates the basic principles and

approaches of CLTS (Community Lead Total

Sanitation) into the newly designed PHAST

(Participatory hygiene and Sanitation Transformation)

training. As both approaches opt for communities’

participations and empowerment and focus on

igniting a change in sanitation and hygiene behaviour,

a PHAST training manual that encompasses both

PHAST methodology and catalysts for change in

sanitation behaviour was prepared and distributed.

After community based health promotions work, and

community conversation establishments at each

village, the accessibility to sanitation facilities and sanitation practices improved. 1446 households who

completed hand washing points and traditional pit latrine (See the figure on the right side) were

awarded NFI to recognize their efforts of behavioral changes.

Hand washing after stool contact and safe disposal of stool have been priorities in hygiene and

sanitation promotion interventions in Wanthowa Woreda. By understanding that for the quickest and

widest adoption of good hygienic practices it is often more cost-effective to rely on social ambitions

rather than health arguments to encourage change, DRC linked hygiene promotion works with social

and cultural values, norms as well as NFI distributions, such that all hygiene promotions were linked with

cultural problems of Nuer society and social values. As a result good improvements in both hand

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washing and safe stool disposal were registered. This can be confirmed by looking at the end line KAP

survey results.

7.2 Waste and Waste Management The majority of disease measures are related to environmental conditions: appropriate shelter, clean

water, good sanitation, and vector control, personal protection such as (insecticide-treated nets,

personal hygiene and health promotion). Appropriate waste disposal mechanism is vital to avoid

environmental pollution and breading place for vectors and pathogens. In this regards, the majority of

the respondents (75%) indicated that they are now burning the household solid wastes on timely bases

(Figure 24). The number of respondents who had been disposing solid wastes in open space and river

significantly decreased after the interventions.

Figure 24: waste disposal practice

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The problems concerning waste were indicated in flies, bad smell, breeding place for mosquitoes.

Majority of the respondents understood that appropriate solid waste disposal plays a vital role in

minimizing the breading of vectors and other pathogens (Figure 25).

Figure 25: Problems related to waste disposal

The majority of respondents indicated that the practice used to dispose household waste is burning.

Improvement in waste disposal and keep the villages clean is observed by DRC field staffs. Similarly the

views of the majority of the respondents on the attributes of clean and health village is improved. It is

noted that availability of safe water, cleanness of the village and availability of latrine considered by

more than three fourth of the respondents as the attributes of clean and health village in the end-line

survey. But those we stated the same were nearly 50% in the baseline survey.

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Similarly, the benefits of keeping a village were mainly identified as decrease of diseases occurrence,

improved beauty of village, minimized presence of mosquitoes and flies by more than three fourth of

the respondents in the end-line where as this nearly 53% in the baseline.

From end-line survey, it can be inferred that majority of respondents indicated that important public

health factors such as availability of safe water and latrines, absence of stagnant water and mosquitoes

among the attributes of an healthy village. They also noted that this has great impact in reduction of

infection disease prevalence. Hence, it can be concluded that the understanding of the majority of the

respondents on disease transmission, transmission routes and its preventions tremendously improved

after the interventions.

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8 Conclusion

Diarrhoea causes dehydration and kills approximately 2.2 million people, mostly children, every year.

Children are more likely than adults to die from diarrhea because they become dehydrated more

quickly. In the past 10 years, diarrhea has killed more children than all of the people lost to armed

conflict since World War II. Its occurrence is closely related to the opportunities that poor people

(especially poor mothers) have to improve domestic hygiene10. Diarrhoea does not only cause disease

and early death in children, but also affects children’s nutritional status, stunting children’s physical and

intellectual growth over time. Skin and eye infections are especially common in arid areas. Both

diarrhoea and other infectious diseases have health as well as socio-economic consequences. Washing

more often can greatly reduce their spread11 . Similarly, the training manual of Amhara region indicated

that improved hygiene, particularly hand washing at critical times can reduce diarrhea by one third and

reduce malnutrition12. Soiled hands are an important source of transmitting diarrhoeas.

Recent research also suggests that hand washing is an important preventive measure in the incidence of

acute respiratory infections, one of the top killer of children under five.13

This KAP survey was conducted in order to compare its results with the results of the baseline survey, to

identify whether the hygiene promotion activities conducted in the frame of the ECHO funded project

had been effective.

The baseline and end-line survey results revealed that positive results have been achieved in the overall

hygiene situation. In the baseline survey the situation was poor i.e. lack of safe water, poor sanitation

facilities, poor hygiene practice etc. At the end of the project, an improvement was noted in the overall

hygiene and sanitation behaviour. Though improvements were noticed after the implementation of

project, it should not be forgotten that it takes time to consolidate behaviour changes, so more follow

up is necessary for further improvement.

10

(Curtis et al., 2000). 11

Brian Appleton and Christine van Wijk (IRC), 2003. 12

Amhara Regional State Health Bureau, 2011; Isabel Carter, 2005 13

See for instance the study of Ryan et al. published in 2001

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9 RECOMMENDATIONS Although the WASH project can been seen as a success, the team noted some recommendations for

future interventions.

Construct 15 shell wells in Lolkuach village so that inhabitants meet SPHERE standards

Assess whether it is possible to dig wells in the locations where people move to during the dry

season

Introduce rain water harvesting techniques, which are easy sources of potable water and would

reduce the distance travelled to access water, thus improving the protection status of the

women and girls that are responsible for this task.

Follow up on well water quality in rehabilitated wells

Although respondents recognized that animal feces can contaminate water, only 15% in the

end-line noted that the proximity of a latrine to a water source can contaminate drinking water.

This could be stressed and improved in future hygiene promotion activities.

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10 References

1. Amhara Regional State Health Bureau (2011). Training Manual on Hygiene and

Sanitation Promotion and Community Mobilization for Volunteer Community

Health Promoters (VCHP)/ Draft for Review. Online Available at:

http://pdf.usaid.gov/pdf_docs/PNADP828.pdf

2. Andrea Naylor. Development and Implementation of Sanitation Survey Using a Knowledge

Attitudes Practices (KAP) Model. University of South Florida (Tampa): CGN6933

“Sustainable Development Engineering: Water, Sanitation, Indoor Air, Health” and

PHC6301 “Water Pollution and Treatment”.

3. Brian Appleton and Christine van Wijk (IRC) (2003). Hygiene Promotion Thematic Overview

Paper. IRC International Water and Sanitation Centre

4. Boot, Marieke T. and Cairncross, Sandy (1993). Actions speak: The study of hygiene behaviour in

water and sanitation project. The Hague: IRC International Water and Sanitation Centre.

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