Thesis Proposal in Hygenic

7/23/2019 Thesis Proposal in Hygenic

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AN ASSESSMENT OF HEALTH AND HYGIENE KNOWLEDGE AND

PRACTICES OF TURBOCULOSIS TRANSMISSION OF A OFFICE

STAFF: A CASE STUDY OF DIVISION OFFICE PERSONNEL

IN 163 POPULATION

DIVISION OFFICE

A THESIS SUBMITTED IN PARTIAL FULFILMENT

OF THE REQUIREMENTS FOR THE DEGREE OF

MASTER OF PUBLIC HEALTH

OF

THE UNIVERSITY OF NAMIBIA

BY

NEVIA NAMASIKU MUNDIA (2002!!"0#

MARCH 2013

MAIN SUPERVISOR: DR$ S$ IIPINGE (UNAM#

CO%SUPERVISOR: MR$ N$ P$ TSHIFUGULA (UNAM#


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ABSTRACT

About 2.4 billion people globally live under highly unsanitary conditions and

practice such poor hygiene that the risks of their exposure to the spread of infection

are enormous. The Department of Health (DH! has been at the forefront of

environmental sanitation over the past years and has developed key materials for the

edification of policy makers and technical people dealing "ith these issues. These

materials include sanitation guidelines# $best practices% in hygiene documentation#

and general health promotional materials (DH# 2&''!.

There is no documented evidence "hich describes either the practice of hygiene by

Division office personnel in the ') Division *opulation or their kno"ledge of the

sub+ect. The purpose of this study "as an exploration and description of the

kno"ledge and the practice of hygiene among these residents.

An explorative# ,ualitative study "as done. The research sample "as comprised of

Division ffice *ersonnel# 4- years of age and older. ace/to/face intervie"s

"ere conducted and the participants0 statements "ere recorded by the researcher. The

follo"ing research ethics "ere observed during the study1 informed consent#

permission from authorities# confidentiality and voluntary participation. eferences

from existing literature "ere also sought.

orty (n34&! Division ffice *ersonnel participated in the study# "ith 2' females

and ' males intervie"ed as sub+ects. The follo"ing themes emerged during

the analysis1


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3

office hygiene and in the surroundings5 disposal of human "aste5 household refuse

removal5 personal hygiene# including hand "ashing# "ater source kno"ledge and

kno"ledge of hygiene/related diseases.

The researcher0s conclusion is that# although the people in the ') *opulation

Division ffice have some general kno"ledge about hygiene# the extent of that

kno"ledge is ,uite limited. The kno"ledge of hygiene is usually not carried out in

practice by the residents for various reasons# "hich include poverty# insufficient

"ater supply# insufficient kno"ledge and lack of access to sanitation facilities.

The follo"ing training is therefore recommended1

office cleaning maintenance# including the proper disposal of domestic and

human "aste#

the practice of proper storage and handling of "ater#

proper hand/"ashing techni,ues#

ho" these practices relate to the prevention of hygiene/related diseases.

The 6aste 7anagement should be advised to formulate strategies that "ill address

issues of "ater# sanitation and hygiene in the ') *opulation Division ffice.


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TABLE OF CONTENTS

CONTENTS PAGE

Abstract88888888888888888888888888888.ii

9ist of igures88888888888888888888888888...ix

9ist of Tables888888888888888.888888888888x

9ist of abbreviations88888888.8888888888888...........xi

Ackno"ledgement888888888888888888888888....xii

Dedication 888888888888888888888888888..xiii

Declaration 888888888888888888888888888.xiv

CHAPTER 1: INTRODUCTION AND BACKGROUND INFORMATION&1

'.' :ntroduction88888888888888888888888888..'

'.2 ;ackground of the study88...88888888888888888......'

'.) perational definitions of concepts8888888888888888..'2


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'.- ?onceptual frame"ork for data analysis888..8888888888...')

'.


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).=.'.2 ?riterion validity8888888888888888888888..4

). *rocedure for data collection88888.88888888888888.=&

).> Data analysis888888888888.8888888888888..='

).- esearch ethics888888888888..888888888888.=2

).-.' *ermission from relevant authorities8888..88888.88888..=)

).-.2 :nformed consent88888888888888888888888.=)

).-.) ?onfidentiality888888888888888888888888.=)

).-.4 Anonymity8888888888888888888888888...=4

).-.= Coluntary participation888888888888888888888==

).-. eferences for information from outside sources88888888888..==

).

4.2 *resentation and interpretation of the data88888..88888888..=>

4.2.' ;iographical data8888.8888888888888888888.=-

4.2.2 Hygiene kno"ledge and practices888888888888888.8...&

4.2.2.' Hygiene in the house and surroundings88888888888888'


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4.2.2.2 efuse removal88888888888888888888888.4

4.2.2.) *ersonal hygiene8888888888888888888888...>

4.2.2.4 @no"ledge of hygiene/related diseases8888888888888...>&

4.2.2.= Human "aste disposal88888888888888888888..>2

4.2.2.=.' Type of toilets888888888888888888888........>4

4.2.2. 6ater source for the community8888888888888888..>>

4.2.2.> Hand "ashing88888888888888888888888...-&

4.)


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8

=.4.= urther research88888888888888888888888...'

=.4. ?onclusive remarks8888888888888888888888.'

REFERENCE LIST&&&&&&$&&&&$&&&&&&&&&&&&&$)3

ANNE*URE

Annexure '1 Approval 9etter from niversity of Eegros88...888888.'&)

Annexure 21 Approval 9etter from 6aste 7anagement888.888888'&4

Annexure )1 :ntervie" Fuide8888888888888888...............'&=


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LIST OF FIGURES

igure ' 7ap of ') *opulation Division ffice8888888888888.-

igure 4.' Fender distribution of respondents88888888888888.=-

igure 4.2 Age distribution of respondents88...888888888888...=

igure 4.) A lady cleaning her yard using a plastic rake88888..8888...'

igure 4.4 A boy "ashing dishes on the ground8888888888...88...2

igure 4.= efuse dumped in an open space888888888888888=

igure 4. A man brushing his teeth888888888888888888-

igure 4.> A plastic structure used as a bathing area888...88888888-

igure 4.- A latrine888888888888888888888888....>=

igure 4. A boy fetching "ater at a communal tap888...88888888.>-

igure 4.'& A man "ashing his hands8..8888888888888888-'


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10

LIST OF TABLES

Table '1 Hygiene/related diseases88888888888888..888..8'&

Table 4.'1 9ist of themes and subtheme8888.888888888888..&


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LIST OF ABBREVIATIONS

AIDS + Ac,uired :mmune Deficiency


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ACKNOWLEDGEMENT

: "ould like to thank Fod Almighty for giving me the strength# "illpo"er and

kno"ledge to conduct this study. 6ithout Him# this study "ould not have been

successful.


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xiii

DEDICATION

: dedicate this achievement to all the people "ho supported me# especially my

immediate family members for their encouragement and financial support. 7ay

Almighty Fod bless you abundantly.


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DECLARATION

: declare that the thesis $An Assessment of Health and Hygiene @no"ledge and

*ractices1 A ?ase


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1

CHAPTER 1: INTRODUCTION AND BACKGROUND INFORMATION

1$1 I,-./-/,

This chapter outlines an introduction to and background for information on the

sub+ect of hygiene# in regards to both kno"ledge and practice# among the population

of Division ffice *ersonnel the prevention of Tuberculosis. A problem statement#

the initiative to conduct this study# operational definitions# and its ob+ectives# are also

outlined.

1$2 B45./, /7 -89 -;

According to the Department of Health access to improved "ater and sanitation

facilities does not# of and by itself# necessarily result in improved health. There is

evidence "hich indicates that hygienic behavior# in particular hand "ashing "ith

soap at critical times# such as after defecating# and before eating and preparing food#

is e,ually important. Hand "ashing "ith soap can significantly reduce the

incidence of tuberculosis. Food hand "ashing practices have also been sho"n to

reduce the incidence of other diseases# notably pneumonia# trachoma# scabies# skin

and eye infections# and diarrhea/related diseases such as cholera and dysentery. The

promotion of hand "ashing "ith soap is also a key strategy for controlling the spread

of avian tuberculosis


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*hiippines stated that the health risks to "hich humans are exposed prove that

good hygienic practice is essential. :n fact# the spread of most Air;orne diseases# like

Tuberculosis# has been attributed to a lack of hygiene. 6ith this in mind it is clear

that# if sound hygienic practices "ere more "ide spread# all people "ould benefit#

including future generations. Food hygiene is actually a group of habitual practices

that need our attention and should be inculcated in ffice *ersonnel at an early age#

indeed# as early as possible.

According to Department of Health(2&''!# it is important to make sure that

information about health is accessible in Fovernment ffices.


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6H (2&''! further stated that# about 2.4 billion people globally live under highly

unsanitary conditions. *oor hygienic behavior# and exposure to the risks of infection

are very serious issues. The DH has been at the forefront of environmental

sanitation and hygienic initiatives during recent years and has developed key

materials directed at policy makers and technical people dealing "ith these issues.

These materials include1 guidelines5 $best practice% documents and promotional

materials on sanitation and hygiene. Around '.' billion people globally do not have

access to ade,uate sources of "ater and about 2 million people die every year due to

diarrheal diseases5 most of them children under five years of age. The most affected

people are those living in developing countries# those living under conditions of

extreme poverty# and peri/urban d"ellers. *roviding access to sufficient supplies of

safe "ater# the provision of facilities for the sanitary disposal of excreta and the

introduction of sound hygienic behavior# are of the utmost importance in the

reduction of disease caused by these risks.

Alvin# ;en# @aren# I Jim (2&&! conducted a cross/ sectional study in

*hilippines to investigate possible factors influencing hygienic practices among

mothers regarding their handling of food and the prevalence of diarrhea among their

children. The study "as conducted in a *hilippines hamlet. The researchers recruited

mothers "ho had ffice personnel bet"een the ages of six months and forty five

years. ?linic hygienic practices noted among these personnel included hand/

"ashing# methods of "ashing utensils# separation of utensils for ra" and cooked

food# and "ell/selected locations for the preparation of food. The findings revealed


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that the risk of tuberculosis "as significantly higher among personnel "hose division

*ersonnel prepared food on surfaces other than tables (typically on the ground!

compared to children "hose ffice personnel prepared food on tables. The results of

the study indicated that mothers in *hilippines "ho practiced good hygiene and did

not prepare food on the ground# at least potentially prevented diarrhea among their

co"orkers.

Alvin# (2&&>! gave information about a study of adolescent ffice girls in ')

*opulation Division ffice that "as conducted to evaluate their kno"ledge and

behavior regarding aspects of menstrual hygiene. indings indicated that the girls

observed in the study did not properly observe hygiene. esults of the study

indicated that 4&.K of the girls had general kno"ledge of hygiene# "hile only

'2.K actually practiced good hygiene. verall# the girls0 kno"ledge and practice

"ere both insufficient. The findings indicated that there "as an obvious need to

educate girls about the process and the significance of menstruation in terms of the

proper use of sanitary pads or absorbents and their correct disposal. The goal of

eliminating misconceptions among adolescent girls regarding menstrual hygiene

could have been achieved through proper training and health education administered

by teachers# family members# health educators and the media.

According to the oundation for 6ater esearch (2&&&! diarrhoea affects millions of

people "orld/"ide. The disease has the greatest impact on children# especially in

developing countries. 6aterborne diseases remain a cause of concern in both

developing and developed countries. :n developed areas# improvement in "aste"ater


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disposal# protection of "ater sources and the treatment of "ater supplies# has greatly

reduced the prevalence of "aterborne diseases. Hygiene education comprises a broad

range of activities aimed at changing attitudes and behavior to break the chain of

disease transmission associated "ith inade,uate "ater and sanitation. :n the context

of rural Africa# the provision of safe piped/in "ater for every household has not been

achieved and the art of maintaining good hygiene assumes an added significance.

Approximately '- million problems associated "ith unsafe hygienic practices include dispersed and diffuse


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pollution of "ater sources resulting in a "ater and fecal disease cycle for

communities "ith untreated "ater supplies (*has"ana and


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that approximately one out of five households in the rural areas rely on unsafe "ater

for drinking and cooking# thereby putting them at greater risk of infection or parasitic

diseases. ver -&K of the households in ?aprivi region have no toilet facilities and

residents must utilise open areas as a toilet. ver 4&K of the households in the urban

areas have no toilet facilities and use the bush to relieve themselves. This implies that

only &K of the households in the to"n have toilet facilities and these are mostly in

the formal settlements. The most common means of disposing garbage in the ?aprivi

region is the use of rubbish pits# utilised by 44K of all households. :n the urban areas

only 2)K of households have their garbage regularly collected (Eational *lanning

?ommission# 2&&'!.

The findings of the Eamibia Demographic and Health indicated

that dehydration# caused by severe diarrhoea# "as a ma+or cause of morbidity and

mortality among children# despite the fact that the condition can be easily treated

"ith oral rehydration therapy (T!. xposure to diarrhoeal/causing agents is

fre,uently related to the use of contaminated "ater# unhygienic practices related to

food preparation and the disposal of excreta (7inistry of Health and


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*oor hygiene is an issue that certainly affects most informal settlements in Eamibia.

*eople have little or no access to sanitation facilities and the absence of hygienic

practices in these communities contributes enormously to the occurrence of hygiene/

related diseases. :n vie" of this vulnerability the area that "as chosen for this study

"as the ?hoto informal settlement. :t is located approximately )&& meters "est of a

tract of houses built by the Eational Housing nterprise and 2& meters south "est of

Freen"ell 7atongo location in @atima 7ulilo (see igure '!.

F.9 1: 7ap of @atima 7ulilo


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1$3 S-4-9?9?9 1: Hygiene/related diseases

DISEASE @ANUARY 0) TO SEPTEMBER 0) 200) TOTAL

UNDER FIVE ("# YEARS

(NUMBER OF PATIENTS#

ABOVE FIVE ("# YEARS

(NUMBER OF PATIENTS#

'. Diarrhoea 4)2 =4 >-

2.

=. ye disease ) )- >4

. ?ommon cold ) )'= -4

TOTAL 1233 1'!6 2!0)

S/.9: K9,4, (200) =$1#$

There is no published documentation "hich records either the hygienic practices of

the people in ?hoto or their kno"ledge of the sub+ect. *rovisions for sanitation and

"ater supply are inade,uate in ?hoto. The residents use communal taps as a source

of "ater and there are no toilet facilities. :nvestigating these conditions# the

researcher "as interested in ans"ering the follo"ing ,uestions.

6hat hygienic practices are observed by ?hoto residentsM

6hat kno"ledge do the residents in ?hoto have regarding hygiene/

related diseasesM


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1$' P.=/9 /7 -89 -;

The purpose of this study is to explore and describe the kno"ledge of hygiene that

the residents of ?hoto possess and to document their observable hygienic practices in

the environment of their informal settlement in @atima 7ulilo.

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There are t"o ob+ectives# namely1

To explore the hygienic practices of people living in ?hoto informal

settlement.

To assess the kno"ledge of the people "ith regard to hygiene/related

diseases.

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The significance of the study is to produce documented information about the

hygienic kno"ledge and practices of people living in ?hoto informal settlement of

@atima 7ulilo. The findings of this study should provide both the residents of the

?hoto community and the entire ?aprivi region "ith helpful information regarding

the possible conse,uences of poor hygienic practices and inade,uate sanitation

facilities. Appropriate recommendations could generate or stimulate action for the

improvement of the hygienic circumstances of people in the entire region.


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1$! O=9.4-/,4? 97,-/, /7 /,9=-

Hygiene is more than +ust being clean. :t is defined as the combined practices that

help people to stay healthy (Advameg# :nc# 2&&!.

Good hygienic practice includes actions people take to stay healthy# like "ashing

hands thoroughly and often# taking a sho"er every day# "earing clean cloths and

keeping homes clean (Auger# ?olinders# ;ihn# Fravani I mbrey# 2&&=!.

Personal hygiene may be described as the practice of maintaining cleanliness and

grooming of the physical body. :n common vernacular it is described by the phrase

$looking after your self% (Hygiene xpert (@!# 2&&&/2&&!.

Health is a state of general physical# mental# and social "ell/being and not merely

the absence of disease or infirmity (6H# 2&'&!.

Hygienic practice means that a person fre,uently engages in activities or behaviour

that serve to promote or preserve health (Ans"ers.?om# 2&'&!.

Sanitation is the process of preventing human# animal and insect contact "ith excreta

to avoid the spread of disease (Flobal ducation# 2&'&!.

Good sanitation is defined by safe# private and hygienic defecation and the

maintenance of ade,uate# accessible facilities for this purpose (a"cett# 2&''!.

Environmental sanitation is a package of measures that eliminate factors that

encourage the proliferation of flies and the spread of disease.


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programmes to improve the personal and environmental hygienic practices of a

population (abiu# Alhassan# +ere I van# 2&'2!.

1$ C/,9=-4? 7.4


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Perceived benefits relates to the difficulty of convincing a person to change

behavior "hen they perceive no personal advantage in changing. :f people

believe that they can use soap comfortably and "ith confidence# they "ill

have no problem doing that# provided that they can afford to buy the soap.

1$) S


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CHAPTER 2: LITERATURE REVIEW

2$1 I,-./-/,

or this study a literature revie" serves to make a critical analysis and to compare

information on hygiene from other geographical areas and to source published vie"s

of scientists regarding hygiene issues. indings made in similar studies help identify

gaps in the body of kno"ledge in the context of the aim and ob+ectives of the current

study. The literature revie" "as also carried out to shed light on the follo"ing

pertinent issues1 personal hygiene# ffice sanitation and the kno"ledge and practices

relevant to hygiene.

2$2 I


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Hygiene is an important issue in personal department# i.e. in taking care of oneself

both physically and emotionally. *eople often have infections because they do not

take good care of themselves physically# such condition that can produce emotional

difficulties as "ell. Food hygiene includes the practice of regularly and thoroughly

"ashing one0s hands and body# brushing one0s hair# flossing the teeth and caring for

gums. These grooming habits "ill reduce vulnerability to harmful bacteria that reside

on the body. 6hile some bacteria are harmless and even beneficial to the body# the

accumulation of bacteria can endanger a person0s health (7oney :nstructor (2&&=!.

7ost people are afraid of contracting infection "ith life/threatening diseases like

A:D


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of unsafe "ater and the lack of "ater associated "ith1 inade,uate hygiene# poor

personal and domestic hygiene# contact "ith unsafe "ater# and the inade,uate

development and management of "ater resources or "ater systems. :n order to

estimate the burden of infectious diarrhoea# exposure scenarios are established

according to "ater supply and sanitation infrastructure# the level of fecal/oral

pathogens in the environment and populations assigned to these scenarios. The health

burden from schistosomiasis# trachoma# ascariasis# trichriasis and hook"orm disease

are all "holly attributable to unsafe "ater# sanitation and hygiene. nsafe "ater#

sanitation and hygiene are important determinants in a number of other diseases#

such as malaria# yello" fever# filariasis# dengue# hepatitis A# hepatitis # typhoid

fever# arsenicosis# fluorosis and legionellosis. A high global disease burden is

attributed to some of these diseases.

6ater# sanitation and health are closely interconnected. Cie"ed "orld"ide# the lack

of sanitary "aste disposal and clean "ater for drinking# cooking and "ashing is to

blame for over '2 million deaths. :n the ma+ority of cases# diarrhoeal deaths occur

"orld"ide due to inade,uate hand "ashing and +ust being able to "ash one0s hands

"ith soap and "ater can reduce the incidence of diarrhoea by )=K (nvironmental

9earning# 2&&)!.

:t is also "orth noting that# given the range of health risks to "hich people are

exposed# it has become vital to maintain as high a standard of hygiene as possible. :n


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fact# most ne"/"orld diseases# like bird flu and s"ine flu# have been attributed to

poor hygiene. :f the present generation "ere to make concerted efforts to improve

hygiene# it "ould have beneficial effects on future generations (:ndia *arenting#

2&'&!.

Health and sanitation are serious concerns in most cities# especially in poor

neighborhoods. 9iving conditions in poor neighborhoods are especially bad because

of inade,uate government investment in informal settlements# "here services such as

basic "ater or sanitation# education or health services# are lacking. :nformal

settlements are commonly marked by overcro"ding. This condition facilitates the

rapid spread of disease "hich# in turn# contributes to the suffering of children due to

poor health. These problems are often based on inade,uate nutrition and the lack of

access to clean "ater and sanitation (@enya ?ommunity


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hygiene/related topics. !# rapid urbanisation is a serious challenge for those

responsible to provide services to urban areas in developing countries. nable to

keep pace "ith rapid population gro"th# many urban areas experience a substantial

increase in the numbers of people living belo" the poverty line in the categories of

informal or unplanned settlements. 7ost informal settlements have no access to

ade,uate and affordable basic services such as "ater supply and sanitation. The

promotion of hygiene# sanitation and health is a key aspect of sanitation service

provision in urban poverty stricken areas and densely populated informal settlements.

The aim of introducing sanitation systems is to ensure measurable health benefits.


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2$3 K,/?99 /7 // 8;9,9

To implement daily hygienic practices and avoid hygiene/related diseases# people

need to possess kno"ledge of# and appreciation for# the importance of good hygiene.

:t is the only "ay people can make informed decisions regarding hygienic practices.

6ater Aid America (2&''! stated that good hygienic practices# such as hand "ashing

and the safe disposal of feces# are essential for maximising the health benefits of safe

"ater and sanitation facilities. vidence sho"s that "hen hygiene education

accompanies the provision of "ater and sanitation# the number of deaths caused by

diarrhoeal diseases is reduced by an average of = percent. Hygiene education and

promotion encourages people to replace their unsafe practices "ith simple# safe

alternatives. 7ost people are only too happy to use clean "ater and safe sanitation

facilities once they are readily available# but "ithout kno"ledge of good hygienic

practices# the health benefits "ill be greatly reduced.

niversal access to "ater and sanitation has been seen for decades as the essential

step in reducing the preventable infectious disease burden in the developing "orld.

Ho"ever# it is no" clear that this goal is best achieved through programmes that

integrate hygiene promotion "ith improvements in the ,uality of available "ater and

sanitation. Eeglect of hygiene goes a long "ay to explain "hy "ater and sanitation


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programmes have often not brought the expected benefits. The current focus in

developing countries is on investment in community "ater supplies and sanitation in

order to meet the 7illennium Development Foals (7DFs! but# if the health benefits

from achieving these goals are to be realised# sector professionals must look beyond

the provision of "ater supply hard"are and toilet facilities (;loomfield# 7artin#

ara# Eath#


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others. ;ed bugs are a common problem "hen good hygiene and regular cleaning are

lacking.

7enstruation and menstrual practices are still often shrouded in taboos and socio/

cultural restrictions "ith the result that adolescent girls remain ignorant of important

health/related information and information on hygiene# "hich sometimes can cause

adverse health outcomes. The onset of menstruation is one of the most important

health/related changes occurring in adolescent girls. eactions to and management of

menstruation depends on a"areness and kno"ledge about the sub+ect. Hygiene/

related practices of "omen during menstruation are of considerable importance#

since a "oman0s period increases her vulnerability to reproductive tract infections

(T:!. The relationship of socio/economic status# menstrual hygiene practices and

T: are obvious. Today millions of "omen are sufferers of T: and its

complications and often infections are transmitted to a mother0s offspring during

pregnancy. 6omen having better kno"ledge regarding menstrual hygiene and safe

practices are less vulnerable to T: and its conse,uences. Therefore# increased

kno"ledge about menstruation# beginning in childhood# may help promote safe

practices and mitigate the suffering of millions of "omen (:ndian Journal of

?ommunity 7edicine# 2&'2!.


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2$' H;9,9 4---9 >984/. 4, =.4-9

Food hygienic behavior and practices can improve a person0s general state of health

and prevent the occurrence of hygiene/related diseases. According to Huuhtanen I

9aukkanen (2&&! hygienic behavior lo"ers the risk of infections. *oor hygienic

behavior can be detected most distinctively in excreta/related diseases and diarrhoeal

infections. *roper hygienic behavior# on the other hand# can decrease the spread of

many diseases# including skin disease# contracted from agents on the ground and

from insects. Ade,uate sanitation is the frontline method of preventing the spread of

excreta/related diseases and spreading of pathogens in residential environments. The

second most important method is hand "ashing# "hich prevents pathogen

transmission to food# "ater# and people.

:mportant practices and facilities that improve hygiene are1

Ade,uate sanitation facilities (such as flush toilets# latrines or improved

ventilated pit latrines!.

Ade,uate storage and use of food.

*roper storage of "ater to prevent contamination

*roper handling and disposal of solid excrement and urine.

6ashing hands after defecation (also children0s hands!

6ashing hands before touching food or containers of "ater

sing clean "ater


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?ontrolling vectors (Huuhtanen I 9aukkanen# 2&&!. $6hen people follo" good

personal hygiene# they do not only help themselves but also others. ;y keeping

clean# one does not spread germs to others and one does not make them sick%

(7ediTrends# 2&&&!. 7any diseases can be linked to the neglect of personal hygiene

that fuels the occurrence and spread of hygiene/related diseases.

?anadian ?entre for ccupational Health and ' individuals (=> K male# 4) K female!. esults of this survey

indicated that kno"ledge differed significantly according to gender# age group#

educational and "orking status. They noted that females had better attitudes

concerning hygiene than males. Despite sufficient kno"ledge and conducive

attitudes# ho"ever# participants0 behavioral responses to :nfluenBa A "ere poor.

Thus# escalated effort on the part of government "as recommended to establish

factors that could be associated "ith adaptive behavior changes among the general

public in order to improve the standard of their hygienic practices.

According to Denoble (2&'&!# a company that claims to be the "orld0s largest

distributor of paper and hygiene products# published the results of a global hygiene


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attitudes study. The stated goal of the study "as to discover ho" the flu pandemic of

2&& might have changed global attitudes to"ards hygiene. The findings of the study

suggest that a larger number of people in ?hina practice good hygiene no" than "as

the case before the flu pandemic. :ncreased in a"areness of hygiene in the "ake of

the global flu pandemic of 2&& has led to increased hand "ashing and home

cleaning in ?hina. The study revealed that nine out of ten people in ?hina "ash their

hands more fre,uently and seven out of ten ?hinese people cleaned their homes more

often# since the flu pandemic of 2&&.

:ndividuals observe their o"n standards of hygiene# and these "ere either actively

taught by# or learned through observation of# others. *ersonal hygiene# if practiced

conscientiously# helps to prevent the spread of disease# the outbreak of epidemics or

even pandemics. bserving very basic practices may help prevent coughs and colds

from spreading from one person to another (Hygiene xpert (@!# 2&&&/2&&!. The

key to spreading the practice of hand "ashing "ith soap resides in promoting

behavioral change through motivation# information and education. There are a

variety of "ays of accomplishing this# for example# through high/profile national

media campaigns# through peer/to/peer education techni,ues# by "ay of hygiene

lessons for children in schools# and subse,uent encouragement of those children to

demonstrate good hygiene to their families and communities (nited Eations

?hildren0s und# 2&&-a!.


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De Haan# Dennill and Casuthevan (2&&=! maintain that personal cleanliness is an

important factor in the maintenance of hygiene. ?onversely# poor standards in

personal hygiene are associated "ith many unhealthy conditions# such as lice

infestation# scabies# trachoma# ya"s and skin infections. :ndividuals "ith poor

standards of personal hygiene not only endanger their o"n health but also the health

of others. The spread of infectious diseases may often be traced to poor hygienic

habits of people "ho handle food or care for children# and people "ho fail to practice

oral hygiene.

According to 6H (2&''!# it is believed in many African cultures that children0s

feces are harmless and do not cause disease. This is patently not true5 the feces of

children contain as many germs as that of adults. :t is very important to collect and

dispose of children0s feces ,uickly and safely. 6ater Aid America (2&''! stated that

a starting point for a hygiene education pro+ect is initiating a discussion "ith

communities about "hat they kno"# do and "ant in relation to hygiene. Actively

involving communities in decision/making ensures that pro+ects "ill en+oy

sustainability because of alignment "ith culturally based belief systems. 6ater Aid

America and its partners recognise that people are not motivated to adopt good

hygienic practices solely because they understand the health benefits# but also

because they experience improvements in privacy# convenience# environmental

cleanliness# self/esteem and social status "hich help to motivate the necessary

behavioral changes.


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2$" E,./,


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toilet compartment for every 2= users. The toilet facilities should be

arranged in separate blocks for men and "omen. The men0s toilet block

should have urinals and toilet compartments# the "omen0s block# toilet

compartments only. The total number of urinals plus compartments in the

men0s block should e,ual the total number of compartments in the "omen0s

block.

Toilet facilities should not be connected "ith kitchens.


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hygienic surroundings ensures that such areas are not turned into breeding grounds

for bacteria and viruses. *eople need only to follo" simple rules in order to ensure

that areas surrounding "ater collection points remain hygienic# namely1

Dispose of waste in an appropriate manner. 6aste material# inappropriately

disposed of# can cause outbreaks of deadly diseases. 7ost epidemics in

history have been caused due to improper "aste disposal.

Maintain a clean home environment.

Acquire and use garbage cans or rubbish bins.

efrain from spitting and urinating in public places.


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disposal. The most threatening source of "ater contamination is often surface "ater.

:f "aste materials are not disposed of properly# they may come in contact "ith "ater

accumulated on the surface# "hich may be collected for drinking and cooking.

?ontamination can be caused by household trash and human and animal "aste

products. The consumption of tainted "ater can cause an outbreak of disease or the

spread of a current outbreak (;anks# 2&&)/2&''!.

Human excreta al"ays contain large amounts of germs# some of "hich may cause

diarrhoea. 6hen people become infected "ith diseases such as cholera# typhoid and

hepatitis A# their excreta "ill contain large amounts of germs that cause those

diseases. 6hen people defecate in the open# flies feed on the excreta and may carry

small amounts of it a"ay on their bodies and feet. xcreta and the germs it contains

are transferred to the food touched by the carrier flies.


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collect "aste through formal# household "aste/collection systems. The public should

therefore accept co/responsibility for the cleanliness of the to"ns and cities "here

they reside and ensure that they dispose of litter and "aste in allocated bins.

Traditional "aste/collection systems are inappropriate# inefficient and costly "hen

applied to informal settlements. ecently developed and innovative "ays of

managing "aste removal in disadvantaged communities are re,uired. The trend "ill

move to"ards community/based "aste collection by1

*aying people to bring litter or "aste to a central collection site# and

:nvolving the community in programmes to keep their neighborhoods clean.

The emphasis should be more on preventing pollution and minimiBing "aste

materials at their source since it is much more costly to clean up "aste after it has

been negligently discarded. This approach is based on the follo"ing principles1

eduction of "aste accumulation through re/use of "aste products# e.g.

using product packaging# such as plastic packets and containers to store

things5 using the blank side of printed paper before sending it to be recycled.

ecycling to reduce the build up of mass in the "aste stream.

ecovering chemicals# gases and metals from "aste (7ahlangu# 2&''!.


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2$6 H;9,9%.9?4-9 949

:n order to eliminate or eradicate hygiene/related diseases it is important to

understand their causes# ho" they spread and ho" they can be prevented.

9ice are parasitic insects that can find a home on people0s heads# bodies# and pubic

area. Human lice survive by feeding on human blood. 9ice infestations are mostly

spread by close physical contact (?enters for Disease ?ontrol and *revention#

2&'&a!. 9ice infestation can be easily controlled and prevented because head lice

cannot +ump from one person to another or cra"l in homes.


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*arents should check their children for nits and head lice at least once a "eek.

Although one may find head lice any"here# they are commonly found at the

back of a child0s head# near the neck and behind the ears.

ne should learn the signs that indicate the presence of head lice# "hich

include an itchy scalp and small red bumps or sores on the back of a person0s

neck and scalp.

A person should "ash their hair regularly# using shampoo and hair

conditioner (:annelli# 2&&-!.


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people have contracted diarrhoea at some point in their lives. Diarrhoea is the most

important public health problem directly related to "ater and sanitation. The simple

act of "ashing hands "ith soap and "ater can reduce diarrhoeal disease by one third

(nited Eations ?hildren0s und (E:?!# 2&&=!. Diarrhoea is usually caused by

viral or bacterial infections and food poisoning. ?ommon types of bacteria "hich can

cause diarrhoea are E"coli (Escherichia coli! and Salmonella. ;oth can be found in

contaminated food or "ater. 7any micro/organisms that cause diarrhoea can spread

from one person to another "hen people defecate in the open. Disposing of excreta

safely# isolating excreta from flies and other insects# and preventing fecal

contamination of "ater supplies# "ould greatly reduce the spread of diarrhoea

(6H# 2&''!.

?holera is not as common as diarrhoea# though their routes of infection are similar.

According to Huuhtanen I 9aukkanen (2&&!# about '4& &&& people "orld/"ide

have been infected# resulting in =&&& cholera deaths every year. The disease is

caused by vibrio cholera bacteria. ?holera epidemics spread more "idely than

diarrhoea# the latter usually occurring in a localiBed environment. Caccinations#

,uarantines and travel bans do not prevent cholera from spreading. As many as &K

of all cholera cases are symptomless# still the carrier of the disease may infect others.

The most important measures for preventing cholera from spreading are similar to

those for diarrhoea. An ade,uate and safe supply of drinking "ater and good food

hygiene are the primary measures to prevent cholera. :t is also recommended that

people avoid eating ra" fish and seafood in areas "here there are outbreaks of


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cholera. 6hen the incidence of the disease is high# gatherings of people should be

avoided.

The ?enters for Disease ?ontrol and *revention (2&'&a! stated that typhoid is a life

threatening illness caused by the bacterium Salmonella paratyphoid. Typhoid fever is

very common in the developing "orld# "here it affects about 2'.= million people

each year. Salmonella paratyphoid lives only in humans. *ersons "ith typhoid fever

carry the bacteria in their bloodstream and intestinal tract. A small number of

persons# designated as carriers# recover from typhoid fever but continue to carry the

bacteria. ;oth ill persons and carriers shed Salmonella paratyphoid in their feces.

Humans can get typhoid fever if they eat food or drink beverages that have been

handled by a person "ho is shedding Salmonella paratyphoid or if se"erage

contaminated "ith Salmonella paratyphoid bacteria gets into potable "ater. or

those reasons# typhoid fever is more common in areas of the "orld "here hand

"ashing is less fre,uent and the "ater is likely to be contaminated "ith se"age.

nce Salmonella paratyphoid bacteria are s"allo"ed they multiply and spread into

the bloodstream. The body reacts "ith fever and other signs or symptoms.

Huuhtanen I 9aukkanen (2&&! stated that# typhoid fever can be prevented and

treated "ith measures that are similar to those used for diarrhoea. Caccination is

recommended only if a person spends long periods of time in a region affected by

typhoid fever. n the other hand# vaccination does not give complete protection

against the disease.


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Hepatitis A is another condition related to poor hygiene. :t is transmitted through

food and drink that has been contaminated by "ater or soil# an infected individual#

excreta contaminated "ater# and direct person/to/person contact. :nsufficient

amounts of drinking "ater and poor sanitation and hygienic conditions increase the

risk of infection. Hepatitis A causes fever# exhaustion# lack of appetite and +aundice.


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child0s immune system is less developed in comparison "ith the immune system of

most adults. ?hildren# therefore# are more vulnerable to infection.


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(?allahan# 2&''!. The most important precaution is to be extremely strict concerning

hand "ashing. :n other "ords a person1 should al"ays "ash hands "ith soap and

"ater before and after touching the eyes# should avoid facial contact "ith others

"hile sho"ing symptoms# and should avoid sharing personal articles such as to"els#

pillo"s or cosmetics. *eople "ho provide healthcare# food services or education

should not "ork until their eyes feel and look normal because of the risk of spreading

the infection to others.

Trachoma is caused by an infection of the eye "ith !hlamydia trachomatis. :nfection

spreads from person/to/person and is fre,uently passed from child to mother

especially under conditions "here there are shortages of "ater# numerous flies or

cro"ded living conditions. :nfection often begins during infancy or childhood and

can become chronic. :f left untreated# the infection eventually causes the eyelid to

turn in"ards "hich# in turn# causes the eyelashes to rub on the eyeball resulting in

intense pain and scarring of the front of the eye. This ultimately leads to irreversible

blindness# occurring typically bet"een )& and 4& years of age (6H# 2&''!.

Trachoma occurs "orld"ide# mostly in the rural settings of developing countries

(*ub7ed Health# 2&'&!. *opulations marked by poverty# cro"ded living conditions#

or poor hygiene are at higher risk of contracting this illness. Antibiotics can prevent

long/term complications if used early in the infection. :n certain cases# eyelid surgery

may be needed to prevent long/term scarring. As noted above# the latter can lead to

blindness if not corrected. :mproved sanitation and avoidance of sharing items# such

as to"els# are important measures for limiting the spread of trachoma.


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According to ?enters for Disease ?ontrol and *revention (2&'&b! giardiasis is a

diarrhoeal illness caused by a microscopic parasite called Giardia intestinalis (also

kno"n as Giardia lamblia or Giardia duodenalis!. The parasite is found on surfaces

or in soil# food or "ater that have been contaminated "ith feces from infected

humans or animals. *eople become infected after accidentally s"allo"ing the

parasite. 7arks I Anand (2&''! stated that giardiasis occurs "here there is

inade,uate sanitation or inade,uate treatment of "ater. The parasite is one of the

causes of "hat is kno"n as Otravelers0 diarrhoea0# "hich occurs during travel to less

developed countries. Fiardiasis is a common cause of outbreaks of diarrhoea in day/

care centers because of the high probability of fecal/oral contamination among

children. ?hildren0s families and day/care center "orkers are all at risk. 7edindia

Health Eet"ork (2&''! stated that giardiasis is prevented and controlled by improved

"ater supply# proper disposal of human feces# maintenance of food and personal

hygiene and health education. nfortunately# no vaccine or effective chemo/

prophylactic drug is available for the prevention of giardiasis infection.

According to the ?enters for Disease ?ontrol and *revention (2&'&c! an estimated

=> to >4& million people in the "orld are infected "ith hook"orm. Hook"orm#

ascaris and "hip"orm are kno"n as soil transmitted helminthes. Together# they

account for a ma+or burden of disease "orld"ide. Hook"orms live in the small

intestine and eggs are passed in the feces of an infected person. :f an infected person

defecates outdoors (near bushes# in a garden or field! or if the feces of an infected

person are used as fertiliBer# eggs are deposited on the soil "here they mature and


56/120

hatch releasing larvae (immature "orms!. The larvae develop into a form that is

capable of penetrating human skin. Hook"orm infection is mainly ac,uired by

"alking barefoot on contaminated soil. Another kind of hook"orm can be

transmitted through the ingestion of larvae. 7ost people infected "ith hook"orms

have no symptoms# especially persons "ho are infected for the first time. The most

serious effects of hook"orm infection are blood loss leading to anemia# and protein

loss. Hook"orm infections are treatable "ith medication prescribed by a health/care

provider. :mprovements in living conditions can greatly reduce hook"orm

infections.

Ascariasis is a type of round"orm infection and affects approximately 2= percent of

the "orld0s population. 7ost cases of ascariasis are so mild that infected persons

sho" no symptoms. Ascariasis occurs most fre,uently in young children and is most

prevalent in tropical and subtropical regions of the "orld# especially in areas "here

sanitation and hygiene are poor (7ayo?linic.?om# 2&'&!. :t is caused by consuming

food or drink contaminated "ith round"orm eggs (*ub7ed Health# 2&&-! and is

found in association "ith poor personal hygiene# poor sanitation and in places "here

human feces are used as fertiliBer. nce consumed# the eggs hatch and release

immature round"orms# called larvae# "ithin the intestine. :t is estimated that one

billion people are infected "orld/"ide and symptoms may include1 bloody sputum#

cough# lo"/grade fever# passing "orms in stool# shortness of breath# skin rash#

stomach pain# vomiting "orms# "heeBing and "orms exiting through the nose or

mouth. An infected person may also sho" signs of malnutrition. Treatment for


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ascariasis# include medications# such as albendaBole or mebendaBole that paralyBe or

kill intestinal parasitic "orms. :f there is a blockage of the intestine caused by a large

number of "orms# endoscopy and# in rare cases# surgery# may be needed. :mproved

sanitation and hygiene in developing countries "ill reduce the risk in those areas. :n

areas "here this disorder is common# routine or preventive (prophylactic! treatment

"ith de"orming medications may be advised (Health Fuide# 2&''!.

2$! S


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general living standards of people. :t is also important to note that the literature

revie" revealed that hand "ashing and proper "aste disposal are t"o of the most

important human behaviors for the reduction and prevention of most hygiene/related

disease.


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CHAPTER 3: RESEARCH METHODOLOGY

3$1 I,-./-/,

This chapter addresses research methodology in terms of research design# population#

sampling procedures# research instruments# data/collecting procedures and data

analysis. :t also highlights ethical concerns that the researcher took into consideration

during the study. The purpose of this study is to explore and describe the kno"ledge

of hygiene that the residents of ?hoto possess and to describe the practice of hygiene

as it is observed in this informal settlement.

3$2 R994.8 9,

An exploratory ,ualitative research design "as used to elicit the kno"ledge and

practice of the respondents in terms of personal hygiene and hygiene in general. The

study is interpretive in nature5 explorative descriptive strategies "ere used. ?res"ell

(2&&)! stated that# ,ualitative research is interpretative research# "ith the in,uirer

typically involved in a sustained and intensive experience "ith participants. The

follo"ing steps "ere used in this study.

Determine a focus for the in,uiry. This "as done by establishing a

location for the study# namely1 the ?hoto informal settlement.


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Determine ho" the research paradigm fit the research focus. The

researcher compared the characteristics of a ,ualitative paradigm "ith

the goals of the research.

Determine "here# and from "hom# data "ould be collected. The data

"as collected from people living in the ?hoto informal settlement.

Determine "hat the successive phases of the in,uiry "ould be. The first

phase of in,uiry "as biographical data and is presented in a graphical

format. The second phase investigated the hygiene and practices. The

results are presented by means of narration supported by ,uotes.

Determine "hat additional instrumentation could be used beyond the

researcher as the human instrument.

*lan data collection and recording modes. These include ho" detailed

and specific research ,uestions "ere formulated and ho" faithfully data

"as reproduced.

*lan "hich data analysis procedures "ould be used.

*lan the logistics of data collection# to include scheduling and

budgeting.

7ack (2&&! stated that the method outlined above is appropriate for the kind of

survey represented by the current study because exploratory research uses open/

ended and probing ,uestions# giving participants the opportunity to respond in their

o"n "ords# rather than forcing them to choose from fixed responses# as ,uantitative

methods do. pen/ended ,uestions have the ability to evoke responses that are1

meaningful and culturally salient to the participant


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unanticipated by the researcher

rich and explanatory in nature.

7ack (2&&! further stated that another advantage of the ,ualitative research method

is that it allo"s a researcher the flexibility to probe initial participant responses

further1 to ask "hy or ho". :n this study the researcher listened carefully to "hat

participants said# engaged "ith them according to their individual personalities and

styles# and used probing ,uestions to encourage them to elaborate on their ans"ers.

An exploratory strategy "as used in this study to obtain greater understanding of the

concept being researched. The study "as conducted to explore the attitudes#

behavior# kno"ledge and practices of hygiene by the residents in ?hoto informal

settlement. xploratory research is preliminary research conducted to increase

understanding of a concept# to clarify the exact nature of the problem to be solved or

to identify important variables to be studied (6iley# 2&&!.

3$3 P/=?4-/,

According to


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intervie"ing children "ho might not understand the ,uestions# or "ho are not old

enough to speak on their o"n behalf "ith regards to giving consent.

3$' S4


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3$"$1 D99?/=


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3$6 P./9.9 7/. 4-4 /??9-/,

;efore embarking on the study# the chairperson of ?hoto informal settlement "as

intervie"ed and the purpose of the study "as fully explained to him. The researcher

then proceeded from house to house to intervie" residents "ho "ere '- years or

older. To begin# the first house that the researcher approached "as randomly

selected. ;efore intervie"s "ere conducted the researcher asked prospective

respondents ho" old they "ere. :f they replied that they "ere minors they "ere asked

to summon a person of maturity age5 if one "as not present in the house at the time#

the researcher moved on to find other respondents. :n order to protect the identity of

potential participants# the researcher assumed that the information provided by them

"as truthfully given. :n other "ords they "ere not re,uested to produce a formal

identity document. All participants "ere intervie"ed in


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valuable. Apart from these notes# the researcher included photographs as

observational data.

3$! D4-4 4,4?;

:n a ,ualitative study# the process of data analysis begins during data collection. This

may take the form of a skillful facilitation of discussions# "hich in turn generates

rich data. :t may take the form of complementary discussions "ith observational

notes and other peripheral information or data. This process itself may be

complemented or extended as the researcher familiarises him or herself "ith data by

reading both observational notes# "hich accompany intervie"s# and summary notes#

"hich are "ritten immediately thereafter (abiee# 2&&4!. ?entral themes# supporting

themes and explanations "ere identified during this process and are described in the

report.

?res"ell (2&&)! stated that data analysis is an ongoing process of continual reflection

about data# asking analytical ,uestions and "riting memos throughout a study.

Analysis is not separated from the other activities involved in the process# such as

data collection. :t also employs open/ended ,uestions "hich facilitate the collection

of sub+ective information for analysis. This process involves asking general ,uestions

of the participants and developing an analysis from the information they supply. The

follo"ing list presents eight steps of data analysis that "ere used in this study1

'. ead content in part# to make sense of the "hole.

2. :dentify commonalities in themes.


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). ?luster and label similar topics5 formulate the ma+or topic# define uni,ue

topics and catalogue $leftovers%.

4. . Assemble the data material belonging to each category in one place and

perform preliminary analysis.

-. ecode existing (data if necessary!.

The researcher "as responsible for data analysis and used an open/coding process#

by "hich data "as organised in themes to facilitate analysis. Ho"ever# one intervie"

transcript "as sent to the researcher0s academic supervisors as co/coders "ho

discussed and agreed on themes. nce data "as organised to place emphasis on the

main themes and sub/themes "ere discussed in detail# the data "as interpreted in the

final step.


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privacy also demands that their permission must be obtained before they are

intervie"ed. After the study is completed# all field notes should be destroyed. :t is

also important that researchers familiarise themselves "ith the ethics policies of any

relevant institutions they interact "ith during the study (7aree# 2&&>!.

3$$1 P9.


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thesis has been submitted for examination purposes. ?res"ell (2&&)! stated that# a

researcher must respect the participants and the sites used for research. espect for

research sites means they are left undisturbed after the study# particularly after

prolonged use for observation and intervie"s. The researcher must be cogniBant of

his or her impact and minimiBe disruption of the physical setting. esearchers also

need to anticipate the possibility of harmful information being disclosed during the

data/collection process. :n these situations# the ethical code for researchers is to

protect the privacy of the participants and to extend this protection to all individuals

involved in the study.

3$$' A,/,;


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3$$" V/?,-4.; =4.-=4-/,

All participants agreed to participate in the study voluntarily. Their consent "as

received before any information "as collected from them. They "ere informed they

had the right to "ithdra" from the study at any point "ithout being victimised or

punished in any "ay.

3$$6 R979.9,9 7/. ,7/.


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sampling. ace/to/face intervie"s "ere conducted "ith the respondents using

,uestions that "ere formulated in advance.

The researcher took notes during the intervie"s and "as solely responsible for data

analysis# utiliBing the open/coding process. Data "as organised according to

categories in order to facilitate the analysis.


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CHAPTER ': DATA ANALYSIS AND ITS INTERGRATION INTO

LITERATURE

'$1 I,-./-/,

:n the previous chapter the research methodology and design "ere discussed. :n this

chapter the data is presented# analysed and interpreted. indings from the intervie"s

regarding the demographics# the hygiene kno"ledge and the practices of people

living in ?hoto informal settlement# are illustrated using narration based on identified

themes. The respondents0 (n34&! biographical data are presented and analyBed in

section 4.2.'. Data of hygiene kno"ledge and practices are presented in section

4.2.2.

'$2 P.99,-4-/, 4, ,-9.=.9-4-/, /7 -89 4-4

:n 4.2.' the biographical data are represented in igure 4.' in a graphical format. :n

4.2.2 the responses obtained during the intervie"s# in terms of hygiene kno"ledge

and practices are presented using italics for verbatim responses. :n addition#

photographs of respondents andLor surroundings are presented (see section ).-! to

illustrate themes. The narrations from the intervie"s "ere categoriBed into themes

and sub/themes as presented in table 4.' belo"1


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'$2$1 B/.4=84? 4-4

Fender distribution of the respondents is depicted in igure 4.'.

25

20

15

Female

Male

10

5

0Male Female

Gender

F.9 '$1: Fender distribution of respondents (n34&!

As indicated in igure 4.'# 2' female (=)K! and ' male (4>K! respondents#

participated in the study. According to the Eamibia 2&'' *opulation and Housing

?ensus# there are generally more females than males residing in @atima 7ulilo

(Eational *lanning ?ommission# 2&'2# p. ='!. The age distribution of the

respondents (n34&! is presented in igure 4.2.

re

que

ncies


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Age

35

30

25

20

15

10

5

0

18-24 25-34 35-44 45-54 55-65 No response

Age in years

F.9 '$2: Age distribution of respondents (n34&!

The ma+ority of the respondents (=)K! "ere bet"een the ages of 2= and )4 years.

espondents bet"een ==/= years of age comprised >K of all the age groups and

"ere the least intervie"ed age group. or the purpose of the study# it is assumed that

the study/population sample indicated in igure 4.2 is representative of the age

distribution of people living in ?hoto informal settlement. Thus# it is maintained that

=)K of the people living in this informal settlement are bet"een the ages of 2= and

)= years. :t is# ho"ever# noted that an inclusion criterion re,uired that participants be

above '- years of age.


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'$2$2 H;9,9 5,/?99 4, =.4-9

espondents "ere given the opportunity to explain their attitudes pertaining to

hygiene kno"ledge and practice beyond "hat "as elicited through the ,uestions.

They "ere encouraged to ans"er the ,uestions from a personal perspective. Three

main themes and seven sub/themes emerged during the analysis of the data# namely1

under sanitation "ere ordered hygiene in the house and surroundings# refuse

removal# personal hygiene and kno"ledge of hygiene/related diseases5 under the type

of toilet used# human "aste disposal "as considered5 and under "ater source# "ater

for the community and "ater for hand "ashing "as ordered.

T4>?9 2: 9ist of themes and subtheme

M4, T89-89


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'$2$2$1 H;9,9 , -89 8/9 4, ../,,

The researcher asked the respondents to explain ho" they practiced hygiene in their

homes. 7ost respondents responded "ith "ords to the effect $the whole yard is

thoroughly cleaned by sweeping to prevent the breeding of mosquitoes and

occurrence of hygiene#related diseases%. igure 4.) sho"s a "oman using a rake to

clean her yard.


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bservation of cleaning activities at the households revealed that the ma+ority of

people cleaned their houses thoroughly. Ho"ever# most of the people "ashed their

dishes on the ground. 6aste "ater from "ashing dishes "as not re/used but poured

onto the ground# as can be seen in igure 4.4.

F.9 '$': A boy "ashing dishes on the ground

As "as discussed in section 4.2.2# the residents of ?hoto clean their homes regularly.

Due to a lack of ade,uate facilities in the houses or the absence other home

amenities# some residents "ash their dishes on the ground# a practice "hich can

result in cross contamination of germs from the ground to the dishes. According to

Eaidoo# ?hidley and 7cEamara (2&&-! nearly a third of all urban residents "orld/

"ide live in informal settlements. This represents approximately a billion people

residing in areas characterised by conditions that are belo" standard "ith regards to

hygiene and "hich promote the spread of disease.


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*oor "ater and sanitation services#

*oor understanding of effective hygiene and hygiene practices#

vercro"ded housing#

:nade,uate or insufficient drainage systems#

Absence of refuse removal.

?hoto informal settlement is no exception "ith regards to the challenges all people

living under substandard conditions must face. The residents in this informal

settlement face challenges# such as unemployment# poverty and a lack of ade,uate

housing and services such as se"er systems and proper roads. These challenges make

it difficult for residents of ?hoto to keep their surroundings hygienic and safe. These

unacceptable conditions can become the cause of ill health. :t is possible# ho"ever#

for the people of ?hoto to devise initiatives to improve their lives. or instance# they

could fashion kitchen racks for their "et dish"are to ensure that "hile cleaning these

utensils they do not become contaminated by the soil. :t is also important for the

residents of ?hoto to continue cleaning their homes and surroundings. According to

:ndia *arenting (2&'&! maintaining hygienic surroundings ensures that such areas do

not become transformed into breeding grounds for bacteria and viruses. *eople need

only follo" a fe" simple rules to keep their surroundings hygienic. or example1

Properly dispose of waste1 if inappropriately disposed of# "aste material can

cause outbreaks of deadly diseases. 7ost epidemics in history have been

caused by improper "aste removal.

Always )eep the home clean.


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*se garbage cans to store waste "hile "aiting for its removal. Though not

al"ays available# their use should be promoted "henever possible.

Do not to spit or urinate in public.


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:t might be deduced from some of the comments made by respondents# that the

service of refuse removal in ?hoto informal settlement is unsatisfactory. The

researcher noted that the area is surrounded by piles of "aste (see igure 4.=!. These

can become a breeding ground for vectors# and other disease/causing agents# or

micro/organisms.

F.9 '$": efuse dumped in an open space

efuse removal in ?hoto informal settlement is a huge challenge. 7any residents are

not satisfied "ith the service they receive. Those "ho do not get the service at all

resort to dumping "aste in open spaces# thus polluting the environment. These areas

are also breeding grounds for vectors# like mos,uitoes# flies and rats# "hich transmit

diseases to humans. The local council collects refuse from each household in ?hoto

informal settlement once a "eek but in some places the truck cannot reach

households because of poor infrastructure. The situation is an indication that this


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service by the local council is inade,uate. :t is evident from the findings of the

current study that the local council needs to engage the residents of ?hoto informal

settlement to devise initiatives to keep the settlement clean. :nitiatives such as

recycling pro+ects and clean/up campaigns could be considered.

7ahlangu (2&''! indicates that local authorities are usually and primarily

responsible for "aste collection. :t is much more costly to remove litter discarded on

streets and public spaces than it is to collect "aste through a formal household/"aste

collection systems. To make a public initiative viable# the population needs to accept

co/responsibility for the cleanliness of its to"ns and cities and ensure that litter and

"aste is disposed of in allocated bins. Traditional "aste/collection systems are

inappropriate# inefficient and costly "hen applied to informal settlements. :nnovative

"ays of managing "aste in disadvantaged communities are re,uired. The trend is to

move to"ards community/based "aste collection by1

*aying people to bring litter or "aste to a central collection depot.

:nvolving the community in programmes to keep their neighborhoods clean.

The emphasis should be on preventing pollution and minimiBing "aste at the source#

since it is much more costly to clean up after"ards. This approach can be based on

the follo"ing measures1


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educe the volume of waste by re/using "aste products. or example#

using product plastic packaging and containers in "hich products are sold to

store things5 using the blank side of printed paper before sending it to be

recycled.

ecycle waste to remove mass from the "aste stream.

ecover waste in the form of chemicals# gases and metals "hich are

bi/ products of "aste.

'$2$2$3: P9./,4? 8;9,9

espondents "ere asked ho" they practiced personal hygiene. 7ost of them stated1

$( ta)e a bath and brush my teeth every morning% (see igures 4. and 4.>!. thers

said $( wash my )ids before they go to school%.

7ost of the respondents felt $it is important to )eep my body clean and wash my

clothes regularly in order to loo) good and prevent sic)nesses%. thers expressed

they felt that &being clean portrays someone+s image as a neat and healthy person%"


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F.9 '$6: A man brushing his teeth

F.9 '$!: A plastic structure used as a bathing area

ne respondent said# $Every day ( bath in the evening and in the morning" ( brush

my teeth and wash my face" 'hen ( bath ( use soap and a face cloth%"


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Although residents sho" an interest in personal hygiene# the facilities they use for

bathing are unhygienic (as evident in the above photograph!.


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The ma+ority of respondents spoke of taking a bath# brushing their teeth#

"ashing their children and "ashing clothing. These are habits that are

important because the lack of personal hygiene can also affect others.

$eHo".com% (2&''! stated that a person0s personal hygiene can have an

impact on other people. *eople "ho do not "ash their hands can pass

infections or viruses to other people. *ersonal hygiene entails bathing

regularly# keeping hair clean# trimming fingernails and toenails# brushing

teeth and using deodorant. *ersonal hygiene can enhance one0s self/

confidence and improve the chances of success in many areas of life. *eople

"ho do not bathe regularly are more susceptible to fungal infections# such as

+ock itch# athlete0s foot or fungal toenail infections. A lack of oral hygiene

can cause oral thrush# "hich is a fungal infection. *eople "ho fail to "ash

their hands regularly are more prone to getting viruses or bacterial infections

from others. urthermore# bed bugs are a common problem "hen good

hygiene and regular cleaning are lacking.

'$2$2$' K,/?99 /7 8;9,9%.9?4-9 949

espondents "ere asked "hether they kne" of any hygiene/related diseases. Almost

all did so. An example being1 $8diseases li)e diarrhoea$ tuberculosis$ malaria$ flu

and cholera can result from staying in dirt areas or by eating contaminated food%.

ne respondent stated that $People maintain good hygiene in order to prevent the


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outbrea) of diseases li)e cholera and diarrhoea%. Although some respondents "ere

a"are of the importance of keeping themselves and surroundings clean# several "ere

not able to name any diseases associated "ith hygiene.


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:t "as evident that the practice of hygiene "as belo" standard as most of the

respondents confirmed that at least one of their family members had suffered from a

hygiene/related disease during the past three months. :t "as also observed that

residents needed improved services to be able to live comfortably# to improve their

health or avoid hygiene/related diseases. According to stun# @ay# e"trell and

;artram (2&&4!# the follo"ing conditions are common1 schistomiasis# trachoma#

ascariasis# trichriais# hook"orm# malaria# yello" fever# filariasis# dengue# hepatitis #

typhoid fever# arsenicosis# fluorosis and legionellosis. These diseases are all

attributable to unsafe sanitation and hygiene.

'$2$2$" H


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diseases like diarrhoea. eferring to these examples it is apparent that proper and

ade,uate means of disposing human "aste are lacking in the settlement. :n turn# the

situation "ill automatically result in the spread of disease. ;y contrast# a fe"

respondents did state that they used ventilated# improved pit latrines "hich they

constructed themselves.

:n ?hoto informal settlement one of the "ays in "hich people relieve themselves is

the use of plastic bags "hich they discard in the road. This practice escalates during

the rainy season as people find it inconvenient to "alk very far to relieve themselves.

The implication of this situation is that fecal matter gets distributed around the

settlement by surface "ater produced by the rain. :t is obvious that people "ill come

in contact "ith the attendant germs and bacteria in this "aste material and they "ill

eventually suffer from ill health. The situation may even cause an outbreak of disease

such as cholera or diarrhoea.


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9ack of proper sanitation facilities not only causes disease but also has a detrimental

impact on the development of the area in ,uestion. nited Eations ?hildren0s und

(2&'&! states that inade,uate access to safe "ater and sanitation services# coupled

"ith poor hygiene practices# kills or infects thousands of children every day and

leads to impoverishment and diminished opportunities for thousands more. *oor

sanitation# "ater and hygiene have many serious repercussions. ?hildren# particularly

girls# are denied the right to an education because their schools lack private and

decent sanitation facilities. *oor farmers and "age/earners become less productive

"hen they are ill. Healthcare systems are over"helmed and national economies

suffer. 6ithout "ater# sanitation and hygiene# sustainable development is impossible.

'$2$2$"$1 T;=9 /7 -/?9-

All the respondents "ere a"are of t"o ma+or types of toilet1 a flushable "ater/system

and a latrine. The respondents all stated they "ould prefer using a flushable "ater/

system toilet. Ho"ever# one respondent admitted that# $( would prefer a pit latrine

because here in !hoto we do not have the sewerage system$ but the town council

should provide the material for the latrine.% Another respondent said# $( want a

flushable toilet because human e,creta will be flushed through the sewerage pipes to

the sewerage ponds and there is no smell%. These responses reveal that people are

a"are that a flushable "ater system is convenient and "hen functioning properly can


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dispose of human "aste. A flushable "ater system "ould reduce the spread of

disease and "ould make life easier for the residents of ?hoto.

F.9 '$: A latrine

The home/made latrine in igure 4.- indicates that sanitation# "ith specific reference

to human "aste disposal# is an issue in ?hoto informal settlement. :t is evident from

this photograph that people resort to constructing latrines# "hich are clearly

inade,uate and "hich# in turn# "ill only exacerbate the situation or facilitate the

spread of disease.

:t seems that the to"n council does not regard sanitation as a priority in this area. The

council opted instead to provide the community "ith "ater# roads and electricity

before sanitation. As "as indicated in the literature revie"# Eational *lanning


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?ommission (2&&'! stated that# the 2&&' ?aprivi ?ensus eport indicated that about

&K of the households in the ?aprivi region of Eamibia depend on public pipes and

boreholes for "ater. According to public health standards# "ater from pipes and

boreholes is regarded safe for drinking and cooking. or the region as a "hole#

slightly over -&K of the households have access to safe "ater.


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ade,uate sanitation is still not "idely understood. :n particular# there is little

appreciation for the long/term financial benefits of operating various sanitation

systems. As a result# communities and local governments are currently choosing

technical options that# over the long term# are either unaffordable or unsustainable.

There are various technical options that meet the re,uirements for basic sanitation

and these need to be considered in terms of sustainability# by "ay of affordability#

operation and maintenance. undamentally# communities have an attractive range of

options1 the single# improved pit latrine# the double/ventilated# improved pit latrine#

and the urine/diversion composting latrines.

'$2$2$6 W4-9. /.9 7/. -89 /


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and the expensive cost of "ater.


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cleaned and some "ere used for a dual purpose1 for bathing and also to fetch "ater

for cleaning dishes. This practice definitely creates a situation conducive to the

spread of hygiene/related disease.

:n ?hoto informal settlement there is also a shortage of "ater. esidents share

communal taps and the "ater dra"n there is primarily used for cooking and drinking.

"ing to a shortage of easily accessible "ater and due to the high cost of "ater#

people are not likely to bathe more than once a day. 6ater is collected at a place

distant from the house and is not free of charge. 6ater is sold by the council at the

rate of EP'- for five drums# each "ith a volume of 2&& liters# for a total of '&&&

liters of "ater.

Fenerally# the ,uality of "ater available to households in Eamibia is safe.

Approximately &K of households do not treat their "ater before consuming or

using it. or example# 'K of rural households treat their drinking "ater# "hereas

only K of urban households do so. verall# drinking "ater is available in -'K of

urban household premises and in )2K of rural households. Drinking "ater is usually

collected by adult females (2=K! for those households that must fetch "ater from an

outside source. The amount of time use by a household to obtain "ater varies1 )K

of rural households take less than )& minutes to collect "ater# compared to '>K in

urban areas (7inistry of Health and


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collect "ater (if they are left open or are unsanitary! is of concern in terms of the

findings of this study. :t "as noted that some residents do not cover the containers in

"hich they store "ater "hile others do not thoroughly clean the containers they use

before collecting "ater.

or decades# universal access to clean "ater and ade,uate sanitation have both been

regarded as essential for reduction of the preventable infectious disease burden in the

developing "orld. Ho"ever# it is no" clear that the goal is best achieved by

programmes that integrate hygiene promotion "ith improvements in "ater ,uality

and availability as "ell as sanitation. The neglect of hygiene goes a long "ay to

explain "hy "ater and sanitation programmes have often not brought the expected

benefits. The current focus in developing countries is on investment in community

"ater supply and sanitation in order to meet the 7illennium Development Foals

(7DFs!. ;ut if the health benefits that are expected from achieving these goals are

to be realised# then the sector professionals must look beyond the mere provision of

"ater supply hard"are and toilet facilities (;loomfield et al.# 2&&!.

'$2$2$! H4, 48,

The respondents "ere asked to explain their hand/"ashing techni,ues. A fe"

respondents indicated they do not use the bo"l they use to "ash hands for other

purposes. A cup or +ar is often used to pour "ater on a person0s hands (see igure

4.'&!.


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household uses this "ater to "ash their hands after going to the toilet or before

eating. ne of the respondents stated1 $'e put water in a small dish and wash our

hands" Adults share the same dish and sometimes we use soap whereas sometimes we

.ust use water$ but most of the time we use soap to wash our hands after answering

the call of nature"%

:f the respondent used only "ater it is most likely because he or she could not afford

to buy soap. The researcher believes there is a high degree of risk that residents could

contract a disease because they share the same "ater for hand "ashing and do not

use detergent. 9ack of proper hand "ashing "ith soap "ill surely enhance the

possibility of contracting and spreading a hygiene/related disease. ther respondents

stated they also use the shared "ater method# but "ith a detergent (sunlight soap or

sunlight li,uid! to "ash their hands.

F.9 '$10: A man "ashing his hands


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The findings of the study indicate clearly that most of the respondents did not "ash

their hands correctly.


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'$3 S


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CHAPTER ": CONCLUSION# LIMITATIONS AND RECOMMENDATIONS

"$1 I,-./-/,

This chapter outlines conclusions arrived at through the study# the limitations that

"ere encountered and recommendations the researcher "ishes to make based on the

study0s findings. The purpose of the study "as to explore and describe the

kno"ledge of hygiene possessed by the residents of ?hoto and the practices

regarding hygiene they observe in this informal settlement in @atima 7ulilo. The

ob+ectives of the study "ere1

'. To explore the hygienic practices of people living in ?hoto informal

settlement.

2. To assess the kno"ledge of the people "ith regard to diseases associated "ith

hygiene.

"$2 C/,?/,

?onclusions are presented in the context of the ob+ectives of the study. The first

ob+ective# listed in =.' above# "as met because the people of ?hoto informal

settlement do practice a verifiable level of hygiene# a fact "hich indicates that they

have general kno"ledge regarding the sub+ect. A $level of kno"ledge% is better


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understood# or verified# "hen evaluated relative to the practical application of that

kno"ledge. :n this particular case study# it "as noted that people may not put into

practice their kno"ledge of hygiene because of a number of limiting factors# such as

poverty (some people cannot afford soap!# or the lack of enough clean "ater or

ade,uate sanitary facilities. ;ecause they often do not practice good hygiene# the

residents of ?hoto informal settlement are prone to suffer from hygiene/related

diseases.

The findings# in terms of the second ob+ective# listed in =.'# revealed that the

residents0 kno"ledge of hygiene/related diseases "as not satisfactory. :t "as obvious

that some respondents tried to guess a suitable response# naming diseases like flu or

tuberculosis. n the other hand# some respondents clearly indicated that they could

not name a hygiene/related disease. ;ecause it "

Thesis Proposal in Hygenic

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