Effectiveness of sanitation and hygiene interventions in changing mothers’ behaviour and improving child health in Turkana District, Kenya

Abstract

It has been established that lack of access to safe drinking water together with inadequate sanitation and hygiene is globally an overwhelming contributor to approximately 4 billion cases of illness annually. In developing countries, diarrhoea accounts for nearly 1.6 million deaths of children aged less than five years, which is approximately 15% in all deaths for this population age group. Poor sanitation and hygiene are among the main factors associated with diarrhoea, worm infestation, eye and skin infections. This study was set out to test the extent to which sanitation and hygiene promotion influenced mothers and children‘s health in Turkana District of Kenya. A longitudinal/cohort design incorporating clustered, stratified and random sampling methods was employed to select a sample of 300 mothers and their children aged less than five years at baseline (2007). Interventions undertaken included capacity building and empowerment approach to trigger communities to demand hygiene and sanitation facilities. A post-intervention survey with the same baseline participants was carried out in 2008. Interviews, laboratory analysis and spot observations/inspection were used to collect study data on demographics, socio-economic status, waste disposal parameters and testing faecal coliform count in drinking water as well as diarrhoea related microbes in children stool. Data were entered into the computer and analyzed using SPSS for frequencies, descriptive and multivariate analysis. After intervention, the results showed there was significant change in sanitation and hygiene parameters. Household ownership of traditional pit latrine increased from 45.5% in 2007 to 63.6% in 2008 (χ²=4.43, P=0.035). For hand washing practice, those who washed hands regularly hand in Turkana District increased from 73.5% to 91.3% (χ²=9.34, P=0.053). Similarly, improvements in hand washing practice were observed to increase by age group with those aged 36 and 45 years increasing significantly from 66.7% in 2007 to 88.9% in 2008 (χ²=10.01, P=0.04). In addition, presence of soap in households increased significantly from 65.4% to 77.9% (χ²=3.87, P=0.049) within the population with no formal education. he mean faecal coliforms in drinking water reduced from 88 faecal coliform units in 2007 to 30.2 faecal coliform units in 2008 (P=0.005) in Kakuma Division, 91 to 17.3 faecal coliforms units (P=0.003) in Lodwar Central, and from 63.8 to 23.6 units (P=0.006) in Lokichogio Division. Overall, community health outcomes before and after the intervention were significantly improved, with comparative reduction in faecal coliform count in drinking water ranging from 40.2% to 73.7% (P=0.003 to P=0.006) across the three Divisions within Turkana District. Similarly, diarrhoea related microbes in children‘s stool reduced by 13% (P=0.003) while diarrhoea prevalence in children aged less than five years reduced from 43.7% in 2007 to 30.7% in 2008 (P=001). Promotion of hygiene and good sanitation practices in the study area improved mother‘s hygiene behaviour and child‘s health with an associative strength of about 40% (R square of 39.6%, P=0.048). These associated gains were strongly related to age of the mother (P=0.015), presence of latrine (P=0.038), and reasons given at baseline for not having latrine (P=0.005). On the other hand, multivariate analysis showed that diarrhoea related microbes presence or absence could be predicted with an overall precision of 92.7% with core determinants/predictors being mothers education level (P=0.033), toilet presence (P=0.022), distance to latrine (P=0.004), source of drinking water (P=0.019), treatment of drinking water at point of use (P=0.013), and storage methods of drinking water (P=0.067). In addition, the main risk factors associated with diarrhea in children aged less than five years after intervention (2008) were strongly linked to behavioural characteristics; namely if the child had diarrhoea at baseline (P=0.029), mother‘s education (P=0.011), latrine availability (P=0.029, latrine structure (P=0.002) and chlorine level in the drinking water after the intervention (P=0.054). In conclusion therefore, it is evident that promotion of improved sanitation and hygiene using community participatory approaches such as Participatory Hygiene and Sanitation Transformation (PHAST) in the context of community led total sanitation (CLTS) led to significant reduction of diarrhoea prevalence in children aged less than five years and its application should therefore be up-scaled in disadvantaged communities.