- Email: [email protected]
Impact of rural water projects on hygienic behaviour in Swaziland
Physics and Chemistry of the Earth 35 (2010) 772–779
Contents lists available at ScienceDirect
Physics and Chemistry of the Earth journal homepage: www.elsevier.com/locate/pce
Impact of rural water projects on hygienic behaviour in Swaziland Graciana Peter ⇑ Department of Geography, Environmental Science and Planning, UNISWA, Private Bag 4, Kwaluseni, Swaziland
a r t i c l e
i n f o
Article history: Received 2 February 2010 Received in revised form 18 July 2010 Accepted 25 July 2010 Available online 1 September 2010 Keywords: Hygienic behaviour Impact Millennium development goal Water supply
a b s t r a c t In Swaziland, access to safe water supply and sanitation has improved significantly and was expected to result in improved health and, in particular, reduced infant mortality rates. On the contrary, mortality rates in the under 5 years age group are high and have doubled from 60 in 1996, to 120 deaths per 1000 in 2006. The main objective of the study was to assess whether the water projects permit, and are accompanied by, changes in hygienic behaviour to prevent transmission of diseases. The study area was Phonjwane, located in the dry Lowveld of Swaziland, where water projects play a significant role in meeting domestic water demands. Hygienic behaviour and sanitation facilities were analysed and compared before and after project. The results of the study show that domestic water supply projects have significantly reduced distances travelled and time taken to collect water, and that increased quantities of water are collected and used. While the majority of respondents (95.6%) used the domestic water project source, the quantities allowed per household (125 l which translates to an average of 20.8 l per person) were insufficient and therefore were supplemented with harvested rainwater (57.8%), water from a polluted river (17.8%), and water from a dam (2.2%). Increased water quantities have permitted more baths and washing of clothes and hands, but significant proportions of the population still skip hygienic practices such as keeping water for washing hands inside or near toilet facilities (40%) and washing hands (20%). The study concludes that the water supply project has permitted and improved hygienic practices but not sufficiently. The health benefits of safe domestic water supplies are hampered by insufficient quantities of water availed through the projects, possible contamination of the water in the house, poor hygienic behaviours and lack of appropriate sanitation measures by some households. There is a need to provide sufficient quantities of safe water to meet all domestic demands. Domestic water supply must be accompanied by appropriate sanitation and hygienic education. Ó 2010 Elsevier Ltd. All rights reserved.
1. Introduction 1.1. Impact assessments of water supply, sanitation and hygienic interventions Previous assessments of water supply tended to measure the number of water points and people served. However, the reality was that even those who did get improved access still suffered from waterborne diseases. The most important realisation was that people’s behaviour was more significant than hardware in achieving the expected benefits from water supply schemes (Dyer, 2002). As a result, assessments changed from focussing on hardware coverage to assessing the outcomes of people’s behavioural changes. According to epidemiologists, better results in evaluating the reduction of ill-health resulting from water supply, sanitation and hygienic promotion interventions are noted through observations of practical outcomes, such as the use and maintenance ⇑ Tel.: +268 518 4011x2258. E-mail addresses: [email protected], [email protected] 1474-7065/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.pce.2010.07.024
status of facilities, or improvements in hygienic practice (Department For International Development (DFID), 1998). Existing literature on impact studies shows that in cases where a significant health impact was found, the provision of water supply or sanitation had been accompanied by improvements in hygiene. ‘Hygiene’ in this context refers to practices such as the washing of hands, food and utensils, or the disposal of children’s stools. Hygienic practices may be promoted through improved access to water and sanitation, or by means of hygienic education. Improvements in hygiene may be reflected in increased water consumption. The higher the quantities of water used the higher the frequency hygienic practices will be performed. If no such change in behaviour results from improved water supply or sanitation, the only benefits likely to occur are those stemming from improved water quality – in many settings, these are relatively minor or even negligible (Cairncross, 2008). Health improvements are the culmination of a long chain of cause and effect, which begins with the original construction of water supplies or sanitation facilities, through their operation and hence their use, permitting changes in hygienic behaviour
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
and thus the prevention of disease transmission. The principle of the World Health Organisation (WHO) Minimum Evaluation Procedure is to examine the intermediate links in the chain-functioning and use. Hygienic behaviour is another such link (WHO, 1983). Instead of attempting to measure disease rates, studying patterns of hygienic behaviour has far greater diagnostic power in terms of indicating opportunities for project improvement. Since it is further up on the causal chain, it is easier to attribute health improvements to the project intervention. It is also quicker and cheaper than epidemiological studies. It can also be done at the project design stage. This would not only help to establish a baseline yardstick against which to compare evaluation results, but would also improve project design (WHO, 1983). WaterAid Uganda (2003) observed that hygiene and sanitation interventions are commonly encountered as mere afterthoughts to water supply programmes. Little priority is accorded to their implementation and even less is given to their monitoring and evaluation, which would be valuable in improving the understanding of what facilitates or hinders changes in hygienic behaviour. This paper attempts to address the need for further studies that evaluate the impact of water supply and sanitation programmes on people. 1.2. Why the focus on hygienic behaviour in domestic water supply projects? Infectious diarrhoea is mainly responsible for the burden caused by waterborne and waterwashed diseases. From a health perspective, improving access to safe water supply and sanitation services is a preventive intervention, whose main outcome is a reduction in the number of episodes of diarrhoea and, accordingly, a proportionate reduction in the number of deaths (WHO, 2004a). It has been estimated that environmental health hazards account for at least 25% of the overall burden of disease worldwide (Smith et al., 1999), the vast majority of this being borne by developing countries. Diarrhoeal diseases and acute respiratory infections (ARIs) together account for half of the global burden of environmentally related diseases. Diarrhoeal diseases cause 15% of all child deaths worldwide (Biran and Hunt, 2004). The WHO (2004b) estimated that 1.8 million deaths annually result from diarrhoeal diseases (including cholera), 88% of which is attributed to unsafe water supply, and inadequate sanitation and hygiene. The majority of these deaths are from diarrhoeal diseases in children, and 90% of these are in developing countries (WHO, 2004b). There are environmental interventions for the control of diarrhoeal diseases that are considered effective and feasible. The most important of these are safe sanitation and hygienic practices, the latter of which depends on the provision of an adequate water supply (Huttly et al., 1997). ARIs are the leading cause of childhood morbidity and mortality worldwide. There are two possible links between handwashing and ARIs. Respiratory pathogens have been identified on hands and environmental surfaces by microbiological studies and pathogens, especially enteric viruses, which cause diarrhoea, and can also cause respiratory symptoms (Cairncross, 2003). A systematic review and meta-analysis of handwashing and respiratory infections concluded that handwashing could cut the risk of ARIs by 16%, although more rigorous studies in developing countries are required to confirm this (Biran and Hunt, 2004). In developing countries the biggest killers of young children are respiratory infections and diarrhoeal diseases, both preventable through handwashing. Research has shown that there is a significant reduction in the risk of diarrhoea as a result of handwashing or handwashing with soap. Curtis and Cairncross (2003) estimated further that handwashing with soap alone was able to prevent 0.5–1.4 million deaths per year. Ascariasis and trichuriasis are two of the most common and wide-spread intestinal nematode infections, affecting almost two
773
billion people worldwide. Transmission occurs through ingestion. Ascaris eggs have an especially ‘sticky’ nature and they have been found to adhere to money, agricultural produce, cutlery, crockery and hands. Among other measures, handwashing with soap was more effective than handwashing with only water to reduce faecal bacteria on hands (Biran and Hunt, 2004). Washing hands thoroughly at critical times is accepted as an effective intervention against diarrhoeal disease. Evidence is now growing for the effectiveness of handwashing against respiratory infections (Biran and Hunt, 2004). Literature review (Curtis and Cairncross, 2003; Biran and Hunt, 2004) also suggests that washing hands with soap at key times can reduce severe diarrhoea by over 50% and could thus prevent 1 million diarrhoeal deaths annually. Improvements in domestic hygienic practices can be brought about by hygienic promotion. Delivering effective hygienic promotion on a large scale is now a major public health challenge (Curtis, 2002). Effective hygienic practices rely on access to convenient water supplies. Domestic water use declines when collection times exceed about 30 min and increases dramatically when household connections are provided (Cairncross et al., 2003). The main purpose of domestic water supply projects is to provide safe and convenient water to households. Improved access to water, coupled with hygienic education, will permit and improve hygienic behaviour and reduce disease transmission which results in human death. More specifically, as observed by Cairncross (1997), water availability is likely to have an impact on the frequency of handwashing. When water is located more than about a kilometre from the home, there is a tendency to restrict handwashing, whereas when it is readily available nearby, handwashing becomes more frequent. There is thus a need to assess whether the water projects have improved access and use by households. More importantly, it needs to be established whether the main benefits expected from water projects, such as effective hygienic practices – in particular handwashing, have been promoted and adopted. 1.3. Water supply, sanitation, hygienic behaviour and disease burden in Swaziland The mandate to provide safe and clean drinking water supplies to residents in the rural areas of Swaziland have been invested with the Rural Water Supply Branch (RWSB) under the Ministry of Natural Resources and Energy. The overall goal of the RWSB is to facilitate improved health and increased productivity in the individual homestead. The function of the RWSB is deeply entrenched in the primary healthcare process, as it is focussed on preventive rather than curative health. The overall objective is to supply potable water supplies and provide adequate sanitation facilities to all rural communities in Swaziland in an effort to improve the standard of living of the inhabitants through the reduction of the incidence of waterborne and water-related diseases (Government of Swaziland (GOS) RWSB, 2009). Several players in the rural water and sanitation sector (nongovernmental organisations (NGOs), government, external support agencies (ESAs), and the private sector) have made significant contributions to the expansion of water supply and sanitation services to the unserved and underserved rural population in Swaziland (Busari et al., 1996; Kingdom of Swaziland, 2005). The percentage of the Swazi population with access to sanitation facilities increased from 63% in 1980 to 80% in 1998. In the urban areas, the ratio decreased slightly from 100% in 1985 to 97% in 1998, but increased in the rural areas from 25% in 1985 to 71% in 1998. The population with access to safe water in 1998 stood at 56% for the country as a whole, 37% in the rural areas and 91% in the urban areas (UNDP, 2001).
774
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
An assessment of Rural Water Supply and Sanitation (RWSS) coverage in Swaziland in 2004/2005 as part of the Rural Water Supply and Sanitation Initiative (RWSSI) showed that the sector had made significant progress towards meeting the national targets of providing water and sanitation to the entire rural population. It showed, too, that with adequate financial resources, Swaziland was likely to achieve 100% coverage of both water supply and sanitation by the year 2022 (Mwendera, 2006). More recent figures (UNICEF and WHO, 2008) showed that coverage of sanitation by 2006 was 50% national, 64% urban and 46% rural. Coverage of improved drinking water had further increased to 60% national and 51% rural. There was a further decline in urban areas to 87%. The statistics on access to sanitation and safe water show improvements in rural areas and reflect the success of national efforts to promote rural development in Swaziland. Swaziland still suffers from a heavy disease burden despite the improvements in water supply and sanitation. Infant mortality rates have been increasing from 60 deaths per 1000 (1992– 1996) to 90 (1997–2001) and 120 (2002–2006) (CSO Mbabane Swaziland, 2007). Waterwiki.net (2009) attributes the high rate of infant mortality in the country to diarrhoea, malnutrition and infectious diseases, which can be linked to lack of potable water, a lack of improved sanitary facilities and to poor hygiene. It has also been noted that a health-related water supply and sanitation project that aspires to be successful must incorporate a sanitation promotional strategy, including hygienic education (Busari, 2007). 1.4. Aims and objectives of the study The main objective of the study was to assess whether the water projects permit, and are accompanied by, the necessary changes in hygienic behaviour and promote good health. The specific objectives were to establish whether the water projects were accompanied by the necessary hygienic behavioural changes to prevent the transmission of disease and to improve health, and whether the failure to reduce diarrhoea morbidity was due to poor sanitation and hygienic practices. 2. Methodology 2.1. Study area and approach The study was conducted in Phonjwane area located in the water-stressed Lowveld region of Swaziland, where water supply projects play a crucial role in meeting domestic household water demands. Phonjwane is located between latitudes 26° 350 –26° 370 3000 S and longitudes 31° 360 –31° 410 E. The terrain is gently sloped and used mainly for crop cultivation and livestock herding. The other sources of livelihoods include salaried employment, both on-farm as well as off-farm, and petty trading. There were 120 households with a total population of 628 people in Phonjwane (National Population Census, 2007). Spatially, Phonjwane is divided into three small communities: Vikizijula, Phonjwane and Jimba. The households included in this study were only those from Vikizijula, a community served by a domestic water supply project. No sampling was conducted. A total of 45 households were included and respondents were interviewed using a questionnaire. In evaluating the health impacts of water projects, operational evaluations of facility functioning and consumer use, combined with studies of hygienic behaviour, are considered more useful (Bern et al., 1992). In this study, evaluation was based on the availability and use of the water and sanitation facilities and health-related behavioural changes permitted by those facilities.
2.2. Methods Availability and use of the facility was assessed by improvements in terms of the reduction of distance and time taken to travel to water sources, and the increase in quantities of water collected and used. The impact on hygienic behaviour was analysed in terms of changes in hygienic behaviour permitted by the water projects. The behaviour-change approach to hygiene used included qualitative research to identify the behaviours that changed, those that need improvement, as well as the obstacles to the adoption of those behaviours and possible motivating forces. The hygienic practices considered in this research included the following: the use of an uncontaminated water supply; latrine use by family members; handwashing by household members at critical times, in particular after defecation; availability of water for handwashing inside or near toilet facilities; and personal hygienic aspects such as frequency of washing bodies and clothes. Environmental sanitation was assessed by the availability of sanitation facilities such as the toilet. The quality of water stored and used in the homes was assessed indirectly based on how water was drawn from storage containers. Heads of households were interviewed using questionnaires to obtain the required information. Analysis involved comparing the situation before and after the project.
3. Results and discussion 3.1. Impact of the domestic water project on water quality used, distance and time 3.1.1. Quality of water used The domestic water supply project at Vikizijula provided safe water and was used by the majority of community members (95.6%). However, further analysis of the domestic water sources used (Table 1) showed that while the majority of the respondents said they were using the project source provided through the communal stand pipes, more than half (57.8%) supplemented with rainwater harvested from roofs and stored in plastic tanks, while others (17.8%) were still going back to the river and dam (2.2%) – sources which were polluted. Households used other water sources such as the river and dam because the project source could not meet all their water demands. The water from the project was released only during early morning hours and households were not allowed to fetch more than 125 l of water during that time. Use of river water sources, which are polluted, to supplement household demand defeats the whole purpose of the safe domestic water supply. The provision of a safe domestic water supply alone cannot guarantee that households consume safe water as the water can still be polluted in the homes before use. To establish whether water collected was not polluted before consumption, households were asked to indicate how they draw water from containers used
Table 1 Water sources used after water project in Vikizijula. Water sources
(f)
(%)
Reticulated in home Communal stand pipe Water truck River Private borehole Spring/well Rain water harvested Private supplier Dam
1 43 1 8 5 16 26 1 1
2.2 95.6 2.2 17.8 11.1 35.6 57.8 2.2 2.2
N = 45.
775
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
45 40.0 40 Always
Sometimes
% of Respondents
35 30 26.7 24.4
25 20 15 8.9
10
6.7 5
2.2
2.2 0
0
Any utensils
Special utensils
Poured by tilting container
Siphon using water hose
Utensils and method used to take water stored in containers Fig. 1. How water stored in container is decanted for use in Vikizijula.
70
60
% of Respondents
60
Before
After
50
35.6
40
26.8
30
17.8
20
17.7
15.5 11.1
6.7
10 0 Below 0.1km
4.4
4.4
0.1 0.5km
0.5 1.0km
1.0-1.5km
1.5-2.0km
2.0-2.5km
2.5-3.0km
Not there before
Distance to water sources used Fig. 2. Distance to water sources in Vikizijula.
50
46.7
45
% of Respondents
40 35
Before
30
26.7
26.1
24.4
25
17.4
20
17.4 13.1
15
8.7
10 5
After
8.7 4.3
0
2.2
4.3 0
0
0
0
0
0 Less than 10-20min. 20-30min. 30-40min. 40-50min. 50-60min. 60-90min. 10min.
Time taken to walk to water source (in minutes) Fig. 3. Time taken to walk to water source in Vikizijula.
90120min.
Not there before
776
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
the safety of the water. As safe methods to draw water from containers were not used consistently, they cannot be relied on in terms of their safety. While the study could not assess directly the quality of the water in the homes, the indirect measures such as the way the water is taken out of the storage containers for use and the utensils used indicate possible contamination in the homes before use, and reduce the health benefits of a safe water
for collection and storage. The safe way to draw water from containers for use is either by pouring it through tilting the vessel or through the use of a clean, special utensil for this purpose only. The results of this study (Fig. 1) showed that most households used safer methods such as special utensils (40%) or poured directly from containers (24.4%). Quite a number of households (26.7%) used any utensils in the house, a practice which does not ensure
60
55.6 48.9
% of Respondents
50
40.0 40
Before
After
30 20
6.7
10
2.2 0
17.8
15.6
2.2
0.0
less than 20 litres
20-30 litres
6.6 2.2
0.0
30-40 litres
2.2 40-50 litres
0.0 50-100 litres
More than 100 litres
Not there
Before
After
Quantities of water collected (in litres) Fig. 4. Quantities of water collected in Vikizijula.
100
93.3
90
% of Respondents
80 70 60
51.1
50 40
31.1
30
17.8
20
6.7
10 0
One
Two
Not there before
Number of baths taken per day Fig. 5. Number of baths taken in Vikizijula.
70 62.2 57.8
% of Respondents
60 50
Before
After
40 28.9
30 20
15.6
13.3
10
17.8
4.4
0 Less than 5 liters
5-10 litres
More than 10 litres
Quantities of water used for bathing Fig. 6. Quantities of water used for bathing in Vikizijula.
Not there before
777
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
supply. Further research is required to verify the safety of water stored for consumptive use. 3.1.2. Distance and time in water collection The water project has also reduced distances travelled to water sources and time spent collecting water, as shown in Figs. 2 and 3. Before the project, people in Vikizijula walked up to 3 km to fetch
unsafe water (from rivers). The trip to fetch water took two or more hours for most individuals. The majority of individuals (95.5%) now walk a maximum of 500 m to a community stand tap. Before the project, they had to walk down to the river valley to fetch water and walk up hill with a load of water. This is no longer the case as most households (84.4%) reported walking on flat terrain when fetching water.
80
66.7
70
60
% of Respondents
Before
After
50
40 40
35.6
30
24.4 17.8
20
13.3 10
2.2 0
Everyday
More than once a week
Once a Week
Not there before
Frequency of washing clothes Fig. 7. Frequency of washing clothes in Vikizijula.
70
64.4 60 60
Before
After
% of Respondents
50
40 40
30
20
17.8
17.8
10
0
Water available
Water not available
Not there before
Availability of water for washing hands Fig. 8. Availability of water for washing hands inside/near toilets in Vikizijula.
778
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
to other continents, such as Asia, where the average person uses 85 l a day (Hinrichsen et al., 1997), or developed countries: UK – 105 l per day; US – 600 l per day (Shah, 2009). The limited quantities of water availed to rural communities such as Vikizijula can create problems for those with large families who are likely to supplement water with water from polluted sources, or recycle the water, use too little or skip necessary hygienic practices, defeating the whole purpose of the safe domestic water supply.
3.2. Quantities of water collected and used The quantities of water collected and used have increased when compared to the situation before the projects. As an example, in Vikizijula (Fig. 4) the majority of respondents (55.6%) were now able to collect over 100 l per day compared to only 15.6% who were able to collect similar amounts before the project. It is important to note that while the water project has improved the situation, households demand for water has not yet been adequately met. Many households (44.4%) collected and used fewer than 100 l a day. Also, discussions with community members and leaders indicated that water supply was tightly controlled and each family was allowed a maximum of 125 l a day. With an average family size of six people in Swaziland, it means about 20.8 l per person per day. This is below the national stipulated figure of 30 l per person per day. It is also very low when compared to what is used by most African countries in rural areas (30–40 l per person per day) (The Desk and Chair Foundation, 2004). In Africa generally, a person uses an average of 47 l per day, which is still low when compared
3.3. Impact of water project on hygienic behaviour The reduced distances, collection time and increased quantities availed are expected to increase domestic water use and permit changes in hygienic behaviour. The results of this study (Fig. 5) showed that people were cleaner as the majority (93.3%) were able to take two baths a day, compared to only 31.1% who were able to do before. More water was also used in bathing. Before the project, the majority (62.2%) used fewer than 5 l for a bath. Now, the majority (57.8%) use 5–10 l and 28.9% use more than 10 l (Fig. 6). House-
90
80 80 70
Before
After
% of Respondents
60 50
42.2
40 40 30
20
17.8
20 10 0
Washed hands
Did not wash hands
Not there before
Whether washed hands Fig. 9. Washing of hands after defecating/urinating in Vikizijula.
90
84.4
80
% of Respondents
70
Before
57.8
60
After
50 40 30
24.4 17.8
20
11.1 10
0 0
Did not have
2.2
VIP latrine
0 Normal pit latrine
2.3
Flush toilet
Whether had toilet and types used Fig. 10. Sanitation facilities used in Vikizijula.
0 Not there before
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
holds were also able to wash their clothes more frequently: 24.4% washed everyday and 40% washed more than once a week (Fig. 7). Very important hygienic practices such as putting water near toilets for handwashing after the use of a toilet were found to increase after the water project was initiated (Figs. 8 and 9). Availability of water for handwashing increased from 17.7% to 60% after the project began, while handwashing increased from 40% to 80% after project’s initiation. However, while the majority (60%) said they kept water for handwashing near or inside the toilets, 40% did not, despite reduced distances, collection time and increased quantities of water collected. Similarly, while the majority (80%) said they washed hands after using the toilet, 20% did not. The health benefits of a safe domestic water supply are likely to be hampered by poor hygienic behaviour. To realise the health benefits of safe rural water supply, the project managers and all those involved must educate and sensitise people to positively change their behaviour in order to improve their hygiene. The advantages of a safe domestic water supply are also likely to be reduced by a lack of appropriate sanitation measures. This problem is particularly prevalent in communities where the water supply system is not accompanied by appropriate sanitation facilities, which is the norm in the majority of existing water projects. For example, Vikizijula (Fig. 10) has had a working domestic project for a long time but 11.1% of households did not have toilets. 4. Conclusions and recommendations The domestic water supply project in Vikizijula has reduced distances travelled to collect water and the collection time, and has increased the quantity of water able to be collected and used. The project has permitted and improved hygienic practices, but not sufficiently. Health benefits hampered by the low amount of water offered and poor hygienic behaviours. Sanitation and hygienic education need to be re-emphasised to improve hygienic behaviour.
References Bern, C., Martines, J., de Zoysa, I., Glass, R.I., 1992. The magnitude of the global problem of acute diarrhoeal disease: a ten-year update. Bulletin of the WHO 70, 705–714. Biran, A., Hunt, C., 2004. Child Survival and Environmental Health. WELL FACTSHEET. Resource Centre Network for Water, Sanitation and Environmental Health. (08.03.08). Busari, O., 2007. Water, sanitation and sustainability: lessons from a community project. In: Environ Dev Sustain 2009, vol. 11, Springer Science + Business Media B.V., 2007, pp. 71–83. Busari, O., Dlamini, S., Mayisela, M., 1996. Reaching the unreached: challenges for the 21st century. In: Coordination: Coverage Catalyst in Swaziland, 22nd WEDC Conference, New Delhi, India, 1996. (03.07.09). Cairncross, S., 1997. More water: better health. People and the Planet 6(3) (Cited by Curtis, V., Cairncross, S., Yonli, R. 2000. Domestic hygiene and diarrhoea – pinpointing the problem. In Tropical Medicine and International Health, vol. 5(1), pp. 22–32). Cairncross, S., 2003. Editorial. Handwashing with soap – a new way to prevent ARIs? Tropical Medicine & International Health 8(8), 677–679. (01.02.10). Cairncross, S., 2008. Measuring the health impact of water and sanitation. WELL FACTSHEET. WELL Resource Centre Network for Water, Sanitation and Environmental Health. (08.03.08).
779
Cairncross, S., O’Neill. D., McCoy, A., Seth, D., 2003. Health, Environment and the Burden of Disease: a Guidance Note. Department for International Development, London (Referred in Biran, A., Hunt, C., 2004. Child Survival and Environmental Health. (08.03.08). Central Statistics Office (CSO) Mbabane Swaziland, 2007. Swaziland Demographic and Health Survey (SDHS) 2007. Curtis, V., 2002. Health in your hands: lessons from building public–private partnerships for washing hands with soap. In: Water and Sanitation Program. World Bank, Washington (Referred in Biran, A., Hunt, C., 2004. Child Survival and Environmental Health). Curtis, V., Cairncross, S., 2003. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. The Lancet Infectious Diseases 3 (May), 275–281 (Referred in Biran, A., Hunt, C., 2004, Child Survival and Environmental Health). Department for International Development (DFID), 1998. Guidance manual on water supply and sanitation programmes. London School of Hygiene and Tropical Medicine (LSHTM)/WEDC 1998 (Cited in Dyer (2002). Assessing impacts of improved hygiene. Sustainable Environmental Sanitation and Water Services 28th WEDC Conference, Calcutta, India, 2002. (03.07.09)). Dyer, R., 2002. Assessing impacts of improved hygiene. In: Sustainable environmental sanitation and water services 28th WEDC Conference, Calcutta, India, 2002. (03.07.09). Government of Swaziland (GOS) Ministry of Natural Resources and Energy, Rural Water Supply Board (RWSB), 2009. (01.07.09). Hinrichsen D., Robey, B., Upadhyay, U.D., 1997. Solutions for a water-short world. In: Population Reports, vol. 14. Johns Hopkins School of Public Health, Population Information Program, Baltimore (Cited in UNEP Report, Africa Environment Outlook: Past, Present and Future Perspectives, 2009. (31.07.09)). Huttly, S.R.A., Morris, S.S., Pisani, V., 1997. Prevention of diarrhoea in young children in developing countries. Bulletin of the World Heath Organisation 75 (2), 163– 174. Kingdom of Swaziland Poverty Reduction Task Force, 2005. Draft poverty reduction strategy and action plan (PRSAP), vol. 1. Poverty Reduction Task Force, Ministry of Planning and Development, March 2005. Mwendera, E.J., 2006. Rural water supply and sanitation (RWSS) coverage in Swaziland: towards achieving millennium development goals. Physics and Chemistry of the Earth 31(15–16), 681–689. (Water for Sustainable SocioEconomic Development, Good Health for All and Gender Equity (01. 07.09)). Shah, A., 2009. Poverty facts and statistics. Social, Political, Economic and Environmental Issues that affect us. Global Issues Website. (01.05.07). United Nations Development Programme (UNDP), 2001. Swaziland Human Development Report 2000. UNDP, Swaziland, Mbabane. UNICEF and WHO, 2008. Progress on drinking water and sanitation: special focus on sanitation. World Health Organisation and United Nations Children’s Fund Joint Monitoring Programme for Water Supply and Sanitation (JMP). UNICEF, New York and WHO, Geneva, 2008. WaterAid Uganda, 2003. Sustainable Hygiene Behaviour Change. A Study of Key Determinants. Paper written by WaterAid Uganda August 2003. (3/7/2009). Waterwiki.net, 2009. Facing Water Challenges in Swaziland: Swaziland: AWWDR 3 Case Study. WaterWiki.net. (01.07.09). World Health Organisation (WHO), 1983. Minimum Evaluation Procedure (MEP) for Water and Sanitation Projects. WHO, Geneva (Referred in Cairncross, S., 2008. Measuring the Health Impact of Water and Sanitation). World Health Organisation (WHO), 2004a. Costs and benefits of water and sanitation improvements at the global level. evaluation of the health benefits, the additional benefits, and the costs of a range of interventions to improve access to safe water supply and sanitation services. Water Sanitation and Health (WSH). Executive Summary of the Document: WHO/SDE/WSH/04.04. (07. 07.09). WHO, 2004b. Facts and figures: water, sanitation and hygiene links to health. Water Sanitation and Health (WSH). .
Contents lists available at ScienceDirect
Physics and Chemistry of the Earth journal homepage: www.elsevier.com/locate/pce
Impact of rural water projects on hygienic behaviour in Swaziland Graciana Peter ⇑ Department of Geography, Environmental Science and Planning, UNISWA, Private Bag 4, Kwaluseni, Swaziland
a r t i c l e
i n f o
Article history: Received 2 February 2010 Received in revised form 18 July 2010 Accepted 25 July 2010 Available online 1 September 2010 Keywords: Hygienic behaviour Impact Millennium development goal Water supply
a b s t r a c t In Swaziland, access to safe water supply and sanitation has improved significantly and was expected to result in improved health and, in particular, reduced infant mortality rates. On the contrary, mortality rates in the under 5 years age group are high and have doubled from 60 in 1996, to 120 deaths per 1000 in 2006. The main objective of the study was to assess whether the water projects permit, and are accompanied by, changes in hygienic behaviour to prevent transmission of diseases. The study area was Phonjwane, located in the dry Lowveld of Swaziland, where water projects play a significant role in meeting domestic water demands. Hygienic behaviour and sanitation facilities were analysed and compared before and after project. The results of the study show that domestic water supply projects have significantly reduced distances travelled and time taken to collect water, and that increased quantities of water are collected and used. While the majority of respondents (95.6%) used the domestic water project source, the quantities allowed per household (125 l which translates to an average of 20.8 l per person) were insufficient and therefore were supplemented with harvested rainwater (57.8%), water from a polluted river (17.8%), and water from a dam (2.2%). Increased water quantities have permitted more baths and washing of clothes and hands, but significant proportions of the population still skip hygienic practices such as keeping water for washing hands inside or near toilet facilities (40%) and washing hands (20%). The study concludes that the water supply project has permitted and improved hygienic practices but not sufficiently. The health benefits of safe domestic water supplies are hampered by insufficient quantities of water availed through the projects, possible contamination of the water in the house, poor hygienic behaviours and lack of appropriate sanitation measures by some households. There is a need to provide sufficient quantities of safe water to meet all domestic demands. Domestic water supply must be accompanied by appropriate sanitation and hygienic education. Ó 2010 Elsevier Ltd. All rights reserved.
1. Introduction 1.1. Impact assessments of water supply, sanitation and hygienic interventions Previous assessments of water supply tended to measure the number of water points and people served. However, the reality was that even those who did get improved access still suffered from waterborne diseases. The most important realisation was that people’s behaviour was more significant than hardware in achieving the expected benefits from water supply schemes (Dyer, 2002). As a result, assessments changed from focussing on hardware coverage to assessing the outcomes of people’s behavioural changes. According to epidemiologists, better results in evaluating the reduction of ill-health resulting from water supply, sanitation and hygienic promotion interventions are noted through observations of practical outcomes, such as the use and maintenance ⇑ Tel.: +268 518 4011x2258. E-mail addresses: [email protected], [email protected] 1474-7065/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.pce.2010.07.024
status of facilities, or improvements in hygienic practice (Department For International Development (DFID), 1998). Existing literature on impact studies shows that in cases where a significant health impact was found, the provision of water supply or sanitation had been accompanied by improvements in hygiene. ‘Hygiene’ in this context refers to practices such as the washing of hands, food and utensils, or the disposal of children’s stools. Hygienic practices may be promoted through improved access to water and sanitation, or by means of hygienic education. Improvements in hygiene may be reflected in increased water consumption. The higher the quantities of water used the higher the frequency hygienic practices will be performed. If no such change in behaviour results from improved water supply or sanitation, the only benefits likely to occur are those stemming from improved water quality – in many settings, these are relatively minor or even negligible (Cairncross, 2008). Health improvements are the culmination of a long chain of cause and effect, which begins with the original construction of water supplies or sanitation facilities, through their operation and hence their use, permitting changes in hygienic behaviour
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
and thus the prevention of disease transmission. The principle of the World Health Organisation (WHO) Minimum Evaluation Procedure is to examine the intermediate links in the chain-functioning and use. Hygienic behaviour is another such link (WHO, 1983). Instead of attempting to measure disease rates, studying patterns of hygienic behaviour has far greater diagnostic power in terms of indicating opportunities for project improvement. Since it is further up on the causal chain, it is easier to attribute health improvements to the project intervention. It is also quicker and cheaper than epidemiological studies. It can also be done at the project design stage. This would not only help to establish a baseline yardstick against which to compare evaluation results, but would also improve project design (WHO, 1983). WaterAid Uganda (2003) observed that hygiene and sanitation interventions are commonly encountered as mere afterthoughts to water supply programmes. Little priority is accorded to their implementation and even less is given to their monitoring and evaluation, which would be valuable in improving the understanding of what facilitates or hinders changes in hygienic behaviour. This paper attempts to address the need for further studies that evaluate the impact of water supply and sanitation programmes on people. 1.2. Why the focus on hygienic behaviour in domestic water supply projects? Infectious diarrhoea is mainly responsible for the burden caused by waterborne and waterwashed diseases. From a health perspective, improving access to safe water supply and sanitation services is a preventive intervention, whose main outcome is a reduction in the number of episodes of diarrhoea and, accordingly, a proportionate reduction in the number of deaths (WHO, 2004a). It has been estimated that environmental health hazards account for at least 25% of the overall burden of disease worldwide (Smith et al., 1999), the vast majority of this being borne by developing countries. Diarrhoeal diseases and acute respiratory infections (ARIs) together account for half of the global burden of environmentally related diseases. Diarrhoeal diseases cause 15% of all child deaths worldwide (Biran and Hunt, 2004). The WHO (2004b) estimated that 1.8 million deaths annually result from diarrhoeal diseases (including cholera), 88% of which is attributed to unsafe water supply, and inadequate sanitation and hygiene. The majority of these deaths are from diarrhoeal diseases in children, and 90% of these are in developing countries (WHO, 2004b). There are environmental interventions for the control of diarrhoeal diseases that are considered effective and feasible. The most important of these are safe sanitation and hygienic practices, the latter of which depends on the provision of an adequate water supply (Huttly et al., 1997). ARIs are the leading cause of childhood morbidity and mortality worldwide. There are two possible links between handwashing and ARIs. Respiratory pathogens have been identified on hands and environmental surfaces by microbiological studies and pathogens, especially enteric viruses, which cause diarrhoea, and can also cause respiratory symptoms (Cairncross, 2003). A systematic review and meta-analysis of handwashing and respiratory infections concluded that handwashing could cut the risk of ARIs by 16%, although more rigorous studies in developing countries are required to confirm this (Biran and Hunt, 2004). In developing countries the biggest killers of young children are respiratory infections and diarrhoeal diseases, both preventable through handwashing. Research has shown that there is a significant reduction in the risk of diarrhoea as a result of handwashing or handwashing with soap. Curtis and Cairncross (2003) estimated further that handwashing with soap alone was able to prevent 0.5–1.4 million deaths per year. Ascariasis and trichuriasis are two of the most common and wide-spread intestinal nematode infections, affecting almost two
773
billion people worldwide. Transmission occurs through ingestion. Ascaris eggs have an especially ‘sticky’ nature and they have been found to adhere to money, agricultural produce, cutlery, crockery and hands. Among other measures, handwashing with soap was more effective than handwashing with only water to reduce faecal bacteria on hands (Biran and Hunt, 2004). Washing hands thoroughly at critical times is accepted as an effective intervention against diarrhoeal disease. Evidence is now growing for the effectiveness of handwashing against respiratory infections (Biran and Hunt, 2004). Literature review (Curtis and Cairncross, 2003; Biran and Hunt, 2004) also suggests that washing hands with soap at key times can reduce severe diarrhoea by over 50% and could thus prevent 1 million diarrhoeal deaths annually. Improvements in domestic hygienic practices can be brought about by hygienic promotion. Delivering effective hygienic promotion on a large scale is now a major public health challenge (Curtis, 2002). Effective hygienic practices rely on access to convenient water supplies. Domestic water use declines when collection times exceed about 30 min and increases dramatically when household connections are provided (Cairncross et al., 2003). The main purpose of domestic water supply projects is to provide safe and convenient water to households. Improved access to water, coupled with hygienic education, will permit and improve hygienic behaviour and reduce disease transmission which results in human death. More specifically, as observed by Cairncross (1997), water availability is likely to have an impact on the frequency of handwashing. When water is located more than about a kilometre from the home, there is a tendency to restrict handwashing, whereas when it is readily available nearby, handwashing becomes more frequent. There is thus a need to assess whether the water projects have improved access and use by households. More importantly, it needs to be established whether the main benefits expected from water projects, such as effective hygienic practices – in particular handwashing, have been promoted and adopted. 1.3. Water supply, sanitation, hygienic behaviour and disease burden in Swaziland The mandate to provide safe and clean drinking water supplies to residents in the rural areas of Swaziland have been invested with the Rural Water Supply Branch (RWSB) under the Ministry of Natural Resources and Energy. The overall goal of the RWSB is to facilitate improved health and increased productivity in the individual homestead. The function of the RWSB is deeply entrenched in the primary healthcare process, as it is focussed on preventive rather than curative health. The overall objective is to supply potable water supplies and provide adequate sanitation facilities to all rural communities in Swaziland in an effort to improve the standard of living of the inhabitants through the reduction of the incidence of waterborne and water-related diseases (Government of Swaziland (GOS) RWSB, 2009). Several players in the rural water and sanitation sector (nongovernmental organisations (NGOs), government, external support agencies (ESAs), and the private sector) have made significant contributions to the expansion of water supply and sanitation services to the unserved and underserved rural population in Swaziland (Busari et al., 1996; Kingdom of Swaziland, 2005). The percentage of the Swazi population with access to sanitation facilities increased from 63% in 1980 to 80% in 1998. In the urban areas, the ratio decreased slightly from 100% in 1985 to 97% in 1998, but increased in the rural areas from 25% in 1985 to 71% in 1998. The population with access to safe water in 1998 stood at 56% for the country as a whole, 37% in the rural areas and 91% in the urban areas (UNDP, 2001).
774
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
An assessment of Rural Water Supply and Sanitation (RWSS) coverage in Swaziland in 2004/2005 as part of the Rural Water Supply and Sanitation Initiative (RWSSI) showed that the sector had made significant progress towards meeting the national targets of providing water and sanitation to the entire rural population. It showed, too, that with adequate financial resources, Swaziland was likely to achieve 100% coverage of both water supply and sanitation by the year 2022 (Mwendera, 2006). More recent figures (UNICEF and WHO, 2008) showed that coverage of sanitation by 2006 was 50% national, 64% urban and 46% rural. Coverage of improved drinking water had further increased to 60% national and 51% rural. There was a further decline in urban areas to 87%. The statistics on access to sanitation and safe water show improvements in rural areas and reflect the success of national efforts to promote rural development in Swaziland. Swaziland still suffers from a heavy disease burden despite the improvements in water supply and sanitation. Infant mortality rates have been increasing from 60 deaths per 1000 (1992– 1996) to 90 (1997–2001) and 120 (2002–2006) (CSO Mbabane Swaziland, 2007). Waterwiki.net (2009) attributes the high rate of infant mortality in the country to diarrhoea, malnutrition and infectious diseases, which can be linked to lack of potable water, a lack of improved sanitary facilities and to poor hygiene. It has also been noted that a health-related water supply and sanitation project that aspires to be successful must incorporate a sanitation promotional strategy, including hygienic education (Busari, 2007). 1.4. Aims and objectives of the study The main objective of the study was to assess whether the water projects permit, and are accompanied by, the necessary changes in hygienic behaviour and promote good health. The specific objectives were to establish whether the water projects were accompanied by the necessary hygienic behavioural changes to prevent the transmission of disease and to improve health, and whether the failure to reduce diarrhoea morbidity was due to poor sanitation and hygienic practices. 2. Methodology 2.1. Study area and approach The study was conducted in Phonjwane area located in the water-stressed Lowveld region of Swaziland, where water supply projects play a crucial role in meeting domestic household water demands. Phonjwane is located between latitudes 26° 350 –26° 370 3000 S and longitudes 31° 360 –31° 410 E. The terrain is gently sloped and used mainly for crop cultivation and livestock herding. The other sources of livelihoods include salaried employment, both on-farm as well as off-farm, and petty trading. There were 120 households with a total population of 628 people in Phonjwane (National Population Census, 2007). Spatially, Phonjwane is divided into three small communities: Vikizijula, Phonjwane and Jimba. The households included in this study were only those from Vikizijula, a community served by a domestic water supply project. No sampling was conducted. A total of 45 households were included and respondents were interviewed using a questionnaire. In evaluating the health impacts of water projects, operational evaluations of facility functioning and consumer use, combined with studies of hygienic behaviour, are considered more useful (Bern et al., 1992). In this study, evaluation was based on the availability and use of the water and sanitation facilities and health-related behavioural changes permitted by those facilities.
2.2. Methods Availability and use of the facility was assessed by improvements in terms of the reduction of distance and time taken to travel to water sources, and the increase in quantities of water collected and used. The impact on hygienic behaviour was analysed in terms of changes in hygienic behaviour permitted by the water projects. The behaviour-change approach to hygiene used included qualitative research to identify the behaviours that changed, those that need improvement, as well as the obstacles to the adoption of those behaviours and possible motivating forces. The hygienic practices considered in this research included the following: the use of an uncontaminated water supply; latrine use by family members; handwashing by household members at critical times, in particular after defecation; availability of water for handwashing inside or near toilet facilities; and personal hygienic aspects such as frequency of washing bodies and clothes. Environmental sanitation was assessed by the availability of sanitation facilities such as the toilet. The quality of water stored and used in the homes was assessed indirectly based on how water was drawn from storage containers. Heads of households were interviewed using questionnaires to obtain the required information. Analysis involved comparing the situation before and after the project.
3. Results and discussion 3.1. Impact of the domestic water project on water quality used, distance and time 3.1.1. Quality of water used The domestic water supply project at Vikizijula provided safe water and was used by the majority of community members (95.6%). However, further analysis of the domestic water sources used (Table 1) showed that while the majority of the respondents said they were using the project source provided through the communal stand pipes, more than half (57.8%) supplemented with rainwater harvested from roofs and stored in plastic tanks, while others (17.8%) were still going back to the river and dam (2.2%) – sources which were polluted. Households used other water sources such as the river and dam because the project source could not meet all their water demands. The water from the project was released only during early morning hours and households were not allowed to fetch more than 125 l of water during that time. Use of river water sources, which are polluted, to supplement household demand defeats the whole purpose of the safe domestic water supply. The provision of a safe domestic water supply alone cannot guarantee that households consume safe water as the water can still be polluted in the homes before use. To establish whether water collected was not polluted before consumption, households were asked to indicate how they draw water from containers used
Table 1 Water sources used after water project in Vikizijula. Water sources
(f)
(%)
Reticulated in home Communal stand pipe Water truck River Private borehole Spring/well Rain water harvested Private supplier Dam
1 43 1 8 5 16 26 1 1
2.2 95.6 2.2 17.8 11.1 35.6 57.8 2.2 2.2
N = 45.
775
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
45 40.0 40 Always
Sometimes
% of Respondents
35 30 26.7 24.4
25 20 15 8.9
10
6.7 5
2.2
2.2 0
0
Any utensils
Special utensils
Poured by tilting container
Siphon using water hose
Utensils and method used to take water stored in containers Fig. 1. How water stored in container is decanted for use in Vikizijula.
70
60
% of Respondents
60
Before
After
50
35.6
40
26.8
30
17.8
20
17.7
15.5 11.1
6.7
10 0 Below 0.1km
4.4
4.4
0.1 0.5km
0.5 1.0km
1.0-1.5km
1.5-2.0km
2.0-2.5km
2.5-3.0km
Not there before
Distance to water sources used Fig. 2. Distance to water sources in Vikizijula.
50
46.7
45
% of Respondents
40 35
Before
30
26.7
26.1
24.4
25
17.4
20
17.4 13.1
15
8.7
10 5
After
8.7 4.3
0
2.2
4.3 0
0
0
0
0
0 Less than 10-20min. 20-30min. 30-40min. 40-50min. 50-60min. 60-90min. 10min.
Time taken to walk to water source (in minutes) Fig. 3. Time taken to walk to water source in Vikizijula.
90120min.
Not there before
776
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
the safety of the water. As safe methods to draw water from containers were not used consistently, they cannot be relied on in terms of their safety. While the study could not assess directly the quality of the water in the homes, the indirect measures such as the way the water is taken out of the storage containers for use and the utensils used indicate possible contamination in the homes before use, and reduce the health benefits of a safe water
for collection and storage. The safe way to draw water from containers for use is either by pouring it through tilting the vessel or through the use of a clean, special utensil for this purpose only. The results of this study (Fig. 1) showed that most households used safer methods such as special utensils (40%) or poured directly from containers (24.4%). Quite a number of households (26.7%) used any utensils in the house, a practice which does not ensure
60
55.6 48.9
% of Respondents
50
40.0 40
Before
After
30 20
6.7
10
2.2 0
17.8
15.6
2.2
0.0
less than 20 litres
20-30 litres
6.6 2.2
0.0
30-40 litres
2.2 40-50 litres
0.0 50-100 litres
More than 100 litres
Not there
Before
After
Quantities of water collected (in litres) Fig. 4. Quantities of water collected in Vikizijula.
100
93.3
90
% of Respondents
80 70 60
51.1
50 40
31.1
30
17.8
20
6.7
10 0
One
Two
Not there before
Number of baths taken per day Fig. 5. Number of baths taken in Vikizijula.
70 62.2 57.8
% of Respondents
60 50
Before
After
40 28.9
30 20
15.6
13.3
10
17.8
4.4
0 Less than 5 liters
5-10 litres
More than 10 litres
Quantities of water used for bathing Fig. 6. Quantities of water used for bathing in Vikizijula.
Not there before
777
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
supply. Further research is required to verify the safety of water stored for consumptive use. 3.1.2. Distance and time in water collection The water project has also reduced distances travelled to water sources and time spent collecting water, as shown in Figs. 2 and 3. Before the project, people in Vikizijula walked up to 3 km to fetch
unsafe water (from rivers). The trip to fetch water took two or more hours for most individuals. The majority of individuals (95.5%) now walk a maximum of 500 m to a community stand tap. Before the project, they had to walk down to the river valley to fetch water and walk up hill with a load of water. This is no longer the case as most households (84.4%) reported walking on flat terrain when fetching water.
80
66.7
70
60
% of Respondents
Before
After
50
40 40
35.6
30
24.4 17.8
20
13.3 10
2.2 0
Everyday
More than once a week
Once a Week
Not there before
Frequency of washing clothes Fig. 7. Frequency of washing clothes in Vikizijula.
70
64.4 60 60
Before
After
% of Respondents
50
40 40
30
20
17.8
17.8
10
0
Water available
Water not available
Not there before
Availability of water for washing hands Fig. 8. Availability of water for washing hands inside/near toilets in Vikizijula.
778
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
to other continents, such as Asia, where the average person uses 85 l a day (Hinrichsen et al., 1997), or developed countries: UK – 105 l per day; US – 600 l per day (Shah, 2009). The limited quantities of water availed to rural communities such as Vikizijula can create problems for those with large families who are likely to supplement water with water from polluted sources, or recycle the water, use too little or skip necessary hygienic practices, defeating the whole purpose of the safe domestic water supply.
3.2. Quantities of water collected and used The quantities of water collected and used have increased when compared to the situation before the projects. As an example, in Vikizijula (Fig. 4) the majority of respondents (55.6%) were now able to collect over 100 l per day compared to only 15.6% who were able to collect similar amounts before the project. It is important to note that while the water project has improved the situation, households demand for water has not yet been adequately met. Many households (44.4%) collected and used fewer than 100 l a day. Also, discussions with community members and leaders indicated that water supply was tightly controlled and each family was allowed a maximum of 125 l a day. With an average family size of six people in Swaziland, it means about 20.8 l per person per day. This is below the national stipulated figure of 30 l per person per day. It is also very low when compared to what is used by most African countries in rural areas (30–40 l per person per day) (The Desk and Chair Foundation, 2004). In Africa generally, a person uses an average of 47 l per day, which is still low when compared
3.3. Impact of water project on hygienic behaviour The reduced distances, collection time and increased quantities availed are expected to increase domestic water use and permit changes in hygienic behaviour. The results of this study (Fig. 5) showed that people were cleaner as the majority (93.3%) were able to take two baths a day, compared to only 31.1% who were able to do before. More water was also used in bathing. Before the project, the majority (62.2%) used fewer than 5 l for a bath. Now, the majority (57.8%) use 5–10 l and 28.9% use more than 10 l (Fig. 6). House-
90
80 80 70
Before
After
% of Respondents
60 50
42.2
40 40 30
20
17.8
20 10 0
Washed hands
Did not wash hands
Not there before
Whether washed hands Fig. 9. Washing of hands after defecating/urinating in Vikizijula.
90
84.4
80
% of Respondents
70
Before
57.8
60
After
50 40 30
24.4 17.8
20
11.1 10
0 0
Did not have
2.2
VIP latrine
0 Normal pit latrine
2.3
Flush toilet
Whether had toilet and types used Fig. 10. Sanitation facilities used in Vikizijula.
0 Not there before
G. Peter / Physics and Chemistry of the Earth 35 (2010) 772–779
holds were also able to wash their clothes more frequently: 24.4% washed everyday and 40% washed more than once a week (Fig. 7). Very important hygienic practices such as putting water near toilets for handwashing after the use of a toilet were found to increase after the water project was initiated (Figs. 8 and 9). Availability of water for handwashing increased from 17.7% to 60% after the project began, while handwashing increased from 40% to 80% after project’s initiation. However, while the majority (60%) said they kept water for handwashing near or inside the toilets, 40% did not, despite reduced distances, collection time and increased quantities of water collected. Similarly, while the majority (80%) said they washed hands after using the toilet, 20% did not. The health benefits of a safe domestic water supply are likely to be hampered by poor hygienic behaviour. To realise the health benefits of safe rural water supply, the project managers and all those involved must educate and sensitise people to positively change their behaviour in order to improve their hygiene. The advantages of a safe domestic water supply are also likely to be reduced by a lack of appropriate sanitation measures. This problem is particularly prevalent in communities where the water supply system is not accompanied by appropriate sanitation facilities, which is the norm in the majority of existing water projects. For example, Vikizijula (Fig. 10) has had a working domestic project for a long time but 11.1% of households did not have toilets. 4. Conclusions and recommendations The domestic water supply project in Vikizijula has reduced distances travelled to collect water and the collection time, and has increased the quantity of water able to be collected and used. The project has permitted and improved hygienic practices, but not sufficiently. Health benefits hampered by the low amount of water offered and poor hygienic behaviours. Sanitation and hygienic education need to be re-emphasised to improve hygienic behaviour.
References Bern, C., Martines, J., de Zoysa, I., Glass, R.I., 1992. The magnitude of the global problem of acute diarrhoeal disease: a ten-year update. Bulletin of the WHO 70, 705–714. Biran, A., Hunt, C., 2004. Child Survival and Environmental Health. WELL FACTSHEET. Resource Centre Network for Water, Sanitation and Environmental Health.
779
Cairncross, S., O’Neill. D., McCoy, A., Seth, D., 2003. Health, Environment and the Burden of Disease: a Guidance Note. Department for International Development, London (Referred in Biran, A., Hunt, C., 2004. Child Survival and Environmental Health.