Research consultancy
CHAPTER ONE: INTRODUCTION
1.0 Introduction
This chapter focuses on the background of the study, problem statement, purpose of the study, specific objectives, research questions and the justification of the study.
1.1 Background of the study
The World Health Organization (WHO, 2017) defined clean safe water as “water that does not represent any significant risk to health over a lifetime of consumption, including different sensitivities that may occur between life stages”. (WHO, 2012) described clean safe water as portable water that is free from harmful micro-organisms and substances, even if it may have color, odor or taste problem due to dissolved minerals. However, for billions of people across the globe, access to safe drinking water is limited. Lack of safe water creates an enormous burden in the form of waterborne illnesses such as diarrhoeal disease, cholera and typhoid (Malik, Kumar, Verman, Chawala, & Sachdeva, 2013).
Globally, 2.1 billion people live without access to clean safe drinking water and approximately 4.4 billion people are without access to adequate sanitation. An estimated 2 billion people use drinking water contaminated with faeces and contaminated drinking water is estimated to cause 502,000 diarrheal deaths each year (WHO, 2010). Diarrhea and water-borne diseases are leading causes of mortality and morbidity and approximately 88 percent of diarrhoeal diseases are attributed to unsafe water supply, inadequate sanitation and hygiene. The proportion of population in rural areas with access to safe drinking water has a direct impact on the health of the masses (Malik, Kumar, Verman, Chawala, & Sachdeva, 2013).
In 2010, United Nations (UN) general assembly recognized that everyone has a right to sufficient, continuous, safe, acceptable, physical, accessible, and affordable water for personal use. According to (WHO, 2011) water source has to be within 1000 meters from the home and collection time should not exceed 30 minutes and 50 to 100 liters of water per person per day are needed to ensure that most basic needs are met and few health concerns arise.
In sub-Saharan Africa 44 percent of the population must leave their homes to fetch water for drinking and domestic use. This contributes to less water being collected which poses a risk of water-borne illnesses. The study estimated that a 15-minute decrease in any walk time to the water source is associated with 41 percent average relative reduction in diarrhoea and 11 percent relative reduction in less than five child mortality (Pickering & Davis, 2012).
A study in Lesotho Africa revealed that while the MDG for safe water was met ahead of schedule, substantial numbers of people still rely on unimproved sources, surface run off and contamination can occur between the source and consumption. More than 700 million people remained without access to improved sanitation facility and of this 1 million people still practice open defecation. This open defecation contaminates water sources. Similarly, in south Western Kenya poor knowledge and attitude of the community towards safe water greatly influences their willingness to use safe water and this has increased the use of unsafe water and the high prevalence of water-borne illnesses (Kioko & Obiri, 2012).
In Uganda, 8 million people do not have access to safe water and 45,000 children under five years die due to diarrhoea as a result of poor water and sanitation. Despite the 2013 launch of Uganda’s vision 2040 for every Ugandan to have access to clean and safe water, the progress is slow. Many Ugandans especially in rural areas walk for long distances to collect safe water, share water sources with animals or generally do not have water sources. This increases the uptake of unsafe water, predisposing people to water-borne illnesses, which in a long run costs the country and retards the economy (International water Aid Organization, 2016).
In Korosi ward in Kaproron town council in Kween district, clean safe water access was at 52 percent according to the health inspector’s field report for the year 2018/2019 which leaves many people using unsafe water (Okalany, 2019). Therefore, since the use of clean safe water is still far from satisfactory, it is against this background that this study sought to investigate the knowledge, attitude and practices of the community members towards the use of clean water in Korosi ward, Kween district.
1.2 Problem statement
Globally, it is everyone’s right to have sufficient, safe, acceptable, accessible and affordable water for personal use without discrimination yet this has not been achieved (UNICEF, 2014).
Access to safe water in Korosi ward is still far from satisfactory which leaves many people using unsafe water for domestic use. In 2016/2017, 2017/2018 and 2018/2019, 48 percent, 46 percent and 52 percent of the total population respectively got complications such as diarrhoea, typhoid and dysentery (Okalany, 2019).
Despite the sensitization done by health workers on clean safe water use and maintenance of safe water chain within the ward, majority of the population still suffer with complications of unsafe water such as diarrhea and typhoid. Studies have been done to achieve the objectives of clean safe water use; however, research in the area of clean and safe water use is still insufficient. Therefore, this study seeks to uncover the knowledge, attitude and practices leading to unsafe water use in Korosi ward.
1.3 Purpose of the study
The study assessed the knowledge, attitude and practice of the community members in Korosi towards clean safe water use so as to identify gaps hindering the use of clean safe water.
1.4 Specific objectives
- To assess the knowledge of community members regarding clean safe water use in Korosi ward in Kween district
- To identify the attitude of community members regarding clean safe water use in Korosi ward in Kween district
- To determine the practice of community members regarding clean safe water use in Kween district.
1.5 Research Questions
- What is the level of knowledge regarding clean safe water use among community members in Korosi ward?
- What is the attitude of the community members regarding clean safe water use in Korosi ward?
- What are the practices of the community members regarding clean safe water use in Korosi ward?
1.6 Justification
The study would be useful in the following ways;
The study would generate information that could be used by the Ministry of Health to design policies aimed at promoting clean safe water use.
The information generated from the study could be used by the district health department to put up measures aimed at controlling water-borne diseases through promotion of clean safe water use. Generated data could be used as a baseline by future researchers interested in carrying out similar studies.
This research could be helpful to health professionals in the prevention of water-borne diseases. The study would be important to the researcher because it is a requirement for partial fulfillment for the award of a Diploma in Midwifery by the Ministry of Education and sports.
CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
This chapter reviews literature by other researchers related to the knowledge of community members regarding clean safe water use, their attitude and practice towards clean safe water use. This includes literature from books, published research reports and journals.
2.2 Knowledge of community members regarding clean safe water use
In a study conducted in India, on community based cross sectional study to assess the drinking water handling practices and its association with water borne disease at household level on 152 households, 47.4 percent of the members of the households had little knowledge on water disinfection to render it safe for drinking. Whereas only 15 percent knew that boiling water was a method used for disinfection or purification (Fernandes & Chakkarrwar, 2018). (Clasen, 2015) Also reported that in low- and middle-income countries, many communities had the knowledge of household water treatment and adequate (HWT) method uptake increased by wealth quantile which affected many in the rural areas due to inability to afford the cost of a (HWT) method.
In Northern Ethiopia, a study carried out on knowledge, attitude and practice of mothers/caregivers on household water treatment methods on 845 households with mother and child paired who participated in the study, half of the participants 417(49.3 percent) had good knowledge towards the different methods of household water treatment. Of those who had satisfactory knowledge, 276(71.1 percent) knew boiling, The study further established that 37.4 percent of the participants’ sources of knowledge was health extension workers (HEWs) and 21.4 percent got knowledge from health professionals in institutions (Bitew, Gete, Biks, & Adafrie, 2017). In a related study in western Ethiopia, mothers’ knowledge level regarding safe clean water use and transmission of diarrhoea was low. Only 20.15 percent of the mothers had satisfactory knowledge (Merga & Alemayehu, 2015).
According to (Onabolu, et al., 2011) In a study on the causes of house hold water contamination conducted in Nigeria found out unsatisfactory or poor knowledge of the community members regarding good household water treatment practices. In addition, family members lacked knowledge that the water once in their possession would be contaminated especially after using the toilet and after handling dirty objects (Badowski, et al., 2011)
This was controversial to a study by (Halvorson, Williams, Ba, & Dunkel, 2011) whose study on water quality and water borne disease revealed that knowledge of the community members regarding safe clean water use in Niger River inland delta in Mali was poor or unsatisfactory. The respondents were not able to relate between poor water quality and oral fecal transmission of water borne diseases.
According to (Atuyambe, Ediau, Orach, Musenero, & Bazeyo, 2011) in a study on rapid assessment of water, sanitation and hygiene situation Bulucheke camp in Bududa found out that many of the community members had satisfactory knowledge on household water treatment such as covering water containers.
2.3 Attitude of Community members regarding safe clean water use
According to (UNICEF, 2014) in a study on the rights to safe water and sanitation, there are major disparities in access to safe drinking water among countries between urban and rural areas within many countries, and between the rich and the poor. In rural communities where people’s opinion about poor waste disposal is not their concern, diarrhoeal diseases mostly caused by faecal contamination annually kills children of under the age of 5 yet this is not something to worry about in rural areas. In the same study, rural dwellers underrate the effect of diarrhoeal diseases which can cause irreversible damage to a child’s physical and mental development in rural settings in a long run.
In a study carried out by (Cummings, et al., 2012) in Karamoja on cholera outbreak among semi-nomadic pastoralists in northern Uganda, women considered children’s faeces as less infectious and could be disposed off poorly either on land or in the rivers where water for home use was collected from and neither chlorinated nor boiled. The risk factors associated to this include scarcity of clean safe water, poor sanitation and waste management. In such circumstances, public health is overwhelmed and prevention services are hampered. Diarrhoeal diseases have continued to be a major cause of morbidity and mortality during such emergencies. These diseases mainly result from inadequate quality and quantity of clean safe water, substandard and insufficient sanitation facilities and poor hygiene (Atuyambe, Ediau, Orach, Musenero, & Bazeyo, 2011).
(Gelanh & Mamo, 2019) In a study on the knowledge, attitude and practice towards water supply, sanitation and hygiene in Arsi Nagele town in South Eastern Ethiopia showed that unfavorable attitude results from poverty and urban environmental sanitation becomes a problem. The impact of inappropriate dumping of wastes in open fields and around road sides is perceived to be less dangerous which results in loss of environment’s natural beauty, results in bad odor, health problems on the society and pollution of surface and groundwater. In addition, majority of the people were against the idea that “open burning of wastes has a negative impact on the health of human beings”, they viewed human waste disposal as not a problem and that child faeces were not dangerous as adult yet this could be of a huge risk if water sources are not protected.
(Joshi, Singh, Prasad, Kasav, & Segan, 2014) in their study on water, sanitation and hygiene knowledge, attitude and practice in urban slums of New Delhi, India noted that majority of the people perceive available water as safe for drinking which is not true, others’ opinion was that the quality of water can affect health yet gastro intestinal tract infection was perceived to be the most important effect of consuming unsafe drinking water. On overall majority of the people do not use any method to make water safe for drinking, reason being that water received was already clean.
Similarly, in a study by (Wright, et al., 2012) on bacteria tests for faecal contamination of water in India, Most people felt that water was safe for drinking while others felt that the level of water quality can affect health and more than two-thirds felt that unclean water can cause gastro intestinal tract infection or disorder. They also added that three-fourth of people felt that water is already clean so there is no need to treat it. In contrast, the result of water sample collected from households showed that 53 percent of the samples were contaminated and that the potable water samples from 78 percent of the town/villages showed E.coli contamination.
2.4 Practice of Community members regarding safe clean water use
In most of the African communities the people in rural areas and some urban place depend on the un protected wells as the main source of water for both cattle and also for human drinking, there is estimated 790 million people (11% of the world’s population) without access to an improved water supply and 100 million people in Nigeria lack access to safe drinking safe and therefore rely on unprotected wells for water (Abubakar, 2019). However in other areas they depend on boreholes and running water from rivers. In the northern part of Nigeria the local people in these are mainly depend on unprotected springs to get water for drinking (Calow, MacDonald, Nicol, & Robins, 48). The large part of the northern morocco the main source of water has been rain water collections and unprotected springs in rural areas while in urban areas it is mainly protected springs.
In most of the African communities like the Masai women are observed to as the ones responsible for providing domestic labour and it is the responsibility of women and to train their daughters on domestic chores like fetching water (TIAN, 2019) . Fetching water in most of the northern Nigerian tribes is observed as the work for women. According to (Jensen, 2012) domestic chores at homes is mainly seen as the work for women and girls and therefore the women train their daughters from young age to do domestic work.
In a study in northern Zambia there is extreme poverty which has been orchestrated by lack of clean drinking water, in this place water is shared between animals and humans (Chipungu, Tidwell, Chilengi, Curtis, & Aunger, 2019) . The factors that has led to lack of clean drinking is often blamed on lack of government support this has therefore led to multiple diseases in this areas. Lack of water in rural parts of Niger is often observed by the fact that the local communities share water with camels.
In order to ensure that water is safe for drinking the Kenyan government has been emphasizing boiling of water as one of the cheapest ways of ensuring water is safe for drinking. Boiling of water is not a common practices across most of the communities in sub-Saharan Africa as a result it has most communities do not believe it is important to boil water for drinking (Onyango, Okoth, Kunanga, & Aliwa, 2018)
Ensuring the different rural communities has safe drinking water is important to improve the general welfare of the community members around this is imperative enabling the communities fight against the water borne diseases that can affect in the process of drinking water that is contaminated (Nanseu-Njiki, Gwenzi, Pengou, Rahman, & Noubactep, 2019).
In the rural areas water which is flowing from the rivers to the wells normally gets contaminated along the way mainly through open defecation by locals, dumping of industrial wastes or dumping of domestic wastes on the water. Most wells in rural communities in Kenya are contaminated mainly because of the sharing water between people and animals like domestic and wild animals (Busiene, Ogendi, & Mokua, 2019) .
CHAPTER THREE: METHODOLOGY
3.1 Introduction
This chapter presents an over view of the study design and rationale, study setting and rationale, study population, sample size determination, sampling procedure, inclusion criteria, definition of variables, research instruments, data collection procedures, data management, data analysis, ethical consideration, limitations of the study and dissemination plan.
3.2 Study design and rationale
This study used a descriptive cross sectional design employing quantitative methods of data collection. The design was chosen because it would enable the researcher to capture a lot of information in a short period of time.
3.3 Study setting and rationale
The study was carried out in Korosi ward, Kaproron town council, in Kween district. Kween district is located in eastern Uganda and it is bordered by Nakapiripirit district to the North, Amudat district to the North East, Bukwo district to the East, Kenya to the South, and Kapchorwa district to the West.
The total population in Kween was approximated to be 59,700 people while that of Korosi ward was about 360 people. The economic activities carried out in Korosi ward, Kaproron town council were mostly by small holder farmers and these included growing of crops like maize, potatoes, beans, bananas among others and the rearing of animals like cattle, goats, sheep, donkeys and domestic birds. These had a negative impact on unprotected water sources making it unsafe for human use, therefore this study area was chosen because of the increasing cases of diarrhoea, typhoid and dysentery in Korosi ward as a result of the above economic activities.
3.4 Study population
The study population was community members from Korosi ward, Kaproron town council in Kween district.
3.4.1 Sample size determination
The study included a total of 30 community members from Korosi ward, Kaproron town council in Kween district. This was chosen because according to a study by Kothari a sample size of 30 would produce relatively accurate results and according to Uganda Nurses and Midwives Examination Board, a sample size of 30 is recommended.
3.4.2 Sampling procedure
A simple random sampling technique was used to select 30 respondents, because everyone in the target population has equal chances of being included in the study. The researcher wrote and folded 35 pieces of papers written on numbers 1-35 and put them in a box. Community members who picked papers written on numbers 1-30 were included in the study. Selection of the respondents was done every day of data collection.
3.4.3 Inclusions criteria
Both male and female adult community members aged 18years and above in Korosi ward, Kaproron town council in Kween district who were available during the days of data collection and consented participated in the study. The study excluded community members below the age of 18 and those who had not completed 1year living in Korosi.
3.5 Definition of variables
The independent variables included the following;
Knowledge is the fact of knowing about something, generally understanding or familiarity with a subject, or a situation. This can also be the awareness of a particular fact or situation; a state of having been informed or made aware of something.
Attitude is a manner of acting, feeling, or thinking that shows one’s disposition and opinion. A way of thinking or feeling about something.
Practice is the actual application or use of an idea, belief, or method, as opposed to theories relating to it. A repeated exercise in performance of an activity or skill so as to acquire or maintain proficiency in it. Practice can also be the act of doing something again and again in order to become better at it, it can also be a regular occasion at which you practice something.
The dependent variable included;
Clean safe water use is water that does not represent any significant risk to health over life time consumption. This can also be defined as portable water that is free from harmful micro-organisms and substances, even if it may have color, odor or taste problem due to dissolved minerals.
3.6 Research instrument
Survey questionnaires were formulated in accordance with the research questions. These captured all the necessary information needed to answer the research questions.
3.7 Data collection procedures
The researcher used questionnaires to collect data; this was done through face to face administration of the questionnaires to the respondents and the responses were written in the research questionnaires. For respondents who were not able to read and understand English, questions were translated for them in the local language (kupsabiny) and the responses were recorded in the research questionnaires. A total of 6 different respondents were interviewed per day for 5days and these were randomly selected from Korosi ward.
3.7.1 Data management
After each day of data collection, filled in questionnaires were collected, edited, checked for completeness and coded, the raw data was stored in files while the electronic data was stored in a flash disk for back up.
3.7.2 Data analysis
Collected data was manually analyzed, coded and entered in a computer using Microsoft excel version and later presented using tables, figures and statistical texts inform of percentages and frequencies.
3.8 Ethical consideration
After approval of the proposal by the Research committee of Public Health Nurses College, Kyambogo, an introductory letter was obtained from school introducing the researcher to the local council (LCIII), who introduced the researcher to the community to carry out the study. The researcher explained the nature and purpose of the research to the respondents and assured them of utmost confidentiality of their responses and seeked their informed consent before carrying out the study.
3.9 Limitations of the study
The study encountered a problem of inaccessibility due to the poor road network as it was dictated by the terrain, the unpredictable weather (rainfall) and COVID-19 pandemic. The above constraints caused delays during data collection process. These were dealt with using other means of transport like motorbikes and use of umbrellas during times of rain. COVID-19 pandemic was dealt with by following the standard operating procedures (SOP’s).
3.10 Dissemination of the results
On completion, the study results were disseminated to the following stake holders;
- Uganda Nurses and Midwives Examination Board
- Public Health Nurses College Kyambogo
- District health officer, Kween District
- Medical Superintendent Kaproron Health Centre IV.
