INTRODUCTION

BACKGROUND TO THE STUDY

1.1 Introduction

Efforts to assuage poverty cannot be complete if access to good water and sanitation systems are not part. In the 2000, 189 nations adopted the United Nations Millennium Declaration, and from that, the Millennium Development Goals were made. Goal 4, which aims at reducing child mortality bytwo thirds for children under five, is the focus of this study. Clean water and sanitation considerably lessen water-related diseases which kill thousands of children every day (UN, 2006). According to the World Health Organisation (WHO), 1.1 billion people lacked access to an enhanced water supply in 2002, and 2.3 billion people got illfrom diseases caused by unhygienic water. Each year 1.8 million people die from diarrhoea diseases, and 90% of these deaths are of children under five years (WHO, 2004).

. Despite efforts by the development partners, water supply and sanitation related diseases are highly prevalent in the state. Data obtained from the Public and Environmental Health Department of the Ministry of Health (M.O.H., 2008) showed that the top ten most prevalent diseases in the state include malaria, acute respiratory infections, skin diseases and diarrhoea. The others are acute eye infection, rheumatism, dental carries, hypertension, pregnancy related complications and home/occupational accidents. A lot more illnesses occur but on a lower scale and these include intestinal worm attacks, coughs and typhoid fever. A complete data on the top ten diseases prevalent in the state is attached as Appendix E. Table 1.1 is a selection of the illnesses that directly result from poor quality water and sanitation practices in the Bayelsa.

Table 1.1: HIGHLY PREVALENT DISEASES THAT DIRECTLY RESULTS FROM

Source: Regional Directorate of the Ministry of Health, 2008

The number of malaria cases decreased from 350 in 2006 to 300 cases per 1000 population in 2008. Despite the decrease, the values involved are still quite high as compared to values available from neighbouring BayelsaAmenfi East State for the same period (compare Appendix F and Appendix G). The incidence of diarrhoea among infants and acute respiratory infection remained 30 and 60 cases per 1,000 populations respectively. This can be attributed to several reasons, including populationgrowth, lack of continuousservices and inadequate functioning of facilities. In fact, according to the WHO(2004), an estimated 90% of all incidence of diarrhoea among infants can be blamed on inadequate sanitation and unclean water. For example, in a study of 11 countries in Sub-Saharan Africa, only between 35-80% of water systems were operational in the rural areas (Sutton, 2004). Another survey in South Africa recognised that over 70% of the boreholes in the Eastern Cape were not working (Mackintosh and Colvin, 2003). Further examples of sanitation systems in bad condition have also been acknowledged in rural Nigeria, where nearly 40% of latrines put up due to the support of a sanitation program were uncompleted or not used (Rodgers , 2007). In the Bayelsa approximately there are 224 public toilets, 560 hand-dug wells, 1,255 public standpipes and 3 well-managed waste disposal sites. According to the 2006 projection, the population of the state was expected to reach 295,753 by the end of the year 2009 (WWDA, 2006). 

Development partners in the past have concentrated their efforts on facilities provision only. These facilities are prerequisites for the attainment of good sanitation practice but they have not looked well at the possible causes of the persistence of disease transmission despite the effort they are making. Relationships between household’s sociocultural demographic factors and people’s behaviour with respect to the practice of hygiene could prove an essential lead to the solution of the problem. The fact is, merely providing a water closet does not guarantee that it could be adopted by the people and used well to reduce disease transmission. Epidemiological investigations have revealed that even in dearth supply of latrines, diarrhoeal morbidity can be reduced with the implementation of improved hygiene behaviours (IRC, 2001: Morgan, 1990). Access to waste disposal systems, their regular, consistent and hygienic use and adoption of other hygienic behavioural practices that block the transmission of diseases are the most important factors. In quite a lot of studies from different countries, the advancement of personal and domestic hygiene accounted for a decline in diarrhoeal morbidity (Henry and Rahim, 1990).For example, a literature meta-analysis by Curtis and Cairncross (2003) based on data from Burkina Faso found that the single hygiene practice of hand washing with soap is able to reduce diarrhoea incidence by over 40% and intestinal infections (cholera, dysentery, hospitalized diarrhoeas due to other causes) by over 50%. The World Bank (2003) identifies the demographic characteristics of the household including education of members, occupation, size and composition as factors influencing the willingness of the household to use an improved water supply and sanitation system. Education, especially for females results in well spaced child birth and greater ability of parents to give better health care. This in turn contributes to reduced mortality rates among children under 5years (Grant, 1995). 

1.3The problem statement

 The Bayelsa in the is home to several large scale mining companies and hundreds of small scale and illegal mining units.  Towns and villages in the state have been affected by mining, forestry and agricultural activities for over 20 years (BGL EIS, 2005). Because of this development, the local environment has been subjected to varying degrees of degradation. For example, water quality analysis carried out in 1989 by the former Canadian Bogoso Resources (CBR) showed that water samples had total coliform bacteria in excess of 16 colonies per 100ml (BGL EIS, 2005). Most of the water and sanitation programmes executed in the state exerted little positive impact and thus, diarrhoeal diseases are still very high in the towns and villages. 

However, in order to solve any problem it is important to appreciate the issues that contribute to it; after all, identifying the problem in itself is said to be a solution in disguise. Numerous health impact research have evidently recognized that the upgrading of water supply and sanitation alone is generally required but not adequate to attain broad health effects if personal and domestic hygiene are not given equivalent prominence (Scherlenlieb,  2003).The troubles of scarce water and safe sanitation provisions in developing countries have previously been dealt with by researchers for quite some time. However, until recent times they were mostly considered as technical and/or economic problems. Even rural water and sanitation issues are repeatedly dealt with from an entirely engineering point of view, with only a simple reference to social or demographic aspects. 

Therefore, relatively not much is has been learnt about how the socio-cultural demographic factors impinge on hygiene behaviour which in turn influences the transmission of diseases. The relationship between household sociocultural factors and the sanitation conditions of households in the Bayelsa especially the Bogoso Rural Area Council has not been systematically documented or there is inadequate research that investigates such relationship. 

1.4The research questions

            The following research questions were posed to help address the objectives:

1.      Why are the several sanitation intervention projects failing to achieve the desired results?

2.      Why is the prevalence of malaria and diarrhoea diseases so high in the state?

3.      What types of common bacteria are prevalent in the stored drinking water of households?

1.5Objectives

1.5.1 General objectives

The main aim of this research was to investigate effect of poor sanitation practice on public health and suggest ways to reduce the incidence of diseases in the community.

1.5.2 Specific objectives

The specific objectives were:

1.  To assess the quality of stored household drinking water 

2.  To establish the extent to which sanitation behaviour is affected by household socio-cultural demographic factors like age and education level of the head

3.  To investigate the occurrence of diarrhoea among young children (0-59 months old) in the households and

4.  To identify and recommend good intervention methods to eliminate or reduce the outbreak of diseases and improve sanitation.

1.6Hypothesis

In addition to the above objectives, the following hypotheses were tested:

1.      Occurrence of infant diarrhoea in the household is independent of the educational attainment of child caretakers and

2.      There is no relationship between households’ background factors and the sanitation conditions of the household.

1.7 limitations of the study

The study was self-financed and that made it difficult for the researcher to cover more households for water quality sampling. Most of the study communities had very bad roads and that made transportation expensive. Also, some respondents took the researchers for community and environmental health workers (popularly called saman-saman) and were unwilling to cooperate. They only accepted to respond after researchers explained the project and showed student ID cards.