Assessment of the Effectiveness of Environmental Sanitation in the Control of Malaria.
CHAPTER ONE
Objectives Of The Study
The general objective is to carry out an assessment of the effectiveness of environmental sanitation in the control of malaria, using Abeokuta metropolis as a case study. The specific objectives are:
- To ascertain if inhabitants of Abeokuta metropolis know the implications of indiscriminate waste disposal in their environment.
- To find out the level of efficiency in the control and management of waste in Abeokuta metropolis.
- To know the rate of malaria infection among inhabitants of Abeokuta metropolis.
- To investigate if inhabitants of Abeokuta metropolis adopt an effective environmental sanitation.
- To examine the effect of environmental sanitation on the spread of malaria among inhabitants of Abeokuta metropolis.
CHAPTER TWO
LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK
Introduction
Over the years a number of research works have been carried out to examine the sanitation problem confronting developing countries and its effect on the economy, social, psychological and human health among others. The United Nations (UN) in 2000 adopted the MDG 6 target to halt and begin to reverse the incidence of malaria and other major diseases. This chapter reviews previous studies by researchers on sanitation and its effect on social, economic and incidence of malaria.
Definition of Sanitation
Mensah (2002) defines sanitation as the state of cleanliness of a place, community or people. He relates it to those aspects of human health including the quality of life determined by physical, biological, social and psychological factors in the environment.
Schertenleib et al. (2002) define sanitation as measures put in place to reduce people’s exposure to diseases by providing a clean environment in which to live and with measures to break the cycle of disease. Diseases arise due to improper disposal of wastes by household, business and industries. Improper disposal of waste is when people dispose of waste indiscriminately. Usage of improved sanitation facility by households is likely to reduce incidence of malaria and other sanitation-related diseases.
Improved toilet facility is one such improved sanitation facility since it can hygienically separate human excreta from human contact (WHO/UNICEF, 2012). Users of improved toilet facilities are considered to have access to improved sanitation. But this based on the condition that the improved toilet facility is not shared by multiple households and other members in the community. Improved types of toilet facilities include (1) flush or pour-flush to piped sewer system, (2) flush or pour-flush to septic tank, (3) ventilated improved pit latrine (VIP), (4) pit latrine with slab and (5) composting toilet. About 63 per cent of the world’s population has access to improved sanitation facilities (WHO/UNICEF, 2012). Access to improved toilet facility improves the health status of people and the quality of the environment they live in.
Unimproved toilet facilities include (1) flush or pour–flush to elsewhere, (2) pit latrine without slab, (3) open pit, bucket, (4) hanging latrine, (5) public or shared toilet facilities, and (6) open defecation in the bush, field or beach. A shared toilet facility is defined as a facility of an otherwise acceptable type that is shared between two or more households. In this context, public toilet facilities are considered to be shared and hence unimproved. An estimated 2.5 billion people are still without access to improved toilet facility as at 2010, 425 million of the world population use public toilet facilities while 1.1 billion people still practise open defecation (WHO/UNCIEF, 2012). Even though the proportion of people practising open defecation is decreasing in the world, many countries are off track in achieving the MDG sanitation target.
The proportion of people who practise open defecation; bushes, fields, beaches and water bodies in Ghana decreased slightly from 20.2% in 2000 to 19.3% in 2010. However the proportion of households using public toilet facilities, considered to be unimproved facilities, increased from 31.4% in 2000 to 34.6% in 2010 (Ghana Statistical Service (GSS), 2013, p.391). This GSS report also indicated that 15.4% of Ghanaian households have access to water closet toilet facility (improved facility), 19.0% have access to pit latrine (with or without slab) and 10.5% have access to Kumasi Ventilated Improved Pit (KVIP) (GSS, 2013, p.391).
CHAPTER THREE
METHODOLOGY
The study was carried out in Abeokuta metropolis of Ogun state, Nigeria. The area has 10 political wards with a population of 218, 734 persons covering a landmass of approximately 334.43 square kilometres. Most inhabitants of the areas are mainly commercial farmers, petty traders and civil servants. A descriptive crosssectional study design was used for the study. Multi-stage sampling technique was used to select 450 respondents who were available and expressed enthusiasm to participate in the study. Firstly, five council wards were used for the study. Simple random sampling technique (takea-pick lottery method) was used to select five (5) wards out of the ten council wards in Abeokuta Local
Government Area (LGA). Numbers were assigned to each ward, folded in pieces of papers, put in a container and mixed thoroughly. Then, the research assistants were asked to pick a piece of the folded paper each. Names of wards written on the paper picked were considered for the study. Secondly, out of the selected five (5) wards, simple random sampling technique (take-a-pick lottery method) was also used to select five (5) villages from each ward(i.e. 5 x 5 = 25 villages). Thirdly, the primary health center (PHC) house-enumeration list for Abeokuta L.G.A. was used as the sample frame and systematic random sampling technique was utilized to select eighteen (18) households in each selected village. The sample interval was obtained by dividing the total number of households in each village by the sample size (households to be sampled) depending on the total number of households in each village. Lastly, in each of the randomly selected households, an adult, either male or female was selected by simple random sampling to participate in the study. The total number of respondents recruited for the study was 450. A total of 450 copies of the questionnaire were administered to 450 households in 25 villages in the selected 5 wards of the study area. A pretested structured questionnaire developed by the researcher was used to collect quantitative data from eligible respondents (18 years and above). The rationale for considering individuals who were 18 years and above is based on the fact that data needed to draw inference and generalization should constitute reliable data which these category of individuals can provide.
CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
Conclusions
This study involved an analysis of effectiveness of environmental sanitation in the control of malaria in Abeokuta metropolis. This chapter outlines a summary of the main findings and policy recommendations. In order to address the three main objectives outlined in chapter one, a multi-stage cluster sampling was used to randomly select 120 householders from Abeokuta. About 59.2% of respondents were females whiles 40.8 % were males. A conceptual framework developed by the researcher was used to guide the analysis of factors that led to poor sanitary condition and the link between poor sanitary condition and malaria.
Concerning the first objective of establishing the factors perceived by householders as being responsible for the improper disposal of wastes, the results indicated that householders perceived attitude problem due to lack of care in proper disposal of wastes, high fees charged at the public dump sites and by private waste collection service providers and weak enforcement of sanitation byelaws by government authorities as the major factors. Poor sanitary condition often led to incidence of malaria and other sanitation-related diseases as the surrounding served as a breeding ground for mosquitoes.
The second objective of the study was to ascertain the various methods of waste disposal and human excreta by householders. Householders used various means to dispose of their solid wastes. About 30.8% of respondents burned and/or dumped their solid wastes in the public dump and containers; 18.5% burned and/or threw their wastes into the bush while 17.5% of respondents disposed their solid wastes into public dump and containers without burning them. About 10.8% of respondents only burned their wastes and 10% of respondents hired private waste collection firms to collect and dispose of their household solid wastes.
The third objective of the study was to determine the factors that influenced the household’s choice of the method of collection and disposal of solid wastes. Logistic regression analysis was used to identify variables which influence the householder’s choice of solid waste disposal method. The significant factors that influenced solid waste disposal method were total household income and the number of people in a household. The probability of using an improved method of disposing solid wastes increased with increasing household income but it decreased with increasing number of household members.
The fourth objective was to determine the perceptions of households with regards to the link between the quality of sanitary condition and malaria. About 98.3% of respondents indicated that the existing environmental sanitary condition had adversely affected their health over the previous two years. Further, 81.3% of respondents reported that one or more of household members had suffered malaria over the previous two years. The main cause of malaria as perceived by respondents was the poor environmental sanitation quality exemplified by the improper disposal of wastes which served as a breeding ground for mosquitoes which then transmitted malaria to humans. This factor was indicated by about 95% of the respondents.
Recommendations
The study established a clear linkage between the poor quality of environmental sanitation and the incidence of malaria at Abeokuta based on the perceptions of residents in the area. The poor environmental sanitation quality of the area was largely attributed to improper disposal of wastes. The four most important causes of improper disposal of wastes at Abeokuta were bad attitude towards disposal of waste, high fee charged for disposal of waste, weak enforcement of laws and inadequate sanitation facilities. As asserted by Agbola (1993) attitudes are learned by people and can therefore be changed or modified. People with bad attitudes towards wastes disposal can be changed for the betterment of society and a clean environment. This can be done through education. Hence the Waste Management Department and PHNSDC must embark on an educational campaign to educate residents on risks associated with improper disposal of wastes including the increased incidence of malaria and its attendant societal cost burden. Also, in order to reduce incidence of malaria among households, and religious leaders of various faiths must educate and persuade their followers on the proper disposal of wastes.
High fees charged by both public dump managers and private waste collection firms were cited as an important cause of the use of unimproved methods of waste disposal by respondents. Further the logistic regression analysis clearly indicated that households with high number of people are less likely to use improved methods of waste collection and disposal. This result illustrated the market failure problem of poor people and those with low incomes who are unable to pay for proper disposal of wastes and resort to use of unimproved methods such as dumping into open spaces which contributes to increased incidence of malaria.
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