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CHAPTER ONE 

INTRODUCTION AND BACKGROUND TO THE STUDY 

• 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).

Ghana Water Company Limited had traditionally been the major stakeholder in the provision of safe water and sanitation facilities. Since the 1960’s the GWCL has focused its activity in the urban areas at the expense of rural areas (GWCL, 2007) and thus, rural communities in the Ekiti state are no exception. According to the Ghana 2003 Core Welfare Indicators Questionnaire (CWIQ II) Survey Report (GSS, 2005), roughly 97% in Accra, 86% in Kumasi and 94% in Sekondi-Takoradi owned pipe-borne water. Once more, the report show that a  few households do not own any toilet facilities and depend on the bush for their toilet needs, that is 2.1%, 7.3%, and 5% for Accra, Kumasi, and Sekondi-Takoradi correspondingly. Access to safe sanitation, improved water and improved waste disposal systems are more of an urban than rural occurrencein Ghana. In the rural poor households, only 9.2% have safe sanitation, 21.1% use improved waste disposal method and 63.0% have access to improved

water.  The  major  diseases  prevalent  in  Ghana  are  malaria,  yellow  fever, schistosomiasis (bilharzias), typhoid and diarrhoea. Diarrhoea is of critical concern since it has been recognized as the second most universal disease treated at clinics and one of the major contributors to infant mortality (UNICEF, 2004). The infant mortality rate in Ghana stood at about 55 deaths per 1,000 live births (CIA, 2006).

 Facilities provided by mining companies and other organizations

The Ekiti state of Ghana has seen an improvement in water and sanitation facilities during the last decade. Most of the development projects in Ekiti state are sponsored by the mining companies, individuals and some non-governmental organisations (NGOs). Between 2002 and 2008, Goldfields Ghana Limited (GGL) constructed 118 new hand dug wells (77 of which were fitted with hand pumps) and repaired48 wells which were in poor condition. Also, a total of 44 modern style public water closets were constructed in their operational catchment areas. The company also donated 19 large refuse collection containers (skips) to Ekiti state Assembly and built 6 new nurses quarters. GGL has so far spent 10.5million US dollars of which 26% went into health, water and sanitation projects, 24% into agricultural development, 31% into formal education and the remaining went into other projects like roads and community centre construction (GGL, 2008). Golden Star Resources (consist of Bogoso/Prestea Mine and Wassa Mine at Akyempim) also established the community development department in 2005 and has since invested 800 thousand US dollars. Their projects include 22 Acqua-Privy toilets, 10 hand dug wells (all fitted with hand pumps) and supplied potable water to villages with their tanker trucks (BGL, 2007). Other development partners complimenting the efforts of the central government include NGOs like WACAM, Care International and Friends of the Nation (FON). WACAM is an environmentally based NGO which monitors water environmental pollution by large scale mining companies. They have sponsored about 10 hand dug wells for villages in Ekiti state. Care International sponsors hygiene and reproductive health programmes in schools and on radio. They have also donated a couple of

icycles to public health workers in Ekiti state who travel to villages to organise health education programmes. Despite efforts by the development partners, water supply and sanitation related diseases are highly prevalent in Ekiti 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 Ekiti 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 Ekiti 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 Ekiti state.

Table 1.1: HIGHLY PREVALENT DISEASES THAT DIRECTLY RESULTS FROM POOR WATER AND SANITATION PRACTICE

Diseases	Prevalence rate per 1,000 population
	2006	2007	2008
Malaria	350	320	300
Infant Diarrhoea	30	30	30
Acute respiratory infection	60	60	60
Dental Carries	10	20	10

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 WassaAmenfi East District 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 Ghana, where nearly 40% of latrines put up due to the support of a sanitation program were uncompleted or not used (Rodgers , 2007). In the Ekiti state 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 Ekiti 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).

 The problem statement

 

Most of the water and sanitation programmes executed in Ekiti 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 Ekiti state especially the Bogoso Rural Area Council has not been systematically documented or there is inadequate research that investigates such relationship.

 The 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 Ekiti state?

 

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

 

 Objectives

 

• General objectives

 

The main aim of this research was to investigate people’s awareness and practice of environmental sanitation, access to quality water and sanitation, possible causes of diarrhoeal diseases and suggest ways to reduce the incidence of diseases in the community.

 

   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

 Hypothesis 

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

 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 explainedthe project and showed student ID cards.