Water, Sanitation and Hygiene Practices as Predictors of Diarrhoea Occurrence among School Age Children in Ganze Sub County, Kenya

Abstract

Water, sanitation and health are inseparably linked. Diarrhoea and other water related diseases are the major causes of health problems in developing countries. Although the need for water and sanitation interventions for health promotion has been recognised, these are labeled as costly and are often neglected in the primary healthcare programmes. Since water and sanitation initiatives include both availability of provisions and their effective use, they are technically and socially challenging. The main objective of the study was to determine WASH practices as predictors of diarrhoea occurrence among school age children in primary schools in Ganze Sub County, Kilifi County, Kenya. A comparative school-based cross-sectional study design was employed in which data from both sets were compared. A total of 240 participants from 24 schools were sampled (12 control and 12 intervention), 10 pupils aged 5-15yrs were randomly selected from each school. Guardians/parents of the 240 selected pupils were also paired and interviewed. Quantitative data was collected through a structured questionnaire and data keyed-into the SPSS vers. 23 and was analysed while qualitative data was collected through Focus Group Discussions (FGDS), Key Informant Interviews (KII) guide and observational checklist and was analyzed by use of NVIVO Vers.10.0. Scientific and ethical approval for this study was sought from Scientific Ethical Review Unit (SERU). Study findings registered a significant association between school age children below 15years affected by diarrhoea in the last 3 months (χ2= 2.098, df = 2, P<0.005). Demographic characteristics like age (p=.000), behavioural (p = .000) and environmental (p = .000) characteristics significantly predicts diarrhea occurrence. A significant relationship was posted between training on health related issues (χ2= 3.938, df = 1, P<0.005) and diarrhoea occurrence. Children aged 5-15 years old were less likely to experience diarrhoea occurrence in schools implementing Home Grown School Meals Programme (HGSMP) compared to the same age set in non HGSMP schools (χ2= 1.455, df = 1, P<0.005). Further findings revealed level of significance between the use of a latrine by pupils and their gender (p = .000). At the household level, demographic characteristics such as gender (χ2= 7.979, df = 1, P<0.005), marital status (χ2= 12.081, df = 5, P<0.005) and age (χ2= 17.438, df = 7, P<0.005) revealed significance relationships. Further significance was noted between diarrhoea occurrence and its association with water (χ2= 235.986, df = 3, P<0.005). A positive significance was also noted between knowledge of diseases associated with WASH (χ2= 235.986, df = 3, P<0.005) and diarrhoea occurrence. Amount of money incurred per day on water usage at the household level (χ2= 11.978, df = 4, P>0.005) as well as preferred water treatment methods (χ2= 11.978, df = 4, P<0.005) also revealed positive significance. However, school provision of handwashing facilities, washing of hands after visiting the toilet and participation in WASH programmes revealed no level of significance (P<0.005).The Study concludes that demographic, behavioral and environmental characteristics significantly predicts diarrhoea occurrence both at school and at home. Other interventions like feeding and WASH programmes are essential component in prevention and control of diarrhoea hence prevention and control programs need to adopt a more synergistic and comprehensive approach at the school and community level. Health education is also imperative in significantly reducing diarrhoea occurrence and morbidity.