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Go BackWELL FACTSHEET - Regional Annex for East AfricaPersonal Hygiene Behaviours Author: Gerald Rukunga, AMREF, Kenya, 2005 Quality Assurance: Eveline Bolt
To
achieve the greatest health benefits from water
supply and sanitation provision improvements in
hygiene should be made concurrently. For
people to utilize and benefit sustainably from water
and sanitation facilities they must adopt the
appropriate hygiene practices and therefore hygiene
promotion should be an integral part of water supply
and sanitation. 1.1
billion people in the world do not have access to
safe water, and 2.6 billion do not have access to
adequate sanitation. It is estimated that 2.2
million people in developing countries, most of them
children, die annually due to diarrhoea linked to
lack of access to safe drinking water, inadequate
sanitation and poor hygiene (WaterAid 2006). Poor water quality continues to pose a major threat to human
health. Diarrhoeal disease alone amounts to an
estimated 4.1 % of the total DALY global burden of
disease and is responsible for the deaths of 1.8
million people every year. It was estimated that 88%
of that burden is attributable to unsafe water
supply, sanitation and hygiene and is mostly
concentrated on children in developing countries,
(WHO, 2004). Provision
of safe water supply and sanitary conditions coupled
with sustainable proper personal hygiene can
drastically reduce this burden. Hygiene
behaviour plays an important role in the prevention
of diseases related to water and sanitation, such as
cholera, typhoid, dysentery, diarrhoea and
intestinal worms. Providing water and sanitation
facilities does not necessarily lead to a decrease
in these diseases. For real impacts to be felt,
provision of these facilities has to go hand in hand
with their proper use and maintenance. This is achieved by persuading people to change their behaviour
in order to reduce ‘risk’ practices that
predispose them to hygiene and sanitation related
diseases. Campaigns
to promote hand washing with soap, food protection,
domestic hygiene and safe excreta disposal, in
particular of infants’ stools, have been shown to
deliver big health gains. The simple habit of hand
washing if widely adopted would save more than one
million lives around the world annually, the
majority of them children under the age of five in
poorer countries. The simple act of washing hands
with soap can reduce diarrhoea by over 40% (WaterAid
2006). Better hygiene through hand washing and safe
food handling reduces child diarrhoea by 35%,
improved water quality by 15-20% and safe disposal
of children’s faeces by nearly 40%. In
view of the current HIV/AIDS prevalence rates
improved hygiene practices and access to safe water
and sanitation facilities also reduce the chance of
infection with opportunistic diseases (diseases
which attack the body due to weakened immunity) such
as diarrhoea and tuberculosis.
In
addition, greater access to improved water and
sanitation services and improvement in personal
hygiene behaviour may confer other benefits. These
include averted health-related costs, avoidance of
time lost from daily activities as a result of
illness, and time saved by having water and
sanitation closer to home. Time saved may translate
into higher productivity and higher school
attendance. The
Grim Situation in East Africa In
Kenya, it is estimated that 38% of the population
have no access to adequate and safe water supply and
52% lacks access to adequate and appropriate
sanitation, (UNICEF 2006). A rapid applied research
pilot study to determine the level of hygiene
awareness conducted in Korogocho slums of Nairobi in
Kenya by NETWAS Kenya and Water Supply and
Sanitation Collaborative Council in 2003 indicated
that knowledge on the key hygiene behaviours and
practices by the slum residents was very low and
only 29% of the respondents had ever attended any
form of hygiene training (NETWAS 2003)4 In
Uganda, developments in hygiene and sanitation have
dragged behind in the water sub sector which has
blunted the impact of water and sanitation projects.
The traditional approach has focused mainly on
improving water supplies. Consequently, 80% of incidences of diseases in Uganda are
linked to poor sanitation, (WaterAid, 2006). Despite
its importance in achieving better health, water and
sanitation coverage has been low in East Africa
especially in the rural areas. Major efforts to
address this problem have been concentrated on urban
slum dwellers and less to informal rural
settlements. Provision of water and sanitation facilities is necessary but not sufficient for sustainability of hygiene behaviour changes. A lot of emphasis in East Africa in the recent past has been placed on provision of the hardware component without necessarily providing the software. Case studies in Kenya and Uganda carried out by Water Aid have identified key determinants to sustainable adoption of hygiene behaviours such as:
Therefore,
there is need to shift the focus and integrate
hygiene awareness and education programmes to
influence behaviour change. In
an effort to address part of this challenge, school
sanitation and hygiene education activities have
been initiated in several parts of Kenya to
influence hygiene practices among pupils, teachers
and parents using child to child as well as child to
parent approaches.
A
Water, Sanitation and Hygiene (WASH) campaign was
launched in Kenya in 2002 aiming at, among other
things, promoting hygiene awareness. This targeted
key behaviors such as hand washing after using
toilets and before handling food as well as latrine
use and maintenance at home and in schools. In
Kenya, Uganda and Tanzania, the Participatory
Hygiene and Sanitation Transformation (PHAST)
approach to water and sanitation projects has been
adopted to promote hygiene and sanitation
improvements, and community management of water and
sanitation facilities. PHAST was introduced in the
understanding that hygiene behaviours are
particularly difficult to change because they relate
to daily activities, they are shared by the whole
community and they form part of the culture and
traditions of the community. This is addressed by
involving community groups in discovering the routes
of water-borne diseases, analyzing their own behaviours
in light of this information and then planning how
to block contamination routes. PHAST also
facilitates communities in deciding what they want
from hygiene and sanitation projects, how these
should be set up and paid for and how to ensure
sustainability. Another
approach adopted in East Africa (Kenya and Uganda)
to promote safe hygiene practices is the Personal
Hygiene and Sanitation Education (PHASE), which
targets school children. It aims to reduce
diarrhoeal diseases linked to poor hygiene and to
improve children’s overall health and wellbeing by
providing guidance on the importance of hand washing
and other hygiene practices. A
multi-country study on sustainability of hygiene behaviour
involving selected countries in Asia and Africa
including Kenya, indicates that intensive hygiene
promotion interventions, such as working with small
groups and through personal contact, will have
tangible and sustained impact on people’s behaviour, (Cairncross
S., Shordt K. 2004). The study further concludes
that sustainability of the desired behaviour is
possible when hygiene is highly prioritized and
adequate resources are committed to hygiene
promotion. Scaling
up and increasing the effectiveness of investments
in sanitation need to be accelerated to meet the
ambitious Millennium Development Goals.
This Regional Annex was developed by Gerald Rukunga, AMREF Kenya (2004) under the WELL Partnership. For further information contact: rukungag@amrefke.org
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