CHAPTER ONE

GENERAL INTRODUCTION

1.1.Background to the Study
According to WHO(2000) diarrhoea is define as the passage of three or more loose stools per day or more frequently than is normal for the individual .It  is usually a symptom of gastro intestinal infection, which can be caused by a variety of bacterial, viral and parasitic organisms..  Diarrhoea diseases kill an estimated 1.8 million people each year, it is the second leading killer of children under age six, accounting for approximately 15% of under six child deaths world-wide WHO (2006). Among children under six years in developing countries, diarrhoea accounts for 17% of all deaths UN (2006). According to Kirkwood (1991), the situation in Africa is more worrying as diarrhoea has been estimate to account for 25-75% of all childhood illnesses. The world focus on the issue of potable water delivery has become a major concern in the past decades. Access to safe drinking water, sanitation and good hygiene are fundamental to health, survival, growth and development. The availability of safe drinking water significantly affects the incidence of diarrhoea. Low incidence of diarrhoea is associated with private indoor pipes and standpipes but increases with vended water and lack of access to safe water. An estimated 94% of the diarrhoea burden of disease is attributable to the environment, and associated with risk factors such as unsafe drinking water, lack of sanitation and poor hygiene ( Pruss-ustin and Corvalen 2006) . Contaminated drinking water, along with inadequate supply of water for personal hygiene and poor sanitation are the main contributors to an estimated 4 billion cases of diarrhoea each year causing 2.2 million deaths mostly among children under the age of six WHO (2000a).   Shier eta l (1996) found high incidence of diarrhoea morbidity and mortality associated with untreated water among young children in Northern Ghana. Bacteriological studies in rural Nigeria have also shown consistent contamination of traditional water sources with faecal coli forms and streptococci (Blum etal 1987).

Several global initiatives have been taken to ensure access to water and basic sanitation. In 1977, the UN water conference in Mardel Plata (Argentina) recommended that the 1980’s should be proclaimed the ‘ International Drinking Water supply and sanitation Decade’ (IDWSSD), The aim of the decade was for all countries to achieve 100% coverage in water supply and sanitation by 1990 and yearly, conferences on this initiative are been held. WHO/UNICEF (2008).  The Millennium Development Goals (2000) states under goal 7 the need for reducing by half the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015. Private sector participation was promoted heavily in the 1990’s as a means of achieving greater emphasis and coverage in the water and sanitation sector. The African Ministers Council on Water (AMCOW) has also taken stock of the situation. In collaboration with it partners, it organised regional conference on sanitation and hygiene (Africasan) in February 2008 in south Africa with the main aim of facilitating regional and international corporations through the coordination of policies and action among African Countries regarding water resources issues.

Despite the global initiatives, rapid pace of urbanization and continuous increase in population posed a major challenge to achieve it aim, privatization of the water sector could not cope up with coverage levels of the world poor. To achieve the target of the global initiative to improved access to water and basic sanitation, the challenge now is for countries  to set realistic targets, develop achievable action plans and commit enough financial and human resources.

1.2. Problem Statement

Stakeholders in the water sector have been making strenuous efforts to improve water and sanitation coverage in Ghana. Available statistics indicates that 46% of the urban population in Ghana have access to clean drinking water whilst 54% of the rural population have access. A general nationwide water and sanitation coverage is 75% and 18% respectively. Even though Ghana aims at achieving 85% coverage of water and sanitation by 2015 which exceeds the MDG’S target of 78%, majority of her population still lack clean drinking water and sanitation systems, as a results  there are severe health concerns in Ghana contributing to 70% of diseases in the country. WHO/UNICEF, (2008).Since 1994 the water sector have been gradually modernised through the introduction of private sector participation and decentralisation of rural water supply. Reforms are aimed at increasing cost recovery and the modernisation of the urban utility as well as rural water supply systems (CWSA, 2008). The Upper East Region is made up of mostly rural and small town communities. It is estimated that water and sanitation coverage for the rural communities and small towns is about 59 and 28% respectively (GSS, 2011) indicating the insufficiency of potable water and sanitation access.

A study “Review of Diarrhoeal Diseases Cases Admitted to the Busy Referral Hospital in Ghana”, Baffoe-Bonnie etal (1998) indicated that children less than six(6)years of age make up 84% of all child admissions and 56.5% of them being infants below one(1)year in Ghana. Diarrhoea is estimated to rank second among the top ten (10) most infectious diseases at the PML Hospital in Ghana I.C.O.Tewiah (2004). Diarrhoeal disease is caused by a variety of bacterial, viral and parasitic organisms and spread through contaminated foods, drinking water or from person to person as a result of poor hygiene and sanitation, severe diarrhoea leads to fluid lost and may be life threatening particularly in young children and people who are malnourished or have impaired immunity. Lower maternal education, poor sanitation, lack of good hygienic practices, lack of training, unemployment and poverty are the main contributors to high prevalence of diarrhoea and its complications in Ghana. The government of Ghana have started operating a National Health Insurance Scheme (NHIS) to reduce the cost of medical care in the country. Major therapeutic and preventive measures include Oral Rehydration salts (ORS) and Therapy (ORT), improve nutrition exclusive breastfeeding, improved weaning practices, health education and the provision of pit latrines. Diarrhoea infections ranked fourth among the top ten (10) diseases in the Upper East Region and for that matter, the Talensi- Nabdam district and the community understudy GHS (2009). The issue is that access to environmental services such as water, sanitation and hygiene has not been encouraging. . Several interventions  have been undertaken by government and its development partners through the provision of health centres and chips compounds, sanitation and hygiene education, and provision of hand dug wells within the Talensi-Nabdam district to improve health, sanitation, hygiene and access to safe drinking water (CWSA, 2008) but access to these environmental services still remain a big problem in Pwalugu the community understudy  (CWSA, 2008, Fieldwork, 2009).The main questions that baffles this research is :  are the people of Pwalugu having enough access to environmental services which is critical to their health improvement?, Is the socio-economic and educational status of  households having an influence on the use of environmental services? Does inadequate access to these environmental services have an effect on diarrhoea prevalence in the community? What interventions could be made to address the problem of inadequate access to these services and the prevalence of diarrhoea? Based on the above questions,   the research is  intend to delve into the issues of access to environmental services and its implication on the prevalence of diarrhoea among children under age six (6).

       1.3. Research Questions

The research questions this study aims at providing answers to are:

  1. To what extent does access to environmental services contributes to diarrhoea infections among children under age six.
  2. What are sources of drinking water in the community?
  3. What is the situation of sanitation services in the community?
  4. What hygiene practices exist within the households especially the principal homemaker?

5. What impact do these variables (education, socio-economic status, access to water, hygiene behaviours) have on diarrhoea prevalence in children under age six?

     1.4. Research Objectives

The main research objective is to examine how access to environmental services    contributes to diarrhoea infection among children under age six. The specific research   objectives are to;

 1. Examine the availability and access to water in the community.

 2. Analyse the availability and access to sanitation services.

 3. Examine household hygiene behaviours.

 4. Analyse the impact of these variables on diarrhoea prevalence in children under age six.

       1.5. Justification of the Study

The quest for providing access to environmental services and eluding the incidence of diarrhoea is gaining much prominence in the world and Ghana in particular. At the millennium summit in September 2000 the state of the United Nations agreed on a set of millennium development goals, one of the specific targets identified was to half the proportion of people without sustainable access to safe drinking water by 2015. At the world summit on sustainable development in September 2002, another relevant target was set; halving the proportion of people without sustainable access to basic sanitation by 2015 (Jessica Budds and Gordon McGranahan 2003).

Therefore, the essence of any issue/ activity skewed towards achieving this goal cannot be over emphasized. A research which is design to delve into the issue concerning access to environmental services and the prevalence of diarrhoea among children under age six is very crucial. A research of this kind will not only help to uncover how access to environmental services affects the prevalence of diarrhoea in children under age six which is know previously but it will go a long way  to help stakeholders, NGO’S, the government agencies in ensuring environmental services provision to  the people of Pwalugu. In addition, the study will serve as a useful material for future researchers as well as non-governmental organizations interested in access to environmental services and health.

1.6. Scope of the Study

The research location is Pwalugu in the Talensi-Nabdam district of the upper east region. It was purposely selected due to its rural and outstanding cases of access to environmental services and prevalence of diarrhoea in children under six.

1.7. Research Methodology

1.7.1. Sources of Data

Both secondary and primary data was used in this research.

1.7.1.1. Secondary Sources

Secondary data was sourced from documents, field reports, books, newspapers, journals, internet, and other relevant written scripts.

1.7.1.2. Primary Sources

Primary data was obtained from the field through the following techniques.

1.7.1.2.1. Questionnaire

A Sample of forty (40) questionnaires was administered to the principal homemaker to ascertain generic views specifically from the principal homemaker about access to environmental services in the community. Questionnaires will cover access variables such as access to water, sanitation and hygiene practises, socio-economic status, distance and time spent in search for water as well as quantity accessed.

1.7.1.2.2. Interviews

Primary data was collected by conducting interviews with the aid of interview guide to Environmental Health Personnel and Community Health Nurses in the community. This was to elicit their views on the relationship between accesses to environmental services and diarrhoea prevalence in the community and the past interventions that stakeholders has put in place to address the situation.

1.7.1.2.3.Focus Group Discussion

Two separate focus-group discussions were held, one with sampled infant mothers with the experience of diarrhoea infection of their children ever reported to the local clinic and the other with the Magazia and other women groups. The main essence is to elicit their views on the causes of diarrhoea especially in their community, the state of access to environmental services, and its effects on their children health as well as interventions that are put in place in providing environmental services and the prevention of diarrhoea.

1.7.1.2.4.Observation

Observation was used to ascertain how people dispose off their waste materials in the community, do they have waste-bin containers, availability of water sources and its accessorily to the community. Observation emphasis was on access to environmental services especially why it is difficult to strike underground water for domestic uses in the community.

1.7.1.2.5.Transect Walk

 This was adopted with the assistance of key informant to understand power division, environmental services, and the management of sullage water in the community as well as some of the problems associated with the accessibility of water in the community.

1.7.2. Sampling Techniques

1.7.2.1. Purposive Sampling

In coming out with the community understudy, purposive sampling was used to choose Pwalugu due to its high prevalence of diarrhoea incidence among children under age six. Environmental health personnel and nurses were also  purposively selected and interviewed due to their special knowledge in the issues understudy.

1.7.2.2. Stratified Sampling

This sampling technique was used to divide the community into three major strata. These strata include High-class residential area (HCRA), Medium class residential area (MCRA), and Low class residential area (LCRA) with questionnaire assigned to each stratum (residential areas) to ascertain generic views from the principal homemaker.

1.7.2.3.Systematic Sampling

This technique was used to sample households from each stratum. This was done by selecting every ninth (9th) household within each stratum.

1.7.3.Techniques of Data Analysis

 Quantitative data was generated from the questionnaire and was analysed using Ms Excel and SPSS. The data was represented by using tables, graphs and charts. Qualitative data was obtained through content analysis by using instruments like questionnaires, interviews, focus group discussions, observations and transect walk.

1.8. Organization of Report

The final report was organised into five chapters. Chapter one provided a background to the study. Chapter two looked at the study area. The next chapter reviewed relevant literature related to access to environmental services and the prevalence of diarrhoea. The fourth chapter provided major findings. Chapter five contained conclusion and recommendations

CHAPTER TWO

PROFILE OF THE STUDY AREA

2.1. Introduction

This chapter gives details of the study area. It considers the features of the area into five thematic areas; Geographical location, climate and related issues, Demographic characteristics, Socio-Cultural, Socio- Economic, Socio-Political, Water and Sanitation as well as Technical infrastructure.

2.2. Geographical Location, Climate and Related Issues

Pwalugu is located in the Talensi-Nabdam District of the Upper- East region and has its district capital at Tongo. The district is one of the newly created districts, which was carved out in 2004.The community lies between Latitude 100 36’’and 10 45’’north of the equator and longitude 1.000 and 0.50’’west of the green meridian. The geology of the community falls within the Birimain Tarkwain voltain rocks of Ghana.

It is mostly made up of igneous rocks (muscovite biotite granite), undulating lowlands with gentle slopes ranging from 1% to 5% gradient with some isolated rocks peaks constituting the relief. The White Volta and its tributaries with low underground water potential drain the community. The climate of the community is classified as tropical and has two distinct seasons, a rainy season, which is erratic, and runs from May to October and a long dry season that stretches from October to April. The main rainfall ranges between 88mm-110mm with annual of 950mm.The area experiences a maximum temperature of 450c in April and a minimum of 120c in December. The vegetation is guinea savannah woodland consisting of short widely spread deciduous trees and underground flora of grasses which get burnt during the long dry season. The economic trees are shea trees, cashew, dawadawa and baobab.

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2.3. Demographic Characteristics

Secondary data from the 2000 PHS reveals a total population of 3371people.Current update on the population shows that the community has a total population of 3971 people, out of this population, the male constitute one thousand eight hundred and twelve (1,812) representing 46% whilst the female constitute two thousand, one hundred and twenty –seven (2,127) representing 54%. This increased in population is attributed to high birth rate. The community has a total household of three hundred and forty-eight (348) with an average of (12) people constituting each household.

2.4. Socio-Cultural Characteristics

Pwalugu is a heterogeneous community with different ethnic groups but the dominant ethnic group is frafra. The natives of the community trace their ancestors through the male line, thus the patrilineal system of kingship. The dominant family system in the community is the extended family system where the ties between members of the family are very strong. Polygamy is practiced in the community but mostly based on the financial status of the man.

Majority of the people are predominately African Traditional Worshipers followed by Christianity and Islam. In terms of property ownership everyone can own a property irrespective sex, tribe or religion. Properties owned by capable individuals in the community include land, animals and houses. Property in the community can be group into communal family and individual property ownership. In terms of festival celebration the people of Pwalugu celebrate the ‘Tingana’ festival which takes place throughout the month of January every year. This festival is usually celebrated as a thanksgiving for good harvest. It is a thanksgiving festival of offering of sacrifice, traditional music accompany with drumming and dancing among the Talensi tribe.

2.5. Socio-Political Organization

The traditional political system is well structured with the chief having the highest authority followed by sectional heads and then followed by ordinary people. Information’s flows to the community from the chief and passes through the sectional heads to the entire community and vice versa.

Figure 1The  communication system between the modern and traditional systems

DISTRICT ASSEMBLY
CHIEF

TRADITIONAL                                                                    MODERN

CCC

SECTIONAL HEADS
ASSEMBLYMAN
SON
UNIT COMMITTEE
COMMUNITY

Source: Field Survey, 2012

The figure above shows the communication flow between the modern political system and that of the traditional system in the community, information flows from the chief to the district assembly and vice versa as well as the community members.

2.6. Socio-Economic Characteristics

Pwalugu is predominantly an agricultural community .The main source of employment is crop agriculture through which about 90% of the population earn their livelihood. Other activities undertaken by the people include livestock rearing, poultry production, fuel wood extraction, fishing from the White Volta, food processing, and surface mining. There exists a quarry industry in the community where the quarry obtains their raw materials from the large expansions of rocks found in the community

However, the dominant agricultural sector crop producers are mostly peasant farmers with few of them engage in large scale agriculture production. There is an average land holding of 1.2 hectares per household. Large scale agricultural farmers are mostly tomato farmers who cultivate to sell to the Northern Star Tomato factory found in the community and the excess for the local markets in the surrounding villages.

2.7. Water and Sanitation

The main source of water for domestic consumption in the community are hand-dug wells fitted with hand pumps, the white Volta, and dam which are short in supply during the raining season and sometimes in the raining season when the water table goes down. The dam and the Volta river sources are not   potable for consumption and people who resort to them because of inadequate potable water suffer from diverse diseases such as diarrhoea, guinea worm infestations among others.

2.8. Technical Infrastructure

The community has location advantage in terms of transportation. The community is divided by a second class road which links Bolgatanga the regional capital to Tamale, there are bus terminals at vantage points in the community. All the telecommunication networks exist in the community and among them include Vodafone, Tigo, MTN, and Kasapa. In terms of banking service, there exist a rural bank in the community know as Mamprusi community bank which operates mostly on market days where banking staffs comes from the main rural bank branch at walewale.

Part 2 of this research is available in our next post. Check back soon!!

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