Journal of Environmental and Public Health

Journal of Environmental and Public Health / 2020 / Article

Research Article | Open Access

Volume 2020 |Article ID 6532512 | https://doi.org/10.1155/2020/6532512

M. K. C. Sridhar, O. T. Okareh, M. Mustapha, "Assessment of Knowledge, Attitudes, and Practices on Water, Sanitation, and Hygiene in Some Selected LGAs in Kaduna State, Northwestern Nigeria", Journal of Environmental and Public Health, vol. 2020, Article ID 6532512, 14 pages, 2020. https://doi.org/10.1155/2020/6532512

Assessment of Knowledge, Attitudes, and Practices on Water, Sanitation, and Hygiene in Some Selected LGAs in Kaduna State, Northwestern Nigeria

Academic Editor: Issam A. Al-Khatib
Received06 Feb 2020
Revised04 Aug 2020
Accepted16 Aug 2020
Published31 Aug 2020

Abstract

Access to safe water, sanitation, and hygiene (WASH) facilities is a basic necessity for human livelihood, survival, and well-being. Adequate WASH facilities provision is a critical issue to most developing countries around the world including Nigeria. Knowledge, attitudes, and practices regarding WASH are integral to effective and sustainable WASH facilities provision. This study assessed the level of knowledge, behavior, and practices towards water, sanitation, and hygiene in Kaduna state, Nigeria, with a view to ensuring sustainable WASH facilities intervention in the region. Data collection tools included spot check observation and questionnaire involving 854 participants, selected from five local government areas (LGAs): Chikun, Kajuru, Soba, Kachia, and Zango Kataf. From the results, major drinking water sources were surface waters (52.5%) and unprotected hand dug wells (44.8%); only 46.2% treated their water supply and few (16.6%) used chlorination method. Pit latrine toilets were the major (76.5%) excreta disposal means, and open defecation practices were widespread (41.4%). Level of personal and environmental hygiene understanding was fairly good in all the local government areas, and 65.4% claimed to use water and soap for washing hands after defecation. Incidence of water related diseases is generally low in the area. Despite the commendable findings in the study areas, communities are still at risk due to lack of safe water supply and poor practices of home treatment and excreta disposal. Therefore provision of WASH facilities and WASH education is fundamental for ensuring public health in the study area.

1. Introduction

Access to safe water, sanitation, and hygiene (WASH) facilities is considered a basic human necessity for survival and well-being [1], without these basic needs, the health conditions of millions of people especially children are at risk [2]. However, 2.3 billion and 844 million people across the globe lack access to basic drinking water and sanitation facilities, respectively [3], causing 842,000 deaths every year [4], which is undoubtedly a major public health concern. WASH services are considered means of contacting and at the same time preventing diseases [5]. It has been estimated that overall 9% of the global burden of disease could be prevented through improvement in adequate WASH facilities [6, 7]. Children are one of the most vulnerable groups affected by lack of water, sanitation, and hygiene facilities [2]. In developing countries, the high mortality rate resulting from diarrheal among children under the age of five was majorly due to WASH challenges [2, 5].

The provision of safe WASH facilities has been greatly influential on people’s health status and livelihood; however, the availability of these facilities remains critical in Nigeria especially in the rural areas [812]; a large percentage of rural communities in Nigeria live without access to safe WASH facilities [13]. The situation has thus subjected the communities to the utilization of water from rivers, ponds, and streams for drinking and domestic activities [14] and to the practice of open defecation [15] which consequently has often led to deaths, illnesses, and spread of waterborne diseases [1618]. The few improved water facilities from boreholes and wells with hand pumps available are largely insufficient; women and children mostly travel far distances to access water, which is energy and time consuming, thus affecting children’s education and women’s household and economic productivity [19]. On the other hand, hygiene facilities such as excreta disposal (toilets) have also been inadequate for usage at community households and public places such as schools [20], markets [21], and even hospitals [22], which left people with no alternative but to defecate openly and sometimes in and around water sources [23] with no use of soap or any cleaning agents for protection [24]. Moreover, toilet facilities available were poorly maintained and mostly shared among numerous people with no consideration of gender segregation and women integrity [21]. However, government failures have led to the intervention by organizations such as UNICEF and WHO for aid through their programs known as WASH. UNICEF’s WASH team works in over 100 countries globally to provide water and sanitation facilities [25].

Knowledge, attitudes, and practices (KAP) associated with WASH are of pertinent concern towards sustainable and effective implementation of WASH programs in communities [26]. KAP regarding WASH are contributing factors to waterborne disease prevalence in communities; poor WASH knowledge leads to unhygienic practices and poor attitudes which pollute water and spread illness [27, 28]. Such inadequate WASH knowledge leads to wrong perception of quality of water resulting in large dependence on surface waters for drinking [14, 29], open defection practices being perceived normal and commonly practiced, minimal household water purification practices to prevent diseases [30, 31], and poor water collection and storage behaviors contaminating water and causing illnesses [3234]. Household and environmental hygiene also tend to be poor, and children stool is often overlooked and perceived harmless in sanitation programs, hence increasing the risk of disease transmission [3537], all due to limited WASH understanding and poor attitudes and practices towards WASH. Therefore, there is a need to provide hygiene education programs and increased awareness towards promoting good WASH practices and ensuring good public health in the communities. In Nigeria, it is expected that there is currently a dearth of data on the status of WASH; thus, it is increasingly becoming difficult to plan any meaningful WASH program to improve health and well-being. Therefore, this study aims at assessing the knowledge, attitudes, and practices related to WASH in 5 local government areas in Kaduna state, Nigeria, with a view to providing reliable and sufficient data for effective implementation of WASH programs and ensuring good public health. The KAP survey is a follow-up of an earlier nationwide survey on water, sanitation, and hygiene carried out by UNICEF, Nigeria, during the years 2007–2009. The study objectives are to assess the demographic characteristics of the study areas relevant to the survey, the various water sources for drinking and domestic activities, home water treatment methods and practices, water collection and storage attitudes and practices, knowledge of quality drinking water, excreta disposal systems used and related perceptions, personal and environmental hygiene, and water related diseases relevant to the study.

2. Materials and Methods

2.1. Study Area

Figure 1 shows the map of Kaduna state. It is located on the southern end of the high plains of Northern Nigeria. The state is situated between longitudes 06.00 and 09.00 east of the Greenwich Meridian, and between latitudes 09.00 and 11.00 north of the Equator. The major cities of Kaduna state are Kaduna town, Zaria, and Kafanchan. Other cities include Kachia, Zonkwa, Saminaka, Birnin Gwari, Makarfi, Ikara, Giwa, Zango Kataf, and Kagoro. Kaduna is the capital of the state and consists of two LGAs (Kaduna North and Kaduna South). The state shares common borders with Zamfara, Katsina, and Kano to the north; Niger to the west; Nasarawa to the south; Bauchi and Plateau to the east; and the Federal Capital Territory, Abuja, to the southwest. Kaduna state has an area of 46,053 square kilometers. The current projected population of Kaduna state (based on the 2016 population census) is estimated at 8,252,366. For conducting the KAP survey, 5 LGAs (Chikun, Kajuru, Soba, Kachia, and Z/Kataf) were selected from 23 LGAs (Figure 1). From each LGA, one community was picked up randomly for the KAP survey. The communities are Gwagwada (Chikun LGA), M/Kajuru (Kajuru LGA), Soba (Soba LGA), Kachia (Gumel) (Kachia LGA), and Gukwu (Z/kataf LGA).

2.2. Sample Size and Survey Procedure

Scientific steps were followed to ensure the technical appropriateness of the survey sample size and sampling procedure. The following formula was used to determine the sample size [38]:where n is the sample size estimate, D is the design effect,  is the proportion practicing hand washing as a hygiene practice, Z1−α/2 is the standard score corresponding to 95% confidence level, N is the total population, and d is the degree of precision.

Using hand washing as a proxy for the indicators, was chosen to be 50% (the value that will yield the largest sample size). The design effect was estimated at 2 because of the clustering in the target population, and the level of precision was set to 0.05. The total population of Kaduna state was obtained from the official gazette of the Federal Republic of Nigeria for the 2016 population census and used as N. After the application of the above formula, the estimate obtained for Kaduna state was adjusted for a nonresponse rate of 10%.

A three-stage sampling procedure was adopted for selection of respondents. In Kaduna state, the IYS (International Year of Sanitation) LGAs were 5 (Table 1). The first stage was a random selection of 40% of the IYS LGAs in each of the state LGAs. The NPC population estimates of the selected LGAs were obtained from the 2016 census [39]. The proportion of the total population constituted by each LGA was computed. Sample sizes for each LGA were then proportionately allocated to the selected communities.


S/NLGACommunitySample size/LGA

1ChikunGwagwada236
2KajuruM/Kajuru71
3SobaSoba188
4KachiaKachia (Gumel)156
5Z/KatafGukwu203

Total854

The second stage involved the random selection of 40% of the IYS communities in each of the selected LGA. The sample sizes allocated to each LGA were equally allocated to the selected communities. Table 1 shows the breakdown of sample sizes for the state and selected LGAs and communities. The last stage was the random selection of street blocks (as clusters) based on the map of the selected community. Household heads (or representatives) were interviewed in selected clusters.

2.3. Data Collection and Analysis

The study is a cross-sectional field survey involving the use of structured questionnaire and field observation. A total of 854 questionnaires were administered and retrieved. The number was distributed across the LGAs as follows: Chikun: 236 (27.6%); Kachia: 156 (18.3%); Kajuru: 71 (8.3%); Soba: 188 (22.0%); and Zango/K: 203 (23.8%). The study variables include sociodemographic characteristics, water sources, and KAP regarding household water treatment, water collection and storage systems, excreta disposal, and household and environmental hygiene. In order to support the questionnaire data, observational checklists were used to capture and ensure the practices of household compound cleanliness, excreta disposal, and storage systems. Data collection was performed and supervised by 3 trained and experienced environmental and public public health professionals with assistant from various trained field staff members and researchers in Kaduna state. The survey was closely monitored for data quality assurance. Results of the surveys were entered into EpiData and analyzed.

3. Results

3.1. Background Characteristics of the Study Population

Table 2 shows the background characteristics of the survey respondents of which the majority (84.5%) were males. About 81.8% of them have been residents for more than 10 years. Some 47.6% were aged 30–50 years, and about 88.8% were married. Some 80.2% reported that they have been to school. However, 36.1% of them had Quranic education, 20.4% primary schooling, and 24.4% secondary schooling, while 14.0% had postsecondary education. Hausa accounted for 39.7% of the ethnic groups; others accounted for 58.4% in the selected LGAs. Christianity is the most common religion of the respondents (63.4%) followed by Islam (32.6%). Major occupations were farming (50.9%), civil service (17.1%), and self-employed (7.9%), and unemployment stood at 3.4%.


VariableChikun (236)Kachia (156)Kajuru (71)Soba (188)Zango/K (203)Total (854)

Gender
 Male86.673.590.498.975.184.5
 Female13.426.59.61.124.915.5

Residency in the household
 Less than 1 year0.40.60.00.01.00.5
 1–10 years12.216.123.313.37.813.0
 Above 10 years84.583.276.786.775.181.8
 Always2.90.00.00.016.14.7

Age
 Below 30 years21.413.513.713.317.616.6
 30–50 years50.047.161.647.340.547.6
 Above 50 years27.338.724.738.827.831.8

Marital status
 Single2.14.59.66.92.04.2
 Married91.284.582.291.089.888.8
 Divorced1.31.90.01.10.51.0
 Widowed5.59.08.21.17.85.9

Ever attended school
 Yes61.886.590.499.575.680.2
 No38.213.59.60.524.419.8

Highest school attended
 Quranic school45.411.011.066.525.436.1
 Basic literacy1.34.51.43.26.83.6
 Primary school25.221.321.910.122.920.4
 Vocational school0.80.04.11.12.91.5
 Secondary school17.237.434.210.632.224.4
 Postsecondary school10.125.827.48.59.814.0

Religion
 Christianity66.891.669.90.593.763.4
 Islam28.22.628.896.33.432.6
 Others5.05.81.43.22.94.0

Occupation
 Student3.84.54.12.72.03.3
 Housewife2.53.94.11.110.24.4
 Retired/pensioner4.29.70.01.61.03.5
 Farmer46.638.135.660.662.050.9
 Private employment2.99.05.56.91.04.7
 Self-employed13.05.212.35.34.97.9
 Civil servant17.221.331.516.09.817.1
 Others4.23.92.71.62.43.0

3.2. Sources of Water for Drinking and Other Activities in the Communities

As shown in Table 3, across the 5 LGAs, sources of drinking water include surface waters (52.5%), unprotected hand dug wells (44.8%), and protected hand dug wells (36.2%). Rain water harvesting was practiced by 52.5% of the communities. Kachia and Zango/K collect rain water to a large extent, 85.8% and 63.9%, respectively. These communities also utilize surface waters to a great extent, 89.0% and 95.1%, respectively. During dry season, unprotected hand dug wells (36.2%) and surface waters (51.9%) were the main sources. However, some still sought additional water from vendors. The sources of water for other domestic purposes were as follows: surface waters (47.8%), unprotected hand dug wells (39.16%), and protected hand dug wells (34.9%).


FeatureChikunKachiaKajuruSobaZango/KTotal

Sources of water for households
 Motorized borehole0.40.00.22.10.00.8
 Hand pump borehole0.41.945.221.85.410.4
 Protected dug well with hand pump2.50.06.82.10.01.7
 Protected hand dug well39.52.661.669.118.536.2
 Unprotected hand dug well49.692.911.021.336.644.8
 Developed spring1.30.60.00.50.50.7
 Undeveloped spring14.31.30.01.12.04.9
 Rain water harvesting26.085.817.836.263.954.2
 Bottled water0.01.30.00.50.00.3
 Sachet (pure) water0.00.62.75.30.51.6
 Tanker water vendor0.45.20.02.10.51.6
 Truck water vendors0.478.70.026.10.520.1
 Surface water (river/pond/lake)37.489.030.13.795.152.5
 Others0.01.30.01.60.50.7

Main source of drinking water during dry season
 Motorized borehole0.00.00.01.60.00.3
 Hand pump borehole0.40.645.220.72.09.1
 Protected dug well with hand pump1.30.011.02.70.52.0
 Protected hand dug well35.72.639.768.112.731.7
 Unprotected hand dug well34.091.611.016.024.436.2
 Developed spring0.80.01.40.00.50.5
 Undeveloped spring12.20.02.70.50.53.8
 Rain water harvesting8.820.02.712.86.810.7
 Bottled water0.41.30.00.50.00.5
 Sachet (pure) water0.49.71.45.31.03.4
 Tanker water vendor0.430.30.04.31.06.8
 Truck water vendors1.360.60.031.40.018.2
 Surface water (river/pond/lake)35.789.721.93.797.151.9
 Others0.00.60.03.70.00.9

Main source of drinking water during wet season
 Motorized borehole0.00.00.01.60.00.3
 Hand pump borehole0.01.334.212.25.47.1
 Protected dug well with hand pump1.70.04.12.70.01.4
 Protected hand dug well13.42.660.362.813.226.2
 Unprotected hand dug well36.692.36.89.634.637.7
 Developed spring0.00.00.00.00.50.1
 Undeveloped spring3.41.90.00.50.51.5
 Rain water harvesting72.787.742.555.385.972.2
 Bottled water1.71.30.00.50.00.8
 Sachet (pure) water0.41.90.01.10.00.7
 Tanker water vendor0.00.60.01.61.60.50.6
 Truck water vendors0.013.50.027.71.08.7
 Surface water (river/pond/lake)13.414.813.70.583.927.7
 Others0.00.60.00.00.00.1

Main source of water for other domestic purposes
 Motorized borehole0.00.62.71.60.00.7
 Hand pump borehole0.01.337.013.86.37.9
 Protected dug well with hand pump2.50.00.02.10.01.2
 Protected hand dug well36.63.964.467.616.134.9
 Unprotected hand dug well44.585.28.216.030.239.1
 Developed spring0.40.00.00.00.00.1
 Undeveloped spring13.90.60.01.11.04.4
 Rain water harvesting52.570.311.021.342.042.8
 Tanker water vendor0.41.30.01.60.00.7
 Truck water vendors0.069.00.026.61.018.5
 Surface water (river/pond/lake)30.379.423.33.793.747.8
 Others0.01.30.01.60.50.7

3.3. Water Treatment Methods Used and Communities Level of Practice

About 46.2% of the respondents claimed to have treated their water supply (Table 4). The most common method was filtration through cloth (45.2%). Other methods mentioned were boiling (44.4%) and chlorination, though very few (16.6%) as shown in Figure 2. There is frequency of household water treatment in all the LGAs as 43.3% indicated that they treated water that day, 22.6% the previous day, 15.8% less than one week ago, 3.3% less than a month ago, and 5.7% more than a month ago, and very few (9.3%) could not remember the last time they treated water.


Water treatment for safe drinkingChikunKachiaKajuruSobaZangoTotal%

Yes30.316.838.456.465.942.7
No67.283.260.343.133.756.2
Never1.70.01.40.00.50.7

3.4. Household Drinking Water Storage Practices, Handling Attitudes, and Knowledge of Quality Drinking Water

The facilities used for storing drinking water were mostly covered clay pots (54.1%) and covered plastic containers (48.4%) (Table 5). Open containers were also common among 15.1% of the respondents. Plastic buckets with taps were used only in Kachia by 24.5% of the respondents. Items used in fetching drinking water from the storage facility included cup with handle (84.9%), cup without handle (4.9%), calabash (8.3%), and bowl (2.0%). These items were common in all the LGAs studied. These items were either kept on the storage container (59.4%), kept in a basket or shelf (22.5%), or hung (12.6%). Cleaning of the storage facilities was done daily by 72.6%, weekly by 15.0%, and when dirty by 11.5%. Again, the frequency of cleaning varied widely across the LGAs. When respondents were asked about the qualities of safe drinking water, there were responses such as visually clear (65.4%), free from germs (40.0%), odourless (36.0%), and sweet taste (30.0%). These views were consistent among the LGAs.


FeaturesChikunKachiaKajuruSobaZangoTotal%

Containers/fetching methods
 Open container8.811.04.126.119.515.1
 Covered plastic container29.872.939.746.856.148.4
 Clay pots with cover53.465.858.941.556.154.1
 Clay pots without cover12.67.71.48.520.011.6
 Iron bucket containers without cover0.45.20.018.11.55.4
 Plastic buckets with tap2.524.511.011.72.49.2
 Basins without cover1.32.60.04.31.52.1
 Others4.60.00.00.50.01.4

Item used in fetching drinking water from storage facility
 Cup with handle81.181.991.885.688.384.9
 Cup without handle5.55.82.74.84.44.9
 Calabash13.011.01.46.44.98.3
 Bowl0.41.34.13.22.42.0

Place where item for fetching drinking water is kept
 On the storage container72.347.149.346.868.859.4
 In a basket/shelf14.733.539.716.522.422.5
 On the floor4.21.34.110.16.85.6
 Hanging8.818.16.826.62.012.6

Frequency of cleaning of storage container
 Daily55.561.387.784.085.472.6
 Weekly26.923.21.410.14.415.0
 Monthly0.43.20.00.00.50.8
 When dirty17.212.311.05.99.811.5

3.5. Excreta Disposal, Preferences, and Affordability
3.5.1. Excreta Disposal Methods and Practices in the Study Area

The use of traditional pit latrine was a common practice in all the 5 LGAs as 76.5% claimed usage (Table 6). However, about 41.4% still practice open defecation. Kachia and Kajuru had large number of traditional pit toilets. Improved pit toilets and VIP toilets were also found in Kachia (47.1%) and Kajuru (23.3%). In the households, 65.7% use traditional pit latrines, 5.9% use improved pit toilets, and 22.8% practice open defection. People use these facilities because they are cheap (25.7%) or easy to maintain (31.9%) or because they cannot afford to build a better one (30.5%). Among those practicing open defecation, 90.3% were willing to stop and start using traditional pit latrine (37.9%) and improved pit toilets (27.1%). Those who were not willing to stop open defecation cited lack of money as being the reason.


FeatureChikunKachiaKajuruSobaZangoTotal

Types of excretal disposal facilities in community
 Open defecation48.33.241.110.147.341.4
 Digging, defecating, and burying in soil2.56.513.78.03.95.7
 Traditional pit toilet87.490.393.276.691.276.5
 Improved pit toilets1.722.623.36.412.210.8
 VIP toilets0.047.18.23.70.010.0
 Pour flush toilets0.010.320.511.71.06.4
 Water closet toilets0.08.48.21.10.02.4
 Others0.00.00.00.50.00.1

Types of excretal disposal facilities in households
 Open defecation2.80.09.68.029.822.8
 Digging, defecating, and burying in soil0.40.61.47.40.52.1
 Traditional pit toilet72.785.874.076.162.065.7
 Improved pit toilets2.50.612.36.49.85.9
 VIP toilets0.03.92.72.10.01.4
 Pour flush toilets0.00.01.41.60.01.5
 Water closet toilets0.40.61.40.50.00.5
 Others0.00.00.00.00.00.0

In the communities, it was common for under-5 children to defecate around the house (25.4%), in the toilet (28.32%), and in the potty/chamber pot (24.7%). Defecation around the house is most common in Zango (47.8%). The use of potty/chamber pot was more frequent in Kajuru (37.0%) and Chikun (34.0%). After children defecation, the feces were dropped into a toilet facility (63.0%), thrown into the bush (16.3%), or eaten by dogs (10.4%). Dropping of children feces into toilet facility was generally a common practice across the LGAs as shown in Table 7.


FeatureChikunKachiaKajuruSobaZango/KTotal

Under-5 defecation
 Around the house22.319.413.714.447.825.4
 In the potty/chamber pot34.00.637.026.126.324.7
 In the toilet22.367.717.831.46.328.3
 In pampers1.30.00.04.80.51.5
 Within the compound10.50.05.51.62.914.7
 Others9.212.316.421.316.114.7

Methods of disposal of children’s feces
 Dropped into a toilet facility59.783.972.681.930.263.0
 Eaten by dogs3.86.52.70.532.710.4
 Buried in the soil9.73.91.45.38.36.6
 Thrown into the bush18.11.36.82.142.016.3
 Disposed with solid waste3.40.62.71.10.51.6
 Nothing/left there0.40.60.01.18.82.6

3.5.2. Perception of a Good Toilet, Type of Toilet, and Preferred Ownership by the Population

The information on how the respondents perceive a good toilet, the type of toilet, and preferred ownership is displayed in Table 8. In terms of perception, the respondents were of the opinion that privacy (46.4%), disease prevention (46.0%), and safety (33.1%) mean a good toilet. Most (70.9%) of the respondents preferred private toilet, some preferred compound toilet (22.4%), and very few opted for communal toilets (6.8%). Flush toilet (56.5%) and traditional pit toilet (25.4%) are the most preferred types in the selected LGAs followed by VIP (14.6%) and San Plat (3.5%) types. About 73.8% could afford the preferred toilet type, and only 7.8% are willing to contribute towards the preferred toilet.


FeatureChikunKachiaKajuruSobaZangoTotal (%)

Perception of a good toilet
 Privacy58.452.341.126.648.346.4
 Safety31.136.126.034.034.633.1
 Preventing diseases21.866.541.158.548.846.0
 Easy to use8.026.519.222.918.017.9
 Well covered and clean9.711.647.95.329.817.1
  Used by children on their own7.116.11.42.111.28.1
 Built close to the house0.80.64.10.02.01.2
 Others0.00.02.70.50.00.3

3.6. Personal, Household, and Environmental Hygiene Practices of the Respondents
3.6.1. Personal Hygiene

The respondents used soap for washing clothes (77.5%), taking bath (85.4%), bathing children (49.4%), and washing hands after defecation (31.3%) as shown in Table 9. When asked about when is it important to wash hands, there was a consensus among the respondents from the LGAs that hands should be washed before meal (85.1%), after meal (73.5%), after defecation (46.8%), and after cleaning children feces (13.5%). After defecation, hand washing is practiced the most in Kachia (76.8%) followed by Zango (53.7%). Items used for hand washing include soap with water (65.4%), water only (21.6%), and sand and water (8.8%). A sizable number understood that personal hygiene means bathing (87.5%), washing of clothes (63.0%), cutting of hair (46.4%), and cutting of nails (46.9%). The knowledge was comparable among the communities.


FeatureChikunKachiaKajuruSobaZangoTotal (%)

Uses of soap
 Washing clothes71.889.783.678.272.277.5
 Taking bath84.980.094.580.391.785.4
 Bathing children38.783.221.960.636.549.4
 Washing child’s bottom2.936.112.328.716.118.5
 Washing children’s hands1.336.111.038.816.620.3
 Washing hands after defecating5.956.828.847.927.331.3
 Washing hands after cleaning child1.329.012.328.714.616.4
 Washing hands before feeding child1.734.816.438.415.120.4
 Washing hands before preparing food0.440.019.246.318.023.4
 Washing hands before eating5.953.547.950.033.734.3
 Others0.45.81.43.70.02.1

Important time to wash hands
 Before meal91.671.075.387.289.885.1
 After meal68.565.865.871.389.873.5
 After defecation26.976.838.443.153.746.8
 After cleaning the children feces4.611.017.815.322.413.5
 Others0.415.513.75.92.05.8

Immediate practice after defecation
 Cleaning up71.460.020.518.159.550.5
 Going own way1.71.32.76.42.93.0
 Washing hands26.938.776.775.537.646.4

Items for hand washing
 Water only32.88.330.49.239.021.6
 Water with soap53.163.358.978.957.165.4
 Water with ashes0.00.03.69.20.03.8
 Sand and water0.00.03.621.82.68.8
 Others0.00.00.01.41.30.8

3.6.2. Household and Environmental Hygiene

Sweeping of the house (90.6%), cleaning of kitchen (42.8%), proper disposal of waste water (35.5%), cleaning of toilets (46.6%), and proper disposal of solid waste (30.6%) regularly are practices referred to as household and environmental hygiene by the respondents. This understanding of household/environmental hygiene is fairly uniform in all the LGAs. When asked how often they clean their compounds, respondents said once daily (54.6%), every other day (8.7%), and only when dirty (10.4%). Taking refuse to the dump sites (56.5%) is the most common way of household waste disposal, while other practices are open dumping (26.2%) and burning 26.1%. With respect to animal waste, the majority (79.9%) take it to the farms while 6.4% dump it openly. Presence of stagnant water around water points was reported by only 23.3%, and this was the highest in Kajuru (41.1%) and the lowest in Chikun (2.9%). In order to prevent water stagnation, 81.0% said they would clear it, while 3.0% said they would divert it to farms. There was however a consensus (94.5%) that community members should be responsible for prevention of stagnated water.

3.7. Water Related Diseases Perceived in the Households and Communities

There were reports of epidemics of water related diseases within the last year by 40.9% of all respondents. The common diseases are malaria (88.6%), typhoid (56.5%), measles (51.8%), and diarrhea/dysentery (33.1%) as shown in Table 10. These are prevalent in all the LGAs. Diseases of great concern are typhoid and diarrhea which were relatively more in Kachia and Zango LGAs. Yellow fever was reported to be high in Kachia (60.6%), and no Guinea worm was reported in any of the LGAs.


FeatureChikunKachiaKajuruSobaZangoTotal (%)

Common diseases in community
 Malaria81.998.191.888.388.388.6
 Measles41.642.660.361.758.551.8
 Diarrhea/dysentery40.324.517.821.347.333.1
 Cholera13.412.930.111.248.322.6
 Yellow fever8.460.613.728.230.227.8
 Chicken pox9.731.041.123.930.224.2
 Meningitis11.823.26.89.025.416.1
 Typhoid45.476.847.937.874.156.5
 Guinea worm0.00.00.00.00.00.0
 Onchocerciasis0.01.30.03.74.42.1
 Trachoma0.03.20.03.71.01.6
 Schistosomiasis0.00.00.02.71.00.8
 Worm infestations0.86.50.03.213.25.2
 Scabies0.44.51.43.27.83.6
 Others0.40.61.42.12.41.4

Major childhood diseases
 Malaria70.685.278.176.679.077.2
 Measles67.258.164.471.356.163.6
 Diarrhea/dysentery39.512.913.721.340.528.8
 Cholera8.45.211.013.813.815.8
 Yellow fever4.254.223.328.726.325.5
 Chicken pox10.525.852.118.127.822.6
 Meningitis10.132.31.47.417.614.6
 Typhoid24.824.58.224.546.828.5
 Guinea worm0.00.00.00.00.00.0
 Onchocerciasis0.00.01.42.71.51.0
 Trachoma0.40.00.02.70.50.8
 Schistosomiasis0.00.00.02.10.50.6
 Worm infestations0.47.10.02.110.74.4
 Scabies0.01.92.71.69.33.1
 Others0.01.32.71.12.91.4

3.8. Structured (Spot Check) Observations Findings

The results of the spot checks are summarized in Table 11. Presence of feces was reported around the house (38.6%), inside the house (25.1%), and near the water source (7.2%). Kachia showed the highest presence of feces around the households (63.2%), and all the LGAs showed high presence inside the households. Cow dung and animal excreta (42.3%) and children’s feces (26.3%) were also seen around the premises. However, water sources were kept fairly free from the feces. Traditional pit toilets (89.5%) were the most observed. The observed features of the toilets are as follows: small enough hole (34.5%), adequate privacy (25.5%), safe floor (35.5%), presence of slab (16.1%), and having superstructure (23.1%). Locations of the toilets were mostly outside the compound (56.0%). In terms of the indicators for the current usage of the toilet, the following results were obtained: clear paths leading to it (50.4%), cleanliness (41.2%), being free of smell (23.4%), and being free of flies (22.0%). Hand wash facilities were located inside the house (21.7%) or within walking distance (11.5%) and next to the toilet (18.6%).


FeatureChikunKachiaKajuruSobaZango/kTotal

Evidence of feces around the premises
 Inside the house30.336.121.929.87.825.1
 Outside/around the house9.763.231.519.174.138.6
 Near the water source3.814.84.19.04.97.2

Observations on the feces around the premises
 Infants/young children’s feces34.526.515.122.324.426.3
 Adults’ feces5.525.24.111.212.711.9
 Cow dung and other animal feces15.563.956.224.568.342.3

Type of toilet observed
 Digging, defecating, and burying in soil1.31.31.46.94.93.4
 Traditional pit toilet97.591.084.983.086.889.5
 Improved pit toilets0.83.28.24.37.34.2
 VIP toilets0.04.52.72.70.01.6
 Others0.00.00.00.00.51.2

Features of the toilet in the household (if available)
 Having superstructure21.025.235.630.912.223.1
 Safe floor8.872.374.045.316.135.5
 Having a slab27.312.323.316.03.416.1
 Small enough hole17.255.558.935.628.834.5
 Adequate privacy18.528.460.330.314.625.5

Location of toilet
 Inside the compound48.729.752.175.018.044.0
 Outside the compound51.370.347.925.082.056.0

Toilet in current use
 Clear path leading to it45.875.578.151.126.350.4
 Being clean18.972.375.357.416.641.2
 Being reasonably free of smell9.738.164.430.96.823.4
 Being reasonably free of flies9.241.358.924.56.822.0
 Cleansing materials2.563.942.518.12.920.5
 Presence of water in the vicinity1.348.439.722.92.918.2
 Presence of ash in the vicinity0.828.446.613.81.512.7
 Any other evidence of use8.841.343.818.63.418.5

Presence of hand washing facility
 Next to the toilet2.145.219.233.53.918.6
 Within walking distance0.430.315.116.54.411.5
 Inside the house0.429.030.121.837.621.7

Observing the presence of the following
 Storage container22.726.532.941.546.834.1
 Separate bowl/cup to fetch water5.019.434.243.143.927.7

4. Discussion

4.1. Sources of Water for Drinking

Access to safe water supply is integral to health and survival [1]. In the study area, there is virtually total absence of improved source of water; thus, communities extensively utilize surface water and unprotected wells for drinking which can be infectious [12]; this is similar to many KAP surveys in developing areas [32, 40] including a recent counterpart study in Kaduna [41], Nigeria, where the majority of surveyed communities utilized polluted water sources due to lack of adequate clean water sources. However KAP studies by Pradhan et al. [42] and Hothur et al. [20] depict otherwise where almost 73.6% of the households were consuming water from improved source of water; this disparity is not unconnected to lack of effective water policy and governmental commitments in the respective study locations; efficient water policy can be helpful extensively towards mitigating the high WASH related mortality and morbidity rate in Nigeria [13].

4.2. Home Water Treatment Methods and Practices

Household water treatment practices can improve dramatically microbial drinking water quality and prevent diseases [43]; it is found to reduce rate of diarrhea infection among children [31] and shown to decrease level of cholera outbreak and disease transmission among people [44]. In the study area communities’ level of home water treatment practices was considerably low as 54.8% do not treat water particularly using efficient methods such as chlorination. The absence of home treatment practices is often consistent in many communities across developing countries in the world as shown by many studies [28, 40, 4547], being more pathetic in the rural areas [48, 49]; it is perceived unimportant by the rural dwellers due to lack of education and awareness on WASH, which has continued to impact negatively on their health status.

4.3. Storage System Practices, Handling, and Knowledge of Quality Drinking Water

Appropriate use of storage vessels and handling attitudes are vital to maintaining quality drinking water and preventing waterborne diseases at households [5052]; uncovered water storage containers and those with wide openings make water susceptible to contamination; frequent cleaning of containers is essential in mitigating household water bacterial recontamination [33], and it is highly recommended as part of sanity that cups used to retrieve water from storage containers should have ladles or handles [46], to avoid unclean hands dipped into water in the process of fetching, and be kept on clean surface [40] or hung after usage. In the study area, different storage systems used are safe for storing water and are fairly covered and cleaned periodically; this is similar to findings by Reddy et al. [46], Pradhan et al. [42], and Ssemugabo et al. [53]. However the study population lacks knowledge of quality drinking water as many responded that quality water means visually clear water. This understanding affects home water treatment practices, consequently subjecting communities to diarrhea and waterborne diseases [31]. Contrarily, some similar studies show that water consumers are knowledgeable about safe drinking water [53].

4.4. Excreta Disposal Practices

The lack of improved toilets facilities was a huge concern in the study areas, resulting in open defecation being a common practice especially by children at households, which is a major health and social burden for the community at large [54]; this corresponds to various findings in developing countries [30, 46]. Nonetheless, the respondents have positive perception regarding good toilet facilities and are willing to stop open defecation; however, it was reported that unavailability of improved toilets was due to lack of financial capability. Toyobo et al. [55] and Miner et al. [15] reported similar scenarios, where communities suffer WASH challenges due to lack of fund. Livelihood empowerment and poverty eradication in the rural areas are vital to sustainable toilet facilities in the area.

4.5. Personal and Environmental Hygiene

In the study area adequate knowledge of personal hygiene led many to the good practices of using water and soap for cleaning hands after defecation, which is essential in preventing diseases [31], similar to studies by Orimoleye et al. [30] in Ibadan and Miner et al. [15] in Jos, Nigeria; practices of environmental hygiene were also fairly good as children feces were majorly perceived as harmful and were disposed in a toilet facility as reported by 63% of the respondents. However increased education is essential at critical times as children feces were observed in many households (38.6%) during inspection.

4.6. Waterborne and Water Related Diseases

Relating to the KAP on WASH in the study area, waterborne diseases of diarrhea, malaria, and dysentery seem to be prominent in the area; dysentery and diarrhea were more common among children under 5, relating to the findings by Yaya et al. [2] and Prüss-Ustün et al. [5] where leading cause of death under the age 5 in developing countries was diarrhea. Generally, the disease prevalence was low among the communities.

4.7. Constraints, Challenges, and Strength of the Research

During the research exercise, we were faced with some constraints and challenges which can affect the quality of the exercise which are lack of efficient means of transportation, poor accessibility to some communities, noncooperative attitude of some few respondents due to bulky nature of the questionnaire, and inadequate time for the exercise; however, the strength is the general cooperation of the community and stakeholders.

5. Conclusion and Recommendations

The deficiency in knowledge, poor attitudes, and lack of practices of WASH, particularly with regard to home water treatment, use of unsafe water sources, and open defecation, are routes of exposure to waterborne infections associated with the study area. Effectiveness of WASH does not depend on facilities provision alone. Therefore, WASH education is fundamental for promoting good practices and behavior towards WASH in order to protect public health. The study further suggests investigation regarding personal and environmental hygiene practices and the related disease implication in the study area.

Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Acknowledgments

Thanks are due to various staff members from Kaduna state, the selected LGAs, WASH Coordinator, UNICEF Zone C WASH Coordinator and others, community leaders, and several research and field staff members who assisted in the data collection, data entry, and data analysis. The authors thank in particular Dr. Bolu Onabolu, Ms. Yetunde Adegoke, and Dr. Gloria Onyilo for their contributions to the design of data collection.

References

  1. IWA (International Water Association)/WHO (World Health Organisation), Promotion of Tap Water Drinking and Public Relation Practices in Water Utilities Water Safety Plans, IWA (International Water Association), Beijing, China, 2011, 6th IWA-JWWA Workshop.
  2. S. Yaya, A. Hudani, O. Udenigwe, V. Shah, M. Ekholuenetale, and G. Bishwajit, “Improving water, sanitation and hygiene practices, and housing quality to prevent diarrhea among under-five children in Nigeria,” Tropical Medicine and Infectious Disease, vol. 3, no. 2, p. 41, 2018. View at: Publisher Site | Google Scholar
  3. WHO and JMP, “Launch version July 12 2017,” in Progress on Drinking Water, Sanitation and Hygiene—2017 Update and SDG Baselines, WHO Library Cataloguing-in-Publication Data, Geneva, Switzerland, 2017. View at: Google Scholar
  4. WHO, Water, Sanitation and Hygiene: Transforming the Regional Agenda towards Equitable Access to Safe and Sustainable Services, World Health Organization, Copenhagen, Denmark, 2017.
  5. A. Prüss-Ustün, J. Wolf, J. Bartram et al., “Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: an updated analysis with a focus on low- and middle-income countries,” International Journal of Hygiene and Environmental Health, vol. 222, no. 5, pp. 765–777, 2019. View at: Publisher Site | Google Scholar
  6. WHO, “Valuing water, valuing livelihoods,” in Paul Jagals and Katherine Pond, J. Cameron and P. Hunter, Eds., IWA Publishing, London, UK, 2011. View at: Google Scholar
  7. WHO, “Water safety plans: risk-based preventive management of drinking-water supplies,” in Proceedings of the 3rd Municipal Water Quality Conference, Cape Town, South Africa, June 2011. View at: Google Scholar
  8. UNICEF, Water Sanitation and Hygiene in Nigeria, UNICEF, New York, NY, USA, 2010, FACT SHEET, http://www.unicef.org/nigeria/ng.
  9. H. T. Ishaku, M. R. Majid, A. A. Ajayi, and A. Haruna, “Water supply dilemma in Nigerian rural communities: looking towards the sky for an answer,” Journal of Water Resource and Protection, vol. 3, no. 8, pp. 598–606, 2011. View at: Publisher Site | Google Scholar
  10. M. S. Isa, I. A. Allamin, H. Y. Ismail, and A. Shettima, “Physiochemical and bacteriological analysis of drinking water from wash boreholes in Maiduguri Metropolis, Borno state, Nigeria,” African Journal of Food Science, vol. 7, no. 1, pp. 9–13, 2013. View at: Publisher Site | Google Scholar
  11. A. Hyeladi and J. E. Nwagilari, “Assessment of drinking water quality of Alau dam Maiduguri, Borno state, Nigeria,” International Journal of Scientific and Research Publications, vol. 4, no. 10, pp. 2250–3153, 2014. View at: Google Scholar
  12. S. Lukman, A. Ismail, M. A. Asani, K. A. Bolorunduro, P. U. Foghi, and I. A. Oke, “Effect of Selected factors on water supply and access to safe water in Nigeria,” Ife Journal of Science, vol. 18, p. 3, 2016. View at: Google Scholar
  13. M. C. Obeta, “Rural water supply in Nigeria: policy gaps and future directions,” Water Policy, vol. 20, no. 3, pp. 597–616, 2018. View at: Publisher Site | Google Scholar
  14. A. Kaoje, M. Yahaya, M. Raji, S. Hadiza, A. Sylvanus, and T. Musa, “Drinking water quality, sanitation and hygiene practices in a rural community of Sokoto state, Nigeria,” International Journal of Medical Science and Public Health, vol. 7, no. 11, p. 1, 2019. View at: Publisher Site | Google Scholar
  15. C. A. Miner, Y. O. Tagurum, Z. Hassan, T. O. Afolaranmi, D. A. Bello, and A. Dakhin, “Knowledge and practice of sewage disposal in abbatoir community of Jos south LGA, Plataeu state, Nigeria,” Research Journal of Health Sciences, vol. 4, no. 1, pp. 74–82, 2016. View at: Google Scholar
  16. O. A. Emmanuel, A. Prossy, A. S. Abdul-Azeez, and S. Eunice, “Spatial analysis of factors responsible for incidence of water borne disease in Ile Ife, Nigeria,” J. Sustainable Society, vol. 1, no. 4, pp. 96–113, 2012. View at: Google Scholar
  17. E. E. Ibok and E. E. Daniel, “Rural water supply and sustainable development in Nigeria: a case analysis of Akwa Ibom state,” American Journal of Rural Development, vol. 2, no. 4, pp. 68–73, 2014. View at: Publisher Site | Google Scholar
  18. N. Forstinus, N. Ikechukwu, M. Emenike, and A. Christiana, “Water and waterborne diseases: a review,” International Journal of Tropical Disease & Health, vol. 12, no. 4, pp. 1–14, 2016. View at: Publisher Site | Google Scholar
  19. B. Adeleye, S. Medayese, and O. Okelola, “Problems of water supply and sanitation in Kpakumgu area of Minna (Nigeria),” Glocalism: Journal of culture, politics and innovation, pp. 1-2, 2014. View at: Publisher Site | Google Scholar
  20. R. Hothur, S. Arepalli, and A. D. Veera Bhadreshwara, “A KAP study on water, sanitation and hygiene among residents of Parla village, Kurnool district, Andra Pradesh,” International Journal of Community Medicine and Public Health, vol. 6, no. 5, p. 2081, 2019. View at: Publisher Site | Google Scholar
  21. F. Eremutha, B. Hammed Taiwo, M. K. C. Sridhar, and A. Aluko Olufemi, “Evaluation of sanitary conditions in kuje market in Abuja, Nigeria with diverse cultural practices and provision of a dry ecological toilet system,” Sociology and Anthropology, vol. 4, no. 11, pp. 1011–1019, 2016. View at: Publisher Site | Google Scholar
  22. WHO, Water Sanitation and Hygiene in Health Care Facilities: Practical Steps to Achieve Universal Access, World Health Organization, Geneva, Switzerland, 2016.
  23. J. O. Okullo, W. N. Moturi, and G. O. Morara, “Open defacation and its effects on the bacteriological quality of drinking water sources inisiolo country, Kenya,” Environ. Health Insights, vol. 11, pp. 1–8, 2017. View at: Publisher Site | Google Scholar
  24. M. V. Shrestha, N. Manandhar, and S. K. Joshi, “Study on knowledge and practices of water, sanitation and hygiene among secondary school students,” Journal of College of Medical Sciences-Nepal, vol. 14, no. 3, pp. 160–165, 2018. View at: Publisher Site | Google Scholar
  25. UNICEF, Water, Sanitation and Hygiene, UNICEF, New York, NY, USA, 2020, http://www.unicef.org/wash/#.
  26. USAID, The KAP Survey Model (Knowledge, Attitudes and Practices), USAID, Washington, DC, USA, 2011, https://www.springnutrition.org/sites/default/filespublicationsannotationspring_kap_survey_model.pdf.
  27. A. S. Yusuf, W. John, and A. C. Oloruntoba, “Review on prevalence of waterborne disease in Nigeria,” Journal of Advancement in Medical and Life Sciences, vol. 1, no. 2, pp. 1–3, 2014. View at: Google Scholar
  28. C. A. Miner, A. P. Dakhin, A. I. Zoakah, T. O. Afolaranmi, and E. A. Envuladu, “Household drinking water; knowledge and practice of purification in a community of Lamingo, Plateau state, Nigeria,” E3 Journal of Environmental Research and Management, vol. 3, pp. 230–236, 2015. View at: Google Scholar
  29. A. Omarova, K. Tussupova, P. Hjorth, M. Kalishev, and R. Dosmagambetova, “Water supply challenges in rural areas: a case study from Central Kazakhstan,” International Journal of Environmental Research and Public Health, vol. 16, no. 5, p. 688, 2019. View at: Publisher Site | Google Scholar
  30. E. O. Orimoloye, C. O. A. Amadi, A. N. Amadi et al., “Assessment of water sanitation and hygiene practices in Ibadan,” International Journal of Research, vol. 2, no. 2, pp. 94–100, 2015. View at: Google Scholar
  31. N. E. Soboksa, A. B. Hailu, S. R. Gari, and B. M. Alemu, “Water supply, sanitation and hygiene interventions and childhood diarrhea in Kersa and Omo Nada districs of Jimma Zone, Ethiopia: a comparative cross-sectional study,” Journal of Health, Population and Nutrition, vol. 38, no. 1, 2019. View at: Publisher Site | Google Scholar
  32. E. J. Kurui, G. M. Ogendi, W. N. Moturi, and D. O. Nyawanga, “Household water handling practices in the arid and semi arid lands in Kenya,” in The Relavance of Hygiene to Health Developing Countries, IntechOpen, London, UK, 2019, https://www.intechnopen.com/books/the-relavance-of-hygiene-to-health-in-developing-countries/household-water-handling-in-the-arid-and-semi-arid-lands-in-kenya. View at: Publisher Site | Google Scholar
  33. R. Meierhofer, B. Wietlisbach, and C. Matiko, “Influence of container cleanliness, container disinfection with chlorine, and container handling on recontamination of water collected from a water kiosk in a Kenyan slum,” Journal of Water and Health, vol. 17, no. 2, pp. 308–317, 2019. View at: Publisher Site | Google Scholar
  34. S. L. McGuiness, J. O’ Toole, S. F. Barker et al., “Household water storage management, hygiene practices and associated drinking water quality in rural India,” Environmental Science & Technology, vol. 54, no. 8, pp. 4963–4973, 2020. View at: Publisher Site | Google Scholar
  35. J. Brown, S. Cairncross, and J. H. J. Ensink, “Water, sanitation, hygiene and enteric infections in children,” Archives of Disease in Childhood, vol. 98, no. 8, pp. 629–634, 2013. View at: Publisher Site | Google Scholar
  36. R. Bawankule, A. Signh, K. Kumar, and S. Pedgaonkar, “Disposal of children’s and its association with childhood diarrhea in India,” BMC Public Health, vol. 17, no. 1, 2017. View at: Publisher Site | Google Scholar
  37. M. Islam, A. Ercumen, S. Ashraf, M. Rahman, A. K. Shoab, and S. P. Luby, “Unsafe diposal of faecec of children < 3 years among households with latrine access in rural Bangladesh: association with houdrhold characteristics, fly presence and child diarrhea,” PLoS One, vol. 13, no. 4, 2018. View at: Publisher Site | Google Scholar
  38. K. Suresh and S. Chandrashekara, “Sample size estimation and power analysis for clinical research studies,” Journal of Human Reproductive Sciences, vol. 5, no. 1, pp. 7–13, 2012. View at: Publisher Site | Google Scholar
  39. National Population Commission (NPC), 2017 Census Will Complement the Change Agenda, National Population Commission, Abuja, Nigeria, 2017, http://www.population.gov.ng/index.php/material/290-2017-census-will-complement-the-change-agenda.
  40. G. K. Genet and H. H. Desta, “Assessment of water and handling and sanitation practices among rural communities of Farta Woreda, northwest Ethiopia,” American Journal of Health Research, vol. 5, no. 5, pp. 119–124, 2017. View at: Google Scholar
  41. J. M. Ibrahim, B. M. Sufiyan, A. A. Oloruko-Oba, A. A. Gobir, H. Adam, and L. Amadu, “Knowledge, attitudes, and practices of household water purification among caregivers of under-five children in Biye community, Kaduna State,” Archives of Medicine and Surgery, vol. 1, pp. 35–41, 2017. View at: Google Scholar
  42. S. K. Pradhan, U. Sinha, D. M. Satapathy, A. P. Swain, and R. P. Mishra, “Assessment of household water treatment and storage practices,” International Journal of Community Medicine and Public Health, vol. 5, no. 3, pp. 1060–1063, 2018. View at: Publisher Site | Google Scholar
  43. UNICEF, Water Sanitation and Hygiene (WASH) in School, United Nations Interntional Children’s Emergency Fund, New York, NY, USA, 2018, http://www.unicef.org/publications/files/CFS-WASH-E-web.pdf.
  44. D. Lantagne and T. Yates, “Household water treatment and cholera control,” The Journal of Infectious Diseases, vol. 2018, no. suppl_3, p. S147, 2018. View at: Publisher Site | Google Scholar
  45. L. S. Mudau, M. S. Mukhola, and P. R. Hunter, “Cholera and household water treatment why communities do not treat water after a cholera outbreak: a case study in Limpopo Province,” Southern African Journal of Infectious Diseases, vol. 32, no. 1, pp. 5–8, 2017. View at: Publisher Site | Google Scholar
  46. V. B. Reddy, Y. S. Kusuma, C. S. Pandav, A. K. Goswani, and A. Krishnan, “Water and sanitation hygiene practices for under-five children among households of Sugali tribe of Chittoor district, Andhra Pradesh, India,” Journal of Environmental and Public Health, vol. 2017, Article ID 7517414, 7 pages, 2017. View at: Publisher Site | Google Scholar
  47. B. D. Bitew, T. T. Adafrie, G. A. Biks, and Y. K. Gete, “Knowledge, attitude, and practice of mothers/caregivers on household water treatment methods in northwest Ethiopia: a community-based cross-sectional study,” The American Journal of Tropical Medicine and Hygiene, vol. 97, no. 3, pp. 914–922, 2017. View at: Publisher Site | Google Scholar
  48. G. Rosa, M. L. Huaylinos, A. Gil, C. Lanata, and T. Clasen, “Assessing the consistency and microbiological effectiveness of household water treatment practices by urban and rural populations claiming to treat their water at home: a case study in Peru,” PLoS One, vol. 2014, no. 9, Article ID e114997, p. 12, 2014. View at: Publisher Site | Google Scholar
  49. G. Rosa, T. Clasen, and P. Kelly, “Consistency of use and effectiveness of household water treatment practices among urban and rural populations claiming to treat their drinking water at home: a case study in Zambia,” The American Journal of Tropical Medicine and Hygiene, vol. 94, no. 2, pp. 445–455, 2016. View at: Publisher Site | Google Scholar
  50. T. F. Clasen and S. Cairncross, “Editorial: household water management: refining the dominant paradigm,” Tropical Medicine and International Health, vol. 9, no. 2, pp. 187–191, 2004. View at: Publisher Site | Google Scholar
  51. T. F. Clasen and E. D. Mintz, “International network to promote household water treatment and safe storage,” Emerging Infectious Diseases, vol. 10, no. 6, pp. 1179-1180, 2004. View at: Publisher Site | Google Scholar
  52. E. O. Oloruntoba, T. F. Babalola, O. M. Morakinyo, and A. Mumuni, “Effects of improved storage containers on the bacteriological quality of household drinking water in low-income urban communities in Ibadan, Nigeria,” Water Supply, vol. 16, no. 2, pp. 378–387, 2016. View at: Publisher Site | Google Scholar
  53. C. Ssemugabo, S. T. Wafula, R. Ndejjo et al., “Knowledge and practices of households on safe water on safe water chain maintenance in a slum community in Kampala City, Uganda,” Environmental Health and Preventive Medicine, vol. 24, no. 1, p. 25, 2019. View at: Publisher Site | Google Scholar
  54. S. Lahiri, R. N. Yegbemey, N. Goel, L. Mathew, and J. Puri, Promoting Latrine Use in Rural India, International Initiative for Impact Evaluation, New Delhi, India, 2017, 3ie Scoping Paper 8.
  55. A. E. Toyobo and N. B. Tanimowo, “Evaluation of rural water supply scheme in selected communities in Oke-Ogun area, Oyo State, Nigeria,” Global Journal of Science Frontier Research, vol. 11, no. 9, 2011. View at: Google Scholar

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