CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Sanitation can be seen as the policy and practice of protecting health through hygienic measures. In the view of the World Health Organization (WHO) (2007), sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and faeces. It has been realized that improving sanitation is known to have a significant impact on health both in households and across communities (WHO, 2007). Similarly, Iheke (2010) sees sanitation as the process of keeping places clean and hygienic especially by providing a sewage system and a clean water supply.
Sanitation refers to all conditions that affect the health of people in a geographical area. The word sanitation operationally refers to the maintenance of hygiene conditions, through services such as garbage collection and waste water disposal so as not to endanger the health and welfare of people and also for the social and environmental effects, it may have on people. Most communities lack basic sanitation methods.
Basic sanitation is described as having access to facilities for the safe disposal of human waste (faeces and urine), as well as having the ability to maintain hygienic conditions, through services such as garbage collection, industrial/hazardous waste management, and wastewater treatment and disposal.(World Health Organization & UNICEF, 2012).According to WHO and UNICEF (2012), without immediate acceleration in progress, the world will not achieve the United Nations’ Millennium Development Goal (MDG) sanitation target (i.e., to halve the proportion of people without sustainable access to basic sanitation by 2015).
Basic Sanitation is very important in all places and environments especially communities. Community sanitation refers to hygienic practices that occur in communities. Coppens (2005) consider Community Sanitation and Hygiene Education as the combination of hardware and software components that are necessary to produce a healthy community environment to develop or support safe hygiene behavior.
The promises of community health and hygiene education programmes have not always been fulfilled by either the government or stakeholders in education (Danida, 2007). Many community environments in most institutions are not safe for women due to neglect of the operation and maintenance of health facilities. Danida further states that communities often suffer from non-existent or insufficient water supply, sanitation and hand washing facilities, dirty and unsafe water supply, toilets or latrines that are not adapted to the needs of women particularly girls; nonexistence of hygiene education, unhealthy and dirty classrooms/community compounds among others. Also, lack of sanitation, unsafe disposal or storage of waste in/around houses and streets, and in undesignated containers may provide habitats for vectors of diseases that cause various infectious diseases including typhoid fever and diarrhoeas (Ogawa, 2005).WHO (2007) estimates that 88% of diarrhoeal disease is caused by unsafe water supply and inadequate sanitation and hygiene. This has led to the need for measures to be evolved that will enhance proper sanitation in communities.
In the context of this work, environmental sanitation is used interchangeably with sanitation. This is because it is the particular type of sanitation of particular interest to institutions. Environmental sanitation encompasses four major subsets which include; solid waste management, water and wastewater treatment, industrial waste treatment and noise and pollution control. There has been considerable awareness of water supply in institutions, but the problems of excreta and waste disposal have received less attention (Danida, 2007).
In the University of Nigeria, Nsukka, a lot of places are littered with pure water polythene, pieces of papers and so on. In community hostels, there are problems of overcrowding and these affects the health of the women in the hostel. Many women share few toilets which leads to the spread of diseases among women. As a result learning is usually affected because a sick person only thinks of how to get cured and not what to learn in the classroom.
Therefore, the researchers seek to find out the implication of sanitation and hygiene practices on women’ health in Egbele, Esan North East Local Government Area, Edo state. Due to the fact that poor sanitation could affect not only the woman’s health but also their attendance to lectures and exams, it became necessary to find out ways in which environmental sanitation can be improved in the Egbele, Esan North East Local Government Area, Edo state.
1.2 Theoretical Framework
1.2.1 Health Belief Model (HBM) by Janzand Marshall (1984)
The health belief model (HBM) is a psychological health behaviour change model developed by Janzand Marshall (1984) to explain and predict health-related behaviors, particularly in regard to the uptake of health services. The health belief model suggests that people’s beliefs about health problems, perceived benefits of action and barriers to action and self-efficacy explain engagement (or lack of engagement) in health-promoting behavior. A stimulus, or cue to action, must also be present in order to trigger the health-promoting behavior. According to Janzand Marshall (1984), Health Belief Model includes:
- Perceived severity
Perceived severity refers to the subjective assessment of the severity of a health problem and its potential consequences. The health belief model proposes that individuals who perceive a given health problem as serious are more likely to engage in behaviors to prevent the health problem from occurring (or reduce its severity). Perceived seriousness encompasses beliefs about the disease itself (e.g., whether it is life-threatening or may cause disability or pain) as well as broader impacts of the disease on functioning in work and social roles. For instance, an individual may perceive that influenza is not medically serious, but if he or she perceives that there would be serious financial consequences as a result of being absent from work for several days, then he or she may perceive influenza to be a particularly serious condition.
- Perceived susceptibility
Perceived susceptibility refers to subjective assessment of risk of developing a health problem either in unhealthy environment of eating unhealthy things. The health belief model predicts that individuals who perceive that they are susceptible to a particular health problem will engage in behaviors to reduce their risk of developing the health problem. Individuals with low perceived susceptibility may deny that they are at risk for contracting a particular illness. Others may acknowledge the possibility that they could develop the illness, but believe it is unlikely. Individuals who believe they are at low risk of developing an illness are more likely to engage in unhealthy, or risky, behaviors. Individuals who perceive a high risk that they will be personally affected by a particular health problem are more likely to engage in behaviors to decrease their risk of developing the condition.
The combination of perceived severity and perceived susceptibility is referred to as perceived threat. Perceived severity and perceived susceptibility to a given health condition depend on knowledge about the condition. The health belief model predicts that higher perceived threat leads to a higher likelihood of engagement in health-promoting behaviors.
Health-related behaviors are also a function of perceived barriers to taking action. Perceived barriers refer to an individual’s assessment of the obstacles to behavior change. Even if an individual perceives a health condition as threatening and believes that a particular action will effectively reduce the threat, barriers may prevent engagement in the health-promoting behavior. In other words, the perceived benefits must outweigh the perceived barriers in order for behavior change to occur. Perceived barriers to taking action include the perceived inconvenience, expense, danger (e.g., side effects of a medical procedure) and discomfort (e.g., pain, emotional upset) involved in engaging in the behavior. For instance, lack of access to affordable health care and the perception that a flu vaccine shot will cause significant pain may act as barriers to receiving the flu vaccine.
- Self-efficacy
Self-efficacy was added to the four components of the health belief model (i.e., perceived susceptibility, severity, benefits, and barriers) in 1988. Self-efficacy refers to an individual’s perception of his or her competence to successfully perform a behavior. Self-efficacy was added to the health belief model in an attempt to better explain individual differences in health behaviors. The model was originally developed in order to explain engagement in one-time health-related behaviors such as being screened for cancer or receiving an immunization. Eventually, the health belief model was applied to more substantial, long-term behavior change such as diet modification, exercise, and smoking. Developers of the model recognized that confidence in one’s ability to effect change in outcomes (i.e., self-efficacy) was a key component of health behavior change.
1.2.2 Theory of Planned Behavior by Azjen (1991)
The theory of Planned Behavior Theory was proposed by Azjen (1991), which has a strong connection to human behaviour, environment and health. This model of planned environmental behavior considers the intention to act and objective situational factor as direct determinants of pro-environmental behavior and human health. The Intention itself is considered summarizing the interplay of cognitive variables which include; (knowledge of action strategies and issues, action skills) as well as personality variables (locus of control, attitudes, health and personal responsibility).
The Planned Behavior Theory grew out of the Theory of Reasoned Action and it suggests that human behaviour is influenced by three belief constructs: beliefs about consequences; expectations of others and things that may support or prevent behaviour. A strong premise of the theory is that, at the conceptual level, links among influences on behavior and their effects are captured through one of the components of the model or relationships in the model.
Azjen’s model therefore, allows for representation of cognitive elements through affective elements by their influence on beliefs. For instance, when a person understands that he/she has control over a certain situation and environment, his/her behavioral intentions reflect this understanding as much as his/her beliefs as to the outcome of a certain behaviour.
The application of the above theories is that the theories provide further explanations into the connection between knowledge, attitude, behavioral of individuals in the environment as they influence waste management practices and their health status. Knowledge is not a specific component in the theories but “attitudes are a function of beliefs” and health; since in this context, beliefs refer to knowledge about a specific behavior that influences a person’s health.
1.3 Statement of Problem
Evidence in many tertiary institutions has shown that women are fond of littering community environment with waste materials. A closer survey of Egbele, Esan North East Local Government Area environment reveals that there is poor Waste disposal by the women, refuse disposal as well as inadequate water supply are problems in the community environment. It is caused by a lot of factors. These include neglect of the operation and maintenance of health facilities, lack of hygiene education for the women, non-existent or insufficient water supply, poor sanitation and inadequate hand washing facilities, dirty and unsafe water supply; toilets or latrines that are not adapted to the needs of women as well as unhealthy and dirty classrooms/community compounds. These factors have led to consequences on woman health.However, it is not clear on the extent in which community management have contributed in curbing poor sanitation and hygiene practices. A lot of literature available talks about environmental sanitation strategies but most of them have been done in the wider communities and not in institutions of learning such as Egbele, Esan North East Local Government Area (Sanni, 2015). Therefore, the study seeks to find out the strategies which could be employed to improve sanitation in Egbele, Esan North East Local Government Area in order to reduce its effects on women’ health.
1.4 Purpose of the Study
The major purpose of this study is to find out how sanitation and hygiene practices affect women health in Egbele, Esan North East Local Government Area. Specifically this study seeks to:
- Examine the effect of provision of hygiene educationon the health state of women in Egbele, Esan North East Local Government Area
- Determine the effect of provision of toilet facilities on the health state of women in the Egbele, Esan North East Local Government Area
- Investigate the effect of monitoring the operation and maintenance of sanitation facilities on the health state of women in Egbele, Esan North East Local Government Area
- Examine the effect of employing external cleaner in the institution on the health state of women in the Egbele, Esan North East Local Government Area
- Find out the effect of provision of adequate water system on the health state of women in the Egbele, Esan North East Local Government Area.
1.5 Research Question
The following research questions guided the study
- What is the effect of provision of hygiene education on the health state of women in Egbele, Esan North East Local Government Area?
- What is the effect of provision of toilet facilities on the health state of women in the Egbele, Esan North East Local Government Area?
- What is the effect of monitoring the operation and maintenance of sanitation facilities on the health state of women in the Egbele, Esan North East Local Government Area?
- What is the effect of employing external cleaner in the institution on the health state of women in the Egbele, Esan North East Local Government Area?
- What is effect of provision of adequate water system on the health state of women in Egbele, Esan North East Local Government Area?
1.6 Statement of Hypothesis
The following research hypotheses were postulated and used in the study
- There is significant effect of provision of hygiene education on the health state of women in Egbele, Esan North East Local Government Area
- There is significant effect of provision of toilet facilities on the health state of women in Egbele, Esan North East Local Government Area
- There is significant effect of monitoring the operation and maintenance of sanitation facilities on the health state of women in the Egbele, Esan North East Local Government Area
- There is significant effect of employing external cleaners in the institution on the health state of women in the Egbele, Esan North East Local Government Area
- There is significant effect of provision of adequate water system on the health state of women in the Egbele, Esan North East Local Government Area
1.7 Significance of the Study
The result of the findings would help to create awareness among the women in the Egbele, Esan North East Local Government Area on the need to constantly keep the community environment clean, at the same time will inform them of the consequences of poor sanitation and hygiene on their health and bringing a better way of maintaining a clean environment.
The findings of the study would also provide information to government to provide the necessary funds needed by the community management to ensure the procurement of various facilities/equipment needed for women to live in a hygienic environment.
The findings of the study will motivate the community management has to ensure that the various ways of improving sanitation within the institution are used in synergy instead of in isolation due to fact that these methods are all important.
1.8 Assumptions of the Study
The study was based on the following as assumptions:
- It was also assumed that 90 percent of the questionnaire sent out would be answered by the respondents.
- It was assumed that the independent variables used in this study will affect the health status of women.
- That the results obtained could be capable of being generalized across all the communities in Nigeria.
1.9 Scope of the Study
This study will be delimitation to women in the Egbele, Esan North East Local Government Area, Edo State. Other sanitation and hygiene practices that affect health state of women would have been considered, but for the purpose of this study, provision of hygiene education, provision of toilet facilities, monitoring the operation and maintenance of sanitation facilities, employing external cleaner and provision of adequate water system were considered.
1.10 Definition of Operational Terms
The following core terms are defined based on their usage in this study
Sanitation and hygiene practices: These are activities that involve the cleaning and disposal of waste, garbage and sewage materials in community environment.
Health State: This refers to the condition of human body or mind especially in terms of the absence or presence of illness.
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