Water Hygiene And Enhancement Strategies Among Pregnant Women Attending Antenatal Care

Abstract

In some cases in Plateau State, water was got from source closest to the user irrespective of its quality. Moreover, fetched water was mixed with stored one, which is troubling and point to problems among others. Therefore, the aim of this study was to investigate the water hygiene KAP of women attending ANC in Plateau State and the outcome used to proffer water hygiene KAP enhancement strategies.

To achieve the main purpose, the study determined water hygiene KAP of women attending ANC in Plateau State using ten research questions and six hypotheses tested at 0.05 level of significance. Descriptive survey research design was used for the study.

The population for the study consisted of 150,913 (all the women who attended ANC in Plateau State in 2014). The sample size for the study was 777 drawn from the population using multi stage sampling procedure. Two types of instruments (WaHKAPQ & WaHESQ) used for the study were validated by five experts from the Department of Human kinetics and Health Education and

Measurement and Evaluation, University of Nigeria, Nsukka. The Cronbach Alpha reliability index of WaHKAPQ was .80 and WaHESQ, .89. The research questions were answered using descriptive statistic of frequencies, percentages and means. The Chi-square statistic was used to test all the null hypotheses at 0.05 level of significance.

The findings of the study revealed that majority (61.6%) of women who attended ANC possessed correct knowledge regarding water hygiene, water collection (75%), water source protection (74.8%) and water transportation (74.2%) while more than half of women possessed correct knowledge regarding water storage

(58.3%) and about half of women possessed correct knowledge regarding PoU of water (49.2%) whereas over 30 per cent of women possessed correct knowledge regarding water purification (37.1%). Also, more than half (56.4%) of women expressed positive attitude regarding water hygiene while majority of the women expressed positive attitude regarding water source protection (76.7%) and water storage (70.2%)

whereas over one half of the women displayed positive attitude towards water purification (58.5%), water transportation (51.8%) and PoU of water (50.5%) while 30.6 per cent of women expressed positive attitude regarding water collection (30.6%). Also, the finding showed that women attending ANC practised: water hygiene (overall always = 32.7%, sometimes = 23.7%, rarely

• 9%); water source protection (always = 49.9%, sometimes = 32.6%, rarely = 10.4%); water collection (always = 40.7%, sometimes = 25.6%, rarely = 16.3%), water storage (sometimes = 40.5%, always = 38.6%, rarely = 8.9%); water purification (always = 37.7%, sometimes = 33.7%, rarely = 20.3%), transportation of water (always = 34.2%, sometimes = 20.1%, rarely = 15.7%) and point-of-use (PoU) of water (sometimes = 32.7%, always =

29.5%, rarely = 17.2%). The findings further showed that there was no significant difference with regard to practices of water hygiene of women who attended ANC based on location (overall c ² = 2.077, P-value .586 > .05), storage of water ( c ² = 1.638 > P = .672, df = 3), transportation of water ( c ² = 2.107 > P = .551, df = 3), water collection ( c ² = 3.25 > P =

.422, df = 3), PoU of water ( c ² = 1.999 > P = .591, df = 3), water source protection ( c ² = 1.584 > P = .673, df = 3) and purification of water ( c ² = 1.884 > P = .607, df = 3). In

addition, the findings of the study also showed that the enhancement strategies of water hygiene KAP were adjudged very appropriate with cluster means of 2.55 with SD of 559, which fell between 2.49 – 3.00; means of 2.62 with SD = .515, which fell between 2.49 – 3.00 and 2.65 with SD = .496, which fall between 2.49 – 3.00 among others. Based on the findings of the study, it was recommended among others that women attending ANC should practise the items contained in the water hygiene enhancement strategy aspects of the strategies on attitude towards water hygiene. This becomes necessary so as to influence all women attending ANC in both rural and urban areas express positive attitude towards water hygiene.

CHAPTER ONE

Introduction

Background to the Study

Water hygiene knowledge, attitude, practice (KAP) and enhancement strategies are key to ensuring the sustenance of good health, wellbeing, comfort and survival of man, including women attending antenatal care (ANC). This is because water has impurities that affect it in the environment. These impurities are often ingested as a result of man’s inability to embark on correct water hygiene, which results to dire consequences.

For instance, in many homes, water related diseases have been one of the leading causes of mortality and morbidity in developing countries (World Health Organization and United Nation International Children Fund [WHO/UNICEF], 2000). In addition, WHO (2004) further revealed that approximately 88 per cent of water related diseases were attributable to unsafe water use, inadequate sanitation and hygiene.

Furthermore, the consequences of inappropriate water hygiene according to UNICEF/WHO (2009) led to diarrhoea that killed 1.5 million children of less than five years of age annually more than deaths from acquired immune deficiency (AIDS), malaria and measles combined globally. According to Craun, Brunkard, Yoder, Roberts, Carpenter, Wade,…Roy (201 0), from 1971 to 2006, 54 per cent of reported water related disease outbreaks were due to the use of untreated water.

Jones (2011) showed that 37 per cent of people not using improved source of water lived in sub-Saharan Africa, which included Nigeria and Plateau State. Jones further pointed that poor practices of water hygiene were on the increase and accounted for 2.2 million children deaths of less than 5 years of age.

The scourge of water related diseases had been on the increase. Nigeria Center for Disease Control – NCDC reported an increase in wate r borne diseases with 9,006 cases and 106 deaths in the first quarter of 2014 (Leo, Sadiq, Alao, Auwal, Liman & Mohammed, 2014). When untreated water was ingested, cholera occurred (Igomu, 2011).

It may be in this regard that in 2013, Plateau State government reported 130 cases of cholera disease and 11 deaths (Sadiq, Auwal & Joseph, 2013). Therefore, the ingestion of untreated water can lead to many health problems such as gastrointestinal illness, reproductive problems and neurological disorders (Center for Disease Control [CDC], 2013).

Moreover, infants, young children, pregnant women, the elderly and patients with compromised immune system due to AIDS, chemotheraphy or transplant medications may be especially susceptible to illness (United States Environmental Protection Agency [USEPA], 2013). Thus, safe water supports

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life. The above statistics lend credence to the importance of the ingestion of safe water if good health is desired.

Water is an important ingredient necessary to all forms of life. Mathur (2007) viewed water as a great cleaning agent that is used both externally and internally. Moshby (2009) defined water as a chemical compound, which one molecule contains one atom of oxygen and two atoms of hydrogen. Leeds (2014) conceived water as a compound that is made of two parts, hydrogen and one part oxygen.

Quotes (2015) posited that water is the fluid which decends from the clouds in rain and which forms rivers, lakes, seas and oceans. Water as used in this study refers to any clear, colourless, odourless, pleasant tasting liquid that is necessary for all forms of life.

Thus, it may imply that water is a transparent fluid which forms the world’s streams, lakes, oceans and rain that is a major chemical constituent of the fluids of living things. Furthermore, water can be used for domestic, irrigation, commercial, industrial and hydroelectric power purposes (Heaton, 1999).

Domestic water includes water used for normal household purposes such as drinking, food preparation, bathing and personal hygiene, dish washing, laundry, general household cleaning, watering of lawns and gardens.

Water is used for irrigation, which involves the supply of an area of land through pipes or channels with water to grow crops. Commercial and industrial water is used for manufacturing of goods, while water is also used for the generation of electricity, known as hydro-electricity.

Water is required in the human body for the maintenance of vital physiological and biochemical processes such as digestion, respiration, excretion and circulation. Water used for these purposes need to be clean, clear and free from harmful substances, minerals, chemicals and microorganisms.

This implies that water introduced into the human body must be safe. The consumption of safe water does not cause illness or health problems but maintains health. Safe water ought to be free from dirts, wastes, feaces and germs.

Also, it must be free from poisonous chemical compounds or the presence of chemicals, which must be below permitted level and minerals therein not exceeding tolerant level. It must also be tasteless, colourless, odourless, and drinkable.

Unfortunately, water often contains particles, dirts, microorganisms, bacteria of cocci, bacilli or flagella, coliforms, viruses, algae, Escherichia coli, Pseudomonas aeruginosa, Campylobacter spp, Salmonella spp, protozoas of Crysptosporidium and giardia lamblia thus making it unclean. In other to make water clean and safe for use, measures of hygiene like purification of water among others become important.

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Hygiene is a term that refers to practices that help maintain sound health and prevent disease. Pugh, Warner, Filardo, Binns, Francis, Lukens,…Cradle (2000) defined hygiene as any practice of cleanliness that promotes health and wellbeing especially of a personal nature.

Rand and Frazier (2007) referred to hygiene as including practices that relate to personal hygiene, food hygiene; environmental hygiene and keeping household environment free of excreta and solid wastes, as well as keeping drinking water supplies safe and free from contaminants.

It involves regular washing of the body, clothing, hair, brushing of teeth and caring for the gums (Ilika & Obanu, 2009). In addition, Center for Disease Control (CDC, 2014) referred to hygiene as behaviors that can improve cleanliness and lead to good health such as frequent hand washing, face washing and bathing with soap and water.

Nyanghura (2014) viewed hygiene as any personal effort to make oneself clean. Hygiene as used in this study refers to keeping water odourless, tasteless, colourless and free from microorganisms to prevent illness or disease in other to promote sound health when used.

It involves all the practices that help people stay healthy. This implies that hygiene is an embodiment of cleanliness of the human body, food, kitchen, environment and keeping water clean. The focus of this study was water hygiene.

Water hygiene eliminates or removes impurities and microorganisms from water to keep it safe for use. According to Business (2015), water hygiene is a process for enhancing the quality of water so that it meets the quality criteria for its fitness for intended use.

To achieve correct water hygiene, Mintz, Reiff and Tauxe (1995) revealed that one needs to have container with single opening five to eight centimeters in diameter with strong, tightly fitting cover that makes it easy to fill and add disinfectant but difficult to immerse hands or utensils.

In addition, Sobsey (2002) pointed that water carrying vessels should be between 10-25 liters capacity, rectangular or cylindrical with one or more handles and flat bottoms for portability and ease of storage among others.

In the context of this study, water hygiene refers to the use of various ways to eliminate impurities, odour, taste, colour and pathogens from water in order to keep it suitable for use to prevent disease and promote sound health when used.

In order to eliminate impurities, filtration, disinfection, aeration, coagulation, flocculation and sedimentation are important (Joint Departments of the Army and Air Force United States of America (JDAAUSA, 1985). Therefore, for any water hygiene to be effective, the multiple barrier principles identified by JDAAUSA (1985) as ways for the removal of contaminants in raw water is necessary.

This study is anchored on three theories – the soci al cognitive theory (SCT), theory of changing attitude (TCA) and the stage of change (transtheoretical) model (TTM). The SCT which was propounded by Bandura in 1986 assumes that learning occur when there is interrelation between behavoural, environmental and personal factors.

The SCT suggests how knowledge of women attending ANC may influence water hygiene. The theory of changing attitude (TCA) was developed by Zanna and Rempel in 1988. TCA is predicated on the tenets of cognition, affect and past. The theory suggests that attitude is not something stable but something that might change based on internal or external cues.

This theory suggests its influence by cognition (a source of information concerning water hygiene), the affect (one’s feelings as experienced in interaction with water) and the past (one’s previous experiences in interaction with water) that influence water hygiene KAP. The TTM was propounded by Prochaska and Diclemente in 1983 as a theoretical model of behavior (practice) change. The tenets are precontemplation, contemplation, preparation, action and maintenance.

It suggests that for any water hygiene practice to occur, women attending ANC may go through the stages. Gold (2013) suggested that for any change to be stable, the stage of successful, sustained lifestyle modification (practices) has to be attained.

Applied to this study, the transtheoretical theory suggests that women attending ANC can begin their practices of water hygiene at any point and when they become stable, there is sustained modification of lifestyle. However, the modification in practices of water hygiene may be of public health significance even in Plateau State.

This study was conducted in Plateau State, Nigeria. Situated in the middle belt region of the country, Plateau State shares common boundaries with the States of Bauchi, from the north; Taraba from the east; Nassarawa from the south; and Kaduna from the western part.

It was located in the middle belt region and one of the 36 States in Nigeria. Plateau State has an area of 26,899 square kilometers with three senatorial zones of northern, central and southern zones and 17 local government areas, with the State capital in Jos.

Nigeria Information and Guide (2014) noted that Plateau State got its name from the Jos plateau, a mountainous area with captivating rock formations. It is a source of minerals and many rivers to northern Nigeria due to volcanic activities million years ago. The rivers serve as sources of water for most people including women attending ANC.

It was expected that those attending ANC receive health education during their visits to the health facilities, which enables them to appreciate the need for hygiene, safety and good health for themselves, their foetus and other members of their family. In addition, it helps women attending ANC to strengthen the realization of the goal of safe delivery and good health as desired by ANC to its attendees.

Regrettably, it was observed that some women attending ANC often preferred and collected water for domestic use from sources closest to them irrespective of its quality, which implied negative attitude regarding water hygiene. Again, they chose wide opened containers to collect safe water for domestic use implying incorrect water hygiene knowledge.

Also, women attending ANC were observed to have collected and transported safe water in wide opened container for domestic use, which implied poor water hygiene practice. Thus, the expression and display of KAP of women attending ANC in the State as it concerned safe water use was worrisome.

It was obvious that the water situation in the State was plagued with concerns. No wonder, Chollom et al. (2013) revealed that contaminants in the water used in the State posed serious hazard to human health. This implied that it affected all and sundry, especially women attending ANC because of their condition. Moreover, the State authorities paid lip service to issues of safe water.

This was because the existing water treatment facilities were not maintained as large sums of monies was voted and publicized over the media with plausible intended water projects completed only on paper but not on ground for the people to benefit. The consequences involved the collection and use of water from all sources whether safe or unsafe.

Moreover, the way and manner water was collected, transported, stored and used by women attending ANC seemed troubling. It was against this background that the water hygiene KAP among women attending ANC was determined and the outcome used to proffer water hygiene enhancement strategies in Plateau State.

Statement of the Problem

Striving to get safe water requires scaling up safe water sources and ensuring that portable water reaches the homes in safe or hygienic state and used in such state by all and sundry including women attending ANC. To achieve this, government of Plateau State proposed the expansion of the existing water treatments facilities in the State.

The effort of the State government was further enhanced by the drilling of boreholes across the State by foreign Non-governmental organizations. Radio jingles on water use and handling by government was an attempt to ensure that safe water was used in homes in the State to promote sound health and wellbeing.

Regrettably, people including women who attended ANC and received hygienic orientation in health facilities of Plateau State collected water from different sources such as streams, rivers, surface water and shallow wells. Some collected water with wide opened containers.

In addition, the surroundings of the wells and boreholes which water for domestic use was got appeared unhygienic. Stray animals used spilled water around the drinking water source. Furthermore, freshly collected water was mixed with stored water for use.

Moreover, water was scooped from stored container at home. Women who attended ANC allowed little children scooped from stored water before use. They preferred and got water from any source closest to them for domestic use irrespective of its quality.

Despite the State government lofty efforts to avail safe water to the citizens for use; the projects were only completed on paper as the ongoing water project facilities were not

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completed and existing ones not maintained. This accounted for the collection of safe water for domestic purposes from nearest sources such as streams, rivers, and wells, which were sometimes unsafe.

Also, domestic water was sometimes collected and transported by women who attended ANC and received hygienic orientation in health facilities in opened containers without lid, implying incorrect practices of water hygiene. Moreover, women who attended ANC and received hygienic orientation in health facilities perceived stored domestic water in opened containers as positive attitude towards water hygiene.

Again, they chose wide opened containers like basins to collect domestic water implying incorrect knowledge of water hygiene. Also, the way and manner water was collected, transported, stored and used by women who attended ANC and received hygienic orientation in health facilities seemed troubling.

In addition, diseases such as hepatitis, typhoid fever and abdominal discomfort were often diagnosed in the State. Furthermore, literature reviewed revealed a study conducted on knowledge and practice of water purification in Lamingo community.

Such study did not cover the entire State neither was it particular to women who attended ANC and received hygienic orientation in health facilities nor their attitude or provision of enhancement strategies, which was worrisome.

The inadequate data on water hygiene KAP of women who attended ANC and received hygienic orientation in health facilities of Plateau State was the gap this study filled. Based on existence of the aforementioned in the State, this study determined the water hygiene KAP among women attending ANC in Plateau State and the outcome used and proffered the water hygiene enhancement strategies.

Purpose of the Study

This study determined the water hygiene knowledge, attitude, practice (KAP) and enhancement strategies among women attending ANC in Plateau State. Specifically, the study sought and determined:

1. water hygiene knowledge of women attending ANC in Plateau State;

2. water hygiene attitude of women attending ANC in Plateau State;

3. water hygiene practices of women attending ANC in Plateau State;

4. water hygiene knowledge of women attending ANC based on level of education in Plateau State;

5. water hygiene knowledge of women attending ANC based on location in Plateau State;

6. water hygiene attitude of women attending ANC based on level of education in Plateau State;

7. water hygiene attitude of women attending ANC based on location in Plateau State;

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8. water hygiene practices of women attending ANC based on level of education in Plateau State;

9. water hygiene practices of women attending ANC based on location in Plateau State; and

10. enhancement strategies of water hygiene KAP of women attending ANC in Plateau State.

Research Questions

In order to guide this study, the following research questions were posed:

1. what is the water hygiene knowledge of women attending ANC in Plateau State?

2. what is the water hygiene attitude of women attending ANC in Plateau State?

3. what is the water hygiene practices of women attending ANC in Plateau State?

4. what is the water hygiene knowledge of women attending ANC based on level of education in Plateau State?

5. what is the water hygiene knowledge of women attending ANC based on location in Plateau State?

6. What is the water hygiene attitude of women attending ANC based on level of education in Plateau State?

7. What is the water hygiene attitude of women attending ANC based on location in Plateau State?

8. What is the water hygiene practices of women attending ANC based on level of education in Plateau State?

9. What is the water hygiene practices of women attending ANC based on location in Plateau State?

10. What are the enhancement strategies of water hygiene knowledge, attitude and practice of women attending ANC in Plateau State?

Hypotheses

The following null hypotheses were postulated and tested at .05 level of significance.

1. There is no significant difference in the water hygiene knowledge of women attending ANC based on level of education in Plateau State.

2. There is no significant difference in water hygiene knowledge of women attending ANC based on location in Plateau State.

3. There is no significant difference in the water hygiene attitude of women attending ANC based on level of education in Plateau State.

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4. There is no significant difference in water hygiene attitude of women attending ANC based on location in Plateau State.

5. There is no significant difference in the water hygiene practice of women attending ANC based on level of education in Plateau State.

6. There is no significant difference in water hygiene practice of women attending ANC based on location in Plateau State.

Significance of the Study

The present study determined the water hygiene KAP of women who attended ANC in Plateau State. The study of this nature would be useful in several ways. Data generated on knowledge of water hygiene would be beneficial to health educators, environmental inspection officers (EHOs), midwives, researchers, women attending ANC and their family members.

The result of the study showed that majority of the respondents’ possessed correct knowledge regarding water hygiene. Health educators would find this result useful as they use the aspect of incorrect knowledge regarding water hygiene useful in sensitizing and teaching students on water hygiene issues.

The attempt to sensitize and teach students with the findings would create awareness in them concerning water hygiene, which ought to influence the students to better exercise appropriate water hygiene measures when it comes to water issues wherever they find themselves.

When students are sensitized and taught, they are better prepared to make informed decisions concerning water related issues wherever they find themselves. Moreover, health educators will utilize the result of the findings on knowledge of water hygiene as a guide to identify which area has incorrect knowledge of water hygiene and emphasize the dangers when teaching.

Additionally, EHOs will use the knowledge of the incorrect water hygiene to establish the most critical areas concerning water that attention needed to be drawn to among the populace including women attending ANC so as to avoid water contamination and live devoid of health problems from unsafe water that affects health when used.

Data generated on majority of women possessing correct knowledge of water hygiene, which implies that some possessed incorrect knowledge of water hygiene would be useful to researchers and midwives. This finding would serve as a resource of literature as well as serving as empirical data concerning research issues when the finding is quoted.

The midwives would use the findings to understand the magnitude or otherwise of the water hygiene issues of women attending ANC. As the midwives acquired this knowledge, they would in turn use it to teach women attending ANC when it comes to issues of water hygiene

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and the need to enhance knowledge of water hygiene. As the teaching to women attending ANC is done by the midwives using the finding, women attending ANC are better handled; and this leaves them better informed, consequently, benefiting better.

Within the field of water and allied profession, findings from knowledge of water hygiene based on level of education would generate data that will be useful to academics when they are conducting researches, planning workshops or seminars for their clients on water hygiene. It may also improve the education system because learning and teaching of women attending ANC would be enhanced by using the findings in future.

Findings on attitude towards water hygiene would be useful to women attending ANC and their family members. Through the findings on attitude towards water hygiene negative attitude towards water hygiene, which women attending ANC and their family members had would be modified or altered after their negative effects are exposed.

Additionally, the change or modification in the negative attitude towards water hygiene of women attending ANC and their family members would curtail the negative attitude towards water hygiene thereby promoting the health and wellbeing of women attending ANC and their family members when they understand the consequences of the expression of negative attitude towards water hygiene.

Health educators on the other hand would use the findings on the attitude towards water hygiene of women attending ANC and publicize it as a means for sensitizing the vulnerable groups.

As attitude towards water hygiene are published in reputable journals, they would enrich global data on the subject matter. When this is done, it would help to expand the literature on such aspects and also sensitize the public in general and women attending ANC in particular on the attitude towards water hygiene that are inimical to health.

This study generated findings on water hygiene practice. Results from water hygiene practice would unveil those practices regarding water hygiene that women attending ANC exhibited in Plateau State.

As the practices regarding water hygiene of women attending ANC were unveiled, it could be used as a weapon for making strong case for the need of education concerning correct practices regarding water hygiene. Based on the results of the practices of water hygiene of women attending ANC, Nigeria’s consumer policy makers may see the need to formulate policies that would make the teaching of water hygiene mandatory to all and sundry including women attending ANC.

Data generated from enhancement strategies revealed the impact appropriate strategies would have on women attending ANC and perhaps the populace. The revelation would be useful across gender irrespective of their occupation, social status and economic

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standing. It would again help women who would put to practice the various enhancement strategies so as to live healthy as they interact with water. As this is done, it will promote, maintain and preserve their health and those of their family members; thus making them healthy including their fetuses. Furthermore, the social cognitive theory; theory of change attitude and transtheoretical model of change were used in this study.

To give this study theoretical significance, the social cognitive theory, theory of changing attitude and the stage of change (transtheoretical) model were the theories of anchor. These theories were based on the premises that suggested how and why women who attended ANC possessed correct or incorrect knowledge of water hygiene; why attitude towards water hygiene was expressed by women who attended ANC and why women who attended ANC were involved in the practice of certain practices of water hygiene.

Scope of the Study

This study was delimited to Plateau State, Nigeria, with three senatorial zones and seventeen local government areas. The study also covered water hygiene KAP and enhancement strategies among women who attended antenatal care in Plateau State.

The study was also delimited to the various components of water hygiene hygiene, which included water storage, water transportation, and water collection, point-of-use (PoU) of water, water source protection and water purification.

The components of water hygiene were determined in relation to demographic variables such as location and level of education. Furthermore, the study was delimited to theories such as Social Cognitive Theory (SCT), Transtheoretical Model of Change (TTM) and theory of Changing Attitude (TCA) which were relevant to water hygiene KAP in Plateau State. The study also covered women who attended antenatal care in Plateau State.

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