A research proposal On

Knowledge and Practice on Water Sanitation and Hygiene (WASH) among mother groups of under-5 children

Submitted to Department of Public Health Valley College of Technical Sciences Purbanchal University

Submitted by Anil Dhungana Bachelor of Public Health Third Year (1st Batch) Valley College of Technical Sciences Mid- Baneshwor, KathmanduJuly, June, 2011

ABBREVIATIONS

AIDS ARI BPH DALY DoHS ECHO ENPHO HIV KDS KIRDARC MDG MoHP NDHS NEWAH NHRC ORS PHC PPPHW SNV

Acquired Immune Deficiency Syndrome Acute Respiratory Illness Bachelors of Public Health Disability-Adjusted Life Years Department of Health Science European Commission Humanitarian Aid and Civil Protection Environment and Public Health Organization Human Immune deficiency Virus Kami Damahi Sharki Karnali Integrated Rural Development and Research Centre Millennium Development Goals Ministry of Health and Population National Department of Health Survey Nepal Water for Health Nepal Health Research Council Oral Rehydration Solution Primary Health Care Public-Private Partnership for Hand Washing Netherlands Development Organization

SPSS
UN UNICEF VCTS VDC WASH WHO WSH

Statistical Package for Social Sciences United Nations United Nations Childrens Fund Valley College of Technical Sciences Village Development Committee Water Sanitation and Hygiene World Health Organization Water Sanitation and Hygiene

SUMMARY

Water Sanitation and Hygiene (WASH) is still a burning issue in the context of developing countries like Nepal as many diseases related to it are causing the maximum number of childs death.

This study will be focused on evaluating knowledge and practice on WASH among the mother groups of under-5 children.

The research is targeted to mother groups because it has been found that the diarrhoeal diseases caused due to poor sanitation and hygienic condition as well as impure drinking water is the leading cause of under-5 mortality and morbidity.

The general objective of this study is to systematically assess level of the knowledge and practice on water, sanitation and hygiene among the mother groups of under-5 children.

The design for the study will be cross-sectional descriptive study. The data will be collected from the mother groups of under-5 children in Dharmasthali VDC of Kathmandu district. The data will be collected by interview using questionnaire.

The findings although may not be generalized to other wards and the country as a whole, it will be forwarded to the concerned sectors for recommendations.

The time frame for the study will be five months starting from Chaitra 2067 to Shrawan 2068.

TABLE OF CONTENT
Content ABBREVIATIONS SUMMARY TABLE OF CONTENTS Page No. i iii iv

CHAPTER I: INTRODUCTION 1.1 1.2 1.3 Background Statement of the problem Rationale of the study

1-4 1 2 3

CHAPTER II: LITERATURE REVIEW 2.1 2.2 Status of WASH in Global Scenario Status of WASH in the context of Nepal

5-9 5 7

CHAPTER III: RESEARCH OBJECTIVES 3.1 3.2 General Objectives Specific Objectives

10

CHAPTER IV: RESEARCH QUESTIONS

11

CHAPTER V: RESEARCH METHODOLOGY 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Study area Study Method Study Design Study Population Sample Unit Sample Size Sampling Method Data Collection Tools

12-14 12 12 12 12 12 12 13 13

5.9 5.10 5.11 5.12 5.13 5.14

Data Collection Techniques Criteria of the Study Ethical Consideration Validity and Reliability of the Study Limitation of the study Data Management and Analysis

13 13 13 14 14 14

CHAPTER VI: VARIABLES

15

CHAPTER VII: CONCEPTUAL FRAMEWORK

16

CHAPTER VIII: OPERATIONAL DEFININATION

17

CHAPTER IX: WORK PLAN

18

CHAPTER X: BUDGET

19

REFERENCES

20-22

UNIT I INTRODUCTION

1.1

Background

In many countries there exists a high prevalence of water and sanitation related diseases, causing many people, children in particular, to fall ill or even die. Improved hygiene practices are essential if transmission routes of water and sanitation related diseases are to be cut. Whereas appropriate hygiene education can bring about the intention to change hygiene behaviour, for most hygiene behaviours appropriate water and sanitation facilities are needed to allow people to transform intention to change into real change. 1

Access to Water, Sanitation and Hygiene (WASH) is a pre-condition for people to acquire good health, well-being and even benefit from economic development. Without it, the increasing rate of population and economic growth tend to negatively affect the most vulnerable segments in society: women, children and marginalized communities. 2

It is obvious that to reduce infant and child mortality, improve quality of life, and reduce poverty, greater efforts and investment are needed to increase safe water, affordable hygienic sanitation and adequate hygiene promotion. Improvement of water, sanitation and hygiene promotion provides a range of benefits for peoples well-being, particularly the poor and marginalized. Improved sanitation and promotion of hygienic behaviour reduce health risks, and eventually contribute to the socio-economic development of the nation.3

The disease burden from unsafe water, sanitation and hygiene (WSH) is estimated at the global level taking into account various disease outcomes, principally diarrhoeal diseases. The risk factor is defined as including multiple factors, namely the ingestion of unsafe water, lack of water linked to inadequate hygiene, poor personal and domestic hygiene and agricultural practices, contact with unsafe water, and inadequate development and management of water resources or water systems. 4

The disease burden caused by the risk factor unsafe WSH was estimated at the global level in 1990 (Murray and Lopez 1996a). This original estimate examined WSH in terms of diarrhoeal and selected parasitic diseases, based on the partial attribution of their disease burden to the risk factor. It was found that worldwide the risk factor accounted for 5.3% of all deaths and 6.8% of all disability-adjusted life years (DALYs). Other communicable (e.g. hepatitis A and E, malaria) and non-communicable diseases (arsenicosis, fluorosis, methaemoglobinaemia) were not considered in that assessment. 4

1.2 Statement of problem Inadequate and unsafe water, poor sanitation, and unsafe hygiene practices are the main causes of diarrhoea, which results in at least 1.9 million under-5 child deaths annually worldwide. Diarrhoea morbidity rates are increasing- children in developing countries average four to five debilitating bouts of diarrhoea per year, which can cause and exacerbate malnutrition and result in long-term growth stunting. The only way to sustainably reduce this massive burden of disease is through the use of safe drinking water, sanitation and improved hygiene practices, in particular hand washing with soap.6

Water, sanitation and hygiene are also linked to many other diseases that kill children or stunt their development, including helminth infections, dracunculiasis, trachoma, cholera, fluorosis and arsenicosis. Children (and adults) living with HIV/AIDS, because of their weakened immune systems, are especially susceptible to the debilitating effects of persistent bouts of diarrhoea. There is also emerging evidence linking better hand-washing practices with reduced incidence of acute respiratory infections. 6

In the context of Nepal, sanitation coverage is just 27% which results in widespread disease as the majority of people do not have a latrine and have to defecate in the open. The national average of access to toilets of Nepal is estimated at 40%. 2, 7

Water-related diseases are very common in Nepal but for the majority of the population the causes of ill health are shrouded in superstition. Hand-washing is not common practice, with only 37% washing their hands with water, and 12% with soap at critical times. 7

According to the DoHS survey, 113 deaths of children under-5 years of age had been reported due to diarrhoeal diseases resulting from poor sanitation and hygiene and impure drinking water in the fiscal year 2063/64 in Nepal.9

1.3 Rationale of the problem Many people believe that simply providing a fresh, clean water supply will substantially reduce water-borne illnesses. What most people do not know is that safe hygiene practices and access to sanitation are crucial for combating the main health threats to children under five, in particular diarrhea. Approximately 88 per cent of all diarrhea infections worldwide are attributed to unsafe water supply, the lack of safe hygiene practices and basic sanitation Infrastructure (Evans 2005). And the scale of the problem is immense: today, nearly twice as many people lack access to sanitation compared with water supply (UN 2005).5

In recent years, sanitation has raised up the international policy agenda. In 2002, sanitation was included in the Millennium Development Goals (MDGs), and specifically within MDG 7 Target 10 which sets the aim of halving by 2015. The proportion of people without sustainable access to safe drinking water and basic sanitation yet at national level in most developing countries, hygiene and sanitation do not yet receive much attention, despite important health implications. 5 WASH is linked in many ways to peoples livelihoods and sustainable development in general; it is an important input not just for Target 10 of Millennium Development Goal 7 but for all of the Goals. WASH is a key input for the achievement of universal primary education and reductions in child mortality (Goals 2 and 4) and is directly linked to the eradication of poverty and hunger, the empowerment of women, improvements in maternal health and the reduction of diseases (Goals 1, 3, 5 and 6).6

In addition to coverage disparities between countries and regions, there are significant inequities within countries: clear rural-urban disparities as well as coverage and service level disparities between richer and poorer households. The urban poor usually have very low access to water and sanitation services, and pockets of people - such as indigenous groups often have even lower access.6 Diarrhea is caused by dirty water and lack of sanitation and good hygienic practices and diarrheal disease kills 2.2 million people mostly children under five worldwide each year. There are around 4 billion cases of diarrhea each year. 8 The Alma-Ata conference held in 1978 also had determined an adequate supply of safe water and basic sanitation as one of the element of primary health care (PHC).

The study is targeted to the mother groups of under-5 years of age children because the diseases associated with WASH are the leading cause of under-5 mortality and morbidity and the mothers are directly linked with the childs health as they are the one who take care of their children.

UNIT II LITERATURE REVIEW

The study problem is selected after thorough literature search and discussion with teachers and colleagues. The related information required for the study has been collected from different sources such as DoHS Annual reports, library of different institutions i.e. ENPHO library, VCTS library, MoHP library, NHRC library, different related journals and publications and internet search.

The relevant national and international literatures on water sanitation and hygiene among different group published by different organizations are reviewed and attempted to present in this section. The various facts & figures reviewed from different literatures, that are directly or indirectly relevant to the study topic are presented here as follows:

2.1 Status of WASH in Global scenario A large fraction of the worlds illness and death is attributable to communicable diseases. Sixty-two percent and 31% of all deaths in Africa and Southeast Asia, respectively, are caused by infectious disease. This trend is especially notable in developing countries where acute respiratory and intestinal infections are the primary causes of morbidity and mortality among young children. Inadequate sanitary conditions and poor hygiene practices play major roles in the increased burden of communicable disease within these developing countries. Previous hand hygiene studies have indicated that children with proper hand washing practices are less likely to report gastrointestinal and respiratory symptoms. Hand washing with soap has been reported to reduce diarrheal morbidity by 44% and respiratory infections by 23%. However, globally, the rates at which hands are washed with soap range from only 0-34% of the time. 10

A study conducted by the Global Public-Private Partnership for Hand Washing (PPPHW) which included several sub-Saharan African countries (i.e. Kenya, Senegal, Tanzania, and Uganda) reported that 17% of participants washed their hands with soap after using the toilet, while 45% used only water traction (i.e. cleaner people are more attractive), comfort (i.e. hands feel and smell fresh), and fear (i.e. avoid the risk of disease).10

According to Ricard Gine, 884 million people do not use improved sources of drinking water, and 2600 million people do not use improved sanitation. 84% of the world population, without an improved drinking-water source, lives in rural areas in developing regions, 94% of the urban population uses improved sources. In rural areas, it is only 76%. Seven out of 10 people without improved sanitation live in rural areas. In developing regions, use of improved sanitation in urban areas (68%) but it is only 40% in the rural areas.11 Almost 900 million people lack access to an improved water supply and 2.6 billion to basic sanitation (WHO & UNICEF 2010).12

Many studies have reported the results of interventions to reduce illness through improvements in drinking water, sanitation facilities, and hygiene practices in less developed countries. Diarrhoeal disease is one of the leading causes of morbidity and mortality in less developed countries, especially among children aged under-5 years.13

Since 1990, over 1 billion people have gained access to improved drinking water and sanitation services. Nonetheless, 2.6 billion people - over half of the developing worlds population - do not have improved sanitation facilities, and 1.1 billion are still using water from unimproved sources. Barely one third of the population of South Asia uses improved sanitation facilities. In sub-Saharan Africa, sanitation coverage increased by only 4% between 1990 and 2002, and in nine countries, rural sanitation coverage is less than 10%.6

According to the survey done by Kashmir Charitable Trust in District Muzaffarabad, Pakistan, in August 2008, 48% people havent any latrines and go to open fields for defecation and among people having latrines, only 48% of women use it. 72% of the respondent of the survey reported that muddy water to be dirty and 6% said that filtering by

cloth can make the water clean. Also, 55% of the survey population use stones to clean themselves after defecation. 5

A survey done by WE Consult Lda for UNICEF Mozambique in 18 districts of Mozambique in 2009, had found only 15% of the households practices some form of household water treatment. The water quality at the household is significantly lower than at the source, indicating unhygienic practices during collection, transport and storage. 54% of all households still practices open defecation. The coverage of improved sanitation facilities is on average only 2% for the whole survey area. The majority of the households bury the stools of children or disposes of them in the latrine. Although almost everyone washes the hands, only 1% uses the proper practice, which is washing with running water and using soap or ashes. The vast majority washes the hands in a basin or bucket.14

2.2 Status of WASH in the context of Nepal Ninety percent of urban households and 80% of rural households have access to a source of drinking water, and 46% have access to improved sanitation facilities in Nepal (NDHS, 2006). The growth trend of water coverage (46% in 1990 and 82% in 2006) and the increase in sanitation achievements (6% in 1990 and 46% in 2006) indicate that Nepal is progressing toward its MDG target. Nonetheless, achievement of universal coverage is still in question. It is obvious that to reduce infant and child mortality, improve quality of life, and reduce poverty, greater efforts and investment are needed to increase safe water, affordable hygienic sanitation, and adequate hygiene promotion. Even though Nepal has made significant progress in reducing the child mortality rate (162 in 1990 to 61 per 1,000 live births in 2006) as per NDHS, 2006; however, basic indicators of better health, such as hygiene and sanitation, are still in a critical state in Nepal. Among WASH associated diseases, skin diseases, Acute Respiratory Infections (ARI), and diarrhoeal diseases are the top three leading preventable diseases reported in Nepal. Water Aid in Nepal highlighted during the year 2009 through various reports that, ARI and diarrhoeal diseases remain the leading

causes of child deaths (10,500 diarrhoeal deaths among children under 5 years of age and younger per year) in Nepal.3

Statistics from a national study indicate that in rural areas of Nepal, 37% of people wash their hands with water only, and only 12% use soap (Will, 2008). Research study findings from Nepal produced by Johns Hopkins Bloomberg School of Public Health in 2008 indicate that hand washing also saves newborn lives; the study indicated a 19% lower risk of death among newborns at home in rural Nepal when birth attendants washed their hands before delivery and a 44% reduction in risk of death if mothers washed their hands prior to handling their newborn infant. Although hygiene promotion and its adoption by local people significantly improves human health, in contrast to water supply or sanitation, associated targets for addressing hygiene awareness have not been set at the national level in Nepal in the WASH sector.3

According to a survey done by Mission East and KIRDARC on Water, Sanitation and Hygiene (June 08 till July 09) funded by ECHO, in selected villages of Kalika, Shreenagar, Jaira, Saya VDCs of Humla district and Dainakot VDC of Mugu district, Karnali zone, 71% of the respondents were using tap water as a source of water. Only one fourth (25%) had practice of covering the water pot. 40%of the respondents had a latrine in their house with direct pit. 50% of their children less than 5 year used to defecate on their clothes and the rest of them in the household surrounding area. Among those with access to a latrine, observation shows that 62% of latrines are dirty. 90% of respondents did not practice hand washing before preparing the food. 40% of them used to wash their hands before feeding their baby. Hand washing after defecation was 95%.Of those who wash their hand after defecation, 21% wash their hands only with water, and 23% have the practice to use soap/ash water. Regarding taking care of children's health, it was found that more than 53 % of respondents didnt care about their childrens health. 25% of respondents were aware about diarrhoea symptoms, and it was found that 27% of the respondents had suffered from diarrhoea during the previous month.15

According to the an article published on a newspaper Sanjiwani Patra on May 23, 2008, A campaign spreading message of "One Household, One latrine" has begun in Mahankal a community located in Bhugdeu VDC of Kavre district in order to improve the sanitary sondition of the VDC. Only after when NEWAH supported to provide awareness on subjects like latrine usage, environmental sanitation, usage of clean drinking water etc to the people, they started taking interest in sanitation activities in the community.16

UNIT III RESEARCH OBJECTIVES

3.1 General objectives To assess the knowledge and practice on water, sanitation and hygiene among the mother groups of under-5 children.

3.2 Specific objectives To identify gaps between knowledge and practice regarding WASH. To describe the socio demographic, cultural information of respondents. To find out the incidence of disease due to unhygienic practices.

UNIT IV RESEARCH QUESTIONS

What is the knowledge on water sanitation and hygiene (WASH) among mothers of under-5 children?

What is of practice on water sanitation and hygiene (WASH)?

What is the gap between the knowledge and practice among the mother groups of under-5 children?

CHAPTER V RESEARCH METHODOLOGY

5.1 Study Area Dharmasthali VDC of Kathmandu district is chosen purposively.

5.2 Study Method

The study is quantitative.

5.3 Study Design

Cross-sectional Descriptive

5.4 Study population

Mother group of under-5 children of Dharmasthali VDC

5.5 Sample Unit Individual mothers

5.6 Sample size

The sample size will be calculated using the formula given below: z2pq d2

sample size (n) =

where, 'p' is the proportion of the cases, q = 1-p d = systematic error z = level of significance

5.7 Sampling Method Simple random sampling will be used to get the required number of cases.

5.8 Data collection tools Data will be collected by using structured and semi-structured interview questionnaire. The questionnaire will consist of four main parts:

Socio-demographic data Questions related to water Questions related to sanitation Questions related to hygiene

5.9 Data collection technique Interview

5.10

Criteria of the study

5.10.1 Inclusion criteria All mothers having children less than 5 years of age will be studied irrespective of social class, caste, ethnicity etc.

5.10.2 Exclusion criteria Non responsive mothers

5.11 Ethical considerations The approval letter from the college will be taken for the conduction of the research on my topic. Purpose and the objective of the research will be explained before to the respondents. Verbal consent of the respondent will be taken prior to data collection.

Privacy and confidentiality will be maintained

5.12 Validity and Reliability of the Study Nepali language will be used during data collection with respondents. Research will be carried out under assistance the research guide. The researcher will be directly involved in data collection, cross-checking, data processing and data analyzing. Each filled questionnaire will be re-checked just after the interview in order to correct any mis/under responds. Regular review of literature will be done.

5.13 Limitations of the study

This is a small-scale study done for the partial fulfillment of the requirement of the BPH program within short period of time hence covers small area of study.

Limited resources as a student. Difficult to generalize the result to district and the country.

5.14 Data management and analysis Filled questionnaire will be checked on the spot for its completeness. All the collected information will be examined on the basis of the research objectives. Data entries, editing and coding/recoding will be done in Excel/SPSS program. Standard general statistical methods will be applied using computer for data analysis. Findings will be presented through texts, tables & figures.

UNIT VI VARIABLES
6.1 Dependent Variables 6.1.1 Knowledge and practice on WASH Water related variables Knowledge and practice of water purification Sanitation related variables Knowledge of proper waste disposal (solid and liquid waste) Practice of use of latrine Practice of proper waste disposal (solid and liquid waste) Hygiene related variables Knowledge and practice of proper hand washing Knowledge of ORS preparation Knowledge of WASH related diseases

6.2 Associated Variables/ Independent Variables 6.2.2 Socio-demographic variables Age Ethnicity Religion Education Occupation

UNIT VII CONCEPTUAL FRAMEWORK

Independent Variables

Water Related Variables

Sanitation Related Variables

Hygiene Related Variables

Dependent Variable
Knowledge
Water Sanitation Hygiene Practice

Socio-Demographic Variables
Figure 1: Conceptual Framework

UNIT VIII OPERATIONAL DEFINATION

Educational status of the mother: Illiterate: Cannot read and write Literate: Can read and write Non formal Received Primary education: Up to Grade V. Secondary education: Grade VI to X Certificate and above

Occupation of the mother: Housewife: Work done only at their home Service: Work done on basis of their salary Agriculture: Work done in farm for cultivation Student: Studying in certain level Labourer: Work done on daily wage basis

Diseases related to WASH Dairrhoea, helminth infections, cholera, dysentery.

Proper hand washing: Knows 6 steps of hand washing recommended by WHO

UNIT IX WORK PLAN

The overall work plan of the activities of the research that is to be carried out is explained on the Gantt chart below:
S. N

Activities

Chaitra
1 2 3 4

Baisakh
1 2 3 4

Jestha
1 2 3 4

Ashad
1 2 3 4

Shrawan
1 2 3 4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Literature search & review Topic selection Proposal writing Finalization of proposal Submission of proposal Preparation of tools Finalization of tools Preparation of data collection Data collection Data entry & analysis Report writing Submission & comment on draft Revision of report Submission of report Oral defense

UNIT X BUDGET

The tentative budget that is needed for different purposes during entire research work is summarized below:

S.N

Particulars

Amount (in NRs.)

1. 2.. 3.. 4.. 5.. 6. 7.

Questionnaire print cost Photocopying cost Travel cost Fooding cost Report print & binding cost Report duplication Miscellaneous cost Total cost

200.00 500.00 1000.00 1500.00 300.00 1000.00 500.00 5000.00

REFERENCES

1. A Manual on School Sanitation and Hygiene. New York: United Nations Childrens Fund; [updated 1998 Sept; cited 2011 Apr 16]. Available from:

http://www.unicef.org/wash/files/Sch_e.pdf

2. Water, Sanitation and Hygiene. Kathmandu: SNV; [cited 2011 Apr 16]. Available from: http://www.snvworld.org/en/countries/nepal/ourwork/Documents/SNV%20factsheet%20 WASH.pdf

3. Gautam, O.; Adhikari,B.; Rajbhandari,K.; Jones,O. Stages of Hygiene Monitoring: An Operational Experience from Nepal. South Asia Hygiene Practitioners' Workshop; Feb 2010: Dhaka, Bangladesh: Water Aid Nepal. Available from:

http://www.wsscc.org/sites/default/files/publications/8_gautam_stagesofhygienemonitori ng_nepal_2010.pdf

4. Annette Prss-stn, David Kay, Lorna Fewtrell and Jamie Bartram, Unsafe water, Sanitation and Hygiene. In: Comparative Quantification of Health Risks. P. 321-48. Available from: http://www.bvsde.paho.org/bvsacd/cd56/1321-1352.pdf

5. PRE KAP Report on Sanitation and Hygiene. Muzaffarabad District: Kashmir Charitable Trust; [cited 2011 Apr 16]. Available from:

http://www.docstoc.com/docs/22257035/KAP-report-on-sanitation-and-hygiene 6. UNICEF Water, Sanitation and Hygiene Strategies for 2006-2015. United Nations Childrens Fund; [updated 2006; cited 2011 Apr 16]. Available from:

www.unicef.org/wash/index_43004.html

7. Water, Sanitation and Hygiene. Kathmandu: Water Aid Nepal; [cited 2011 Apr 17]. Available from: http://nepal.wateraid.org/what-we-do/sanitationandhygiene

8. Integrating Water, Sanitation and Hygiene into Primary Schools and Teacher Training. Washington DC. Hygiene Improvement Project, the Academy for Educational Development; [updated 2008 Sept; cited 2011 Apr 18]. Available from:

http://www.k4health.org/system/files/sites%252Fdefault%252Ffiles%252FWASH%2Bin %2Bschools%2Bteacher%2Btraining.pdf

9. Department of Health Services. Annual Report 2063/64. Kathmandu: 2063; Department of Health Services. 10. A.P. Vivas , B. Gelaye , N. Aboset, A. Kumie, Y. Berhane, M.A. Wiliams. Knowledge, Attitudes and Practices (KAP) of Hygiene among School Children in Angolela, Ethiopia. Washington: Bizu Gelaye; [updated 2010; cited 2011 Apr 17]. Available from http://www.jpmh.org/issues/201051205.pdf 11. Ricard Gine. Key Challenges for the Rural WASH Sector (Water, Sanitation and Hygiene) in Developing Countries. Science against Poverty Conference; 8-9 April, 2010: La Granja. Available from:

http://www.scienceagainstpoverty.com/Resources/documentos/Programa/ppt/d1/Ricard_ Gine_ppt.pdf

12. Guy Howard, Katrina Charles, Kathy Pond, Anca Brookshaw, Rifat Hossain and Jamie Bartram. Securing 2020 Vision for 2030: Climate Change and Ensuring Resilience in Water and Sanitation Services. Journal of Water and Climate Change. 2010 Mar 17; 01.1. Available from: http://www.iwaponline.com/jwc/001/0002/0010002.pdf

13. Lorna Fewtrell, Rachel B Kaufmann, David Kay, Wayne Enanoria, Laurence Haller, and John M Colford Jr. Water, Sanitation, and Hygiene Interventions to Reduce Diarrhoea in Less Developed Countries: A Systematic Review and Meta-Analysis. Aberystwyth, UK: Lorna Fewtrell; [updated 2005 Jan; cited 2011 Apr 17]. Available from: http://www.bvsde.ops-oms.org/texcom/nutricion/ref7.pdf

14. Water, Sanitation and Hygiene. Maputo, Mozambique: UNICEF Mozambique; [updated 2009 Jan; cited 2011 Apr 18]. Available from:

http://www.unicef.org/mozambique/WASH_baseline_survey_UNICEF_270209.pdf 15. Clean Water, Improved Sanitation and Hygiene Promotion in Rural Villages of Humla and Mugu, Mid West Nepal. Nepal: Mission East/KIRDARC; [updated 2009 Oct; cited 2011 Apr 18]. Available from: http://reliefweb.int/node/338125

16. Dahal, Rama. One Household One Latrine. Sanjiwani Patra. 2008 May 23.

ANNEX

Valley College of Technical Sciences Mid Baneshwor, Kathmandu Bachelors of Public Health (3rd Year) Research Questionnaire On
Knowledge and practice on Water, Sanitation and Hygiene (WASH) among mother group of under-5 children

Date:-..

Respondent No.:-

A. Socio-demographic Information
1. 2. 3. 4. 5. 6. Name of respondent:-. Age of respondent:- District:- Kathmandu VDC:- Dharmasthali Ward No.:-. Education:a) Illiterate b) Literate c) Primary level d) Lower Secondary level e) Secondary level f) Higher Secondary level g) Bachelors and above b) Agriculture e) Labour b) Chettri e) KDS b) Buddhist f) Other... c) Service f) Other c) Newar f) Other c) Christian

7. Occupation: - a) House wife d) Student 8. Ethnicity: a) Brahmin d) Rai/ Limbu/ Gurung 9. Religion: a) Hindu d) Muslim

B. Questions related to water

10. What is the main source of your drinking water? a) River or Stream b) Spring d) Standpipe or tap e) Stagnant pool or dam 11. What time does it take to reach the source of water? a) 5 or less than 5 minutes b) 5-15 minutes c) 15 minutes or more 12. Do you purify drinking water before use? a) Yes b) No 13. If yes, which method do you use for purification of water? a) Boil b) Filter c) Chlorinate d) Other. 14. What kind of water do you use to dilute or mix in the babys food? a) Boiled water b) Unboiled but filtered c) Filtered water d) Tap water e) Other.. 15. Only at the time when you are sick you need to drink clean water. a) Yes b) No c) Dont know

c) Borehole or well f) Other

C. Questions related to sanitation

16. How do you manage Liquid Wastes coming from household activities? a) Use in kitchen Gardening b) Feed to cattle c) Throw haphazardly d) Other. 17. How do you dispose Solid Waste that comes out of your house? a) Burn b) Bury c) Throw haphazardly d) Prepare compost e) Other 18. Where do you defecate? a) Latrine b) River bank d) Other.

c) Haphazardly (open places)

19. (If no latrine), why didnt you construct latrines? a) Not necessary b) No money c) No place d) Didnt know e) Other 20. Where do your children under-5 years defecate? a) Latrine b) River bank c) Haphazardly (open places) d) Other.... 21. Where do you dispose of stools of children younger than 3 years? a) Put/rinsed in drain or ditch b) Left in the open c) Throw in into garbage/ with solid waste d) Buried e) Used toilet or rinsed in toilet f) other

22. Why is it important to have latrines? (multiple choices) a) To keep Clean village b) Free from odor c) Safe from disease d) Other.

D. Questions related to hygiene

23. What do you use to wash your hands before having meal? a) Only water b) Soap and water c) Ash and water d) Mud and water e) Dont wash hands f) Other... 24. What do you use to wash your hands after defecation? a) Only water b) Soap and water c) Ash and water d) Mud and water e) Dont wash hands f) Other... 25. Why should we wash our hands? (multiple choices) a) To be clean b) To reduce diseases d) To reduce foul odour e) Dont know 26. Do you know the proper hand washing steps? a) Yes b) No 27. (If yes) demonstrate. a) Correct

c) To be healthy f) Other.

b) Incorrect

28. Age of children they begin using latrine. a) About 1 b) About 2 c) About 3 e) About 5 f) Children do not use latrines

d)About 4

29. Do you know what causes worms to children? (multiple choices) a) Eating sweet things b) Dirty water c) Stale food d) Unbalanced diet e) Flies f) Dont know g) Other 30. How diarrhea spreads?(multiple choices) a) Dirty environment c) Use of unhygienic food e) Dont know b) Pathogens from stools d) Drinking unsafe water f) Other..

31. In previous 6 months, had any one suffered from any diarrhoeal disease? a) Yes b) No 32. If yes, what was the problem? a) Diarrhoea d) Helminth infection

b) Dysentery e) Other.

c) Cholera

33. How do you treat yourself or family members after getting diarrhea? a) Use ORS b) Use homely made sugar-salt solution c) Take to HPs d) Take to Traditional Healers e) Do nothing f) Other.. 34. What you do in case child gets attack of diarrhea? a) Consult medical personnel b) Consult Peer c) Use ORS d) Keep Home e) Do nothing f) Other. 35. (If ORS is not used) Have you heard about ORS for treating diarrhea? a) Yes b) No 36. Do you know the process of preparing ORS? a) Yes b) No 37. If yes, how do you prepare? a) Correct b) Incorrect

38. Are your babies exclusively breastfed? a) Yes b) No 39. On what you fed your baby/babies? a) Bottle b) Bottle & Breast c) Other..

c) By Breast only

40. How is baby bottle or cup cleaned? a) Soap, boiled water b) Boiled water only c) Soap, unboiled water d) Tap water e) Other. 41. When do you wash vegetables? a) Before cutting b) After cutting

c) Both times

d) Dont wash