Water, Sanitation, and Hygiene Practices and Socioeconomic Factors that Contribute to Diarrhea in School-Aged Children in the Moyamba District in Sierra Leone Open Access

Abstract

Title: Water, Sanitation, and Hygiene Practices and Socioeconomic Factors that Contribute to Diarrhea in School-Aged Children in the Moyamba District in Sierra Leone

Background: Diarrhea remains the second leading cause of death among children under five and kills more children than AIDS, malaria, and measles combined (CDC, 2015). It is estimated that nearly 90% of diarrhea-associated deaths are attributable to unsafe water and inadequate sanitation and hygiene (CDC, 2015). As of 2017, WASH was the number two risk factor driving death and disability rates in Sierra Leone (Institute for Health Metrics and Evaluation, 2019). The purpose of this thesis is to understand whether WASH practices and socioeconomic factors contribute to diarrheal disease in school-aged children in five villages in the Moyamba District of Sierra Leone.

Methods: Data was collected via paper copy household surveys administered from May to July in 2019 in five villages in the Moyamba District of Sierra Leone. Data was cleaned in Excel, imported into SAS, and analyzed using descriptive statistics, Chi-square, and logistic regression analyses.

Results: There were 21 cases of diarrhea (13.8%) reported by 152 participants. As for WASH practices, 71.1% of all participants used unprotected water sources, 61.8% used unimproved sanitation facilities, and 52.6% reported using soap and water for handwashing materials as opposed to just water. For socioeconomic factors, 65.8% of participants reported no head of household education; 51.3% of the participants had daily household income less than 10,000 leones; over 50% had a PPI score greater than 43 (highest score = 81); 52.6% had mud flooring in their households; and over half of all participants reported discarding of child feces into a bush. Logistic regression showed type of toilet had largest impact on diarrhea with an odds ratio of 1.30 (99% CI: 0.139, 12.1780) when controlling for water source, handwashing materials, household flooring material, disposal location of child feces, and head of household education.

Conclusion: The findings from this thesis contribute to the existing public health knowledge regarding the importance of safe WASH practices and the impact they have on diarrhea. Furthermore, these findings provide evidence that no single intervention will affect diarrhea as profoundly as an intervention that considers water, sanitation, and hygiene in addition to socioeconomic status.

Table of Contents

Table of Contents

List of Tables and Figures………………………………………………………………….       ii

Introduction…………………………………………………………………………………       1

   Introduction and Rationale………………………………………………………………...       1

   Problem Statement…………………………………………………………………………      3

   Purpose of Study…………………………………………………………………………...      4

   Significance Statement……………………………………………………………………..      5

   Definition of Terms………………………………………………………………………...      6

Literature Review……………………………………………………………………………     7

   Introduction………………………………………………………………………………...      7

   Definition and Etiology of Diarrhea……………………………………………………….      7   

   Transmission Routes for Diarrheal Pathogens…………………………………………….     10

   Diarrhea Globally………………………………………………………………………….     12

   Childhood Diarrhea in Sierra Leone………………………………………………………     14

   Water, Sanitation, and Hygiene (WASH) Globally……………………………………….     15

   WASH in Sierra Leone…………………………………………………………………….    19

   Socioeconomic Risk Factors for Diarrhea…………………………………………………    20

   Research Gaps and Importance…………………………………………………………….    23

Methodology………………………………………………………………………………….   25

   Introduction…………………………………………………………………………………   25

   Study Setting and Population……………………………………………………………….   25

   Research Instrument and Design……………………………………………………………  27

   Procedures…………………………………………………………………………………..   29

   Data Analysis………………………………………………………………………………..  30

   Ethical Considerations………………………………………………………………………  33

Results…………………………………………………………………………………………  34

   Descriptive Analysis………………………………………………………………………...  34

   Chi-square Analysis…………………………………………………………………………  37

   Logistic Regression with WASH Factors…………………………………………………...  38

   Logistic Regression with Socioeconomic Factors…………………………………………..  39

   Logistic Regression with WASH Factors, Controlling for Socioeconomic Factors………... 42

   Full Logistic Regression Models, Controlling for WASH and Socioeconomic Factors……. 43

Discussion, Recommendations, and Conclusion……………………………………………. 46

   Discussion…………………………………………………………………………………… 46

   Limitations…………………………………………………………………………………..  49

   Recommendations…………………………………………………………………………...  50

   Conclusion…………………………………………………………………………………... 51

References……………………………………………………………………………………...  53

   Appendix A………………………………………………………………………………… 57

   Appendix B…………………………………………………………………………………. 65      

List of Tables and Figures

Figure 1: F-Diagram highlighting pathways for pathogen transmission………………..……   10

Figure 2: Rates of child mortality due to diarrhea per 100,000 people in 2010………..…….   12

Figure 3: Map showing study region……………………………………………………..…..   26

Figure 4: Inclusion and exclusion criteria…………………………………………….…..….   27

Table 1: Descriptive statistics for bivariate relationships……………………………….…....   36

Table 2: Chi-square relationships between individual WASH variables and diarrhea…….…   38

Table 3: Odds ratios for relationships between WASH variables and diarrhea………………   41

Table 4: Odds ratios for relationship between various socioeconomic factors and diarrhea…   41

Table 5: Odds ratios for relationships between WASH variables and diarrhea when controlling for various socioeconomic factors……………………………………………...……………..   45

Table 6: Odds ratios for relationship between WASH variables and diarrhea when controlling for all confounders…………………………………………………………………………….   45

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Water, Sanitation, and Hygiene
Committee Chair / Thesis Advisor	Dr. Joanne McGriff, Emory University
Committee Members	Alex Edwards, Emory University

Last modified

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Water, Sanitation, and Hygiene Practices and Socioeconomic Factors that Contribute to Diarrhea in School-Aged Children in the Moyamba District in Sierra Leone ()	2020-04-15 15:34:51 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions