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Water, Sanitation and Hygiene Practices in Dawa and Tugakope: A Multiple Methods Baseline Assessment of Two Rural Communities in Ghana

Chudgar, Reena (2010)
Master's Thesis (140 pages)
Committee Chair / Thesis Adviser: Moe, Christine L
Committee Members:
Research Fields: Health Sciences, Public Health; Health Sciences, Hygiene; Health Sciences, General
Partnering Agencies:
Keywords: water; sanitation; hygiene; baseline assessment; GIS
Program: Rollins School of Public Health, Hubert Department of Global Health
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Water, Sanitation and Hygiene Practices in Dawa and Tugakope: A Multiple Methods
Baseline Assessment of Two Rural Communities in Ghana
By Reena Chudgar

Background: An estimated 884 million people lack access to improved water and 2.6
billion people lack access to improved sanitation worldwide. In rural Ghana, 26% of the
population does not have access to improved water and 93% to an improved latrine.
Diarrheal diseases are the second leading cause of death worldwide; 90% of this burden
is attributed to poor water, sanitation and hygiene (WASH) practices.

Objectives: This study performed a baseline WASH assessment of two rural
communities in Ghana (Dawa and Tugakope) to understand access, use and practices.

Methods: Four data collection approaches were used: 1) GPS mapping of households,
water sources and sanitation facilities, 2) household questionnaires on WASH
knowledge, attitudes and practices, 3) microbiological water quality testing (Dawa), and
4) focus group discussions (not included in analysis). Inter- and intra- community
comparisons were made.

Results: In total, 87 households in Dawa and 31 households in Tugakope participated.
Ninety percent of households in Dawa and 3% in Tugakope used standpipe water as their
primary drinking water source. Distance to primary drinking water source was
significantly shorter in Dawa (286.8 meters) compared to Tugakope (802.7meters). Water
quality testing indicated high concentrations of E. coli contamination in household
drinking water. Open defecation was widely practiced in Dawa (79%) whereas most
households in Tugakope reported using VIP latrines (74%). The presence of soap in the
household was significantly less in Dawa (59%) compared to Tugakope (94%). Point
prevalence of diarrhea among children under five years was 26% in Dawa and 17% in
Tugakope, based on one week recall.

Discussion: Improved WASH practices are associated with reduced diarrheal prevalence.
Uptake of interventions that increase access to improved WASH is related to community-
specific factors such as distance, cost, habit, taste, and sense of ownership. Additionally,
good quality source water does not ensure safe household drinking water. We measured
high concentrations of E. coli in household stored water indicating post-source
contamination that may be associated with source water quality, storage practices,
household hygiene, and handling practices. Our assessment of these communities
demonstrates that appropriate WASH interventions to reduce diarrheal disease require
understanding community-specific
factors that affect WASH.

Table of Contents

Table of Contents

Introduction: 1

Background: 4

Global burden of diarrheal disease: 4

Strategies to reduce the diarrheal disease burden: 6

Baseline knowledge, practice, attitudes, and use surveys: 10

Geographic Information Systems (GIS): 14

Water Quality Testing: 15

Ghana: 17

Purpose and Aims: 19

Methods: 22

Community selection and entry: 22

GPS Mapping: 24

Initial Community mapping: 25

Household mapping: 25

Household Door-to-door questionnaires: 25

Incentives: 26

Water Quality Testing: 26

Public Water Testing: 26

Household Water Testing: 26

Database: 27

Analysis: 27

Geospatial Analysis and Mapping: 27

Descriptive and Univariate Analysis: 28

Microbiological Analysis . 29

Results: 30

Demographics: 30

Water Sources: 33

Public Water Source Characteristics: 33

Spatial Analyses of Water Sources: 34

Microbiological Quality of Water Sources in Dawa: 40

Education Level and Presence of Children Under Five Effects on Choice of Water Source: 41

Household Drinking Water 42

Reported Household Drinking Water Storage and Treatment Practices: 42

Education Level and Presence of Children Under Five Effects on Household Water Treatment: 45

Household Water Quality in Dawa: 47

Comparison of Water Source and Household Water Contamination Levels: 49

Spatial Analysis of Microbiological Quality of Water Source and Household: 51

Sanitation: 54

Household Sanitation Practices: 54

Spatial Analyses of Defecation Practices: 57

Hygiene: 58

Hygiene Practice: 58

Diarrhea: 58

Diarrheal Prevalence: 58

Discussion: 61

Diarrheal Prevalence for Children Under Five Years: 61

Water Source Access and Use: 63

Factors that influenced choice of water source within the communities . 65

Water Quality: 67

Source Water Quality: 67

Household Water Quality: 67

Household Water treatment: 70

Sanitation: 72

Hygiene: 75

Strengths and Limitations: 76

Strengths: 76

Limitations: 78

Summary and Conclusions . 80

References . 82

Figures: 89

Appendices . 113

APPENDIX A: IRB Study Exemption Letter 113

APPENDIX B: Household Questionnaire . 115


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