ABSTRACT
This research was done using multiple methods case study to determine if environmental sanitation conditions affect malaria infection rates in children of two communities; one urban area and one rural area. Fasari settlement in Kuje Area Council was the rural case study while Wuse zone 6-, Abuja was the urban case study. The specific aim of this research was to investigate the incidence of malaria in children under 5- in relation to environmental sanitation conditions in the two communities. Fasari and Wuse Zone 6- was used because of the different environmental conditions.
The research was done within the months of February and April 2015, also the study made use of all available records at the Federal Staff Hospital, Abuja.
Information was obtained from design questionnaire, a total of 50 cases notes were studied and analysed.
My research didn’t specifically show that environmental sanitation is responsible for different malaria rates in the two study areas. This was because the respondents in Wuse Zone 6 were using prophylaxis for their children and the respondents in Fasari rural settlement had no records of malaria incidence of their children.
Conclusively, malaria is a treatable ailment that continues to cause death to children under the age of five years. Environmental factors such as stagnant water, bushy environment and poor environmental sanitation play an important role in spreading the disease.
Title page………………………………………………………………………………………… i
Certification……………………………………………………………………………………. ii
Readers’ approval…………………………………………………………………………… iii
Dedication…………………………………………………………………………………….. iv
Acknowledgement…………………………………………………………………………… v
Abstract……………………………………………………………………………………. vi-vii
Table of contents………………………………………………………………………. viii-ix
List of figures…………………………………………………………………………………. x
Introduction……………………………………………………………………………………………………. 1
Background………………………………………………………………………………………………… 1
Research Rationale (Importance of the Study)………………………………………………….. 2
Environmental Sanitation………………………………………………………………………………. 3
Water-Related Diseases…………………………………………………………………………………. 5
Malaria……………………………………………………………………………………………………….. 8
Malaria Impact on Children’s Health…………………………………………………………….. 10
Statement of problem………………………………………………………………………………….. 12
Specific aim………………………………………………………………………………………………. 12
Objectives…………………………………………………………………………………………………. 12
Null Hypothesis (H0)…………………………………………………………………………………… 13
Research Hypothesis (H1)……………………………………………………………………………. 13
Study Area………………………………………………………………………………………………… 13
Methodology………………………………………………………………………………………………… 13
Study Sites………………………………………………………………………………………………… 13
Rural Area………………………………………………………………………………………………… 13
Urban Area……………………………………………………………………………………………….. 15
Research Design………………………………………………………………………………………… 16
Comparative Case Study……………………………………………………………………………… 16
Prospective Case Study……………………………………………………………………………….. 16
Cross Sectional Case Study………………………………………………………………………….. 16
Data Analysis…………………………………………………………………………………………….. 17
Research Challenges…………………………………………………………………………………… 17
Result……………………………………………………………………………………………………….. 18
Result from Comparative Study……………………………………………………………………. 18
Result from prospective Study……………………………………………………………………… 26
Result From Cross Sectional Study……………………………………………………………….. 28
Discussion……………………………………………………………………………………………………. 31
The poor environmental sanitation of Fasari community………………………………….. 31
From the comparative case study………………………………………………………………….. 31
From the prospective and cross-sectional case studies……………………………………… 33
Conclusion…………………………………………………………………………………………………… 34
Recommendations…………………………………………………………………………………………. 35
References……………………………………………………………………………………………………. 37
Appendix……………………………………………………………………………………………………… 40
List of Figures
Figure 1: How environmental sanitation can reduce malaria in children of Fasari…….. 19
Figure 2: How environmental sanitation can reduce malaria in children of Wuse Zone 6. 20
Figure 3: Environmental Conditions of Fasari and Wuse Zone 6……………………………. 20
Figure 4: How often environmental sanitation is carried out in Fasari and Wuse Zone 6. 21
Figure 5: Awareness of traditional medication in Fasari and Wuse Zone 6 for curing malaria in children…………………………………………………………………………………………………………………… 22
Figure 6: Respondent in Fasari and Wuse Zone 6 with children…………………………….. 22
Figure 7: Respondents children in Fasari and Wuse Zone 6 that have had malaria infection.23 Figure 8: Frequency of medical check-up of children in Fasari and Wuse Zone 6…………………. 24
Figure 9: Distance of health facilities in Fasari and Wuse Zone 6………………………….. 25
Introduction
Background
Living in a clean environment, access to sanitation facilities and good health is every child’s right. However, many children in developing countries such as Nigeria lack safe and clean environment sanitation and good health (IRC International Water and Sanitation Centre, 2001). School-going children also lack environment sanitation facilities, leading to possible health effects. Lack of proper maintenance and preservation of the environment causes potential danger to the health of children at home and in schools. Provision of sanitation facilities does not make healthy physical learning environment sustainable, but utilization of such facilities and related hygiene behaviors that lead to accrued health benefits. In schools, hygiene education aims to boost sustainable environment sanitation practices that will help in preventing water and environmental sanitation-related diseases. In practice, the sanitary situation in many schools and many homes in Nigeria is unacceptable. Water supply and sanitation practices are inadequate to many school-going children in schools and at home. Children use non-functional toilets and latrines that lack water for flushing whereas some are open with freely flowing sewage. These conditions make schools and homes unsafe places for children where waterborne infectious diseases such as diarrhea and cholera and water-related vector-borne diseases such as malaria are rampant (WHO, 1997).
Nigeria experiences high child mortality rates from malaria (30%) as one of the water-related vector-borne diseases. Other diseases that kill include diarrhea and dysentery. Carrier mosquitoes that breed in stagnant water cause malaria. Therefore, poor environmental sanitation practices that result to stagnant water provides such
breeding grounds for mosquitoes. Consequently, the rates at which children are infected by the deadly disease tend to increase. The millennium development goals (MDGs) adopted by the United Nations in 2000 aimed at reducing such diseases and poverty. Accordingly, the first MDG’s objective was eliminating and reversing the effects of malaria and other main diseases by 2015. Despite the fact that the MDGs were set and adopted worldwide, many African countries failed to initiate the strategies to combat malaria. The MDGs and the Malaria Declaration in Abuja in 2000 have had minimal impact on the spread of the disease and related death cases. Additionally, Nigeria recorded a growing resistance of the malaria disease to first line drugs. As such, infected people use the expensive ACT combination therapy.
Malaria in children is a prevalent issue in Nigeria, where more than half of the population lives below the poverty line. Living under such conditions condemns majority of the children to living in poorly preserved physical environment. Lack of basic environmental sanitation practices leads to increased malaria cases.
Research Rationale (Importance of the Study)
Many diseases, including malaria are not only the result of malnutrition and poverty, but also the result of environmental risk factors. As such, it is important to consider environmental health issues that affect a child’s health. In addition, it is paramount to discuss water-related diseases that pose danger to a child’s survival especially in malaria-stricken areas. This study uses a case-study approach to examine the relationship between environmental sanitation and malaria incidence in rural and urban sites in Abuja; Nigeria. In order to attain sustainable results, there is a need to improve preventive measures directed towards children’s health.
Additionally, preventive measures such as improving environmental sanitation are
successful in reducing children’s exposure to disease agents thus averting latent infections. This literature review looks at the correlation between environmental sanitation and malaria among children in Nigeria.
The main objective of this review is to provide required information to decision-makers on the possible and appropriate policies to aid in the reduction of children infections and deaths from malaria. The information will also help in protecting the health and well-being of young children through providing sustainable environment sanitation practices. This entails the reduction of the environmental risk factors by offering suitable interventions that prevent exposure. In addition, this review will also help in understanding the environmental risk factors, ways in which the children are exposed, and how to alleviate the potential health impact.
Accordingly, the study will also provide a better understanding of the relationship between environmental sanitation and malaria among children in Nigeria.
Environmental Sanitation
According to the WHO, environmental sanitation entails the control or modification of the physical environment in order to avert the transmission of diseases to humans. This involves access to a safe and adequate water supply-, and sanitary disposal, free of human excreta. It also involves household waste management and changing individuals’ behavior through hygiene education. The International Drinking Water Supply Decade of 1981-1990 recorded a remarkable increase in water supply and sanitation across the globe. As a result, over 1.6 billion people could access safe water for drinking. However, in 2001, over 1.1 billion people were without adequate sanitation and safe drinking water in the globe.
Further, in 2000, about 80% of Africans lacked improved sanitation and clean water.
In rural areas in China and India alone, over 1.3 billion people had inadequate sanitation especially in rural areas. According to the WHO (2001), approximately 40% of the world’s population lacked adequate sanitation. Since 1990 to date, efforts to achieve global coverage of sanitation and clean water have been unsuccessful. This is attributed to rapid population growth that overwhelms the improvements made and the extent of resources required to achieve the set goal. In 2011, about 2.5 billion people in the world use inadequate sanitation facilities and approximately 1 billion people practice open defecation. In the same year, 64% of the world’s population relies on improving sanitation amenities.
The situation in Africa alone is worse than other parts of the world. Africa experiences the poorest environmental sanitation practices. According to 2000 statistics, only 62% of Africa’s population had access to improved sanitation and clean water supply. The situation in rural areas in Africa was worse with only 47% of the population enjoying adequate sanitation. Urban areas portray a different statistic with about 85% of residents enjoying improved sanitation and clean water supply (World Health Organizations, 2002). In 2012, sub-Saharan Africa recorded 44% of the population that experience low sanitation coverage. An estimated 26% of the population practices open defecation in this region (United Nations, 2011).
In Nigeria, the water situation and environment sanitation are also unacceptable. The country’s population grows rapidly, with about 54% of the people living in abject poverty. Even though the country has enough water to meet the current drinking demand, lack of ability to distribute the water leads to inadequate supply in some areas. Additionally, the population also suffers poor sanitation amenities that pose public health problems to children. Efforts by the Minister of Water Resources in the country initiated a program to improve water supply and
environmental sanitation. The efforts were successful where the country recorded an improvement of 30% during 1999-2004 periods. In 2012, the country recorded estimated improvements to 32% for improved sanitation. Despite these improvements, the country still faces major challenges in achieving the Millennium Development Goals.
The inability to achieve the MDGs through providing clean water and environmental sanitation to its population is attributed various reasons. Bad governance practices lead to poor environmental sanitation and inadequate of clean water to the population. Numerous funds directed to sanitation and water sector from the government and foreign aid are misappropriated and stolen through corruption.
This problem affects Nigeria and many other African countries. Consequently, sanitation goals become difficult to achieve. Government officials also frustrate civil society groups’ efforts in providing environmental sanitation practices. Secondly, lack of political will and commitment by the government, civil societies and donors. These stakeholders lack the commitment to ensure that environmental considerations are implemented in order to achieve improved sanitation amenities. Such lack of commitment is evident in health centers and schools that are built without toilets and good drainage systems.
Water-Related Diseases
Water-related diseases are key barriers to sustainable development.
According to Toepfer (2004), disease statistics are especially tragic in the developing countries such as Nigeria. Diarrhea and malaria are the largest causes of death in children below the age of 5 years in Africa. Most of the deaths experienced are preventable. Increased population, growing water demands and climate change have
led to vulnerability of water-related diseases. According to the WHO (2008), water- related diseases can be categorized into, 1) waterborne infectious diseases such as diarrhea and cholera and 2) water-related vector-borne diseases such as malaria.
Recent outbreaks of water-related diseases in parts of West Africa and especially Nigeria have prompted different organizations towards establishing appropriate methods to eliminate and prevent the spread. In earlier years, health and sanitation education in Nigeria concentrated on teaching theory and memorization of facts on water-related diseases. The official curriculum ignored the practical implementation of sanitation through strengthening hygiene practices. Nigeria government offered formal, non-specific civic and school education that failed in enabling people on how to eliminate and prevent the spread of water-related diseases. The most affected parts of the country are the rural areas where majority of residents lack basic water sanitation practices. Additionally, schools topics on sanitation have been disregarded because the curricula fail to accommodate adequate teachings on water sanitation and hygiene. Nigerians also experience water shortages and water infrastructure problems in the some urban and rural areas leading to difficulties in maintaining water sanitation (Wright et al., 2004). Many people collect water for daily survival from any available water collection points rendering the fight against water-related diseases even more difficult (Newsom, 2006). In spite of all the efforts made by the Nigerian government agencies, the non-governmental organizations, and local interest groups, basic sanitation in schools and major cities remains poor. Both urban and rural areas, schools and health centers have limited access to appropriate sanitary facilities.
