UPTAKE OF HEPATITIS B VACCINATION AND ITS DETERMINANTS AMONG HIGH RISK HEALTH CARE WORKERS IN SELECTED HOSPITALS IN KENYA

0
426

TABLE OF CONTENTS

DECLARATION…………………………………………………….. Error! Bookmark not defined.

DEDICATION………………………………………………………………………………………………… ii

ACKNOWLEDGEMENT………………………………………………………………………………. iv

TABLE OF CONTENTS………………………………………………………………………………… v

LIST OF TABLES………………………………………………………………………………………….. ix

LIST OF FIGURES………………………………………………………………………………………… x

ACRONYMS AND ABBREVIATIONS………………………………………………………….. xi

DEFINITION OF OPERATIONAL TERMS…………………………………………………. xii

ABSTRACT………………………………………………………………………………………………….. xiv

CHAPTER ONE : INTRODUCTION……………………………………………………………… 1

CHAPTER TWO : LITERATURE REVIEW…………………………………………………. 7

  1. Introduction………………………………………………………………………………………… 7
    1. Global Overview of open defecation………………………………………………………. 7
    1. Open Defecation in Africa…………………………………………………………………….. 8
    1. Open Defecation in Kenya……………………………………………………………………. 10
    1. Origin and global adoption of the CLTS strategy……………………………………. 11
    1. Adoption of CLTS strategy in Kenya…………………………………………………….. 13
    1. Factors associated with uptake of CLTS………………………………………………… 14
    1. Gaps in Knowledge……………………………………………………………………………… 15

CHAPTER THREE MATERIALS AND METHODS…………………………………….. 16

  1. Introduction……………………………………………………………………………………….. 16
    1. Research design…………………………………………………………………………………… 16
    1. Variables…………………………………………………………………………………………….. 16
      1. Dependent Variable………………………………………………………………………………. 16
      1. Independent Variables…………………………………………………………………………… 17
    1. Location of the Study………………………………………………………………………….. 17
    1. Study population…………………………………………………………………………………. 19
      1. Inclusion Criteria…………………………………………………………………………………… 19
      1. Exclusion Criteria………………………………………………………………………………….. 19
    1. Sampling Techniques and Sample Size…………………………………………………… 19
      1. Sampling Techniques……………………………………………………………………………… 19
      1. Sample size determination………………………………………………………………………. 22
    1. Data collection tools…………………………………………………………………………….. 23
    1. Pre-testing of tools………………………………………………………………………………. 23
      1. Validity……………………………………………………………………………………………….. 23
      1. Reliability…………………………………………………………………………………………….. 24
    1. Data Collection Techniques………………………………………………………………….. 24
      1. Administration of Questionnaires……………………………………………………………. 24
      1. Focused Group discussions…………………………………………………………………….. 24
      1. Key Informant Interviews………………………………………………………………………. 25
      1. Direct observations………………………………………………………………………………… 25
    1. Data analysis…………………………………………………………………………………………. 25
    1. Logistical and ethical considerations………………………………………………………… 26

CHAPTER FOUR : RESULTS………………………………………………………………………. 27

CHAPTER FIVE : DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS………………………………………………………………………………………………………………………. 39

5.2.3 Socio-economic factors and uptake of CLTS……………………………………………. 42

REFERENCES…………………………………………………………………………………………… 47

APPENDICES……………………………………………………………………………………………. 58

Appendix I: Informed Consent Form………………………………………………………………. 58

Appendix II: Household Questionnaire……………………………………………………………. 59

Appendix III: FGD Guide for the CHVs…………………………………………………………. 64

Appendix IV: KII Guide……………………………………………………………………………….. 66

Appendix V: Household Observation Checklist………………………………………………… 67

Appendix VI: Clearance Letter from Graduate School………………………………………. 68

Appendix VII: KU-ERC Approval Letter………………………………………………………… 69

Appendix VIII: Research Permit…………………………………………………………………….. 71

Appendix IX: NACOSTI Research Authorization…………………………………………….. 72

Appendix X: Siaya County Health Department Authorization……………………………. 73

LIST OF TABLES

Table 3.1: Proportionate Selection of Households………………………………………………….. 21

Table 4.1: Socio-Demographic Characteristics of the study participants……………………. 27

Table 4.2: Latrine Ownership of the study area, September 2017…………………………….. 28

Table 4.3: Open Defecation Free Status of the study area, September 2017………………. 29

Table 4.4: Socio-Demographic Factors associated with the CLTS uptake, Siaya, September 2017………………………………………………………………………………………………………… 30

Table 4.5: Economic Factors associated with the CLTS uptake, Siaya 2017……………… 31

Table 4.6: Socio-Demographic and Economic factors associated with CLTS uptake in Siaya County, 2017…………………………………………………………………………………….. 31

Table 4.7: Open Defecation Practices in the study area…………………………………………… 36

Table 4.8: Observations on the compliance with the CLTS protocol at the households. 37

LIST OF FIGURES

Figure 1.1: Conceptual Framework, Author, (2014)…………………………………………………. 6

Figure 3.1: A map of Kenya showing the location of Siaya Sub-County, 2019………….. 18

Figure 3.2 Schematic presentation of the Sampling Procedure…………………………………. 20

Figure 4.1: Progress of CLTS implementation in achieving ODF status, Alego Usonga Sub-County, 2010-2017………………………………………………………………………………………… 32

Figure 4.2: Partners’ Support towards CLTS implementation in the study area, September 2017………………………………………………………………………………………………………… 33

Figure 4.3: Advantages of owning and using a latrine……………………………………………. 34

Figure 4.4: Reasons for not using a latrine…………………………………………………………….. 35

ACRONYMS AND ABBREVIATIONS

AIDS– Acquired Immunodeficiency Syndrome
CLTS– Community-Led Total Sanitation
CHMT– County Health Management Team
GDP– Gross Domestic Product
HIV– Human immune-deficiency Virus
JMP– Joint Monitoring Program
MOPHS– Ministry of Public Health and Sanitation
OD– Open Defecation
ODF– Open Defecation Free
PHAST– Participatory Hygiene and Sanitation Transformation
SDG– Sustainable Development Goals
UN– United Nation
UNDP– United Nation Development Program
UNICEF– United Nations Children Education Fund
WASH– Water, Sanitation and Hygiene
WSP– Water and Sanitation Program

DEFINITION OF OPERATIONAL TERMS

Basic Sanitation –       Basic sanitation is described as having access to facilities for the safe disposal of human waste (feces and urine), as well as having the ability to maintain hygienic conditions.

Caregiver-                  The person who takes primary responsibility for someone who cannot take care of himself or herself fully, usually a family member (father or mother).

Community-Led-Total-Sanitation– An innovative methodology for mobilizing communities to eliminate open defecation. Communities are facilitated to conduct appraisal and analysis of open defecation and take action to become open defecation free.

Household –                One or more people who live in the same dwelling and share meals.

Household Head-       The person responsible for making decisions and governing a group that lives together such as a family; he may be married or unmarried.

Improved Sanitation – Refers to the management of human feces at the household level.

On-Site Sanitation- The collection and treatment of waste that is done where it is deposited. Examples are the use of pit latrines and septic tanks.

Open Defecation –     It is a practice whereby an individual and or a group of people in

a community do not patronize the available toilet facilities in particular vicinity but rather go to ease themselves in an open environment. (Ernest, 2012).

Open Defecation Free – Termination of fecal-oral transmission, defined by; no visible feces found in the environment/village; and every household as well as public/community institutions using safe technology option for disposal of feces.

Safe Technology Option – A safe technology option means no contamination of surface soil, groundwater or surface water; excreta inaccessible to flies or animals; no handling of fresh excreta; and freedom from odor and unsightly condition.

Sanitation –                 The provision of facilities and services for the safe disposal of human urine and feces.

Superstructure –        A shelter which provides privacy and protection for the user of the latrine

Uptake-                      The rate or act of taking/accepting something

ABSTRACT

By 2015, an estimated 2.4 billion people lacked basic sanitation and 15% still practiced open defecation globally. In Kenya, approximately 5.6 million people still defecated in the open. Siaya County adopted Community-Led Total Sanitation (CLTS) in 2010 as an approach to address the problem of open defecation. This study aimed at assessing the uptake of the CLTS approach in Siaya County, Kenya. A cross-sectional study was conducted among 370 randomly selected households. Structured questionnaires, Focused Group Discussions, and Key Informant Interviews were used to collect data. Descriptive statistics (mean, median, and standard deviation) was performed for quantitative data using SPSS version 20.0. To identify the factors associated with the CLTS uptake bivariate analysis was performed. Those factors with p-Values ≤0.05 were considered statistically significant. The qualitative data collected were thematically analyzed and used to support the quantitative results. A total of 370 respondents were interviewed. The mean age was 46.2 years (SD=15.2 Years), females were 242 (65%), 283 (76.5%) were married and 132 (35.7%) were age 40–49 years. Sixty-three percent (232/370) of those interviewed had attained primary education. Of the households visited, 303 (82%) had pit latrines, while and 307 (83%) had attained the Open Defecation Free (ODF) status. Of the 303 households with latrines, 97 (32%) shared with their neighbors who did not have, while for the 67 (18%) households that didn’t have pit latrines, 43 (64.2%) shared with their neighbors who had latrines. The ODF status increased from <12 in 2010 to 79 in 2017. Bothmarital status {χ² =0.004, p= 0.952}, Education {χ² =2.19, p=0.334} and Occupation {χ²=2.404, p=0.493} were found not to be significantly associated with the uptake of CLTS approach. There was remarkable progress towards achieving ODF status in the study area. No significant association was found between CLTS uptake and marital status, education, and occupation. Some households despite having pit latrines were not yet ODF. We recommend the county health department and its stakeholders to scale up the CLTS approach to achieve 100% status.

CHAPTER ONE : INTRODUCTION

            Background

Access to improved sanitation is an important component of human health and well- being(P. J. Busienei, Ogendi, & Mokua, 2019; WHO/UNICEF, 2015). Globally, by 2015, approximately 2.4 billion people lacked access to basic sanitation with 892 million people still defecating in the open (UN News, 2019; WHO, 2019a). The lack of access to basic sanitation, the use of unsafe drinking water, and poor hygiene are said to be responsible for about 88% of all deaths from diarrheal diseases in developing countries (Galan, Kim, & Graham, 2013a; Wolf et al., 2018).

Despite many regions experiencing a drop in the number of people practicing open defecation (OD), its rates increased in Sub-Saharan Africa and Oceania regions between 2000–2015 (Saleem, Burdett, & Heaslip, 2019; Vyas & Spears, 2018). The increase was attributed to an increase in population and poverty (Galan et al., 2013a; Saleem et al., 2019). It is estimated that approximately 90% of those who practice open defecation live in the rural areas of Sub-Saharan Africa, Central, and Northern Asia (Saleem et al., 2019; UNICEF/WHO;, 2018) The practice of open defecation has serious health consequences for child health and human capital development (Vyas & Spears, 2018). It facilitates infectious disease transmission which can affect survival, physical growth, cognitive development, and adult economic productivity (Saleem et al., 2019; UNICEF/WHO;, 2018; Vyas & Spears, 2018). As a result of open defecation, an estimated 1.8 billion people worldwide use drinking water that is contaminated with faecal bacteria and an estimated 361,000 sanitation-related deaths among children age <

5 years (Harter, Inauen, & Mosler, 2020; Prüss-Ustün et al., 2014; UNICEF/WHO, 2017). Sanitation-related interventions have contributed to the reduction of the risk of diarrhoea morbidity by 25% (Njuguna, 2019) and evidence of further reduction by 45% when sanitation coverage of above 75 is attained (Njuguna, 2019; Wolf et al., 2018).

To address the problem of open defecation, many countries adopted the Community- Led Total Sanitation (CLTS) approach as part of their national strategy for rural sanitation (Zuin et al., 2019). CLTS is a participatory approach meant to evoke a collective behaviour change in rural settings (Harter et al., 2020; Harter, Mosch, & Mosler, 2018). The CLTS approach was originally developed in Bangladesh in 2009 (Harter et al., 2020; Kar & Chambers, 2008) and has since been adopted globally (Harter et al., 2020, 2018; Venkataramanan, Crocker, Karon, & Bartram, 2018a). It combines a range of activities that are implemented by local facilitators at a community level in three phases, pre-triggering, triggering, and the post triggering (Harter et al., 2020; Kar & Chambers, 2008). Recent studies on the impact of sanitation campaigns have shown that CLTS typically increases latrine coverage by 6–12 and can reach up to 30% (Garn et al., 2017; Harter et al., 2020).

In May 2011, Kenya initiated the Open Defecation Free (ODF) Rural Kenya Campaign, adopting Community-Led Sanitation (CLTS) as the core strategy to achieve the objective (Ministry of Health Kenya, 2017). However, despite many deliberate efforts, Kenya was not able to meet the Millennium Development Goal (MDG) for water and sanitation, which was to reduce to half the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015(UNDP, 2014).

Approximately 5.6 million people in Kenya still defecated in the open (Ministry of Health Kenya, 2017; Njuguna & Muruka, 2017; WB-WSP, 2012). Currently, the CLTS approach is being piloted in two counties, Kitui and Siaya, based on the new protocol (IDS, 2015; Ministry of Health Kenya, 2017). This study therefore aimed at assessing the uptake of the CLTS approach in the attainment of Open Defecation Free Status.

            Problem Statement

One of the major contributors to the prevalence of diseases in Africa stems from a lack of adequate and improved sanitary facilities in both urban and rural areas. It is estimated that more than 5.6 million Kenyans still defecate in the open. (Njuguna & Muruka, 2017; Star, 2017). As a result of poor sanitation, Kenya loses over USD 324 Million annually (WB-WSP, 2012). Kenya adopted the CLTS approach in May 2013 to facilitate control and eventually stop the practice of open defecation in rural areas (Ministry of Health Kenya, 2017). However, even with the adoption of the CLTS approach, the uptake is still low with only 17% of the villages in Kenya certified open defecation free (ODF) (Star, 2017). In Alego Usonga Sub-County where the study was conducted, diarrhea is still a major problem and it’s among the top five causes of morbidity(Ministry of Health, 2019). This is attributed to poor hygiene practices and the practice of open defecation. The latrine coverage for the Sub-County in 2014 was estimated to be at 62% and the ODF status at 29% (IDS, 2015). This study therefore aimed at assessing the uptake CLTS as an approach adopted to realize the 100 ODF status.

            Justification

Community-Led Total Sanitation (CLTS) activities have been ongoing in Alego Usonga Sub-County since its introduction in 2010. In July 2013 a CLTS, roadmap was launched aimed at achieving an ODF County by the end of 2017. However, the county failed to attain its target of becoming ODF by the end of 2017. Siaya County was preferred site for this study because it was one of the two counties where CLTS was being piloted by the Ministry of Health using the revised CLTS protocol, its ODF status was estimated at 29% and has been experiencing waves of cholera outbreaks between 2014–2018 (Centers for Disease Control, 2018; Relief Web, 2016). The findings of the study will help in adding knowledge to the already existing strategies and in informing the Ministry of Health in coming up with other new approaches to addressing the sanitation problem.

            Research Questions

  1. What is the level of uptake of the CLTS approach in Alego Usonga Sub-County?
  • Which factors are associated with the uptake of the CLTS approach in Alego Usonga Sub-County?

            Research Objectives

                  Main objective

The objective of the study was to assess the uptake of Community-Led Total Sanitation as an approach towards the attainment of Open Defecation Free Status in Alego Usonga Sub-County, Kenya.

                  Specific objectives

  1. To determine the socio-demographic factors associated with the uptake of the CLTS approach in Alego Usonga Sub-County.
  2. To examine the socio-economic factors associated with the uptake of the CLTS approach in Alego Usonga Sub-County.
  3. To establish the health systems factors associated with the uptake of the CLTS approach in Alego Usonga Sub-County.
  4. To determine the Knowledge and Practices of residents of Alego Usonga Sub- County towards the CLTS approach.