Associate between poor sanitation practices with diarrheal disease occurrence in Namatala slum, Mbale district:

Abstract

Despite global commitments to improve settlements over the next couple of years, sanitation remains a huge challenge in most informal settlements. Municipal and local governments seem to have neglected part of their prime responsibility of solid waste management which has led to huge amounts of waste to be indiscriminately disposed along streets, water sources and within residential locations. This leads to contamination of both food and water causing water and food borne diseases. Poor sanitation including poor solid waste management leads to more serious public health and environmental risks each of them having socioeconomic and political effects within and outside societies. This dissertation focuses on the sanitation struggles surrounding informal settlements amidst a decentralization form of governance. The objective was to study the association between poor sanitary practices with diarrheal disease occurrence in the cosmopolitan suburb of Namatala in order to raise community and MMLG awareness to contribute towards the prevention and control of diarrhea in Mbale. A community based cross-sectional survey with households as units of study was conducted. The study population were children under five years of age and data were obtained from their mothers and care givers. Diarrhea was the outcome of interest. Quantitative data was collected using a standardized questionnaire survey administered by trained research assistants. Quantitative data analysis was done using a statistical software, Stata edition 14 created by StataCorp. Bivariate and multivariate analyses were done using Chi-square and logistic regression to determine the association between diarrheal disease occurrence and other factors within the household environment. 422 respondents including 144 men (34.1%) and 278 women (65.9%) aged 17-74 years were interviewed. 83.6% of the respondents had gone through formal education and 16.4% never had formal education. 65.2% were unemployed and 34.8% were employed. 55% had no income, 45% had monthly income of at least 50,000UGX ($15). Respondents were concerned about the poor state of their household environment with household garbage (66.03%), open defecation (19.95%), sewage pollution from pits and toilets (12.35%) reported as the major factors affecting the household environment. 82.46% of the households used pit latrines located outside their premises and often these were shared. 70.7% stored unsegregated solid waste in plastic polythene bags. The main source of drinking water for the households was reported to be public stand pipes (70.31%) and only one household reported obtaining drinking water from the river representing 0.24%. This however, may have been a Hawthorne effect as many households were seen collecting water from dug wells. 66.11% of the households were built using semi-permanent materials. 45.73% of the households reported having a child less than five years with diarrhea within three days preceding the survey. Dumping of waste, presence of vectors and breeding sites within households, the age of the care giver, the employment status of the household head, type of toilet/latrine used by the household and location of toilet/latrine within or outside the household were associated with occurrence of diarrhea in children less than five years. All the water sources sampled had positive cultures for Enterobacteriacaea pathogens; Escherichia Coli and Citrobacter Freundii both of which originate from the gut of humans and animals. In conclusion, open defecation as a determinant of diarrhea occurrence is still a common practice in Namatala and this brings into perspective the need to emphasize sanitation and hygiene programing in informal settlements with vulnerable pastoral migrants. This and other factors suggests a link between poor sanitary practices in Namatala and the contamination of water sources leading to diarrheal disease occurrence in children less than five years of age.