Domestic water use and its implications for childhood diarrhoea in the Atwima Nwabiagya

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November, 2015
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Abstract
It is estimated that diarrhoea is responsible for the deaths of 1.5 million children per year making it the second leading cause of death in children under-five years globally. The relationship between water quality and diarrhoea has received much attention in the literature however much needs to be learnt about long-term variations in domestic water use behaviour, per-capita water consumption and its relationship with childhood diarrhoea in Sub-Saharan Africa in general and Ghana in particular. This panel study therefore explored seasonal variations in domestic water use and its relationship with childhood diarrhoea in households having children under-five years. A total of 378 households were drawn from 4 communities in the Atwima Nwabiagya District, Ghana using simple random sampling. The communities were surveyed in the wet season (June – August, 2012) and dry season (January – February, 2013) respectively. Quantitative data was collected from mothers of under-five year old children using interviewer-administered questionnaire and observation schedules whereas qualitative data was collected using Focus Group Discussions (FGDs) and in-depth interviews. Multiple regression and correlational analysis were used to examine the determinants of domestic water use for households in the wet and dry seasons as well as for urban, peri-urban, piped and un-piped households. Bi-variate and multivariate logistic regression were used to identify risk factors associated with childhood diarrhoea and expressed in odds ratios (OR). A paired sample t-test; t(255) = 10.92, p 0.001, showed a statistically significant variation in mean per capita water use in the wet and dry seasons. Mean daily per capita water use was estimated to be 54 liters in the wet (n = 263) and 22 liters in the dry season (n = 366). Household size and size of the primary water storage vessel accounted for 9% of total variation in per-capita water use in the wet season whereas household size, length of water storage (days), duration of water service and size of the primary water storage vessel accounted for 35% of the total variation in per-capita water use in the dry season. Residential location (AOR= 3.01, 95% CI 1.61 – 5.63) showed a statistically significant relationship with childhood diarrhoea in the wet season. In the dry season, the mother’s age (AOR= 3.52, 95% CI 1.00 – 10.32), the mother’s educational level (AOR= 4.67, 95% CI 1.80 – 12.13), storage of water outside the dwelling (AOR= 0.38, 95% CI 0.17 – 0.84) and children often playing on the bare ground (AOR= 3.05, 95% CI 1.35 – 6.89) showed a statistically significant relationship with childhood diarrhoea. This study concludes that mean per-capita water use in households varied across the wet and dry seasons. The number of under-five year olds was not a statistically significant determinant of per-capita water use and no statistically significant association was found between per-capita water use and childhood diarrhoea in the wet and dry season. The intensification of maternal education on the mechanisms of transmission of environmentally related diseases such as diarrhoea in the household was recommended. Other recommendations included the provision and maintenance of adequate sanitation infrastructure, regular monitoring of per capita water use and institutional capacity building. It was recommended that future research focuses on an assessment of the microbiological quality of water sources and stored water in the domestic domain.
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A Thesis submitted to the Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the degree of Doctor of Philosophy.
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