FACTORS ASSOCIATED WITH THE PRACTICE OF OPEN DEFECATION IN LODWAR, KENYA: A MIXED METHOD RESEARCH

ABSTRACT
Approximately 2.5 billion people lack access to improved sanitation globally. The situation is even worse in the Sub-Saharan African (SSA) countries. The practice of open defecation peaks beyond 72% of the population in Turkana. This has resulted into frequent outbreaks of water- related diseases such as cholera outbreak in the year 2013 and 2018. The main aim of this study was to assess socioeconomic factors associated with the persistent practice of open defecation in Lodwar. This is a report on both qualitative and quantitative aspects of a cross-sectional study. Stratified random sampling technique was chosen to select 403 participants for this study with the sample drawn from four administrative units (strata) of Lodwar. A structured questionnaire and observation checklist were used to collect quantitative data. A GPS gadget was also used to map major OD hotspots and latrine coverage. In addition, Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) were conducted to collect qualitative data.

Major OD hotspots included river banks, roads, the arboretum and the stadium. Only 19% of the study population had a latrine facility in their homesteads with 73% of the latrines constructed using poor materials. The quantitative findings revealed that culture was the leading factor why people practiced OD with the frequency of 44% followed by poverty levels that limited latrine ownership among the households (27%). Pearson's chi-square tests revealed that there was a significant association between socioeconomic factors and OD: At χ2=107.317, there was a significant association between latrine presence and the education level of the household, latrine sharing χ2 = 403, and the occupation of the household head χ2 = 74.51 (p<0.05). The quantitative findings from the thematic analysis showed that culture was by far the most common factor that contributed to the practice of OD with a theme intensity of 31.1%. Further analyses identified five major cultural aspects that were associated with the practice of OD. Open defecation as a common habit among the respondents was the most cited factor that contributed to its rampant practice (Theme intensity 31.3%). Poverty and cultural aspects influence latrine adoption. Establishment of child clubs and community members that offer education on sanitation interventions may help foster a culture that can be transferred from generation to generation.

CHAPTER ONE
INTRODUCTION
Background to the Study
As at the year 2014, about 2.5 billion people in the world did not have access to improved sanitation with 1 billion practicing OD (WHO and UNICEF, 2014). This is a major cause of millions of deaths from water-related diseases such as diarrhoea among children under five years (WHO and UNICEF, 2010). Improved sanitation includes sanitation facilities that hygienically separate human excreta from human contact whereas Open defecation (OD) refers to the practice of defecating in fields, forests, bushes, bodies of water or other open spaces(WHO and UNICEF, 2014). OD is practiced in nearly all regions in the world. However, the practice is more common in India and some parts of the Sub Saharan Africa (SSA). In rural India alone, about 360 million don’t have access to a toilet. However, over a third (37%) of the members of households still practice OD despite having a latrine facility(Barnard et al., 2013).

There is still inadequate access to improved sanitation facilities in SSA with approximately 215 million people practicing OD as at the year 2013 (Galan et al., 2013). Nonetheless, there was an improvement going by WHO 2015 report on “World Health Statistics”, that shows increased use of improved sanitation in Africa from 25 percent in 1990 to 32 percent in 2013 (WHO, 2015). This increase, however, consisted more of access to a simple pit latrine, which has deficient levels of privacy, hygiene, and safety. The situation is no different in Kenya. Roughly 50% of the population in rural areas lack access to a basic sanitation facility with 5.6 million Kenyans (14% of the total population) still practicing OD (Njonjo, 2013).

There have been several interventions to end OD in Turkana such as Community Led Total Sanitation (CLTS) introduced in 2007 and the Open Defecation Free Rural Kenyan Campaign launched in the year 2011. These campaigns coupled with the expansion of sanitation facilities may not have been critical efforts to achieve meaningful health outcomes since OD cases are still rampant. Combining such efforts with cultural interventions may be an effective method for achieving ODF societies (Abubakar, 2018; Laura et al., 2015).

Various studies have been done to assess factors that limit latrine adoption in various countries. However, these factors majorly focused on income levels and education levels. A study in rural India between 2005 and 2012 showed that education, economic status, and households’ demographic structures are weakly associated with latrine adoption(Coffey et al., 2017). How cultural factors can be reshaped in communities that practice OD still remains largely unexplored. In Turkana Kenya, there is limited research that has been done to exploit various factors associated with OD practice, and especially cultural aspects. The OD practices peaks beyond 72% of the population despite efforts to eradicate it (Njonjo, 2013). It is against this background that this study was conceived to assess various underlying socio-economic factors that are associated with OD practices in Lodwar.

Statement of the Problem
Access to improved sanitation is an important component to human health. Open defecation can be linked with frequent outbreaks of water-related diseases such as cholera outbreak in Turkana in the year 2013 and 2018, rampant cases of typhoid and trachoma. Approximately 72% of the population in Turkana has been reported to practice open defecation. Efforts such as the construction of latrines by national and county government, Non-Governmental Organizations (NGOs) such as Save the Children, Community-Led Total Sanitation (CLTS) programs introduced in the year 2007, Open Defecation Free Rural Kenya Campaign introduced in the year 2011 as well as other sanitation campaigns have been in existence in Turkana. But despite these efforts, there has been little improvement since a larger percentage of the population still practice open defecation. This study was conducted to identify the underlying factors that contribute to the practice of open defecation despite such interventions.

Objectives
General Objective
Assessment of factors that still leads to persistent practice of open defecation despite various interventions to end it in Lodwar, Turkana County

Specific Objective
i. Assessment of latrine structure, design and condition

ii. Mapping out latrine distribution and open defecation hotspots

iii. Examining socioeconomic factors associated with the practice of open defecation

Research Questions
i. What is the latrine structure, design and conditions of the observed latrines?

ii. How is the distribution of the latrines and where are the common open defecation hotspots in the study area?

iii. What other underlying socioeconomic factors are associated with the practice of open defecation amid a number of efforts that have been put in place to end it?

Justification of the Study
Open defecation may be associated with various factors. These include income-levels, poverty, education levels, law enforcement and culture among others.

Since the research focuses on assessing the practices and various factors associated with open defecation in Lodwar, it is considered substantial for some reasons. First, the study is in line with achievement of the Sustainable Development Goal (SDG) 6, sub-goal 6.2 that aims to achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations as described in the country’s development blueprint-Vision 2030. The study is also in line with Kenya’s New Constitution, Article 42 that ensures a clean and healthy environment for all. The study is also considered helpful in coming up with recommendations to sanitation policymakers on the various interventions measures to end the practice of open defecation in Kenya. Lastly, the study also serves as baseline data for any further investigation and as a useful material for future studies.

Assumptions of the Study
The study had the following assumptions;

i) Cultural practices ( that were unknown to the project team) did not go against practices that were studied

ii) No ethnic conflicts would occur during the project implementation period

Scope and Limitations of the Study
This study was carried out in Lodwar settlements at Kawalathe, Napetet, Kanamkemer and Nakwamekwi human settlements. The town is located in Turkana County which is an Arid and Semi-Arid Land (ASAL). It took place in October 2017 to February 2018. The study focused on latrine coverage in the region and the common open defecation hotspots as well as asking the respondents on various socioeconomic factors that might be contributing to the practice of open defecation.

This study is only focused to the peri-urban population of the four settlements in Lodwar and does not include the rural populations. The area has a high level of illiteracy and some of the respondents selected for the study did not understand the questions presented in the questionnaires and others were not able to fill them. However, four educated research assistants from the community were selected to help in filling the information provided by such respondents on the questionnaires. Lastly, the language barrier presented itself as a great challenge while carrying out the study. However, this was mitigated by the use of local educated research assistants who helped in translating the information given by the respondents.

Definition of Terms
Access to adequate sanitation: This refers to the provision of facilities to a distance of not more than 200 meters from a home for the safe and adequate disposal of human urine and faeces.

Culture: A way of life, the way a community do things. It includes ideas, customs and social behaviours of a community.

Household: Is a group of persons who in most cases eat and live together. They may, or may not be related by blood but usually make common provision for food and other essentials for their livelihoods. A household may comprise one or several members.

Open defecation: Defecating in the fields, water bodies, bushes and other open places.

Open defecation hotspot: A common open place where people go to defecate

Socio-economic factors: These are the combined measure of a household’s employment status and household’s economic and social position in relation to others, based on income and education levels among other factors.

Latrine: A sanitation facility that id dug and constructed at a user interface and allows for convenient and safe disposal of human faeces and urine.

Latrine conditions: Describes latrine filthiness or cleanliness

Latrine structure and design: Describes latrine physical characteristics such as wall, roof or flooring materials

Latrine coverage: The total number of latrines and their location at a particular time in a specific region

Water-related disease: Describes a variety of ailments resulting from contaminated water and include parasitic, viral, and bacterial infections.

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Item Type: Kenyan Material  |  Attribute: 73 pages  |  Chapters: 1-5
Format: MS Word  |  Price: KSh900  |  Delivery: Within 30Mins.
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