Influence of water, sanitation, hygiene on prevalence of waterborne diseases in selected secondary schools in Wakiso district, Uganda.

Abstract

The subject of Water, Sanitation and Hygiene (WASH) in Uganda may be discussed based on the diversity of stakeholders in this field, nature and extent of facilities, knowledge, infrastructure and services in different parts of the country. The policies and systems employed for effective planning, provision, management, improvement and sustainability of WASH services is equally crucial. The journey to efficiency and effectiveness of WASH will however not be complete, without consideration of the quality of the services provided, their socio-cultural dynamics, economic suitability, menstrual services, sensitisation and inclusiveness in terms of community involvement, gender equity, age and disability. These practices and education are expected to spur behaviour changes that will effectively control endemics and subsequently reduce the risk of infection with, and spread of waterborne diseases.

This study assessed the influence of WASH on the prevalence of waterborne diseases in schools in Wakiso District Uganda. The objectives of the study were to: assess the availability and status of WASH facilities in selected secondary schools; assess knowledge and practices of students in relation to WASH in schools and determine the quality of drinking water consumed by students in the schools. A total of 340 respondents including students and staff from 17 schools in Wakiso District in central Uganda were selected for the study. The data collection methods involved focus group discussions, questionnaire administration, interview guides, discussion guides and observation checklists. In testing for water quality of drinking water, samples were also collected from selected secondary schools and tested for turbidity, pH, total dissolved solids, electrical conductivity, Escherichia coli and Salmonella typhi. It was established that the WASH facilities in schools were inadequate and most learners could not appropriately transcribe their knowledge of WASH into safe practices such as proper hand washing and readiness to clean toilets, that prevent prevalence and spread of water borne diseases. The average number of functional toilet stances in all the schools studied was 15. Seventy-eight percent of the schools studied had 11-30 stances, 19 percent of the schools had 1-10 stances and three percent of the schools had over 30 stances. The stance to student ratio ranged from 1:54 to 1:153 for the schools assessed. Generally, government single schools had better WASH facilities whereas private mixed schools had poor facilities. On average, 65 percent of the toilets/latrines in all the schools studied were clean. Over 26 percent of the toilets/latrines were lockable. Only 19 percent of the toilets were both lockable and clean. Over 67 percent of the respondents across all the schools studied recognized the symptoms of water borne illnesses. Up to 73 percent noted that hand washing is important. All students interviewed did not follow the standard procedure of handwashing consistently. Seventy eight percent of students admitted they did not wash their hands regularly. Sixty four percent of the schools studied lacked prompt and competent medical services. Open defecation and urination was reported by 10 percent of the respondents in all the schools studied. Most of the parameters tested (turbidity, pH and electrical conductivity) fell within the

recommended levels of quality for drinking water. E. coli was detected in samples from five schools. None of the samples collected tested positive for Salmonella typhi. The Kruskal-Wallis test revealed that; turbidity (H= 4.32, p<0.05), pH (H=6.26, p<0.01), EC (H=23.51, p<0.05), TDS (H=36.22, p<0.015) and E. coli (H=134566, p<0.05) were significantly higher in the government secondary schools than in the private schools. It is concluded that the adequacy and status of WASH facilities in the schools is poor although the quality of the water provided is generally suitable for drinking, apart from the five schools where E. coli was detected. Measures need to be put in place to prevent contamination of drinking water especially by school managements by ensuring proper treatment, safety of storage systems and means of dispensing the water. More resources should be allocated for operations and maintenance (O&M) of WASH facilities in schools, provision of more toilets, creation of awareness among students, provision of hand washing necessities, treatment of drinking water and competent medical personnel should be recruited by proprietors and government to ensure timely and proper health management and sensitisation.