Project – Household Water, Sanitation and Hygiene Practices and the Risk of Diarrhoeal Diseases among Under-Five Children: A Study of Selected Rural Communities in Obio-Akpor Local Government Area, Rivers State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Water, sanitation and hygiene (WASH) are fundamental determinants of human health and are particularly important for the survival and healthy development of children. Safe drinking water, adequate sanitation facilities and appropriate hygiene practices protect households from exposure to pathogenic organisms that cause a wide range of infectious diseases. The importance of WASH extends beyond the availability of physical facilities because the manner in which water is collected, transported, stored and used, as well as how human excreta and household waste are managed and how frequently household members wash their hands, can determine whether a household environment becomes a source of disease transmission. The World Health Organization (WHO) identifies safe drinking water, sanitation and hygiene as essential to health and well-being, noting that unsafe water and inadequate sanitation can facilitate contamination of groundwater and surface water and contribute to diarrhoeal diseases and other infections (World Health Organization [WHO], 2023).

Diarrhoeal disease remains one of the major public health problems affecting children under five years of age. It is commonly associated with infection of the intestinal tract by bacterial, viral or parasitic pathogens and is frequently transmitted through contaminated water, food, hands and environmental surfaces. The WHO defines diarrhoea as the passage of three or more loose or liquid stools per day, or more frequently than is normal for the individual. The disease is preventable and treatable, yet it remains a major cause of childhood morbidity and mortality globally. WHO reported that diarrhoeal disease was the third leading cause of death among children aged 1–59 months and that approximately 443,832 children under five die from diarrhoeal disease annually. The organization also estimates that there are nearly 1.7 billion cases of childhood diarrhoeal disease every year.

The vulnerability of under-five children to diarrhoeal diseases is related to their developing immune systems, nutritional requirements, behavioural characteristics and dependence on caregivers for food, water and personal hygiene. Young children frequently put their hands and objects into their mouths, play on floors and outdoor surfaces, and may come into contact with soil, animal faeces and contaminated household materials. These behaviours can create opportunities for pathogens to enter the child’s body. In addition, children who are malnourished are more vulnerable to severe diarrhoea, while repeated diarrhoeal episodes can further worsen nutritional status. Thus, diarrhoea and malnutrition can reinforce each other in a cycle that is particularly harmful during the first five years of life (WHO, 2024).

The relationship between WASH and diarrhoeal disease is commonly explained through the faecal–oral transmission pathway. Human and animal faeces may contaminate drinking-water sources, food, hands, household surfaces and soil. When households lack adequate sanitation, pathogens may enter the domestic environment through unsafe disposal of faeces or poorly maintained toilets. Similarly, water that appears clean may become contaminated during collection, transportation or storage. Poor handwashing practices may then facilitate the movement of pathogens from contaminated surfaces or faeces to food and directly into the mouths of children. WHO therefore recommends a combination of safe drinking water, improved sanitation, handwashing with soap, household water treatment and safe storage as important measures for preventing diarrhoeal disease (WHO, 2023).

Household water practices constitute an important component of diarrhoeal disease prevention. The safety of water depends not only on the original source but also on how it is handled within the household. Water from improved sources can become contaminated when collected with dirty containers, transported improperly, stored in uncovered vessels or accessed repeatedly with unclean hands and utensils. Consequently, households need to practise safe collection, transportation, storage and use of drinking water. Household water treatment methods such as boiling, chlorination and appropriate filtration may also reduce microbial contamination where source water is unsafe. The WHO emphasizes that safe water management should extend from the water source through household storage and use rather than focusing exclusively on the physical classification of the water source (WHO, 2023).

Sanitation is another critical component of household health. Adequate sanitation involves the safe separation of human excreta from human contact through appropriate toilets and systems for the safe disposal or management of faecal waste. Where households practise open defecation or use poorly constructed, overflowing or unhygienic toilets, human faeces can contaminate soil, water and household surroundings. The contamination can subsequently reach children through direct contact, insects, footwear, household objects, food and water. Sanitation therefore has implications beyond toilet ownership because the condition, use and maintenance of sanitation facilities determine their effectiveness in preventing environmental contamination.

Evidence from Nigeria demonstrates the relevance of household WASH conditions to childhood diarrhoea. Yaya et al. (2018), using data from 28,596 mother-child pairs in the 2013 Nigeria Demographic and Health Survey, found a reported diarrhoea prevalence of 11.3% among under-five children. Their analysis showed that children in households without improved toilet facilities had higher odds of diarrhoea, while lack of improved water facilities was also associated with increased odds of diarrhoea. The authors concluded that improving living conditions and WASH facilities could contribute to the prevention of diarrhoeal morbidity and child mortality in Nigeria.

Similarly, He et al. (2018) examined the burden of common childhood diseases in relation to WASH among Nigerian children. Their study found a diarrhoea prevalence of approximately 10.5% among the children examined and demonstrated the importance of household WASH conditions in relation to common childhood disease outcomes. The study emphasized that prolonged exposure to insanitary household environments can increase the burden of infectious diseases among children and negatively influence their nutritional status and growth (He et al., 2018).

The Nigerian situation is particularly important because WASH deprivation remains a significant public health and development concern. UNICEF Nigeria identifies clean water, basic sanitation and good hygiene as essential for children’s survival and development and notes that poor access to improved water and sanitation contributes to high morbidity and mortality among children under five. UNICEF further reports that diarrhoeal disease is an important consequence of unsafe water and poor sanitary conditions in Nigeria (UNICEF Nigeria, n.d.).

National data also demonstrate the importance of examining household-level WASH conditions. The 2021 Nigeria Multiple Indicator Cluster Survey (MICS), implemented by the National Bureau of Statistics with UNICEF support, collected nationally representative information on children, households, health, nutrition and WASH indicators. The survey involved tens of thousands of households and more than 31,000 children under five, providing an important national evidence base for understanding variations in child health and household living conditions in Nigeria (National Bureau of Statistics [NBS] & UNICEF, 2022).

Recent analyses of Nigerian data have continued to demonstrate inequalities in access to WASH services. A secondary analysis of the 2021 Nigeria MICS showed that household and child-level characteristics are associated with differences in WASH deprivation, highlighting the continuing importance of socioeconomic and geographical inequalities in access to safe water, sanitation and hygiene facilities (Vondolia et al., 2025). Such inequalities are particularly relevant to rural communities, where households may face challenges involving water availability, sanitation infrastructure, environmental management, poverty and access to health information.

The rural setting is particularly important in the context of diarrhoeal diseases. Rural households may depend on wells, streams, boreholes, rainwater or other community water sources. Even where water is physically available, distance to the source, seasonal variations, overcrowding at water points, lack of water treatment and poor storage practices can affect its safety. Similarly, rural households may have limited access to improved sanitation facilities and may rely on traditional or poorly maintained toilet facilities. These environmental conditions can increase opportunities for faecal contamination and exposure to enteric pathogens.

However, rurality should not be regarded as an automatic indicator of unsafe WASH practices. Some rural households may maintain excellent hygiene practices despite infrastructural limitations, while some households with improved facilities may still engage in unsafe behaviours. This distinction is important because diarrhoeal disease prevention requires attention to both WASH facilities and household practices. A household may have access to an improved water source but fail to protect water during transportation and storage. Similarly, a household may possess a toilet but fail to maintain it adequately or may dispose of children’s faeces unsafely. Consequently, assessing actual household practices provides information that facility-based assessments alone may not capture.

Hygiene practices are especially important because they provide a behavioural barrier between environmental contamination and human infection. Handwashing with soap at critical times—particularly after defecation, after cleaning a child’s faeces and before preparing or eating food—is widely recognized as an important measure for reducing transmission of enteric pathogens. WHO identifies handwashing with soap, safe drinking water and improved sanitation among the key WASH interventions for diarrhoeal disease prevention (WHO, 2023).

The evidence concerning WASH interventions also indicates that the relationship between individual WASH components and diarrhoea can be complex. While improvements in water, sanitation and hygiene have clear biological plausibility and are central to disease prevention, the magnitude of their effects may vary according to intervention quality, baseline conditions, adherence, environmental contamination and the combination of interventions provided. Wolf et al. (2023), in a systematic review and meta-analysis of WASH interventions and childhood mortality, found substantial evidence that WASH interventions can reduce diarrhoea-related mortality, particularly among populations with poor baseline sanitation conditions.

Likewise, systematic evidence has emphasized the importance of examining the pathways through which WASH interventions influence exposure to enteric pathogens. Recent research has investigated whether water, sanitation and hygiene interventions reduce faecal contamination and enteric pathogens in household and community environments, reflecting the need to understand not simply whether a facility exists but whether it effectively reduces exposure (Pickering et al., 2023).

The household environment is therefore an important setting for diarrhoeal disease prevention. Children spend much of their early lives within the household and are dependent on caregivers for the provision of water, food, sanitation and hygiene. Caregivers determine where water is obtained, whether it is treated, the type of container used for storage, how frequently containers are cleaned, how children’s faeces are disposed of, whether toilets are used and maintained, and whether children are encouraged or assisted to maintain personal hygiene. These decisions can either reduce or increase exposure to diarrhoeal pathogens.

Household food hygiene is also closely linked to WASH. Contaminated water may be used to prepare infant food, wash feeding utensils or cook meals. Unwashed hands may contaminate food during preparation or feeding. Dirty utensils and surfaces can provide additional routes for pathogen transmission. Therefore, household WASH practices should be considered as an interconnected system rather than separate behaviours. Safe water without adequate sanitation and hygiene may not provide maximum protection, just as a clean toilet without proper handwashing may leave important transmission pathways open.

The issue is particularly significant for children under five because diarrhoeal episodes can have consequences beyond temporary illness. Repeated or severe diarrhoea can cause dehydration, electrolyte imbalance, loss of nutrients and reduced appetite. Frequent illness can interfere with nutritional recovery and normal growth. WHO notes that diarrhoea is a leading cause of malnutrition among children under five and that children who are malnourished are more susceptible to life-threatening diarrhoeal illness (WHO, 2024).

At the Nigerian national level, the persistence of diarrhoeal disease despite decades of health interventions suggests that prevention must extend beyond treatment at health facilities. Oral rehydration solution, zinc supplementation and appropriate clinical management remain important for children who develop diarrhoea, but prevention through environmental and behavioural interventions is equally essential. The existence of effective treatment should not diminish the need to address the conditions that repeatedly expose children to diarrhoeal pathogens.

The Nigerian WASH sector has received increasing policy and institutional attention. The 2021 Water, Sanitation and Hygiene National Outcome Routine Mapping (WASHNORM) survey was conducted through collaboration involving the Federal Ministry of Water Resources and the National Bureau of Statistics, with support from UNICEF, the World Bank, WHO and other partners. The survey provides information on WASH service levels in households and institutions and represents an important mechanism for monitoring Nigeria’s progress in WASH provision (UNICEF Nigeria, 2021).

Despite these efforts, significant inequalities remain in WASH access and use. The WHO and UNICEF Joint Monitoring Programme continues to emphasize the global challenge of achieving universal access to safely managed water, sanitation and hygiene. The 2025 JMP report, which covers progress through 2024, indicates that although substantial progress has been made globally, large populations still lack safely managed drinking water and adequate WASH services (WHO/UNICEF JMP, 2025).

These global and national realities provide a basis for examining household WASH practices in specific communities. National surveys are useful for establishing broad patterns, but they may not adequately explain the behavioural and environmental conditions in particular localities. Communities can differ in water sources, sanitation infrastructure, housing conditions, cultural practices, environmental characteristics, socioeconomic circumstances and access to health services. Local studies are therefore necessary to identify community-specific risk factors and provide evidence that can guide targeted public health interventions.

This consideration is particularly relevant to selected rural communities in Obio-Akpor Local Government Area of Rivers State. Obio-Akpor is located within the wider Port Harcourt metropolitan environment, but parts of the local government area contain communities where household living conditions, drainage, sanitation arrangements, water access and environmental management may vary considerably. Rapid population growth and urban expansion can also place pressure on existing infrastructure. Where household water and sanitation systems are inadequate, environmental contamination can create opportunities for diarrhoeal disease transmission.

The choice of Obio-Akpor for this study is also important because evidence generated at national or regional levels cannot automatically be assumed to represent every community within Rivers State. The presence of water infrastructure in a locality does not necessarily mean that households practise safe water management. Likewise, the existence of toilets does not guarantee hygienic sanitation practices. There is therefore a need to examine what households actually do with respect to water collection and storage, toilet use, disposal of children’s faeces, handwashing, waste disposal and other hygiene-related behaviours.

The study is consequently premised on the understanding that diarrhoeal disease among under-five children is influenced by multiple interacting factors, with household WASH practices representing important modifiable environmental and behavioural determinants. Assessing these practices in selected rural communities in Obio-Akpor Local Government Area will provide an opportunity to determine the extent to which households practise safe water handling, adequate sanitation and appropriate hygiene, and whether these practices are associated with the occurrence or reported risk of diarrhoeal disease among children below five years.

1.2 Statement of the Problem

Diarrhoeal disease remains a major preventable health problem among children under five years despite the availability of relatively simple preventive measures. Globally, approximately 1.7 billion episodes of childhood diarrhoea occur each year, while hundreds of thousands of children under five die annually from diarrhoeal disease. The WHO identifies unsafe drinking water, inadequate sanitation, poor hygiene and contaminated food as important pathways through which diarrhoeal infections are transmitted (WHO, 2024). The continued burden indicates that the existence of knowledge about diarrhoea prevention has not necessarily translated into universal access to or consistent practice of appropriate WASH measures.

The problem is particularly serious in low- and middle-income countries where inadequate infrastructure, poverty, environmental contamination and unequal access to health services may combine to increase children’s exposure to infectious agents. Nigeria continues to face substantial challenges in providing safe water, sanitation and hygiene services to all households. UNICEF Nigeria identifies poor access to improved water and sanitation as an important contributor to morbidity and mortality among children under five and recognizes diarrhoea as one of the major health consequences of inadequate WASH conditions (UNICEF Nigeria, n.d.).

Evidence from Nigeria demonstrates that household WASH conditions are associated with childhood diarrhoea. Yaya et al. (2018), using a large national dataset involving 28,596 mother-child pairs, found that children in households without improved water and toilet facilities had increased odds of diarrhoea. Their findings provide empirical evidence that deficiencies in the household environment remain relevant to diarrhoeal disease prevention in Nigeria.

Similarly, He et al. (2018) reported a diarrhoea prevalence of 10.5% among Nigerian children in their analysis and found that WASH conditions were important in understanding childhood disease burden. The authors emphasized that prolonged exposure to insanitary living conditions may increase children’s risk of infectious diseases and negatively influence nutritional status and growth (He et al., 2018).

However, the existence of WASH facilities does not necessarily mean that households use them safely. Water may be obtained from an apparently improved source but become contaminated during collection, transportation and storage. Containers may not be regularly cleaned, water may be accessed with unclean hands or utensils, and storage vessels may be left uncovered. Similarly, toilets may be available but poorly maintained, while children’s faeces may be disposed of in open areas, drains or household refuse rather than safely deposited in a toilet. These practices can maintain faecal contamination within the domestic environment even where some physical infrastructure is available.

Hand hygiene also presents an important challenge. A caregiver may possess soap and water but may not wash hands at the critical moments necessary to interrupt disease transmission. Handwashing after using the toilet or cleaning a child’s faeces, before preparing food and before feeding a child is particularly important. Failure to practise hand hygiene can permit pathogens to move from faeces and contaminated surfaces to food, utensils and children’s mouths. WHO consequently regards handwashing with soap as a key component of diarrhoeal disease prevention (WHO, 2023).

Another concern is the vulnerability of under-five children to the consequences of diarrhoea. A child who experiences repeated diarrhoeal episodes may suffer dehydration and nutritional losses. Where episodes are frequent, the child’s growth and nutritional status may be affected. Malnutrition, in turn, can increase vulnerability to severe infection. Thus, diarrhoea is not merely an isolated episode of loose stool but a condition capable of contributing to a wider cycle of poor health and impaired child development (WHO, 2024).

The problem may be more pronounced in rural communities where households experience infrastructural and socioeconomic constraints. Some rural households may depend on wells, boreholes, streams or other community water sources. Seasonal changes can affect availability and quality of these sources. Where households lack sufficient water, they may reduce the frequency of bathing, handwashing, cleaning of utensils or sanitation maintenance. Limited water quantity can therefore become a hygiene problem even when the available source is not grossly contaminated.

Sanitation challenges can similarly create environmental risks. Poorly constructed or inadequately maintained toilets can leak or overflow, while indiscriminate disposal of faeces can contaminate soil and water. Children’s faeces may sometimes be considered less harmful than adult faeces, resulting in unsafe disposal practices. Yet children’s faeces can contain infectious organisms and should be safely disposed of. When such practices occur close to homes, play areas, water points or food preparation spaces, children may experience repeated exposure to enteric pathogens.

Waste management is another component of the household environment that deserves attention. Accumulation of household refuse, blocked drainage, stagnant wastewater and indiscriminate disposal of waste can create unhygienic surroundings and increase opportunities for contamination. Although waste management alone does not explain all diarrhoeal disease transmission, poor environmental sanitation can interact with unsafe water and hygiene practices to create a broader environment in which pathogens circulate.

A further problem is that national and state-level WASH data may conceal substantial variation between individual communities. The 2021 Nigeria MICS provides important national evidence on household and child health conditions, while WASHNORM provides information on WASH service levels. However, such surveys cannot necessarily explain the specific practices and environmental circumstances of selected rural communities in Obio-Akpor Local Government Area.

There is consequently a local evidence gap. While national studies have established an association between WASH conditions and childhood diarrhoea in Nigeria, the findings cannot automatically be generalized to every rural community in Rivers State. The sources of household water, methods of water storage, sanitation facilities, handwashing behaviour, disposal of children’s faeces, household waste management and other hygiene practices may vary from one community to another. Without community-specific information, public health interventions may be designed around general assumptions rather than actual local practices.

The problem is also one of prevention. Much attention may be given to treating children after diarrhoea occurs, including the use of oral rehydration solution and zinc, while insufficient attention may be given to the household practices that facilitate repeated exposure. Although appropriate treatment remains essential, preventing exposure to diarrhoeal pathogens is more desirable than repeatedly treating preventable illness. WASH interventions therefore need to be complemented by behavioural change, health education, environmental sanitation and household-level monitoring.

Furthermore, the relationship between WASH and diarrhoea is not necessarily determined by one factor alone. A household may have access to improved water but poor sanitation; another may have a toilet but poor handwashing practices; another may have water and sanitation facilities but unsafe storage practices. This makes it necessary to investigate WASH as a combination of interconnected household practices rather than examining water, sanitation or hygiene in isolation.

The evidence from systematic reviews also suggests that WASH interventions can produce different effects depending on baseline conditions, intervention quality and the extent to which households actually use the facilities and adopt recommended behaviours. This reinforces the importance of investigating practices at household level rather than assuming that the presence of facilities automatically eliminates disease risk (Wolf et al., 2023).

In selected rural communities of Obio-Akpor Local Government Area, there is therefore a need to establish the prevailing household water, sanitation and hygiene practices and examine their relationship with diarrhoeal disease among under-five children. Specifically, it is important to determine the main sources of household water, the methods used for water treatment and storage, the availability and use of sanitation facilities, the practices surrounding children’s faecal disposal, handwashing practices, household waste management and other hygiene behaviours. It is equally important to determine the reported occurrence of diarrhoeal diseases among under-five children and establish whether poor WASH practices are associated with increased diarrhoeal risk.

Failure to generate such evidence may make it difficult for health educators, community health practitioners, environmental health officers, local government authorities and other stakeholders to identify the most important household-level practices requiring intervention. A community-based assessment can provide evidence for targeted health education, WASH promotion, environmental sanitation activities and policies aimed at reducing preventable childhood morbidity.

It is against this background that this study seeks to examine Household Water, Sanitation and Hygiene Practices and the Risk of Diarrhoeal Diseases among Under-Five Children in Selected Rural Communities in Obio-Akpor Local Government Area, Rivers State. The study will focus on the household as a key environment in which children are exposed to, or protected from, diarrhoeal pathogens and will generate local evidence on the relationship between WASH practices and diarrhoeal disease risk.

1.3 Purpose of the Study

The general purpose of this study is to examine household water, sanitation and hygiene practices and their relationship with the risk of diarrhoeal diseases among under-five children in selected rural communities in Obio-Akpor Local Government Area, Rivers State.

Specifically, the study seeks to:

1. assess the sources and household management practices of drinking water among households with under-five children in the selected rural communities;
2. determine the sanitation practices of households with under-five children, including toilet availability, use, maintenance and disposal of children’s faeces;
3. assess the hygiene practices of caregivers and households, particularly handwashing, food hygiene and environmental cleanliness;
4. determine the prevalence or reported occurrence of diarrhoeal diseases among under-five children in the selected communities

1.4 Research Questions

The following research questions will guide the study:

1. What are the major sources of drinking water and household water-management practices among households with under-five children in the selected rural communities?
2. What sanitation practices are adopted by households with under-five children in the selected communities?
3. What hygiene practices are observed by caregivers and households in the selected rural communities?
4. What is the reported occurrence of diarrhoeal diseases among under-five children in the selected communities?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between household water, sanitation and hygiene practices and the risk of diarrhoeal diseases among under-five children in selected rural communities in Obio-Akpor Local Government Area, Rivers State.

1.6 Significance of the Study

The findings of this study will be useful to several groups, including caregivers and households, public health practitioners, environmental health officers, community health workers, local government authorities, policymakers, researchers and academic institutions.

Caregivers and households: The study will provide information about the importance of safe water collection, treatment and storage, proper toilet use, safe disposal of children’s faeces and handwashing. The findings may help caregivers identify household behaviours that can expose children to diarrhoeal pathogens and encourage safer practices.

Under-five children: Although children may not directly participate in household decision-making, they are expected to benefit from improved household practices resulting from the study. Reduction in exposure to contaminated water, faeces, food and household surfaces may contribute to reduced diarrhoeal morbidity and improved child health.

Public health practitioners: The findings will provide community-level evidence that can guide health education and disease-prevention programmes. Public health practitioners may use the information to design interventions that address specific behavioural and environmental risk factors rather than relying solely on general health messages.

Community health workers: Community health workers can use the findings to strengthen household visits, health talks and community mobilization activities. The study may help them identify areas where caregivers require additional education on water treatment, sanitation, handwashing and childhood diarrhoea prevention.

Environmental health officers: The study may provide useful information for environmental sanitation activities, including household sanitation inspection, waste-management education, promotion of hygienic surroundings and community-level environmental health interventions.

Local government authorities: The findings may assist Obio-Akpor Local Government Area and other relevant authorities in identifying WASH challenges requiring intervention. Evidence from the study may support efforts to improve access to safe water, sanitation infrastructure, environmental sanitation and community health education.

Policy makers: The study may contribute local evidence to the broader Nigerian WASH agenda. Such evidence is important because national-level indicators may not fully describe conditions within specific rural communities.

Researchers: The study will contribute to the body of literature on WASH and childhood diarrhoeal disease in Nigeria. It may also serve as a reference for future researchers investigating household environmental health, childhood diseases, sanitation and community health.

Academic institutions: The findings may provide useful academic material for students and lecturers in public health, community health, environmental health, nursing and related disciplines.

1.7 Scope of the Study

The study focuses on household water, sanitation and hygiene practices and the risk of diarrhoeal diseases among under-five children in selected rural communities in Obio-Akpor Local Government Area, Rivers State.

The study will concentrate on households that have at least one child below five years of age. The content scope covers household sources of water, water treatment, water transportation and storage, sanitation facilities, toilet use and maintenance, disposal of children’s faeces, handwashing practices, food and environmental hygiene, household waste management and reported diarrhoeal disease among under-five children.

The geographical scope is limited to selected rural communities within Obio-Akpor Local Government Area of Rivers State. The study will not attempt to generalize its findings automatically to every community in Rivers State or to all households in Nigeria. Rather, its conclusions will primarily relate to the selected study communities and populations.

1.8 Operational Definition of Terms

Household: A group of persons who live together in the same dwelling and share household arrangements, resources or responsibilities for daily living.

Water, Sanitation and Hygiene (WASH): The interconnected environmental health components involving access to and use of safe water, adequate sanitation facilities and appropriate hygiene practices.

Household water practices: Activities involving the collection, transportation, treatment, storage and use of water within the household.

Safe drinking water: Water that is sufficiently protected from contamination and suitable for drinking and domestic consumption.

Water treatment: Any household process used to improve the microbiological safety of water, including boiling, chlorination, filtration or other appropriate treatment methods.

Water storage: The practice of keeping water for later household use in containers or vessels.

Sanitation: The safe management and disposal of human excreta and related environmental conditions in order to prevent human contact with disease-causing organisms.

Hygiene: Personal and household practices that help prevent the spread of disease-causing organisms, including handwashing, food hygiene and environmental cleanliness.

Handwashing: The cleaning of hands with water and, preferably, soap or another cleansing agent, particularly at critical times such as after defecation and before preparing or consuming food.

Diarrhoeal disease: A condition characterized by the passage of three or more loose or liquid stools within a 24-hour period, or more frequent passage than is normal for the individual (WHO, 2024).

Risk of diarrhoeal disease: The likelihood that an under-five child may experience diarrhoeal illness as a result of exposure to relevant household, environmental, behavioural and WASH-related risk factors.

Under-five children: Children from birth up to but not including five years of age.

Household WASH practices: The actual behaviours and activities carried out by household members concerning water management, sanitation and hygiene.

Sanitation facility: A toilet, latrine or other facility designed to safely contain and manage human faeces.

Safe disposal of children’s faeces: The practice of disposing of a child’s faeces in a manner that prevents human contact and environmental contamination, preferably through the use of an appropriate sanitation facility.

Environmental sanitation: Activities directed at maintaining a clean and healthy physical environment, including proper waste disposal, drainage maintenance and control of environmental contamination.

Rural community: A geographically identifiable community characterized in this study as a less urbanized settlement within the selected area of Obio-Akpor Local Government Area.

Project – Household Water, Sanitation and Hygiene Practices and the Risk of Diarrhoeal Diseases among Under-Five Children: A Study of Selected Rural Communities in Obio-Akpor Local Government Area, Rivers State