Project – The Effect of Household Sanitation Practices on the Prevalence of Diarrhoeal Diseases among Children Under Five Years: A Study of Selected Communities in Ikorodu, Lagos State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Diarrhoeal disease remains an important public health problem among children under five years of age, particularly in low- and middle-income countries where environmental and household conditions may increase children’s exposure to disease-causing organisms. Diarrhoea is commonly defined as the passage of three or more loose or liquid stools within a day and may result from bacterial, viral or parasitic infections transmitted through contaminated water, food, hands and environmental surfaces. The World Health Organization (WHO, 2024) identifies diarrhoeal disease as the third leading cause of death among children aged 1–59 months, with hundreds of thousands of under-five deaths occurring annually. The disease is particularly dangerous in young children because repeated episodes can result in dehydration, nutritional deficiencies, impaired growth and increased vulnerability to other infections. WHO further identifies safe drinking water, adequate sanitation, handwashing with soap and appropriate hygiene as important preventive measures against diarrhoeal disease (WHO, 2023; WHO, 2024). Thus, household sanitation practices represent an important component of childhood disease prevention because the household is one of the primary environments in which young children eat, drink, play and come into contact with human and animal waste.

Household sanitation refers broadly to the facilities, behaviours and environmental practices used by families to safely manage human excreta, domestic wastewater, household refuse and other materials that may create conditions for disease transmission. Important sanitation practices include the availability and proper use of toilets or latrines, safe disposal of children’s faeces, avoidance of open defecation, proper management of household waste, maintenance of clean surroundings and appropriate disposal of wastewater. Poor sanitation can facilitate the movement of faecal organisms from human waste into household water, food, soil, utensils, hands and children’s play environments. WHO (2024) reports that inadequate sanitation is strongly associated with diarrhoeal diseases such as cholera and dysentery and contributes to malnutrition and other infectious conditions. Similarly, the WHO/UNICEF Joint Monitoring Programme emphasizes the importance of universal access to safely managed sanitation as part of Sustainable Development Goal 6 (WHO & UNICEF, 2023). Therefore, the quality of sanitation available at household level is not merely an environmental concern but an important determinant of child health.

The relationship between household sanitation and diarrhoeal disease is particularly important for children under five because their behavioural and biological characteristics can increase their exposure to contaminated environments. Young children frequently put their hands and objects into their mouths, crawl or play on floors and outdoor surfaces, and may come into contact with contaminated soil or faeces when sanitation facilities are inadequate. In addition, children depend heavily on adults and caregivers for safe water, food preparation, cleaning and disposal of faeces. A national Nigerian analysis by Ezeh et al. (2018) found a statistically significant relationship between living-environment conditions, including access to improved toilet and water facilities, and diarrhoea among children under five. The study reported an overall diarrhoea prevalence of 11.3% and found that children without improved toilet facilities had higher odds of diarrhoea than those with improved access. The findings demonstrate that the household environment can contribute to childhood diarrhoeal risk and that improvements in sanitation and related living conditions may have important public-health benefits (Ezeh et al., 2018).

Household sanitation is also closely connected with the safe disposal of children’s faeces, which is sometimes overlooked when families possess a toilet facility. The availability of a toilet does not automatically guarantee safe sanitation if children’s stools are disposed of in open spaces, drains, refuse areas or other inappropriate locations. WHO (2024) emphasizes that improving sanitation facilities needs to be accompanied by safe disposal of children’s and animal faeces and the reduction of open defecation. Evidence from Lagos is particularly relevant to the present study. In a case-control study conducted in Lagos, Nigeria, observations of household environmental conditions found that the presence of faeces in and around toilet areas, the use of chamber pots within dwelling units, indiscriminate waste disposal and the source of domestic water were significantly associated with childhood diarrhoea (Curtis et al., 1991). More recent research among mothers in Lagos also found that although many respondents reported using soap and water for handwashing, less than half reported disposing of their children’s faeces in the toilet, while some reported disposing of faeces in dustbins or rinsing them into gutters (Momoh et al., 2022). These findings show that household sanitation practices involve both the availability of facilities and the actual behaviours through which caregivers manage faeces and household waste.

Hand hygiene and household cleanliness further constitute important components of sanitation-related disease prevention. Although sanitation and hygiene are conceptually different, they operate together in interrupting the faecal-oral transmission pathway. Hands can become contaminated after using the toilet, assisting children who have defecated, cleaning contaminated surfaces or handling faeces, and microorganisms can subsequently be transferred to food, water, utensils and children’s mouths. WHO (2024) identifies handwashing with soap at critical times, including after toilet use and before food preparation, as an important intervention for reducing diarrhoeal disease. The WHO WASH guidance also indicates that inadequate hygiene behaviours contribute to diarrhoeal disease and that sanitation improvements should be accompanied by appropriate hygiene behaviours (WHO, 2024). In Lagos State, Momoh et al. (2022) found that 76.1% of surveyed mothers reported washing their hands before preparing food, while only 27.5% reported handwashing after defecation and 8.1% after attending to a child who had defecated. Such evidence suggests that household sanitation-related behaviours may vary considerably across different activities, making it necessary to examine specific practices rather than assuming that households with sanitation facilities necessarily practise safe hygiene.

Nigeria continues to face substantial challenges in providing adequate water, sanitation and hygiene services, with implications for childhood diarrhoeal disease. UNICEF Nigeria reports that poor access to improved water and sanitation remains an important contributor to morbidity and mortality among Nigerian children under five and identifies diarrhoea as one of the major diseases associated with inadequate WASH conditions (UNICEF Nigeria, 2024). The 2018 Nigeria Demographic and Health Survey provides further evidence of the association between household sanitation and childhood diarrhoea. According to the survey, 13% of children under five had diarrhoea during the two weeks preceding the survey, while diarrhoea prevalence was higher among children living in households with unimproved sanitation than among those living in households with improved sanitation (National Population Commission [NPC] & ICF, 2019). UNICEF’s analysis of Nigeria’s WASH situation has also highlighted major gaps in basic sanitation, water access and hand hygiene, particularly among vulnerable populations (UNICEF Nigeria, 2023). These national conditions make household sanitation an important area of public-health research, especially in densely populated and rapidly changing communities where sanitation infrastructure and household practices may vary substantially.

The issue is particularly relevant in Lagos State, including communities within Ikorodu, where population growth, urban expansion, household density and differences in access to environmental infrastructure can influence sanitation conditions. Evidence from Southwest Nigeria demonstrates that childhood diarrhoea remains associated with multiple environmental, household and behavioural factors. Ugboko et al. (2021), in a study covering Lagos and Ogun States, investigated risk factors associated with diarrhoea among children under five and highlighted the importance of environmental and household factors in understanding childhood diarrhoeal disease in the region. In another Lagos-based study, Momoh et al. (2022) reported that prevention practices among caregivers varied considerably, including practices relating to handwashing, exclusive breastfeeding and disposal of children’s faeces. Importantly, Ogbo, Soremekun and Aina (2021) specifically studied caregivers of under-five children in Ikorodu Local Government Area and reported on home management of acute diarrhoea among 1,236 caregivers, confirming that diarrhoeal disease is a relevant child-health issue within the Ikorodu setting. Against this background, there is a need to examine household sanitation practices specifically and determine their relationship with the prevalence of diarrhoeal diseases among children under five in selected communities in Ikorodu, Lagos State.

1.2 Statement of the Problem

Diarrhoeal diseases continue to pose a significant threat to the health and survival of children under five despite the availability of relatively simple preventive and treatment interventions. Safe sanitation, clean water, handwashing, appropriate food hygiene and proper disposal of human faeces can interrupt many pathways through which diarrhoeal pathogens are transmitted. Nevertheless, evidence from Nigeria indicates that diarrhoea remains common among young children. The 2018 Nigeria Demographic and Health Survey reported that 13% of children under five had experienced diarrhoea during the two weeks preceding the survey, with prevalence being higher among children living in households with unimproved sanitation than among those with improved sanitation (NPC & ICF, 2019). WHO (2024) similarly emphasizes that inadequate sanitation and hygiene contribute substantially to diarrhoeal disease worldwide. The persistence of diarrhoea despite knowledge of preventive measures suggests that the availability of sanitation facilities alone may not be sufficient; the actual practices through which households use and maintain these facilities may also require attention.

A major concern is that some households may have access to sanitation facilities but continue to engage in practices that increase children’s exposure to faecal contamination. Unsafe disposal of children’s faeces, open disposal of household waste, contamination around toilet facilities, inappropriate handling of chamber pots and poor management of domestic wastewater can create pathways for pathogens to reach children. Evidence from Lagos provides direct support for this concern. Curtis et al. (1991) found significant associations between childhood diarrhoea and the presence of faeces around toilet areas, defecation or urination in chamber pots, indiscriminate waste disposal and domestic water sources. More recently, Momoh et al. (2022), in a study conducted in Lagos State, found that less than half of caregivers disposed of children’s faeces in toilets, while some disposed of them in dustbins or gutters. WHO (2024) also emphasizes that safe sanitation requires not only facilities but appropriate disposal of children’s faeces and cessation of open defecation. These findings indicate that household sanitation behaviours remain an important public-health concern.

Another problem is that evidence on household sanitation and childhood diarrhoea may vary according to geographical location and population characteristics. National studies provide useful information on the overall Nigerian situation, but national estimates may conceal differences between states, local government areas and individual communities. Ezeh et al. (2018) found a significant relationship between water and sanitation conditions and diarrhoea among Nigerian under-five children, while Ugboko et al. (2021) identified risk factors for diarrhoea among children under five in Lagos and Ogun States. In Ikorodu specifically, Ogbo et al. (2021) examined home management of acute diarrhoea among a large sample of caregivers, demonstrating the relevance of diarrhoeal disease to the local child-health context. However, examining how household sanitation practices themselves relate to the prevalence of diarrhoeal disease requires a more focused community-level investigation. Without such evidence, health planners may have difficulty identifying which sanitation practices require greater attention among households with young children in selected Ikorodu communities.

The persistence of childhood diarrhoeal disease in the presence of known preventive measures therefore creates an important public-health research problem. Although national and regional evidence indicates that sanitation, water and hygiene conditions are associated with childhood diarrhoea, there remains a need for context-specific evidence concerning actual household sanitation practices in selected communities in Ikorodu, Lagos State. Understanding whether practices such as toilet use, disposal of children’s faeces, household waste disposal, wastewater management, maintenance of toilet facilities and related hygiene behaviours are associated with diarrhoeal disease can provide useful evidence for community health education and preventive interventions. The present study therefore seeks to examine the effect of household sanitation practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State. The study is expected to provide empirical evidence that can support household-level health education and community sanitation interventions (WHO, 2023; UNICEF Nigeria, 2023; Momoh et al., 2022).

1.3 Purpose of the Study

The general purpose of this study is to examine the effect of household sanitation practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State.

Specifically, the study seeks to:

1. Examine the effect of household toilet and latrine practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State.
2. Determine the effect of children’s faeces disposal practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State.
3. Examine the effect of household waste disposal practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State.
4. Determine the overall effect of household sanitation practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State.

1.4 Research Questions

The following research questions will guide the study:

1. What is the effect of household toilet and latrine practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State?
2. What is the effect of children’s faeces disposal practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State?
3. What is the effect of household waste disposal practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State?
4. What is the overall effect of household sanitation practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State?

1.5 Hypothesis

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

H₀: Household sanitation practices have no statistically significant effect on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State.

1.6 Significance of the Study

The study will be significant to parents and caregivers of children under five years because it will provide information about household sanitation practices that may contribute to the prevention or occurrence of diarrhoeal diseases. The findings may help caregivers understand the importance of appropriate toilet use, safe disposal of children’s faeces, proper household waste disposal and maintenance of a clean household environment.

The study will be useful to community health workers and public-health practitioners because it will provide community-level evidence that can guide health education and sanitation promotion activities. The findings may assist health workers in identifying specific sanitation behaviours that require greater attention during community outreach programmes.

The study will also be beneficial to Lagos State and local government health authorities, particularly those responsible for environmental health, sanitation and child-health programmes. Evidence from the study may support the design of targeted sanitation education and disease-prevention interventions in communities where poor household sanitation practices are associated with childhood diarrhoeal disease.

The study will be useful to non-governmental organisations and development agencies involved in water, sanitation and hygiene interventions. The findings may provide additional evidence for designing household-focused WASH programmes aimed at reducing children’s exposure to faecal contamination.

Finally, the study will contribute to academic literature on household sanitation and childhood diarrhoeal diseases in Nigeria. It will provide context-specific evidence from selected communities in Ikorodu, Lagos State, and may serve as a reference for researchers undertaking related studies in environmental health, community health, public health and epidemiology.

1.7 Scope of the Study

The study focuses on the effect of household sanitation practices on the prevalence of diarrhoeal diseases among children under five years in selected communities in Ikorodu, Lagos State.

The independent variable is household sanitation practices, which will be examined through household toilet and latrine practices, disposal of children’s faeces and household waste disposal practices. The dependent variable is prevalence of diarrhoeal diseases among children under five years.

Geographically, the study is restricted to selected communities within Ikorodu, Lagos State, Nigeria. The study will focus on households with children under five years of age and will not cover children outside the specified age group.

1.8 Operational Definition of Terms

Household Sanitation: The facilities, conditions and practices through which a household safely manages human excreta, household waste, wastewater and other materials that may contribute to disease transmission.

Sanitation Practices: The actual behaviours undertaken by household members to maintain hygienic environmental conditions, including toilet use, disposal of children’s faeces, waste disposal and management of household wastewater.

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.

Prevalence: The proportion of children under five years in the study population who have experienced diarrhoeal disease within the specified reference period.

Children Under Five Years: Children from birth up to 59 months of age.

Household Toilet/Latrine Practice: The availability, use, cleanliness and maintenance of household toilets or latrines and the extent to which household members use them appropriately.

Children’s Faeces Disposal: The methods used by caregivers to collect, contain and dispose of faeces produced by children in a household.

Household Waste Disposal: The methods used by households to collect, store and dispose of solid domestic waste.

Hygiene: Practices that reduce exposure to infectious agents, including handwashing with soap, personal cleanliness and safe handling of food and household materials.

Selected Communities: The communities within Ikorodu Local Government Area that will be deliberately selected as the study locations.

Project – The Effect of Household Sanitation Practices on the Prevalence of Diarrhoeal Diseases among Children Under Five Years: A Study of Selected Communities in Ikorodu, Lagos State.