Project – Assessment of the Effects of Poor Sanitation on the Prevalence of Diarrhoeal Diseases Among Children Under Five Years. A study of Selected Primary Health Centres in Enugu State

CHAPTER ONE
INTRODUCTION

1.1 Background to the Study

Sanitation plays a critical role in public health and human development, particularly in reducing the burden of communicable diseases among children under five years of age. According to the World Health Organization (WHO, 2022), poor sanitation contributes significantly to the transmission of diseases such as diarrhoea, cholera, typhoid, and dysentery. Diarrhoeal disease remains one of the leading causes of morbidity and mortality among children globally, especially in low- and middle-income countries where sanitation infrastructure is inadequate. The WHO estimates that 1.5 million children die annually from diarrhoeal diseases caused by unsafe water, poor sanitation, and inadequate hygiene practices (UNICEF, 2021).

In Nigeria, the problem of poor sanitation is a pressing public health concern. Many communities, particularly in rural and semi-urban areas, still lack access to improved sanitation facilities and safe drinking water (National Bureau of Statistics [NBS], 2021). The Federal Ministry of Health (2020) reported that diarrhoea accounts for approximately 16% of deaths among children under five, a rate that is largely preventable through improved water supply, sanitation, and hygiene (WASH) interventions. Children are especially vulnerable because of their weaker immune systems and greater exposure to contaminated environments through play and feeding practices (Adeniran & Ojo, 2022).

In Enugu State, poor sanitation and hygiene practices persist despite various public health initiatives. Many households rely on unimproved water sources such as wells and streams and use pit latrines or open defecation methods. This has resulted in the contamination of water sources and the spread of diarrhoeal pathogens (Eze & Nwosu, 2021). Primary Health Centres (PHCs) in the state continue to record high numbers of diarrhoea cases, particularly among children under five years, due to poor environmental hygiene, inadequate waste disposal, and lack of access to clean water (Okonkwo et al., 2022).

Good sanitation involves the safe management of human excreta, maintenance of a clean environment, and proper waste disposal (WHO, 2021). It also encompasses hygiene practices such as handwashing with soap, safe water storage, and food hygiene. When these measures are not implemented, disease-causing organisms can easily spread within households and communities. Therefore, addressing poor sanitation practices is essential to improving child health outcomes and achieving Sustainable Development Goal (SDG) 6, which aims to ensure availability and sustainable management of water and sanitation for all by 2030 (United Nations, 2020).

This study focuses on assessing the effects of poor sanitation on the prevalence of diarrhoeal diseases among children under five years in selected Primary Health Centres (PHCs) in Enugu State. It aims to establish the relationship between sanitation conditions—such as type of water source, toilet facilities, and hygiene practices—and the incidence of diarrhoeal diseases, with the ultimate goal of providing insights for effective public health interventions.

1.2 Statement of the Problem

Despite numerous health interventions and awareness programs, diarrhoeal diseases remain a major cause of illness and death among Nigerian children under five. In many communities across Enugu State, inadequate sanitation facilities, open defecation, and poor hygiene practices continue to expose children to faecal contamination (Eze & Nwosu, 2021). Access to clean and safe water remains limited, and waste management systems are either inefficient or non-existent, especially in rural and peri-urban settlements.

According to the Enugu State Ministry of Health (2022), diarrhoea cases among children under five remain high in Primary Health Centres, particularly during the rainy season when water sources are easily contaminated. Mothers and caregivers often lack adequate knowledge about hygiene practices such as handwashing and safe water storage. Furthermore, poverty and cultural beliefs sometimes discourage the adoption of improved sanitation practices (Ogbu et al., 2022).

The persistent occurrence of diarrhoeal diseases despite existing health campaigns suggests that current efforts may not be effectively addressing the underlying causes. There is a need for a systematic assessment of how poor sanitation—specifically inadequate water supply, lack of proper toilet facilities, and unhygienic practices—contributes to the prevalence of diarrhoeal diseases among children under five in Enugu State. Understanding these dynamics is essential for designing more effective community-based interventions and improving child health outcomes.

1.3 Objectives of the Study

The main objective of this study is to assess the effects of poor sanitation on the prevalence of diarrhoeal diseases among children under five years in selected Primary Health Centres in Enugu State.

The specific objectives are to:

1. Examine the sources of water used by households with children under five years in Enugu State.

2. Assess the types and conditions of sanitation facilities available to households.

3. Evaluate hygiene practices among caregivers of children under five years.

4. Determine the relationship between sanitation conditions and the incidence of diarrhoeal diseases among children under five years.

1.4 Research Questions

1. What are the major sources of water used by households with children under five years in Enugu State?

2. What types of sanitation facilities are available to households in the study area?

3. What are the hygiene practices commonly observed among caregivers of children under five years?

4. How does poor sanitation influence the prevalence of diarrhoeal diseases among children under five years in Enugu State?

1.5 Research Hypothesis

H₀: There is no significant relationship between poor sanitation and the prevalence of diarrhoeal diseases among children under five years in Enugu State.

1.6 Significance of the Study

This study is significant for several reasons. First, it provides empirical evidence on how inadequate sanitation contributes to diarrhoeal diseases among children under five years, thereby guiding policymakers and health practitioners in designing targeted interventions. Second, it contributes to the growing body of literature on public health and environmental sanitation in Nigeria, especially within the context of child health. Third, the findings will be beneficial to public health officers, community health workers, and non-governmental organizations (NGOs) working in water, sanitation, and hygiene (WASH) sectors, as it will help them to prioritize interventions in the most affected communities.

Furthermore, the study will assist the Enugu State Ministry of Health in developing data-driven strategies for reducing the incidence of diarrhoea and other sanitation-related diseases. Finally, it will raise public awareness about the importance of hygiene practices, safe water use, and improved sanitation facilities in promoting children’s health.

1.7 Scope of the Study

The study focuses on assessing the effects of poor sanitation on the prevalence of diarrhoeal diseases among children under five years in selected Primary Health Centres in Enugu State. It covers issues related to sources of water, sanitation facilities, hygiene practices of caregivers, and reported cases of diarrhoea among children under five. The study is limited to selected PHCs within Enugu State due to time and resource constraints but provides insights applicable to similar contexts in Nigeria.

1.8 Operational Definition of Terms

• Sanitation: The process of maintaining hygienic conditions through the safe disposal of human waste and proper waste management.

• Diarrhoeal Diseases: Illnesses characterized by frequent, loose, or watery stools, often caused by ingestion of contaminated water or food.

• Hygiene Practices: Behaviours and actions taken to maintain cleanliness and prevent disease, such as handwashing with soap and proper food handling.

• Water Source: The origin of water used for domestic purposes, which can be improved (e.g., boreholes, piped water) or unimproved (e.g., rivers, open wells).

• Primary Health Centre (PHC): A basic health facility providing essential healthcare services at the community level.

Project – Assessment of the Effects of Poor Sanitation on the Prevalence of Diarrhoeal Diseases Among Children Under Five Years. A study of Selected Primary Health Centres in Enugu State