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An Assessment of Knowledge and Practice of People in Flood Risky Areas on Health Education and Hygiene in District Charsadda, Khyber Pakhtoonkhwa

Research Article                                          Vol:1,Issue:1

Abid Jan, Afshan Afridi, Abdus Salam

Abstract

Recent flood disasters brought sever epidemics of infectious diseases which caused severe damage to the economy and health of the people. People of the areas which were near the rivers were got rashes, malaria, and diarrhoea like epidemic diseases. The recent study was conducted to assist the level of knowledge regarding health education and hygiene practice in the district of Charsadda, which was one of the affected districts of Khyber Pukhtoonkhwa. Two hundred samples were collected from the four different clusters of Charsadda randomly through a standardized questionnaire. The knowledge and practice regarding health education and hygiene practice were assisted and data were analyzed through SPSS 16 and Microsoft Excel software. One hundred and seventeen 117(58.5%) were having a knowledge regarding health education and hygiene while eighty-three 83(41.5%) had no idea about good hygiene and health education. ten 10(5%) were using water from the river, twenty-four 24(12%) one hundred and thirty-six 136(68%) were using water pumps while thirty 30(15%) were taking water from other sources. One hundred and twenty-seven 127(63.50%) were practicing hygiene while seventy-three 73(36.50%) were not performing hygiene practice and safety. The use of mosquito nets in rainy seasons were 41(20.5%) with positive and 159(79.5%) in negative. The results show that there is an immense need for health education and promotion of hygiene in the flood risky areas. The people of the areas are prone to infectious diseases epidemics in flood seasons.

Key Words: Health Education, Hygiene, Personal Hygiene.

SAJMED.2015; 1(1):07-16                                                               PDF Download 

Introduction

loods are the most common   natural disaster in both developed and developing countries (1). The environmental health and hygiene situation is of serious concern, as some waterborne diseases such as diarrhoea, and skin diseases are increasing in flooded areas where water is becoming unsafe. Garbage collection has been disrupted and resulted to open dumping in flooded communities. There are also instances where some latrines are damaged and/or submerged, and as a result, people are practicing open defecation. People living in these areas are at high risk and thus they need assistance for disease prevention, health and hygiene education(2). In flood conditions, there is potential for increased faecal-oral transmission of disease, especially in areas where the population does not have access to clean water and sanitation. Published studies (case-control studies, cross-sectional surveys, outbreak investigations, analyses of routine data) have reported post flood increases in cholera (3). Water supply and sanitation condition become severely disrupted during flood when it embraces various water borne diseases in Bangladesh. During every flood about two-thirds of the tube-wells and all toilets become unusable. As an adaptation approach tube-wells have been either placed on an elevated base or raised with an extra pipe. But owing to using hanging latrines or a boat and defecating directly into water bodies most people pollute those water bodies. Although majority of the people suffer from different water borne diseases no remarkable adaptation approach is followed. Few people store any emergency medicine before a flood and sometimes take treatment from local rural doctors (4). Floods have occasionally a devastating impact, as the floods in China in 1959 and Bangladesh in 1974 and the tsunami in Southeast Asia in December 2004 show (5). Some 18,000 people were affected by flash flooding in the northern Afghan province of Sar-e-Pol. The flood affected families were living in three districts of the province, which were the worst hit. Media reports stated that 22 people died from the floods. The Afghan Red Crescent Society (ARCS), with support from the International Federation of Red Cross and Red Crescent Societies (IFRC), responded to the needs of the people by distributing non-food items. Further distributions of non-food items, as well as provision of emergency health care, were provided in the coming months as the operation moves ahead (6). Floods are also not a new phenomenon in Pakistan. There have been fifty floods in last twenty eight years. In each of these calamities, those whose lives were devastated never recovered to the state where they were before the disaster. Those who suffer are always the same people (7). Poverty and ill-health go hand–in hand. Individuals who are poor are more prone to ill-health, and vice-versa (8). As the assessment of diarrhoea, skin rash, and dehydration were showing that it is a common health problems faced by the majority of households in the divested flood affected/risky areas. A vast majority of respondents had access to water mostly from unsecure and contaminated sources, unprotected springs, wells and rivers. In areas where the water supply schemes remained intact, the sources of water were blocked due to silting or contamination due to influx of floodwaters. Moreover, the assessment reviewed the sanitation and hygiene situation. The sanitation situation for women was more precarious, as the defecated faeces remained on the surface due to clogged sanitation tanks and channels. This was one of the main contributing factors of diarrhoea and other water borne diseases (9). Floods of all magnitude have the potential to impact on human health. In order to understand better the nature of this health burden the report surveys the evidence base available on the epidemiology of floods. The epidemiological studies provide the substantive results of this review, with studies grouped under the following categories: mortality; injuries; diarrhoeal disease; other faecal-oral; infection from soil-transmitted helminthes; vector-borne disease; rodent-borne disease; mental health; and other health outcomes (10). Floods have the potential to exact a huge impact on the health of human populations. Since 1900, for example, flood disasters alone have led to at least 6.8 million reported deaths and 1.3 million reported injuries (11). A further, undocumented global health burden arises annually from floods that are severe in effect but not classified as full-blown ‘disasters’. To date, there have been few published reviews on the health impacts of floods (12), and these have either focused on particular geographical regions, or not involved a systematic review of the available epidemiological evidence. Therefore, in order to understand better the nature of the overall health burden from floods, this chapter surveys the evidence base available on the epidemiology of all floods (1). Research shows that hygienic practices can have an equal or greater impact on disease prevention than water supply and sanitation facilities. Modern thinking suggests that the two must go hand in hand to effectively combat disease and to boost healthy, sustainable hygienic behaviors. To control diarrhoeal disease, your messages should highlight the priority hygiene practices: hand wash with water and soap, or when not available use ash after contact with faeces; and safe disposal of adults’ and children’s faeces to prevent infection and contamination – i.e. clear scattered faeces, control open defecation and shallow trench latrines, repair toilet facilities and/or build temporary family or communal latrines (13). The 2010 Pakistan floods began in late July, and following heavy monsoon rains that lasted for more than eight weeks, they evolved from normal flash floods into a massive disaster affecting large parts of the country. The floodwater waves washed down from north to south as the Indus River caudal extended to about forty times its usual size and at one point, submerged a fifth of the country’s landmass.  Initially, the provinces of Balochistan and Khyber Pakhtunkhwa (KPK) were flooded. In mid-August, as flood waters flowed south and as Punjab and Sindh provinces experienced resultant widespread flooding, entire populations residing on both sides of the Indus River basin were affected. The floods directly and/or indirectly affected 78 of Pakistan’s 121 districts, devastating and submerging entire villages, roads, bridges, water supply and sanitation infrastructure, agricultural lands, livestock as well as washing away houses and health and education facilities (81). This study was conducted in order to find out the level of knowledge and practice of health education and hygiene in those areas which are the flood(s) affected and always remain at risk to be hit by floods.

Materials and Methods

Questionnaire Development: Data was collected through standardized questionnaire developed for the assessment of knowledge and practice of hygiene by center for diseases control and prevention (CDC). The questionnaire was consisting of 22 questions out of which 7 questions were based on demographic information like age, occupation, living status, monthly income and number of children in the family.The rest of15 questions were based on the hygiene knowledge and practice. Both open end and closed end questions were added so that the person has a wide choice to give the most suitable answer. The questions were selected carefully so that it can reflect our objectives and the answers can satisfy the aim of the study. The geography of the area were kept in mind for the kind of diseases development, during the flood seasons and the diseases already developed during the flood of 2010.

Data Collection: The area of district Charsadda was divided in to four (4) clusters i.e. Utmanzai, Rajjar, Sardaryab and Nisata. Out of these four clusters fifty (50) families were randomly interviewed from each cluster i.e. fifty (50) from Utmanzai, fifty (50) from Rajjar, fifty (50) from Sardaryab and fifty (50) from Nisata. For the purpose, elder of each family was selected as a focal person to be interviewed. The people selected were living near rivers and were affected by the flood of 2010.One questionnaire was used for the information of one family. The data collected was about the demographic information of the residents of the flood affected people such as occupation, living standard and educational qualification. The families were interviewed for the performance of the hygiene practice in daily routine and their knowledge about health and hygiene. The elder or incharge of the family was selected for interview. Male were interviewed by the male data collector while the females were interviewed by female interviewer. The designed questionnaire was printed on one page and two hundred (200) copies were made of it used as one page for one family. The total duration of the data collection was 3 months. The families who refused to cooperate were excluded from the study and those who were out of the area being shifted permanently or living far from flood covering areas were also excluded.

Health Education and Hygiene: The level of health education and hygiene practice was analyzed through the questions like hand washing with soap or not, washing of hands before eating meal and after using washroom, sources of water people use in flood seasons, cutting of nails, cooking of food, knowledge about good hygiene practice and cleaning of streets and houses from stagnant water and mud. The question were asked in a sequence already prepared to avoid duplication and false communication. Some of these questions were provided in format which was answered in “Yes” or “No” only. While some of them were used as open-end questions so that the person has a choice with three or four answers. The prevalence of performing hygiene practice was calculated through standard formula in per hundred (100) population and the result was recorded number of people doing good hygiene practice in percentage. The disease exposure and risk factors were found through the opened end questions in the standardized questionnaire. The questions were about the exposure to malaria and rashes which were a big issue in the floods of 2010. The people were asked about using mosquito nets and removal of stagnant water from their home and around.

Data Analysis: The data collected was analyzed through SPSS 16 version software and Microsoft Excel 2013. The frequencies of people performing hygiene practice were calculated and all the charts and table were made accordingly. The study design was descriptive cross sectional and the target population was two hundreds (200) in number. The sampling unit was house hold the study setting was in district Charsadda.

Results 

The first part of the questionnaire was based on the demography of the people of the four clusters. The average of all the variables were found and recorded through standardized statistical techniques. Average of number of children, level of education, monthly income, age of the guardian of the family were found. In the cluster of Utmanzai average number of children per family was four (4) and the education level of the elder is intermediate. While their average monthly income was twelve thousands (12000) and the average age of the elder of the family was forty (40) years. Similarly in the cluster of Rajjar, the average number of children was four (4) and the educational level of the elder of the family was intermediate while their average age was thirty seven (37) years. Their monthly income was ten thousands (10000) per month. In the cluster of Sardaryab the average number of children per family were three (3) and the educational level of the guardian of the family was metric while their monthly income was ten thousands (10,000) and their age was forty (40) years. In the cluster of Nisata the average number of children per family was four (4) and their average monthly income was eleven thousands. The level of education of the elders in this cluster was intermediate and their average age was forty (40) years. The overall average income of the four clusters families were recorded as thirteen thousands two hundred and fifty (13,250). A very little number of people in the area had graduate level education. While a little number of people had idea about health education and hygiene practice. The role of NGO’s in advance the level of health education is unforgettable as every non-governmental organization has a number of social mobilizers and health educator staff to provide information and its importance to the people regarding health education and hygiene during flood and mosquito breeding seasons.

Health Education and Hygiene: The questionnaire was based on the questions about health education and hygiene practice during and after flood season in the district of Charsadda. The questions were asked about the regularity of nail cutting, boiling of drinking water, washing of handing before eating meal and after using toilet. A total of two hundred (200) of people were interviewed and we got that out of two hundred, one hundred and seventeen 117(58.5%) were having a knowledge regarding health education and hygiene while eighty three 83(41.5%) had no idea about good hygiene and health education. The rate of ignorance regarding knowledge about safety and health is quite high and the people were have no idea how to handle things and keep themselves safe in flood or any other disastrous situations. The people of the flood affected/risky areas were asked about the source of water they use when there is a flood disaster or any other disaster when all the water sources like wells, water pumps and springs are damage and there is no easy availability of water in the area(s). The people were given the options of well, river and water pump. Out of two hundreds, ten 10(5%) were using water from the river, twenty four 24(12%) one hundred and thirty six 136(68%) were using water pumps while thirty 30(15%) were taking water from other sources. A very few number of people were used to boil water before drinking and having no idea why we used to boil it.

Frequency of Hygiene Practice: As stated earlier the knowledge and practice was found through a standard questionnaire, in which were asked the questions about their daily routine of hygiene such how often they take a bath, do they keep clean their houses and streets from mud and dust etc. The result was calculated through standard formula of prevalence of diseases and knowledge assessment. Out of two hundred (200) people, one hundred and twenty seven 127(63.50%) were practicing hygiene while seventy-three 73(36.50%) were not performing hygiene practice and safety.

Diseases Prevention: The people of the four clusters were interviewed for the detection of how much they prone to the epidemics of diseases. Each and every household were interviewed about three basic epidemic diseases i.e. Diarrhea, Rashes and malaria.  The people were asked that whether they use mosquito nets in rainy seasons or not. Which was responded with 41(20.5%) positive and 159(79.5%) in negative. Similarly, they were asked about boiling of drinking water, which was answered as 56(28%) in Yes, and 144(72%) said No. The families of the affected area(s) were also inquired about the usage of water for taking bath, so as to find out whether they were prone to the rashes problem or not. Out of total two hundred, 123(61.5%) were taking bath with clean water, while 77(38.5%) were found not taking care in using clean water for taking bath or washing hands and face in their normal routine.

Discussion

Floods cause severe damage to the country’s economy, health and infrastructure. The prevalence of infectious diseases are mainly increasing due unhygienic condition, lack of health education and practice of hygiene in flood like risky situation. This study was conducted in the observation of literature about the subject (8,10-17). We found that the diseases transfer mainly through contaminated water (10, 15, 18) mud and dust which contaminate our food (8, 31), Poor sanitation, lake of hygiene practice (17) and insufficient facility to protect themselves from income epidemic threats (9). The information about health education and hygiene can best be collected through a standardized questionnaire (11,13) asking about people daily routine regarding food (8, 11-14) hand washing (30, 16) and water sources (10, 15). The area of flood affected in Charsadda was divided into four clusters and the data was collated randomly (16) form households. Each and every member of the house was considered in one unit and the elder of the family was interviewed for the purpose. A total of two hundred samples were collected (16, 17). The study was a cross-sectional one which was conducted to assist the knowledge and practice of health education of the people in flood-affected areas. The role of hygiene promotion in emergencies and preventing diarrhoeal infection (14, 18) by promoting hygienic practices should be our communication priority Number One in an emergency situation. In camp situations, diarrhoeal diseases can account from 25 to 40 percent (19) of deaths in the acute phase of an emergency. More than 80 percent of the deaths usually occur in children under 2 years (20). The level of education found the areas were quite low for having good knowledge about health and hygiene. The practice was also poor due to lack of knowledge and facilities in the areas (21). We ask the questions about the hygiene practice on different aspects which were answered poorly (16, 22, 23). To control diarrhoeal disease, our messages should highlight the priority hygiene practices like hand wash with water and soap, or when not available use ash after contact with faeces; and safe disposal of adults (15, 24) and children’s (18, 25) faeces to prevent infection (15, 23) and contamination –i.e. clear scattered faeces, control open defaecation and shallow trench latrines (21), repair toilet facilities and/or build temporary family or communal latrines (40). Female hygiene promotion should be highlighted as a lady is the running master of the family who can handle unhygienic condition in the house (38). We hired a female interviewer to take interview of the females who manage their houses (26). They were asked questions about boiling of water and washing of their meal pots which detergents before they eat in that. The result shows that more than half of the people do not boil their drinking water before use. They have a poor meal pots condition and whenever they wash it they just wash it with taped water (27). The vulnerability of the people to malaria (12,29) and other diseases (13) like depression (27) were observed. The result concluded so far shows that a very little number of people were using mosquito nets in the summer season so prevent malaria and other mosquito-borne diseases. The hygienic condition of the streets was found not satisfactory while the proper committee for the hygiene promotion has not been established. The need of the day is to promote hygiene and health education among the community of flood risky areas of Khyber Pukhtoonkhwa. The government should try to improve the level of sanitation and clean water facilities in the areas of flood risk. The population control strategy must be strengthening to get the desired community free of disease and mortality.