Households’ Hygienic Practices that Contribute to Recurrent Cholera Outbreaks in Homa-Bay County, Kenya

Abstract

Globally, Cholera affects approximately 3-5 million persons and causes 100000-120000 fatalities annually. Cholera is endemic in Kenya and is experienced thrice in five years. Kenya has recorded cases of cholera from 1971, 1999, 2000, 2007, 2008, 2010, 2012, and 2013 respectively. Ndhiwa Sub-County also experienced cases of cholera epidemics in these time periods. The main study objective was to determine hygienic practices among household members that contribute to severe diarrhea leading to hospitalization in Ndhiwa Sub-County. This was a survey research design, which was cross-sectional analytical in nature and involved 400 participants. Ndhiwa Sub-County was purposively selected because of repeated incidences of cholera outbreaks. Three wards sampled through simple random sampling. A sampling frame of all villages in the three wards was made and three villages were randomly selected. A household register employed to sample 400 household heads by systematic random sampling. Structured questionnaire, checklist, and key informant interviews used for quantitative and qualitative data collection. SPSS version 20 used for data analysis. Descriptive statistics included frequencies and percentages while inferential statistics included cross tabulations and chi square tests for associations testing of the independent against dependent variables. The chi-square was tested at 95% and 99% level of confidence. Results revealed that only 39% of the study respondents were knowledgeable about cholera signs/symptoms, transmission, as well as prevention measures. It emerged that 78% of the respondents had latrines, out of which 42% had functional hand washing facilities. The study revealed that the main source of water was wells/springs at 54.5%. The results showed that only 65% of the respondents could access sufficient water supply throughout the year and 87% of respondents treated drinking water. On waste management, the study revealed that 86.5% of respondents practiced crude dumping of solid wastes and 92% of respondents practiced crude dumping of liquid wastes. From cross tabulation it emerged that 60.2% of the households that had and appropriately used a facility for hand washing with soap reported severe diarrhea leading to hospitalization. This was a negative relationship because the expectation is that households owning and using hand washing facilities should report fewer cases of severe diarrhea. It was observed that 52.7% of the households having pit latrines, at least a member of the family had suffered a severe diarrhea disease leading to hospital admission in the last one year. This is a negative relationship. It was further noted that 41.7% of the households where there was observation of open defecation and 54.0% of the households with evidence of waste management reported severe diarrhea leading to hospitalization. In both cases, a negative relationship existed between the independent variables and the dependent variable. Statistically significant relationship existed between severe diarrhea leading to hospitalization and: existence of facility for hand washing (chi-square = 14.348, p = 0.000 < 0.01), existence of latrine or toilet (chi-square = 7.795, and p = 0.004 < 0.01), signs that latrine or toilet are in use (chi-square = 3.353 and p = 0.043 < 0.05), evidence of open defecation (chi-square = 3.405 and p = 0.041 < 0.05) and evidence of waste management (chi-square = 4.018 and p = 0.028 < 0.05). It is concluded that there is a relationship between households‘ hygienic practices and severe diarrhea leading to hospitalization in Ndhiwa Sub-County. Therefore, it is recommended that Homa-Bay County government and public health department to create awareness on cholera, latrine provision and use as it emerged that 37% of residents were ignorant of cholera causes, 52% of respondents were not aware of cholera transmission, and 61% respondents did not know about signs or symptoms of cholera disease. Homa-Bay County health promotion officer to carry out continuous advocacy that target raising awareness on latrine provision and use as access to latrine is inadequate because 22% of respondents do not access latrine. Public health department should create awareness on hand washing facility provision and use as it emerged that 58% of respondents lacks hand washing facilities. Ministry of health and water to ensure continuous health education on water treatment and safe storage as access to safe water is inadequate in Ndhiwa Sub County. The main water sources are wells and rivers. Water safety is affected by contamination and scarcity caused by drought or distance; all of which poses a challenge to the community members. Homa-Bay County government should carry out continuous awareness campaigns on proper household waste management. The use of dust bins and regular disposal in designated dump site must be emphasized since compounds of the respondents are dirty due to indiscriminate disposal of wastes; 58% practices crude dumping of solid wastes and 94% practices crude dumping of liquid wastes.