Understanding the effects of poor sanitation on public health, the environment, and well-being in Kenya
Report of a study conducted in Homa Bay, Elgeyo Marakwet and Kericho counties in Kenya
Poor sanitation is linked to diarrhoeal diseases, which are among the leading causes of morbidity and mortality in children under the age of five. In Kenya, an estimated 19,500 people die every year because of diarrhoea (WSP 2012). This includes 17,100 children. In nearly all of these cases, the diarrhoea is attributed to poor sanitation and hygiene practices.
To gain more insights into the effects of poor sanitation on public health, the environment and well-being in Kericho, Homa Bay and Elgeyo Marakwet counties in Kenya, a study was commissioned by the Voice for Change Partnership (V4CP) programme, in collaboration with the Institute of Economic Affairs (IEA) and the Centre for Population Health Research & Management (CPHRM).
It is expected that the findings from this survey will support county governments in making informed steps to improve their water, sanitation and hygiene status in the counties, and to expand their initiatives and to deliver effective sanitation services to all.
Evidence creation and the use of this knowledge is crucial for improving the enabling environment in the WASH sector. Generating this information allows civil society organisations (CSOs) to contribute to the development of water, sanitation and hygiene (WASH) sector policies, and systemic change with their government and the private sector.
General overview of the findings across counties:
The findings from the case-control study show that, in general, (case) households had a bigger burden of sanitation-related disease than control families.
Children in the case group were more affected by recurrent diarrhoea: 79% had suffered diarrhoea in the past two weeks compared to only 10% in the control group.
The results also show that nearly half of the children in the sample (45.9%) were receiving mixed feeding (42% in the control and 49% in the cases group), but the results suggest that children in the case category were more exposed to risky feeding practices, which can contribute to an increased risk of diarrhoea.
The study found that slightly more households in the case category used unimproved water sources (37.7%) compared to controls (35.7%). Over 40% of the total combined sample said they do nothing to the water before drinking, while about a third said they use chlorine.
In Homa Bay, Elgeyo Marakwet and Kericho respectively, the Colilert tests on household drinking water were positive in 63.6%, 65.6 % and 80% of the cases respectively, indicating possible presence of faecal or animal waste contamination. There also appears to be link between the source, storage and treatment of the water and the child having diarrhoea.
More respondents in the control group (58%) had been exposed to understanding good practises on sanitation and hygiene than those in the case group (54%). Notably, more respondents in the control group (42%) learnt about good practises when visiting a health facility, compared to those in the case group (30%), suggesting a possible link between exposure to positive messages and information on sanitation and hygiene, and the child having diarrhoea. A Caregiver’s sanitation and hygiene habits were also found to be more at risk of spreading contamination among the case households than in control households. For instance, more respondents in the case households (11%) did not wash hands after using the toilet than in the control households (9%). In addition, more respondents in the case households used only water (45.6%) than in the control households (38.3%), meaning they were exposed to a much higher chance of contamination by faeces.
Poor sanitation and related illnesses have an impact on farming and income generating activities, with adult caregivers reporting that diarrhoea in children disrupted their normal economic activities and incurred extra household expenses.
Some key recommendations to counties included:
Ensure universal access to improved sanitation
Strengthen community led total sanitation initiatives
Monitor and improve the quality of water at source and household level
Promote hand washing with soap
Provide financial and social support for socially excluded persons to be able to access sanitation and water services.
See the following reports and advocacy products for detailed synthesis and county level findings:
National Policy Brief
[F-Diagram Kericho County](http://www.snv.org/assets/explore/download/180008_kericho_f_diagram_a4_lr_0.pdf)
County Policy briefs
Water Testing Guidelines
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