Water, sanitation and handwashing assessment and determination of critical risk factors for diarrhoea among pre-schoolers and students

Water, sanitation, and hygiene (WASH) are essential for good health. Sub-optimal water, sanitation and hygiene conditions have been associated with occurrence of diarrhoea, especially among pre-schoolers in household settings. Every year diarrhoea claims lives of pre-schoolers and affect other groups of people. However, studies around risk factors of diarrhoea have focused mostly on pre-schoolers and at best primary school students. Not much is known about WASH conditions for secondary students and risk factors of diarrhoea from school conditions is less studied. This research uses primary data (for secondary school students) and secondary data (for pre-schoolers from the Multiple Indicator Cluster Survey, 2016/17) to investigate diarrhoeal risk factors for these two groups of children and for their most relevant settings: households for pre-schoolers and school setting for the children of school age. The research assesses WASH conditions available to pre-schoolers and students in Nigeria and closely, using Port Harcourt – Nigeria as a case study. Bivariate analysis (Chi-square test for association) is used to identify risk factors with significant association to diarrhoea among pre-schoolers and students associated with home and school settings respectively. Using risk matrix approach, the study categorises significant risk factors for diarrhoea. To model the contributions of significant predictors (risk factors) to the probability of occurrence of diarrhoea among pre-schoolers and students, multiple regression analysis is used.

Key results reveal WASH in household level were sub-optimal, with 67.5% of households using improved water sources and 48% using improved sanitation services with very low coverage of safely managed water and sanitation services. Schools were categorised schools based on management, gender of students attending and settings, and finds that WASH in school in Port Harcourt are sub-optimal. Challenges identified includes infrequent functionality of water and sanitation facilities, inadequate treatment of drinking water and lack of soap for handwashing. Disparities in water, sanitation and hygiene facilities and conditions were noted between school categories. The prevalence of diarrhoea among pre-schoolers and students were 12.9 and 23%, respectively. The most impacting risk factors for both pre-schoolers and students were exposure-related and these related to sanitation including type of household sanitation facilities, pre-schoolers not using sanitation facilities themselves, infrequent functionality of school toilets and unhygienic state of toilets are the most impacting risk factors of diarrhoea common to pre-schoolers and students. This research concludes that interventions to reduce morbidity of diarrhoea among pre-schoolers and students should focus on improving household and school sanitation facilities and address factors influencing their functionality.