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Estimating the Burden of Diarrheal Disease Caused by Water and Sanitation

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Estimating the Burden of Diarrheal Disease Caused by Water and Sanitation 2011 Estimating the Burden of Diarrheal Disease caused by Water and Sanitation Published by Supported by Nepal Health Research Council World Health Organization Research Report Estimating the Burden of Diarrheal Disease caused by Water and Sanitation Study Team Prof. Dr. Chop Lal Bhusal Dr. Shanker Pratap Singh Mr. Purushottam Dhakal Dr. Krishna Kumar Aryal Mr. Hari Datt Joshi Mr. Bikram Dhimal ACKNOWLEDGEMENT I would like to express my sincere thanks to all the team members of this research project. I am indebted to Mr. Hari Datt Joshi, Co - Investigator of this research project for the generation of idea and proposal development. I am also pleased to Mr. Namraj Khatri, National Operational Officer, WHO for his technical help in development of this research proposal and support in all the activities. I would like to pay my heartily gratitude to World Health Organization (WHO) for their financial support for the conduction of this research study. My immense thanks goes to Dr. Shanker Pratap Singh, Member-Secretary of Nepal Health Research Council and Co–Principal Investigator of this project for his valuable input as well as suggestions and support for the whole project. I am indebted to Dr. Krishna Kumar Aryal, Senior Research Officer of Nepal Health Research Council and Co- Investigator (Public Health) of this project for his valuable input and supervising and coordinating the overall research activity. My special thanks goes to Mr. Purushottam Dhakal, Research Officer of Nepal Health Research Council and Co- Investigator (Biostatistician) of this project for his valuable input in data analysis. My sincere thanks goes to Mr. Bikram Dhimal for his cordial support in overall research activities from data collection to report preparation. I am thankful to all the responsible focal persons of Department of District Water Supply and Sanitation of Dhading, Nawalparasai, Chitwan and Dolakha district for helping to find the study sites and making our study more convenient to perform at field level. Similarly, I would like to acknowledge Mr. Umesh Ghimire and Mr. Sudip Paudel for their technical support at different steps of this research project. Also, I acknowledge Mr. Nirbhaya Kumar Sharma, Mr. Subodh Kumar Karna and all the staffs of Nepal Health research Council who helped us at different administrative and technical aspect to complete this research report on time. At last but not the least I would like to deliver my genuine admiration to all the seen and unseen people who have contributed a lot to prepare this report on time. Dr. Chop Lal Bhusal Executive Chairman ACRONYMS BoD : Burden of Diseases DALY : Disability Adjusted Life Years DoHS : Department of Health Services DW : Disability Weighted EBD : Environment Burden of Disease ENPHO : Environment and Public Health Organization GBD : Global Burden of Disease GoN : Government of Nepal HH : Household NGO : Non Governmental Organization NHRC : Nepal Health Research Council PhD : Doctor of Philosophy RR : Relative Risk SLC : School Leaving Certificate SODIS : Solar Water Disinfection WASH : Water Hygiene and Sanitation WHO : World Health Organization YLL : Years of life Lost YLD : Years of life lived with disability ii EXECUTIVE SUMMARY There is direct relationship between human being, environment and health. The magnitude of health problem is increasing day by day due to various environmental risk factors. Diarrhea is the major health problem in most of the developing countries, and a major significant environment sensitive disease. It is estimated that about 94% of the diarrheal burden is attributable to environment, and is associated with risk factors such as unsafe drinking water, poor sanitation and hygiene. The purpose of this current study is to estimate and calculate scenario based diarrheal diseases burden related to water sanitation and hygiene. This was a cross sectional, descriptive and comparative study in which 360 households were selected from six different scenarios on the basis of water sources and availability of toilet from terai, hill and mountain regions. This study could not represent all geographical and ethnic community because it is conducted within limited district and small scale. The findings of the study are explained on the basis of different scenario. Out of the total diarrheal cases of 132 in the entire scenario the highest proportion is seen high (25%) in scenario spring without toilet, and the lowest (9%) is seen in scenario tap water with toilet. Mean number of days suffered from diarrheal disease and no of episodes was high with scenario having spring water without toilet viz. 7.61 days and 2.03 respectively, and lowest diarrheal episodes was found in scenario having tap water with toilet (1.23). Hygiene and sanitation practice of the community people was found good in all the scenario with more than 90 per cent responding that they wash hand after defecation and before eating food. Most of the people do not make any treatment of water for drinking purpose, only very few percentage of respondents said that they treat water at household before consumption. Years lived with disability was found to be highest, 18.10 per hundred thousand in the scenario spring water without toilet, and least value of YLD was computed 2.39 in the situation of tap water with toilet facility available. Premature Mortality (YLLs) was not revealed in study sample from the selected communities. While the odds of risk of acquiring diarrheal disease for the scenario (spring without toilet) was nearly four times higher than the reference scenario- tap water with toilet facility which was statistically significant as well. iii Thus, disease burden and risk of the disease is seen high among those people who don’t have toilet and consume water from spring or tube well. Appropriate awareness program targeted to high diarrheal disease burden areas should be conducted henceforth to cut short the diarrheal disease transmission and prevent the risk of acquiring it. iv Table of Contents ACKNOWLEDGEMENT ............................................................................................................... i ACRONYMS .................................................................................................................................. ii EXECUTIVE SUMMARY ........................................................................................................... iii CHAPTER I INTRODUCTION ..................................................................................................... 1 1.1 Background ........................................................................................................................... 1 1.2 Rationale of the Study ........................................................................................................... 2 1.3 Objectives .............................................................................................................................. 3 1.4 Study Variables ..................................................................................................................... 3 CHAPTER II LITERATURE REVIEW ........................................................................................ 5 CHAPTER III METHODOLOGY ................................................................................................. 9 3.1 Study type .............................................................................................................................. 9 3.2 Study Area ............................................................................................................................. 9 3.3 Study Duration ...................................................................................................................... 9 3.4 Study Population & Study Unit ........................................................................................... 10 3.5 Sampling Technique ............................................................................................................ 10 3.6 Sample Size ......................................................................................................................... 10 3.7 Data Collection Tools/Technique........................................................................................ 10 3.8 Tools Development and Pretesting ..................................................................................... 11 3.9 Data processing and analysis............................................................................................... 11 3.10 Descriptive analysis........................................................................................................... 11 3.11 Bi-variate analysis ............................................................................................................. 11 3.12 Relative Risk Analysis: ..................................................................................................... 12 The calculation of relative risk was based purely on the findings and analysis process of this study itself. ................................................................................................................................ 12 3.13 DALY Calculation ............................................................................................................ 12 3.14 Reliability and Validity ..................................................................................................... 13 3.15 Limitations of the Study ...................................................................................................
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