Health and Sanitation System: a Case Study at Chuadanga Sadar, Bangladesh

Journal of Advances in Nanotechnology and its Applications Volume 2 Issue 1

Health and Sanitation System: A Case Study at Chuadanga Sadar, Bangladesh

Towfiqul Islam Khan1, Md. Easin Ali2, Chy. Mansura Mehrun3 ¹ Lecturer, Department of Geography & Environment, Shahjalal University of Science & Technology, Sylhet-3114, Bangladesh 2Post Graduate Research Student, Dept. of Geography & Environment, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh 3 B.Sc Research Student, Department of Geography & Environment, Shahjalal University of Science & Technology, Sylhet-3114, Bangladesh *Corresponding Author E-Mail Id: [email protected]

ABSTRACT Health and sanitation are related with each other. Sanitation is a function of excreta management, wastewater management, solid waste management and drainage systems where health means a state of complete physical, mental, and social well-being. This study attempts to know the relationship between health and sanitation system and the study was conducted on 200 respondents of Teghori-Kalagachi Mauza at Chuadanga Sadar Upazila under Chuadanga district. It is observed that 70% of the respondents use ring slab toilet and 54.49% people use healthy water for drinking. It further observed that more than 50% respondents suffer from fever, 10.12% dysentery, 9.34% diarrhoea, 4.28% typhoid and 5.83% from other diseases. Male respondents suffered more than their female counterpart. To examine the relationship between sanitation system and health, Pearson correlation method was used to examine different elements of sanitation system and disease. It is noticed that there is low and moderate correlation between sanitation system and health. The study observed that due to poor level of knowledge about sanitation and health practices, people of the study area often suffered from various types of infectious diseases.

Keywords: Sanitation system, health, disease, drainage systems, correlation

INTRODUCTION Bangladesh [10]. Another study in Health and sanitation are connected with Bangladesh suggests that improved water each other. Each year thousands of people and sanitation facilities actually reduce die from various types of infectious diarrhoea by 99%, dysentery by 90%, diseases. These diseases are caused by intestinal worms by 51% [6]. Washing poor sanitation and hygiene practices. The hand with soap or simply rinsing hands disease that spread more in rural areas of without soap prior to preparation of food Bangladesh are diarrhoea, dysentery, can reduce occurrence of diarrhoea in jaundice, cholera, hook worm, chicken children [6]. This indicates that sanitation typhoid and so on. A study observed that and hygiene practices are major the health related economic loss due to components of environmental health. To inadequate sanitation was 84% of the total keep the environment healthy for human economic impacts or equivalent to 5.3% of habitation and health purposes, sanitation Gross Domestic product (GDP) of is needed because sanitation system is

related to whole way of life [2]. Still now practice, and health. The objectives of the people of the country are not aware about study are: sanitation and hygiene practices. In  To investigate the present sanitation Bangladesh, about 33% of the people have system hygiene practices in the study hygienic latrines. Every 90 seconds a child area. dies from a water-related disease [9].  To identify the health status of the About 1.2 million people of the country people of the study area from 2010 to need access to clean water supply and 3 2020. million people are without sanitation  To examine out the common health facilities[7]. To avoid this problem problems those are directly or different plan are taken into account and indirectly related to the use of water attempts has been made to develop and sanitation. sanitation system. It is estimated that with a population of 149 million only 10% of DATA SOURCES AND RESEARCH the population in Bangladesh practices METHODOLOGY Open Defecation [3]. Only 56% of the For this research the primary information population estimated to have had access to was collected through questionnaire adequate sanitation facilities in 2010. A survey. The questionnaires contain new approach to improve sanitation information on household, socio economic coverage in rural area such as, community- information, sanitation system, hygiene led total sanitation concept has been first practice, location and situation of water introduced in Bangladesh. sources, different diseases that occurred among respondents during the last 5 years. Though the progresses in sanitation and Data were collected from 64 households hygiene practices have been made who permanently live in the study area. substantially, the coverage is not Secondary data were collected from satisfactory. In the remote areas the different published and unpublished progress is significantly low. The study materials and books. Data obtained from area of this study is one of the backward the survey were analyzed using descriptive regions of the country and due this fact and inferential statistical tools. Different this study was carried to examine the software such as, Microsoft word, health, hygiene and sanitation practices. Microsoft Excel, Arc View GIS are used for data analysis. Teghori-Kalagachi AIM AND OBJECTIVES Mauza had in total 2604 people. The ratio The main aim of this research is to identify of male and female was 105:100. It has the sanitation and hygiene practices and total 621 units of household [1]. In 2011 their impacts on health at Teghori- the total literacy rate was 54.1% (male Kalagachi Mauza in Chuadanga Sadar literacy rate is 52.9% and female literacy Upazila. The study was carried out in 2015 rate 47.1%). Fig. 1 shows the Study area and the aim is to examine the relationships map. between sanitation system, hygiene

Fig. 1: Study Area Map.

PRESENT HEALTH STATUS OF THE and literacy, employment/working POPULATION OF THE STUDY conditions, social environments, personal AREA health practices and coping skills, healthy Health is a state of complete physical, child development, biology and genetics mental, and social well-being and not and health care services [11]. merely the absence of disease or infirmity [11]. To know the health status it is need Different Disease to consider determiner of health. The main It was observed that fever is a common determinants of health include the social disease in the study area. Figure 1 shows and economic environment, the physical that about 50.97% people suffered from environment, and the person's individual fever. Besides, this dysentery and characteristics and behaviors. More diarrhoea were other common diseases. specifically, key factors that have been Among 257 people, 10.97% suffered from found to influence whether people are dysentery and 9.34% suffered by healthy or unhealthy are Income and social Diarrhoea. Other diseases were status, social support networks, education

chickenpox, pneumonia skin disease, typhoid, headache etc. Table 1: Disease Pattern in the Study Area. Disease Number Percentage Fever 131 50.97 Dysentery 26 10.12 Diarrhea 24 9.34 Jaundice 7 2.72 Chickenpox 11 4.28 Pneumonia 5 1.95 Skin Disease 4 1.56 Typhoid 11 4.28 Cholera 11 4.28 Strokes 2 0.78 Headache 8 3.11 Phthisis 2 0.78 Others 15 5.83 Total 257 100.00 (Source: Questionnaire Survey, 2019)

Sex, Age, Occupation and Disease disease and 51-75 years old people were There are different disease are found in less prone to disease. From the figure 5 it different sex. Figure 3 represents that male is seen that service holder, unemployment, suffered more from dysentery, diarrhoea, and labour are less attacked by disease. On chickenpox, skin disease and cholera their the other hand farmer housewife and female counterpart. On the other hand, student are more suffered by disease. It female suffered more from heart disease. It also show that student 35.17% house wife was found that there was a variation 29.24% and farmer 19.49% are more between age group and disease occurrence. suffered from disease than other Figure 4 reveals that in the study area 11- occupation people. Figure 2 presents 30 year old people suffered from different different disease in the study area.

Different disease

54.00 48.00 42.00

36.00  30.00 24.00

population 18.00 12.00 6.00 0.00

Diseaes

Percentage

Fig. 2: Different Disease in the Study Area.

(Source: Questionnaire Survey, 2019) Disease and Sex

Male Female 105.00

90.00

 75.00 60.00

Percentage 45.00 30.00 15.00 0.00

Disease

Fig. 3: Sex and Disease. (Source: Questionnaire Survey, 2019)

Age and Disease 16.00

12.00

8.00 Percentage 4.00

0.00

Age

Fig. 4: Age Variation and Disease. (Source: Questionnaire Survey, 2019)

Occupation Status

90 80

70 60 50 40

Perceantage 30 20 10 0

Occupation

Fig. 5: Occupation Status Variation and Disease.

(Source: Questionnaire Survey, 2019) PRESENT SANITATION Hand Washing (After Latrine) CONDITION IN THE STUDY AREA Figure 6 depicts that among 64 Sanitation means the collection, transport, respondents, 39% people used soap, treatment and disposal or reuse of human 34.38% used ash, 23.44% used soil 2% use excreta, domestic wastewater and solid nothing to wash their hands after waste, and associated hygiene promotion defecation. Even most of the people about [8] Sanitation includes four engineering 61% do not use soap after defecation. infrastructure items. These are- excreta Figure 7 also shows that among 200 management systems, wastewater respondents, 57.81 % people used shoe to management systems, solid waste go to a toilet and on the other hand, management systems and drainage 17.19% used shoe sometime, Strikingly, systems for rainwater, also called storm 25% people never used while using toilet. water drainage. Figure 8 & 9 represents latrine types and water quality. Hand washing (after latrine)

24% 39% soap ash

34% soil nothing

Fig. 6: Hand Washing (After Latrine). (Source: Questionnaire Survey, 2019)

Shoes use

25% Yes 17% 58% Sometime No

Fig. 7: Shoes Use in Toilet Time.

(Source: Questionnaire Survey, 2019) Latrine types 80.00%

60.00%

40.00% Percentage 20.00%

0.00% Ring slub Kacha with Hanging Other soil wall

Fig. 8: Latrine Types. (Source: Questionnaire Survey, 2019)

Water quality 60.00 50.00

40.00 30.00

20.00 Percentage Percentage 10.00 0.00 Healthy water drinking Unhealthy water drinking

Water quality

Fig. 9: Water Quality. (Source: Questionnaire Survey, 2019)

Latrine Types population actually had access to an Figure 8 depicts that among 200 improved source of water supply. In respondents, 70% used ring slab toilet. On Teghori-Kalagachi Mauza only 54.69 % the other hand, 30% people had kacha people had access to arsenic free water [5]. toilet. There was no hanging toilet in the study area. Among 200 families, 60 SANITATION SYSTEM, HYGIENE families 93.25% of total sample) had at PRACTICE AND HEALTH least one toilet facility, observed that in Shoes Usage and Disease rural areas of the country, only 53.10% It was revealed that among 200 families have latrine facilities. respondents, 57.81% used shoe in a toilet, 17.19% used shoes sometime and 25% Water Quality never used shoe while using a toilet. About It was observed that is found that 54.69% 53.12% of the respondents affected from people drank clean tube well water and chronic disease such as dysentery, 45.31% drank poor quality water (Figure diarrhea, typhoid, and cholera that are 9). The water of the study is contaminated directly related to poor quality water and with arsenic. According to the poor sanitation. On the other hand, 46.88% Demographic and Health Survey, 99% of people suffered from other diseases as like the urban population and 97% of the rural as fever, headache, diabetes, high pressure,

low pressure, and brain strokes. Table 2 shows the variables for Correlation. Table 2: Variables for Correlation. Shoe user (X) Coding Disease(Y) Yes 1 Fever Sometime 2 Dysentery No 3 Diarrhea 4 Jaundice 5 Chicken Pox 6 Pneumonia 7 Skin Disease 8 Typhoid 9 Cholera 10 Strokes 11 Headache 12 Phthisis 13 Others

Table 3: Correlations Between Shoes Usage and Disease. Correlations Disease Shoe user Pearson Correlation 1 -.014 Disease Sig. (2-tailed) .911 N 64 64 Pearson Correlation -.014 1 Shoe user Sig. (2-tailed) .911 N 64 64

For examine the relationship between shoe displays the relationship between hand use and diseases Pearson correlation washing and disease relationship. The method was used. Table 3 shows that there number of diseased people increases with is a low negative correlation between the decrease of distance from water source shoes usage and disease. This indicates and latrine (Figure 12). It can be observed that people who used shoe during from Figure 13 that respondents who used defecation have lower probability of ring slab toilets suffered less (31.67%) infectious disease. Figure 10 shows shoes from sanitation and hygiene related use and disease relationship and Figure 11 diseases.

Shoes usage and Disease

Chronic disease Other disease

70.00% 65.00%

60.00%

55.00%

50.00% Percentage 45.00% 40.00% 35.00% 30.00% Yes Sometime No

Shoes usage

Fig. 10: Shoes Use and Disease Relationship. Hand washing(after toilet) and Disease Relation

41%

32% Chronic disease 22%

Affected by by disease Affected 13% Other disease 3% soap ash soil nothing Hand wash with Fig. 11: The Relationship Between Hand Washing and Disease Relationship.

Hand Washing and Disease (After who did not use soap for cleaning their Toilet) hands were attacked by infectious disease. Hand washing is an important factor in Table 4 shows variables for correlation. To sanitation. In rural areas of Bangladesh examine the relationship between hand many people cannot use soap for washing washing and disease occurrence after their hand after defecation. It was observed defecation a person correlation model was that people who used soap and soil to run. It may be observed that there is a low clean their hands were less affected by negative correlation between hand chronic disease (Dysentery, Diarrhea, washing and disease occurrence (Table 5). Jaundices, Chicken pox, Pneumonia, That means if people use soap after toilet Typhoid, and Cholera). Among the soap has low risk to suffer from infectious users, 48% were affected by infectious disease. disease. Strikingly, almost all respondents

Table 4: Variables for correlation Coding Disease(X) Hand Wash With(Y) 1 Fever Soap 2 Dysentery Ash 3 Diarrhea Soil 4 Jaundice Nothing 5 Chicken pox 6 Pneumonia 7 Skin Disease 8 Typhoid 9 Cholera 10 Strokes 11 Headache 12 Phthisis 13 Others

Table 5: Correlations between Hand Washing and Disease (After Toilet) Correlations Disease(X) Hand wash with(Y) Pearson Correlation 1 -.092 Disease(X) Sig. (2-tailed) .472 N 64 63 Pearson Correlation -.092 1

Hand wash with(Y) Sig. (2-tailed) .472 N 63 63 Distances between Water Source and respondents, whose water sources were Latrine and Disease Occurrence more than 61-75 feet far, were less Our drinking water comes from a variety affected from sanitation and hygiene of not so sanitary sources and goes through related diseases such as dysentery, a cleaning process before it safe to ingest. diarrhea, typhoid and cholera. On the other If the distance between toilet pit and hand, respondents whose latrines were source of water are less than 30 feet then located within 1-30 feet were more prone the possibility of risk for infectious to sanitation and hygiene related diseases. diseases increase. According to the It was further observed that some Department of Public Health Engineering, household’s toilets were located far from it is necessary to install pit latrines or ring water sources (46-60 feet). But their due to slab latrines 30 feet from shallow hand the closeness of their neighbor’s toilet to tube wells (depth 240 feet) to avoid germs. the water sources (tube well) they were Figure 12 indicates that the number of more prone to diseases. Table 6 denotes diseased people increases with the Distance and Disease (between water decrease of distance from water source and source and latrine) and Table 7 showing latrine. It was observed that the Variables for correlation.

Table 6: Distance and Disease (Between Water Source and Latrine) Distance (feet) Number Percentage Sanitation related disease Percentage Other disease Percentage 1-15 26 42.62% 11 18.03% 15 24.59% 16-30 22 36.06% 14 22.95% 8 13.11% 30-45 4 6.56% 1 1.64% 3 4.92% 46-60 3 4.92% 2 3.28% 1 1.64% 61-75 6 9.84% 2 3.28% 4 6.56% Total 61 100.00% 30 49.18% 31 50.82% (Source: Questionnaire Survey, 2019)

Table 7: Variables for Correlation. Coding Disease (X) Distance(Y) 1 Fever 2 Dysentery Distance between 3 Diarrhea water source and 4 Jaundice latrine(hand) 5 Chicken Pox 6 Pneumonia 7 Skin Disease 8 Typhoid 9 Cholera 10 Strokes 11 Headache 12 Phthisis 13 Others (Source: Questionnaire Survey, 2019)

The correlation analysis depicts a low distance between water source and latrine negative correlation between the two increases the possibility of suffering from variables (Table 8). It indicates that if the infectious diseases decreases.

Table 8: Correlation between disease and distance (between water source and latrine) Correlations Disease Distance Pearson Correlation 1 -.038

Disease Sig. (2-tailed) .771 N 64 62 Pearson Correlation -.038 1 Distance Sig. (2-tailed) .771

N 62 62 (Source: Questionnaire Survey, 2019)

Latrine Types and Disease the other hand, respondents who used Latrine types are an important factor for kacha toilets were more prone to infectious measuring sanitation and hygiene qualities. diseases. Table 9 reveals that there is very It can be observed from figure 13 that low positive correlation between latrine respondents who used ring slab toilets types and disease which actually means suffered less (31.67%) from sanitation and that a poor type of latrines (kacha latrine) hygiene related diseases. About 38.33% actually increases the possibility of suffered from other diseases (fever, suffering from infectious diseases. headache, diabetes, and high pressure). On

Table 9: Latrine Types and Disease. Latrine types Number Percentage Sanitation related disease Percentage Other disease Percentage Ring slab 43 70.00% 19 31.67% 23 38.33% Kacha 17 30.00% 14 23.33% 4 6.67% Hanging 0 0.00% 0 0.0% 0 0.0% Other 0 0.00% 0 0.0% 0 0.0% Total 60 100.00% 33 55.00% 27 45.00% (Source: Questionnaire Survey, 2019)

For calculating the correlation the two (Table 10). Table 11 demonstrations variables are taken where Disease count as Correlation between Latrine types and ‘X’ variable and distance between water Disease source and latrine count as ‘Y’ variable

Table 10 Variables for correlation Coding Disease (X) Distance(Y) 1 Fever 2 Dysentery 3 Diarrhea 4 Jaundice 5 Chicken Pox Pneumonia 6 Skin Disease Distance between water 7 Typhoid source and latrine(hand) 8 Cholera 9 Strokes 10 Headache 11 Phthisis 12 Others 13 (Source: Questionnaire Survey, 2019)

Table 11: Correlation Between Latrine Types and Disease Correlation Latrine types Disease Pearson Correlation 1 .023 Latrine types Sig. (2-tailed) .854 N 64 64 Pearson Correlation .023 1

Disease Sig. (2-tailed) .854 N 64 64 Distance (Between Kitchen and Latrine) more prone to infectious diseases than and Disease people whose toilets were situated 16- 45 Many toilets of the country are properly feet far. Table 14 shows that there is a low made and it was found that those negative correlation between distance from respondents who had toilets near to toilet and kitchen. It actually indicates that kitchen had high occurrence of diseases with the decrease of distance the (Table 12). People whose toilets were possibility of disease will decrease. But located close to kitchen, (1-15 feet) were this relation is not so strong.

Table 12: Distance (Between Kitchen and Latrine) and Disease. Distance Number of Percentage Sanitation related Sanitation related Other Other (feet) Respondent disease disease disease disease 1--15 13 20.96% 6 46.15 7 53.85 16-30 22 35.48% 10 45.45 12 54.55 30-45 18 29.02% 12 66.67 6 33.33 46-60 3 4.85% 1 33.33 2 66.67 61-75 6 9.69% 2 33.33 4 66.67 Total 62 100.00% 31 46.15 31 53.85 (Source: Questionnaire Survey, 2019)

From Figure 14 it is seen that whose such as Dysentery, Diarrhea, Typhoid, kitchen are far from 1-45 feet they are Cholera, hook worm, ring worm and so on. more affected by sanitation related disease

Distance and Disease (between kitchen and latrine)

70.00

60.00

50.00 Percentage

40.00

30.00 1--15 16-30 31-45 46-60 61-75

Distance (feet)

Sanitation related disease Other disease

Fig. 14: Distance (Between Kitchen and Latrine) and Disease. (Source: Questionnaire Survey, 2019)

Table 13 shows the variables for infectious diseases. If it is to be elaborated correlation and Table 14 indicates then in table 13 these researches have few correlations between distance and data. For example, when distance between

kitchen and latrine is coded as 1,that when it is coded as 10,11,12 it indicates means it symbolizes fever and similarly serially Strokes, Headache, Phthisis. Table 13: Variables for Correlation. Coding Disease(X) Distance (Y)

1 Fever 2 Dysentery 3 Diarrhea 4 Hepatitis 5 Chicken Pox 6 Pneumonia Distance between kitchen 7 Skin Disease and latrine 8 Typhoid 9 Cholera 10 Strokes 11 Headache 12 Phthisis 13 Others

(Source: Questionnaire Survey, 2019)

Table 14: Correlations Between Distance (between Kitchen and Latrine) and Infectious Diseases. Correlations Disease Distance Pearson Correlation 1 -.025 Disease Sig. (2-tailed) .845 N 64 64 Pearson Correlation -.025 1 Distance Sig. (2-tailed) .845 N 64 64 (Source: Questionnaire Survey, 2019)

CONCLUSION related to good practices may be Health is an important factor for human disseminated in the study area through life. Every year many people die due to seminars, group discussions and mass different infectious and non-infectious sanitation and hygiene related education. diseases. The common diseases are Local governments and people of the area diarrhoea, dysentery, cholera, jaundice, of the study area may work hand in hand chickenpox, diabetes, hookworm, cancer, to eradicate infectious diseases from the heart attack etc. Most of the diseases are study area. related to poor sanitation system and hygiene practices. After analyzing REFERENCES different phenomena of sanitation systems 1. Bangladesh Population and Housing and causes of different diseases, it was Census 2011. BBS. Community gathered that there exist a close Report Chuadanga Zila June 2012. relationship between health and sanitation http://www.bbs.gov.bd/ Census 2011 system. To avoid sanitation related /Khulna/Chuadanga/Chaudanga_C01. diseases, there is a need to aware people pdf. Accessed, 18 January, 2015. and disseminate the benefit of proper 2. Statistical Year book of Bangladesh. health and hygiene practices. It is BBS, 2013. 32nd edition, Statistics & understood that people of the study area Informatics Division (SID), Ministry should be provided with appropriate health Of Planning , Government of the and sanitation related education. The ideas people's republic of Bangladesh.

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