USAID Village and Sanitation Program West Bank of Palestine
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USAID Village and Sanitation Program West Bank of Palestine Environmental Health Assessment — Phase I by Ali Sha’Ar, Patrick Kelly, Eckhard Kleinau July 2002 Prepared for the Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, U.S. Agency for International Development, under EHP Project 26568/IC.YR4.STRAT.SUP Environmental Health Project Contract HRN-I-00-99-00011-00 is sponsored by Office of Health, Infectious Diseases and Nutrition Bureau for Global Health U.S. Agency for International Development Washington, DC 20523 Table of Contents Abbreviations.................................................................................................................... vii Acknowledgements............................................................................................................ ix Executive Summary........................................................................................................... xi A. Introduction and Background................................................................................. xi B. Study Methods........................................................................................................ xi C. Summary of Findings............................................................................................ xii D. Conclusions and Recommendations ......................................................................xv 1. Introduction....................................................................................................................1 1.1. Background...........................................................................................................1 1.2. USAID Water Project...........................................................................................1 2. Survey Objectives and Conceptual Framework.............................................................3 2.1. Objectives .............................................................................................................3 2.2. Conceptual Framework (Hypotheses to be tested) ...............................................3 3. Study Methods and Preparations ...................................................................................5 3.1. Design ...................................................................................................................5 3.2. Study Type............................................................................................................5 3.3. Sample Selection...................................................................................................6 3.4. Data Collection Instruments and Protocols ..........................................................7 3.5. Training.................................................................................................................9 4. Survey Implementation................................................................................................11 5. Characteristics of Households and Respondents .........................................................15 5.1. Sample Sizes.......................................................................................................15 5.2. Household Heads and Respondents....................................................................15 5.3. Household Demographics...................................................................................16 6. Household Environment and Possessions....................................................................21 6.1. Housing Characteristics......................................................................................21 6.2. Household Economics ........................................................................................22 6.3. Poverty Index......................................................................................................24 6.4. Household Water Supply....................................................................................25 7. Household Sanitation...................................................................................................31 7.1. Sanitation Facilities (see Tables 7.1 and 7.2) .....................................................31 7.2. Garbage Disposal................................................................................................32 8. Intestinal Parasites, Diarrhea and Infant Feeding ........................................................35 8.1. Intestinal Parasites..............................................................................................35 8.2. Diarrhea ..............................................................................................................37 iii 8.3. Infant Feeding.....................................................................................................39 9. Hygiene Knowledge and Practices ..............................................................................41 9.1. Feces Disposal ....................................................................................................41 9.2. Handwashing ......................................................................................................44 9.3. Knowledge and Practices — Caretaker of child 12–47 months .........................45 9.4. Knowledge and Practices — School Children....................................................48 10. Water Quality...............................................................................................................53 11. Relationship Between Environmental Factors (Hygiene, Sanitation Water Source, Quality and Quantity) and Health Outcomes (Intestinal Parasites, Diarrhea).............59 12. Conclusions and Recommendations ............................................................................63 References..........................................................................................................................67 Appendix 1: Basic Village and Household Data ...............................................................69 Appendix 2: Village Water and Sanitation Project Survey of Households in Hebron and Nablus Provinces Final Pretest Version January 6, 2002 ............................................71 Appendix 3: Interviewer Guide for an Environmental Health Assessment...................105 iv Tables Table 0.1. Percentage Distribution of Key Indicators by Province .................................. xii Table 5.1. Survey plans compared with results ................................................................ 15 Table 5.2. Percentage Distribution of HH heads and Respondents .................................. 16 Table 5.3. Percentage distribution of Household Populations by Age and Sex ............... 17 Table 5.4. Percentage distribution of households by size................................................. 18 Table 5.5. Age distribution of caretakers of children 12–47 months................................ 18 Table 5.6. Age distribution children 12–47 months by sex .............................................. 19 Table 5.7. Age distribution of school children interviewed by sex .................................. 19 Table 5.8. Percentage distribution of child caretaker and father characteristics .............. 20 Table 6.1. Percentage distribution of HH by Housing Characteristics............................. 21 Table 6.2. Percentage of households with electricity ....................................................... 22 Table 6.3. Household income, agricultural activities and possessions............................. 23 Table 6.4. Household Distribution of Assets in the Poverty Index by Tercile ................. 24 Table 6.5. Percentage distribution of Households by Water Supply ................................ 25 Table 6.6. Households Using Piped Water ....................................................................... 26 Table 6.7. Households Using Tanker Water..................................................................... 27 Table 6.8. Drinking Water Beliefs and Practices.............................................................. 28 Table 6.9. Drinking water storage .................................................................................... 29 Table 7.1. Percentage of Households with Access to Sanitation Facilities ...................... 31 Table 7.2. Percentage of Households with Access to Hygienic Sanitation Facilities....... 32 Table 7.3. Household Garbage Disposal........................................................................... 33 Table 8.1. Prevalence of Intestinal Parasites in Children 12–47 months.......................... 36 Table 8.2. Two-Week Prevalence of Diarrhea for Children < 5 years ............................. 37 v Table 8.3. Characteristics of Diarrhea* ............................................................................ 38 Table 8.4. Source of Treatment for Diarrhea.................................................................... 39 Table 8.5. Caretaker Knowledge of Causes of Diarrhea for Children < 5 years .............. 39 Table 8.6. Infant Feeding (0–11 months).......................................................................... 40 Table 9.1. Children (12–47 months)................................................................................. 42 Table 9.2. School Age Children (6–12)............................................................................ 43 Table 9.3. Adults............................................................................................................... 43 Table