A study on WASH practices and under five (U5) morbidity pattern using remote sensing and geographical information system in Udupi Taluk. A dissertation submitted in Fulfillment of the Requirement for the Award of Master of Public Health (MPH) Degree Submitted by Dr Yogish C B DEPARTMENT OF PUBLIC HEALTH MANIPAL UNIVERSITY, MANIPAL, INDIA JULY 2015 1 | P a g e A study on WASH practices and under five (U5) morbidity pattern using remote sensing and geographical information system in Udupi Taluk A Dissertation Submitted to Manipal University in Fulfillment for the Award of Master of Public Health (MPH) Degree By Dr Yogish C B Under the guidance of Dr. Varalakshmi Chandra Sekaran Lecture Department of Public Health Manipal University Co-guides Dr. Sanjay M Pattanshetty Dr.Jagadeesha Pai B Dr. Shreemathi S Mayya Associate professor Associate professor Associate professor Dept of Public Health Dept of Civil Engineering Dept of Bio- statistics Manipal University Manipal University Manipal University Manipal-576104 Manipal-576104 Manipal-576104 2 | P a g e DECLARATION I hereby declare that the project entitled a study on “A study on WASH practices and under five (U5) morbidity pattern using remote sensing and geographical information system in Udupi Taluk” has been submitted during the year 2014 – 2015 under the valuable guidance and supervision of Dr. Varalakshmi Chandra Sekaran, Lecturer, Department of Public Health, in fulfilment of the requirement of the Master of Public Health (MPH) degree of Manipal University. Further, I extend my declaration that this report is my original work and has previously not formed the basis for the award of any degree or diploma. Place: Manipal Dr Yogish C B Date: 3 | P a g e Certificate This is to certify that the Research Project entitled “A study on WASH practices and under five (U5) morbidity pattern using remote sensing and geographical information system in Udupi Taluk” prepared by Dr Yogish C B under my supervision in fulfilment of the requirement for Master of Public Health, Manipal University, has not previously formed the basis for the award of any degree or diploma by this or any other University and that this work is a record of the candidate’s personal work. Date: Dr. Sanjay M Pattanshetty Place: Associate professor Department of Public Health, Manipal University. 4 | P a g e Certificate This is to certify that the dissertation entitled, “A study on WASH practices and under five (U5) morbidity pattern using remote sensing and geographical information system in Udupi Taluk” is a bona fide work done by Dr Yogish C B in the Department of Public Health, Manipal University, under our direct supervision and guidance. Guide Dr. Varalakshmi Chandra Sekaran Lecturer Department of Public Health Manipal University Co-Guides: Co-guide Name Co-guide Name Co-guide Name Dr. Sanjay M Pattanshetty Dr.Jagadeesha Pai B Dr. Shreemathi S Mayya Associate professor Associate professor Associate professor Dept of Public Health Dept of Civil Engineering Dept of Bio- statistics Manipal University Manipal University, Manipal University, Manipal-576104 Manipal-576104 Manipal-576104 Date: Date: Date: 5 | P a g e Acknowledgement I would first like to thank the participants, both formal and informal, that have agreed to take part in this research, for their time and information that they have provided. I like to extend my thanks for those who have given consistent, guidance, advice and encouragement in my endeavour. I am deeply indebted to my parents Mr. Channabasappa and Mrs. Gayathrei and my brother Vagish for their prayers, inspiration, guidelines and support, without whose blessings this dissertation would not have been possible. Cannot thank them enough. I would like to express my sincere gratitude to my mentor and MPH coordinator Dr. Sanjay M Pattanshetty, for giving me an opportunity and support to undertake this project My deep sense of indebtedness to Dr. Varalakshmi Chandra Sekaran, my guide for her indisipensable contribution, valuable suggestions at every step of this study. It has been a great privilege to do my study under her guidance. I like extend my special thanks to Dr. Jagadeesh Pai, MIT. His guidance in RS and GIS helped me a lot and gave confidence to work independently and NITK Surathkal to grant me the permission to access the remote sensing software. I am also grateful to Dr. Sheemathi S. Mayya, my co- guide from Department of Statistics, for her valuable suggestions to carry out this project. I would also like to thank my classmates, friends for the support. Thank you 6 | P a g e Serial no. Contents Page no. 1. Acknowledgement 6 2. Abbreviations and acronyms 8 3. List of the Tables 9 4. List of the Figures 10 5. Annexure 11 6. Executive Summary 12 7. Introduction 15 8. Aims and Objectives 19 9. Review of Literature 21 10. Methodology 26 11. Results and Discussion 35 12. Summary 67 13. Conclusion 69 14. Limitations 71 15. Recommendations 73 16. References 75 17. Annexures 79 7 | P a g e Abbreviations and acronyms MDG- Millennium Developmental goals U5- Under five WASH- water, sanitation and hygiene WHO- World Health Organization WB- World Bank HIV- Human immunodeficiency virus UNICEF- United Nations Childers’s Fund DALY- Disability adjusted life year NFHS- National Family Health Survey NRHM- National Rural Health Mission DLHS-District Level Household & Facility survey GIS- Geographic information system RS- Remote sensing PHC- Primary health Centre CHC- Community Health Centre UHC- Urban Health Centre FPAI- Family Planning Association of India MO- Medical Officer MHW- Male Health worker ARI- Acute respiratory tract infection LRTI- Lower respiratory tract infection SD- Standard deviation 8 | P a g e List of tables Table Title Page no. no. 1. Socio- demographic profile of respondent 36 2. Distribution of environmental factors and living condition of 37 participants 3. Distribution of children by age and gender 38 4. Distribution of children with current illness 38 5. Distribution of morbidity conditions among (U5) children 39 6. Treatment seeking behaviour and practice of mothers towards children 40 health 7. Nutritional status of participant children 41 8. Difference in nutritional status based on gender of the children 43 9. Knowledge about causes of diarrhoea and ORS solution. 44 10. Knowledge of ORS among mother/ caregiver of children with 45 diarrhoea 11. Sources of water and water treatment practise. 46 12. Distribution of sanitary facility and practices 49 13. Hygiene practices. 50 14. Materials used for washing their hands 51 15. Feeding habits and practices. 52 16. Association of diarrhoea with WASH practices 53 17. Association between ownership and diarrhoea of the property. 54 18. Association between WASH and cough 54 19. Association of fever with co-morbidities 55 9 | P a g e List of figures Figure Title Page no. no. 1. Udupi taluk map 27 2. Water sanitation and hygiene system map 33 3. Weight for age 42 4. Length/ Height for age 42 5. Weight for length 43 6. Distribution of drinking water according to source 48 7. Types of drinking water sources. 48 8. Map showing distribution of diarrhoea cases in Udupi taluk 56 9. Map showing distribution of Case cluster diarrhoea cases 57 10. Map showing distribution of unimproved drinking water source in 58 Udupi taluk 11. Map showing distribution of fever cases in Udupi taluk 59 12. Map showing distribution of cough cases in Udupi taluk. 60 13. Map showing distribution of lower respiratory tract infection in 61 Udupi taluk 14. Distribution of diarrhoea cases with geographical structure of Udupi 62 taluk 15. Distribution of diarrhoea case with satellite image in Malpe Beach 63 10 | P a g e Annexure Annexure Title Page no. No 1. Subject information sheet 80 2. Informed consent form 82 3. Questionnaire 84 4. Institutional Ethical Clearance Certificate 88 11 | P a g e Executive Summary 12 | P a g e Millennium development goals seven (MDG-7) emphasizes about environmental sustainability. Globally one in five habitually defecates in open and globally, about 13% of world population collects water from unprotected sources; most of the Asian cities fail to meet national water quality standards. MDG Goal-4 targets reducing child mortality. Under the age group of five years diarrhoea is the second biggest cause of death cause by poor water, sanitation and hygiene (WASH) practices. Worldwide unsafe water, inadequate sanitation or insufficient hygiene leads to 80% of diarrhoea. India accounts to 60% of world’s open defecation, only 31% of population use improved sanitation, in rural areas it’s about 21%. In India diarrhoea kills one child per minute. Diarrhoea and respiratory infection are the leading cause of deaths in India. Over 40% of the diarrhoea and 30% of the respiratory infection among children can be reduced, particularly by practicing hand wash with soap after contacted with excreta. An adequate water supply and basic sanitation are important elements of primary health care. This study is an attempt to fill the gap in understanding WASH practices and morbidity pattern among under five children in Udupi taluk. The objective of the study was to assess the morbidity pattern and factors associated with it among U5 children, to identify water, sanitation and hygiene practices in the community and to map morbidity patterns of U5 children in relation to water sources. A cross sectional study was conducted in between February 2015 to June 2015 across Udupi taluk among 258 children between the age group of three to 59 months, mixed method study design approach was used. Of the 258 children, 55.4% participants were female. Majority of the participants lived in nuclear families (64.7%). The current illness of ARI was 7.5% followed by pneumonia (4.7%) and diarrhoea (2.8%).