Abstract
We examine factors associated with the use of basic water supply and sanitation services as part of an integrated community-based nutrition programme which included a drinking water, sanitation and hygiene (WaSH) intervention and emphasise findings related to health risk perceptions. Data were collected from 2658 households in four regions in Ethiopia with a cross-sectional survey in WaSH intervention areas, as well as in control areas, where the intervention was not implemented. The data were analysed using bivariate and multivariable regression analysis. Awareness of health risk factors related to inadequate WaSH was high in the programme area. The use of basic water and sanitation services was associated with several health risk perceptions: Perceiving water quality as good increased the odds of using basic water services as opposed to believing the water quality was poor (OR 3.94; CI 3.06–5.08; p ≤ 0.001). Believing that drinking unsafe water was the main cause for diarrhoea increased the odds of using basic water services (OR 1.48; CI 1.20–1.81; p ≤ 0.001). In the WaSH intervention group, the use of basic sanitation was more likely than in the control group. The use of basic sanitation was associated with households who had previously received sanitation training, as opposed to such who had not (OR 1.55; CI 1.22–1.97; p ≤ 0.001). Perceiving dirty space as the main cause of diarrhoea (OR 1.81; CI 1.50–2.19; p ≤ 0.001), and privacy when using a latrine (OR 2.00; CI 1.67–2.40; p ≤ 0.001), were associated with higher odds of using basic sanitation. Households that indicated a disadvantage of owning a latrine was maintenance costs were less likely to use basic sanitation (OR 0.49; CI 0.38–0.63; p ≤ 0.001). Risk perceptions were important determinants of use of basic services. The findings point to risk perceptions motivating the application of positive WaSH-related and health-protective behaviours. This suggests that well-designed health risk communication strategies may be effective for engaging households in healthy WaSH behaviour.
Highlights
Evaluations of drinking water, sanitation and hygiene (WaSH) interventions in low- and middle-income countries (LMICs) facilitate improvement of global health and development policy making and implementation practice
Intervention and control area, socioeconomic status, multiple use of the main water source, sanitary hygiene, sanitation sensitisation and training, educational background and health risk perceptions determined the use of basic services
Considering that 80% of respondents had taken part in sanitation training or sensitisation activity, which was positively associated with use of basic sanitation service, and given that risk perception is a major motivator for behaviour change [43], well-designed communication strategies and health messaging could speak to a highly effective form to engage households to accept and use basic services [33,39,44]
Summary
Evaluations of drinking water, sanitation and hygiene (WaSH) interventions in low- and middle-income countries (LMICs) facilitate improvement of global health and development policy making and implementation practice. Res. Public Health 2018, 15, 2112 water supplies, the improved distribution of water supplies by installation of hand pumps or household connection, the provision of water treatment for the removal of microbial contaminants at the source or at the point of water consumption, hygiene and health education and the encouragement of health-related behaviours, such as handwashing [1]. Does ‘hardware’ play a role in determining WaSH services, and the ‘software’: health risk perceptions, (mis)beliefs related to WaSH, WaSH-related behaviours, and the cultural context of WaSH [12,13,14]. These aspects are often neglected in project evaluations and studies on risk perceptions motivating WaSH-related behaviour are scarce
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