(1.) Executive Summary
A pilot KAP (Knowledge, Attitude, Practice)
study on hygiene was carried out in three districts of Faryab province
during November/ December of 2005 by male and female interviewers who were
trained to conduct standardized interviews and systematic observations
of households. The aim of this survey was to measure the level of hygiene
knowledge and practice before implementing WatSan projects.
The main findings of this survey were as follows:
A total of 403 households were visited and 468 people in 22 different villages interviewed, whereby more than 90% of them were illiterate.
The main water sources for more than 80% of all interviewees were rivers, streams and ponds and the average time to get drinking water was 262 minutes, ranging from 0 up to 720 minutes. Almost half of all households had a latrine (48%), many of them were unclean and most of them difficult to empty.
34% of the participants reported diarrhoea cases in their families in the two weeks prior to the survey the majority of which were children.
The majority of people (66.5%) did know that unsafe water could cause diarrhoea, but only 1.9% of the participants had done something to make their drinking water safer.
Most children appeared to be unclean (90%) and also a big part of the adults wore dirty clothes (55%). Interviewers also noted that most areas around the main water sources (80%), most of the yards (81%) and most kitchens (85%) were unclean. Animals, garbage or faeces were spread around those places.
A main implication of this assessment was the need for safe water sources in closer vicinities as well as the need for safe sanitation facilities.
Many responses regarding knowledge indicate that information on hygiene exists, but is not being practiced. Also the observation of several risk behaviours, such as open defecation, lack of personal hygiene and irresponsible waste management suggests the need for hygiene education.
Another study will be conducted in the same districts after finishing the hygiene education in the project area to measure its impact. An increase in knowledge and a change in behaviour in most areas should be expected.
(2.) Background
The prevalence of diarrhoeal diseases in Afghanistan continues to be very high, affecting mostly children. Due to a lack of protected water sources and inadequate sanitation facilities plus a lack of knowledge on disease transmission and prevention the incidence of water related diseases is not decreasing.
Hygiene Education (HE) has been an integral part of DACAAR WatSan projects for more than 5 years. Access to safe water alone does not reduce diarrhoeal diseases significantly. Inadequate hygiene practices must be targeted as well when implementing WatSan projects to decrease morbidity and mortality especially in rural Afghanistan. Along with building or improving water points DACAAR therefore provides hygiene education for all user groups.
Hygiene Education is being conducted by male and female Hygiene Promoters, usually married couples, to ensure that all beneficiaries, men and women, are being reached. The number of Hygiene Promoters varies in each site according to the number of water points that are being built or improved in a province/ district.
Hygiene Promoters inform community members about the correct use and storage of water, the need for safe sanitation facilities, personal and environmental hygiene and diarrhoea transmission and management, aiming at sustainable behaviour change. In order to achieve sustainable changes in practices, attitudes and knowledge all user groups receive two household visits by DACAAR hygiene promoters. The first visit includes the delivery of different messages related to drinking water, hygiene and sanitation (according to MRRD guidelines) in a one hour session. The second 'refresher' visit serves to assess what changes have taken place after the first visit and what problems occurred in putting knowledge into practice.
DACAAR provides a high quantity of these hygiene sessions; the overall quality remains unclear. Random observations have previously taken place and small samples have been assessed for quality control. And although both Hygiene Promoters and Supervisors regularly report positive impact and occasionally radical changes of beneficiaries, no systematic evaluation of the quality of our HE intervention has taken place. It is to date uncertain if our approach leads to increased knowledge on the importance of hygiene and more importantly if it brings about sustainable behaviour change.
2.1 GOAL AND OBJECTIVES
The goal of our KAP study was therefore to systematically assess the knowledge, attitude and practice before and after our intervention to identify the impact of our hygiene education and if necessary implement changes in our HE method. In order to measure a potential change in knowledge and behaviour the same baseline and final questionnaire will be administered. Another outcome of interest will be the incidence of diarrhoea. WatSan projects typically reduce diarrhoeal disease about 25%.
(3.) Methodology
3.1 DATA COLLECTION
The study took place from 12th of November until 12th of December and data was collected in three districts of Faryab province: Kwahja Sabz Posh, Dawlatabad and Shirin Tagab. These sites were chosen based on the fact that DACAAR has EC funded WatSan projects in those districts.
The villages for the KAP study were selected by a three step process:
- Firstly a village survey was conducted in all three districts to collect information on the number of households and on the number and type of water sources in all villages.
- Secondly all villages without public or private water points were identified and listed as potential WatSan project villages.
- And thirdly water tests were done to examine the salinity and the water levels of existing water points. All villages with high salinity levels were removed from the list of possible survey villages. From the remaining villages 22 were randomly selected for the KAP study.
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