Knowledge, attitudes, and practices of household water purification among caregivers of under-five children in biye community, Kaduna State

Jimoh M Ibrahim; Muawiyyah B Sufiyan; Abdulhakeem A Olorukooba; Abdulrazaq A Gobir; Hadiza Adam; Lawal Amadu

doi:10.4103/archms.archms_1_17

Knowledge, attitudes, and practices of household water purification among caregivers of under-five children in biye community, Kaduna State

Jimoh M Ibrahim¹, Muawiyyah B Sufiyan², Abdulhakeem A Olorukooba², Abdulrazaq A Gobir², Hadiza Adam², Lawal Amadu²
¹ Department of Community Medicine, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria
² Department of Community Medicine, Ahmadu Bello University Zaria, Zaria, Nigeria

Correspondence Address:
Jimoh M Ibrahim
Department of Community Medicine, Ahmadu Bello University Teaching Hospital Zaria, Zaria
Nigeria

Background: Water is one of the basic needs for survival, and potable water is essential for good health. Contaminated drinking water is a major health hazard in developing countries, and water-related diseases are a significant contributor to the global burden of illness. Thus, for populations without reliable access to safe drinking water, household water treatment provides a means of improving water quality and preventing disease. This study aimed to assess the knowledge, attitudes, and practices of household water purification among caregivers of under-five children in Biye community. Methodology: This was a descriptive cross-sectional study. A multi-stage sampling technique was used to recruit 142 caregivers of under-five children who were randomly selected. Data were collected using a semi-structured questionnaire and analyzed using IBM SPSS. Chi-square was used to test associations. The level of significance was set at <0.05. Results: Majority (63.4%) of respondents used unprotected well, and only 26.1% used protected well as a source of water. Only 12% of respondents had good knowledge. However, the majority of respondents (63.4%) had a positive attitude toward household water purification. Boiling was the most common (79.6%) method of water purification respondents are aware of and only about a third (32.4%) currently practiced household water purification. Conclusion: Majority of the respondents had poor knowledge and practice of household water purification. However, significant proportion of the respondents had a positive attitude toward household water purification. The local government authority should embark on the mass campaign on the importance and methods of household water purification in rural communities.

Majority 90 (63.4%) of the respondents used unprotected well, 15 (10.6%) used sachet water, and only 37 (26.1%) of them used protected well as source of drinking water as depicted in [Table 2].

Table 2: Distribution of the major source of drinking water among respondents (n=142)

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Most of the respondents 134 (94.4%) have heard of household water purification. The predominant source of information on household water purification was media 44 (31.0%) and was closely followed by parents 41 (28.9%) and hospital 31 (21.8%). Other sources of information include school 12 (8.5%), friends 9 (6.3%), and others 5 (3.5).

When the under-five caregivers who indicated awareness of household water purification were asked to mention without prompting, the different water purification method they knew, boiling and filtration were the most common methods mentioned by 112 (79.6%) and 100 (70.4%) of the caregivers, respectively. Other methods mentioned were addition of alum 58 (40.8%), leave water to settle 20 (14.1%), WaterGuard 7 (4.9%), storing in clay pots 4 (2.8%), and 2 (1.4%) know other methods which included the use of a herb called “Saabara” [Figure 1].

Figure 1: Respondents’ knowledge of methods of household water purification.

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[Table 3] shows an association between respondents' educational level and their knowledge on household water purification. The result showed a significant statistical relationship between knowledge on household water purification and educational status (P = 0.001).

Table 3: Respondents educational status and knowledge on household water purification

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With regard to the respondents belief about the purity of source of their drinking water, [Figure 2] above showed over half 81 (57.0%) of them believed that whenever water is clear, it is safe to drink, whereas 38 (26.8%) believed that their major source of drinking water was pure, 22 (15.5%) believed water had no harm and only 9 (6.3%) did not believe in water purification.

Figure 2: Distribution of respondents’ belief about the purity of their major source of drinking.

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Other results on attitude toward household water purification revealed that most of the respondents 128 (90.1%) believed it is good to drink treated water, and only 14 (9.9%) believed it is bad. Most of them also believed that getting the materials for water purification is easy 116 (81.7%).

Less than a quarter 33 (23.2%) of respondents said water purification was expensive and three-quarter 107 (75.4%) said it worth investing money on. However, 51 (35.9%) said that they would rather buy something else if given the money to purchase a water filter.

Most of the respondents 83 (58.5%) said that treating water always is a hassle. However, over three-quarter 111 (78.2%) said that water purification is worth investing time in.

With regard to the use of chemicals such as “alum” and “WaterGuard” in water purification, a third 48 (33.8%) of the respondents thinks they are unhealthy to consume. More than half of the respondents 81 (57.0%) said treated water taste bad.

About half of the respondents 70 (49.3%) said that they have never been told to treat their drinking water by health personnel or health promotion organizations, whereas negligible proportion 6 (4.2%) said that they have always been told. At least two of ten respondents, 33 (23.2%) said that other people such as neighbors and relatives would think bad of them if they are treating their water, whereas a third 52 (36.6%) said that they will think good of them.

About half 69 (48.6%) of the respondents reported tasks that hindered them from treating their water. Of which, 53 (37.3%) said that household chores was the task that hinders them from treating water, few of them 11 (7.7%) mentioned other tasks.

The predominant method of water purification practiced as shown in [Table 4] was boiling 95 (66.9%), followed by filtration 58 (38.7%), the addition of alum 15 (10.6%) and only 10 (7.0%) left the water to settle. No respondent used chlorine tablet.

Table 4: Methods of water purification, frequency of purification and availability of treated water among respondents (n=142)

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Regarding frequency of water purification, only 29 (20.4%) of the respondents mentioned that they always treat their drinking water, 41 (28.9%) mentioned rarely, and 5 (3.5%) of them never purify it. However, only 39 (27.5%) of the respondents had treated water available at the time of the survey [Table 4].

When the knowledge of respondents on household water purification was graded as depicted in [Table 5], over half of the respondents 76 (53.5%) had poor knowledge of household water purification, 49 (34.5%) had fair knowledge, and only 17 (12.0%) had good knowledge.

Table 5: Respondents overall scores on knowledge, attitude, and practice of household water purification among respondents (n=142)

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[Table 5] shows that majority of the respondents 90 (63.4%) had a positive attitude toward household water purification.

Overall, the level of household water purification practice among respondents was low, as less than half 57 (40.1%) of the respondents practice the appropriate method of water purification as depicted in [Table 5].

Discussion

The sociodemographic characteristics of the respondents revealed that their mean age is 24.14 ± 6.38 years; however, about a third of them were within the adolescent age group (10–19 years). This implies that those respondents were married as under aged and likely to drop out of school which in turn can negatively affect their knowledge and practice of household water purification. This is in contrast to a study in Kenya where only 10.2% of caregivers were adolescent, and about two-thirds (64.4%) of the caregivers were between ages 20 and 29.^[5] All the participants in this study were married, female Hausa Muslims. The major religion of the inhabitants of Biye community was Islam.

One of the indicators of the status of women is female education. The study showed a decline by almost half in the female education with only about one in seven of the respondents exposed to secondary education. The female education level is much lower than the North-West value of 41.6% recorded during the NDHS of 2013 and national average of 75%. Female literacy is not only one of the indicators of assessing socioeconomic development, but it is also positively associated with utilization of health services.^[17] The low level of female education recorded in this study may be a major impediment to the practice of point of use water treatment.

The low level of formal education might be because the study was conducted in rural population where underage marriage was very prevalence with high level of poverty.^[12] Those with more years of formal education may be more aware of the dangers of unsafe water and more likely to treat their water. Most of the respondents had a family monthly income of N10,000 and below. This indicates that majority of the respondents were from low-income households. Studies have shown that low-income households are less likely to treat water compared to households with higher income.^[18]

Almost two-third of the respondents used unprotected well as their source of drinking water. Thus, unimproved water sources were the predominant drinking water source in the community, which indicates vulnerability of the study community to waterborne diseases, especially among children who often succumb to the ravages of diarrhea disease.^{[19],[20],[21],[22]} This implies that those population without reliable access to safe drinking water, HWT provides a means of improving water quality and preventing disease.^[3] The findings of this study on improved source of drinking water (i.e., protected) are consistency with the finding from a study in Afghanistan that reported only 29% of the respondents had access to improved water sources.^[23] The results are similar because the studies were from rural areas. However, the finding from this study is lower than the study in the northeast zone of Nigeria, which reported that 49% of the population in this region (both rural and urban in this case) gets its drinking water from an improved source,^[11] as well as a study in Ilorin West Local Government Nigeria which showed that >84% of the respondents had access to improved water sources.^[24] Furthermore, a survey in Southern Sudan showed above half (51.8%) used improved sources of drinking water.^[25]

The high awareness of respondents on boiling, filtration, and addition of alum might not be unconnected to the fact that major water source in the community was turbid with sediments. This finding is higher than a study among women in Pakistan which reported that 39% knew about boiling, 35% cloth filter, and 8.7% chlorine product.^[19] In contrast to the finding from this study which reported (4.9%) of respondents who know about “WaterGuard,” a national survey in Malawi among mothers showed that 64% were aware of WaterGuard.^[26] Furthermore, following a school-based safe water and hygiene intervention among students and their parents in Nyanza Province, western Kenya, at baseline, 89% of students have heard of WaterGuard.^[27] The higher figures recorded in the literature might be due to the frequent creation of awareness regarding the use of WaterGuard during community health intervention programs and better socioeconomic status in those places. The three quantitative surveys and the qualitative study showed a significant association between knowing about the existence of household treatment products and their application.^{[20],[21],[22],[28]}

In this study, more than half of the respondents said the reason for treating water was to kill germs, another three of ten respondents mentioned to prevent diarrhea, very little proportion do not even know why people treat their water. This is comparable to a national survey in Malawi amongst mothers which showed that 68% of the respondents who are aware of “WaterGuard,” believed the product was to make water safe, 21% believed it was to prevent diarrhea, and 10% either did not know or gave another answer.^[26] Similarly, a study in the poor peri-urban community of Santo Domingo, Dominican Republic, among caregivers of under-five children, showed that 74% reported the reason why people chlorinated drinking water was to kill germs, bacteria, parasites, or micro-organisms, only 3% stated that they did not know why water was chlorinated.^[29]

Despite the fact that majority of the respondents have access to unimproved water source, significant proportion had poor knowledge on household water purification which might contribute to the high burden of disease in the study community, especially among children. This is similar to a study in Afghanistan which showed that majority (60%) of the respondents had poor knowledge of water treatment.^[23] Moreover in contrast to a study among women in the rural communities of Ogun state, South West Nigeria which showed that >80% of the respondents had excellent knowledge of water treatment.^[30] Even though both are rural areas, this finding is likely due to the higher level of education in the latter. In this study, there was a significant statistical relationship between knowledge of household water purification and educational status (P = 0.001) [Table 3], overall knowledge of household water purification was the highest among respondents with secondary level of education. Another study in Pakistan found that measures of awareness such as different level of schooling of decision-makers and household heads and their exposure to mass media have statistically significant effects on home purification methods for drinking water.^[31] Respondents' attitude toward the method, trust in the product, and the perceived value and relevance of water purification can influence the decision to adopt water treatment actions.^[27] Studies have found people with positive attitudes were more likely to treat their water and people who distrusted, for example, chemicals were reluctant to apply these methods.^{[19],[32],[33]} This is consistent with the findings from a study amongst women of rural communities in Ogun state Southwest Nigeria which reported that 33.3% perceived their water source to be pure, 20% said they are “used to drinking from the source without any harm,” 20% believed that “as long as the water is clean there is no need for purification, whereas 10% do not believe in water purification.^[30] Similarly, a study among mothers in Southern Sudan reported that, although 35.2% used water from unprotected surface water sources, springs, and wells, 69.5% were of the opinion that the water they used was safe for drinking.^[25] According to finding in some communities in Southern Sudan, surface water such as rivers had been used by their ancestors, and therefore, they did not think the water was unsafe.^[25]

Respondent's practice of household water purification, at least nine out of ten respondents have ever used a water purification method. Despite this, only a third of the respondents are currently using a water purification method, and only a quarter of them had treated water available at the time of the survey. This is consistent with a study among mothers in Southern Sudan which showed that of the 21.1% who used piped water sources, only 47.6% claim to apply any form of water treatment to make it safe before use.^[25] Similarly, studies in urban Lucknow, India showed that the most prevalent treatment method was boiling (26.2%) and filtering (26.9%).^[10] About 30.31% of the people had treated water at the time of the interview, and 30.8% did not apply any kind of treatment method at any time.^[10] In contrast, a study in Western Kenya amongst households showed that; of the river water users, 50% used chlorination, whereas the remaining 50% boiled their water.^[34] For those using tap water, 12.5% used boiling, 50% used chlorination with 37.7% using filtration. Among the borehole water users, 95% used chlorination and 5% filtered their water and 40% of the well water users used chlorination, and 60% of them used filtration.^[34] Similarly, a study in the poor peri-urban community of Santo Domingo, Dominican Republic, among caregivers of under-five children, reported that 27% of the respondents chlorinated water.^[29] Although boiling is an effective strategy in the management of safe water at the household level, it has some drawbacks which is time-consuming to first heat and then cool the water. Others include a change of taste of water, there are cost involved in procuring the fuel or wood, respiratory infections can occur as fuel is usually burnt indoors in poorly ventilated rooms in developing countries, and it is environmentally unsustainable.^[4] Chlorine method which is of low cost and one of most effective methods because it prevents re-contamination in its residual form in water was poorly or not practiced and this might be because some technologies in water purification method, such as filters and chlorine may be more easily purchased in urban areas and towns than rural areas.

In this study, six of ten respondents had an inappropriate practice of household water purification, whereas the remaining had appropriate practice. The low level of practice of water treatment in this study may also be due to the perception that water source was safe or treated water had bad taste. The finding of those with appropriate practice is higher compared with a study in the northeast of Nigeria where only 6% of the households practiced water purification,^[11] and a study in the North-West Nigeria which reported only 12.1% used an appropriate water purification method.^[35] A study in Cameroun among the households reported 67.6% had access to improved source of water and only 20.1% purified water at home.^[36] The high practice of HWT among respondents in this study compared to other literature might be because high proportion of respondents did not have access to improved water source; hence, they tend to purify their water, so as to preventing them from developing waterborne diseases such as diarrhea, especially among under-five children.

The rising poverty levels in the country,^[37] in the face of increasing cost of water purification products and availability problems may be added factors militating against the household water purification. However, social and cultural factors appear to be major impediments to knowledge and practice of household water purification in the study community.^[38]

Conclusion

The study has shown that most respondents had poor knowledge on household water purification and a positive attitude toward household water purification. However, low proportion of the respondents practiced household water purification.

There was a statistically significant relationship between overall respondents' knowledge on household water purification and the socioeconomic status, and attitude. Good knowledge was higher among respondents with some form of education. There was also a statistically significant relationship between respondent's attitude and practice of household water purification.

There is, therefore, an urgent need for Giwa Local Government Authority to begin mass awareness campaign on the importance of domestic water purification and methods of water purification at household level in rural communities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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Figures

[Figure 1], [Figure 2]

Tables

[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]