ASSESSMENT OF KNOWLEDGE AND EXERCISE OF CHOLERA PREVENTION POLICIES AMONG JUNIOR SECONDARY SCHOOL STUDENTS IN KATSINA STATE, NIGERIA
ABSTRACT
This study assessedknowledge and practice of cholera prevention strategies among junior secondary school students in Katsina State, Nigeria. Ex-post facto research design was used. The respondents used for the purpose of data collection were four hundred (400) sampled from a population of 271,690 junior secondary school students inKatsina State Nigeria. The respondents were drawn through multistage sampling technique, which consisted of stratified, simple random sampling andproportionate sampling techniques. A close ended questionnaire was used to obtain responses from the participants. Three hundred and ninety-eight (398; 99.5%) questionnaires were returned. Descriptive statistics of frequency, percentages, means and standard deviations were used to describe the demographic characteristics of the respondents.The hypotheses were tested at 0.05 level of significance using one sample t-test, independent sample ttest and analysis of variance. The findings of the study revealed that knowledge of cholera prevention strategies among junior secondary school students in Katsina State of Nigeria was significantly adequate (t = 3.070; p= 0.001), practice of cholera prevention strategies among junior secondary school students in Katsina state of Nigeria was not significant (t=1.291; p= 0.110), junior secondary school students in Katsina State of Nigeria do not significantly differ in their knowledge of cholera prevention strategies based on demographic characteristics(p = 0.17, 0.21, 0.10)and junior secondary school students in Katsina State, Nigeria do not significantly differ in their practices of cholera prevention strategies based on demographic characteristics (0.7, 0.5, 0.1). On the basis of the findings of the study, it was concluded that Junior secondary school students in Katsina State of Nigeria have knowledge of cholera prevention strategies, but they do not practicecholera prevention strategies,and they do notdiffer in their knowledge and practice of cholera prevention strategies based on demographic characteristics. However, It was,recommended that: school managements should put in place adequate measures within the school environment to checkmate and control the healthy practices of student this include provision of hand washing sink, provision of safe drinking water, supervising the canting, provision of charts and notice board within the school environment and adequate use of latrine by students.
TABLE OF CONTENTS
Cover page i
Title Page ii
Operational Definition of Terms xii
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 4
1.3 Purpose of the Study 7
1.4 Research Questions 7
1.5 Hypotheses 8
1.6 Significance of the Study 9
1.7 Basic Assumptions 10
1.8 Delimitations of the Study 10
CHAPTER TWO: REVIEW OF RELATED LITERATURE
2.1 Introduction 11
2.2 Conceptual Framework 12
2.2.1 Concept of Cholera 12
2.2.2 Prevalence of Cholera 15
2.3 Causes of Cholera 17
2.3.1 Epidemiology 18
- 2Nature of Cholera Spread 20
2.3.3 Risk factors of Cholera 25
-
Study Variables 29
- Knowledge of Cholera Prevention Strategies 29
- Practice of Cholera Prevention Strategies 33
- Cholera Prevention Strategies 39
- Theoretical Framework 67
- Empirical Studies 69
- Summary 74
CHAPTER THREE: METHODOLOGY
3.1 Introduction 76
3.2 Research Design 76
3.3 Population of the Study 77
3.4 Sample and Sampling Techniques 77
3.5 Instrument 79
3.6 Validation of the Instrument 80
3.7 Procedure for Data Collection 80
3.8 Procedure for Data Analyses 81 CHAPTER FOUR: RESULTS AND DISCUSSION
4.1 Introduction 83
4.2 Results 84
4.3 Discussion 104
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary 108
5.2 Contribution to Knowledge 109
5.3 Conclusion 110
5.4 Recommendations 110
5.5 Suggestions for Future Research 111
References 112
Appendices I: Questionnaire 121
Appendices II: Introductory letters 122
LIST OF ABBREVIATIONS
WHO : World Health Organization
OCV : Oral Cholera Vaccine
CPP : Cholera Prevention Practices
ORS : Oral Rehydration Solution
WASH : Water, Sanitation and Hygiene
CDC : Centers for Disease Control and Prevention
OPERATIONAL DEFINITION OF TERMS
Knowledge: Is the awareness or knowing the various ways of preventing cholera by the respondents.
Practice:These are the actions or what the respondents do to improve their skills in the prevention of cholera.
Prevention Strategies: These are skills or activities done in the prevention of cholera.
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Cholera is an acute diarrhea disease that is caused by the bacterium called vibrio cholera, it is an infection of the small intestine caused by ingestion of food or water contaminated with the bacterium vibrio cholera. According to World Health Organization (WHO, 2015),cholera hascontinued to be a global threat to public health and is a key indicator of lack of social development such as human biological development (WHO, 2015). The disease used to be a global health problem, but the developed countries over the years have overcome the challenge now leaving the disease largely confined to developing countries especially in the tropics and subtropics.
It is endemic in Africa, part of Asia, Middle East, South and Central America (Chiyangwa, 2017).
In endemic areas, outbreaks usually occur when war or civil unrest disrupts public sanitation. Natural disasters like earthquakes, tsunami, volcanic eruptions, landslides and floods contribute to the outbreaks by disrupting the normal balance of nature (Qadri, 2016). As such, these create many health problems, food and water supplies can become contaminated by parasites and bacteria when essential systems, like those for water sewage are destroyed. Developing countries are disproportionately affected because of lack of resources, infrastructure and Prevention methods (Sur, 2017). In newly affected areas, outbreaks may occur during any season and affect all ages. The organism normally lives in aquatic environment along the coast. People acquire this infection by consuming water, sea food, or other foods contaminated with the bacterium vibrocholerea. Once infected, they excrete the bacteria in stool. Thus, the infection can spread rapidly, particularly in areas where human waste is untreated (WASH, 2014).
A multidisciplinary approach based on prevention, preparedness and response, with an efficient surveillance system is the key in mitigating cholera outbreak, controlling cholera in endemic areas and reducing deaths (WHO, 2016). In most industrialized countries, cholera was largely eliminated by water and sewage treatment over a century ago. The prevention of cholera constitutes one of the most immediate and serious problem facing government approaches, in African cities Consequently, people‘s health and their economy steadily continue to degrade due to cholera outbreak, if it is not effectively prevented (WHO, 2018).
Usman (2017), believed that Borno,Yobe, Zamfara, Bauchi,Kano and Katsina states of Nigeria are the ‗most affected‘ States in Nigeria with cholera, most parts of the state and its environs are partially or wholly hit by cholera. The situation may have improved but still most of the Northern states rely on hand dug wells, ponds and streams for their sources of drinking water which may be contaminated and putting the community members at risk of contracting the disease. Usually, other source of contamination is through other cholera infected patients when their untreated diarrheal discharge is allowed to get into water supplies (Igomu, 2018). Today, it remains a significant cause of morbidity and mortality in Northern parts of Nigeria, where it is a marker for inadequate drinking water and sanitation infrastructure (Usman, 2017). These deplorable situations are not only unique to Northern parts of Nigeria, but exist in most African Countries.
Sanitation among secondary school students is the hygienic means of promoting health through prevention of human contact with the infected wastes. Wastes that can cause health problems are human and animal feces, solid wastes, domestic wastewater (sewage, sullage, and grey water), industrial wastes, and agricultural wastes. Inadequate sanitation among secondary school students is a major cause of disease world-wide and improving sanitation is known to have a significant beneficial impact on health both in households and across communities (Utsalo, 2018)
In response to cholera outbreak, the Katsina State government and partner agencies initiated emergency public health responseactivities which is aimed at treating suspected cholera cases, preventing new ones and preparing for the outbreak (Pam, 2017). Response activities included mass media, cholera campaigns through radio and hygiene promotion activities by community health workers, and unlimited administration of oral cholera vaccine (OCV). Prevention efforts focused on internally displaced persons‘ settlements in Katsina state and poorer neighborhoods of the state where information regarding cholera knowledge, dissemination of cholera information and prevention was limited (Pam, 2017).Smith (2017) stated that knowledge is a theoretical or practical understanding of a subject. When knowledge is related to prevention of cholera, it is called knowledge of cholera prevention. Knowledge towards cholera prevention as in this study refers to the most common learning and how to remember ways of preventing cholera and the level of available information about cholera prevention.
Practice can be defined as the act of doing something customarily or performing something often (Webster, 2017). Practice is also defined as a way of doing something regularly (Dunkle, 2016). When practice relates to cholera prevention, it is called Cholera Prevention Practices (CPP). Cholera prevention practices in this study, refers to the most common and regular methods of cleaning the environment regularly, covering of water supply, filtering of water, how to prepared oral rehydration solution, washing of hands after using latrine with soap and water among junior secondary school students of Katsina state.
Knowledge and practice of junior secondary school students towards cholera preventionstrategies are important for planning, prevention, execution, and evaluation ofhealth education programs. Cholera prevention is far cheaper and effective by means ofpreventionstrategy than a curative one. This study intends to assess knowledge and practices of cholera prevention strategies among junior secondary school students in
Katsina State, Nigeria.
1.2 Statement of the Problem
An ideal environment in Europe, Asia, and other developed and developing nations of the world including Nigeria and Katsina State in particular should always be free from cholera outbreak. The inhabitant should have adequate and sufficient knowledge of cholera, its symptoms and prevention measures.
In Nigeria, outbreaks of cholera have been occurring with increasing frequency since the first outbreak in 1970. Since then, cholera has continued to cause high mortality in humans. The outbreak of cholera is mostly common in the following Northern States Kaduna, Bauchi, Zamfara, Kano and Katsina of Nigeria killing close to
200 people within a week when the outbreak occur. In Kano State, a total of 5,600 cholera cases and 340 deaths were recorded in 2006 (Ministry of Health, 2006). In 2018,Cholera outbreak was declared in Yobe State, North East Nigeria by the state ministry of health, two weeks after a cholera outbreak was declared in Borno state. The cumulative number of recorded cases in both states are 3126 including 97 deaths. In Yobe State, 989 cases of suspected cholera were recorded in five local government area including 61 death as at 2018. A total of 2137 cases of suspected cholera cases have been recorded in eight (8) local government area including thirty six (36) death in Borno State in 2018 (Ministry of Health,2018). The outbreak of cholera in Katsina state is largely attributed to drinking water sold by street water vendors and failure to wash hand with soap before meals were taken.
This problem is still endemic in Katsina state, with 3110 cholera cases in seven(7) local government as at 2017, the epidemic continues to spread to neighboring communities, with the number of deaths being reported as ninetyone (91) (Mazana, 2017), because most of the communities do not have access to good water sources as they get water from streams or hand dug wells, making the inhabitants more vulnerable to the epidemic. Furthermore, these communities are prone to cholera epidemic which has resulted into poor maintenance and destruction of available infrastructure (like drainage system and water pipes).
The researcher observed that the persons infected with cholera might be as a result of poor knowledge and bad practices of cholera prevention strategies which might involve secondary school students, also overcrowding, dirty environment, unhygienic food and water are likely causes of cholera amongjunior secondary school students.
Most of the boreholes in the communities are not functional, the wells are leftuncovered and the environment not sanitized. Cholera spreads in many ways, in secondary schools, students buy food from food vendors, most food vendors do not cover their food, exposing it to flies that might be carrying the cholera causing bacteria. Eating such food can cause cholera, many schools has a lot of student but very few toilet to care for them, in addition, the toilets are not used properly nor are they cleaned frequently, making them a breeding ground for vibrocholerae. If one student with cholera use them, flies comes into contact with their excreta and then lands on food, this could start a cholera outbreak in schools. Many schools also have poor disposal of refuse, waste create a breeding ground for the bacteria that causes cholera. Unfortunately, school students dispose waste carelessly.
The researcher observed that some schools do not have access to clean, safe drinking water, and some do not have satisfactory facilities for safe disposal of human waste. It is against this background that, the researcher became motivated to study the knowledge and practice towards cholera prevention strategies among junior secondary school students in Katsina State, Nigeria.
1.3 Purpose of the Study
The main purpose of this study was to assess the knowledge and practice of cholera prevention strategies among junior secondary school students in Katsina State,
Nigeria.
The specific purposes of the study are to assess:
- the knowledge of cholera prevention strategies among junior secondary school students in Katsina State, Nigeria.
- the practice of cholera prevention strategies among junior secondary school students in Katsina State, Nigeria.
- the difference of demographic characteristics (gender, age and class) on the knowledge of cholera prevention strategies among junior secondary school students in Katsina State, Nigeria.
- the difference of demographic characteristics (gender, age and class) on the practice of cholera prevention strategies among junior secondary school students in Katsina State, Nigeria.
1.4 Research Questions
The following research questions were raised to guide this study:
- What is the knowledge of cholera prevention strategies amongjunior secondary school students in Katsina State, Nigeria?
- What is the practice of cholera prevention strategies among junior secondary school students in Katsina State, Nigeria?
- Will junior secondary school students in Katsina State, Nigeria differ in their knowledge of cholera prevention strategies base on demographic
characteristics (gender, age and class)?
- Will junior secondary school students in Katsina State differ in their practices of cholera prevention strategies base on demographic characteristics (gender, age and class)?
1.5 Hypotheses
The following research hypotheses were formulated for this study:
- Knowledge of cholera prevention strategies among junior secondary school
students in Katsina State Nigeria is not significant.
- Practice of cholera prevention strategies among junior secondary school
students in Katsina state Nigeriais not significant.
- Junior secondary school students in Katsina State, Nigeria do not significantly differ in their knowledge of cholera prevention strategies base on demographic characteristics.
- Junior secondary school in Katsina State, Nigeria do not significantly differ in their practice of cholera prevention strategies base on demographic
characteristics.
1.6 Significance of the Study
The findingsof this study would improve theknowledge of juniorsecondary
school students in Katsina State as regards to cholera prevention because it would create awareness tostudents and the society at large on causes of cholera and preventive measure. The finding would also correct the possiblenegative practice of junior secondary school students towards cholera prevention.This study would encourage junior secondary school students to intensify effort towards preventing cholera outbreak because it would motivate individual student to improve in the practice of personal hygiene.
It would also help other researchers to come out with similar research in other parts of the country, particularly areas frequently affected by cholera. The finding of this study would be beneficial to Ministry of Health in formulating further polices and guideline on environmental health to prevent outbreak of cholera in Katsina state. The findings of this study would be significant to teachers, Ministry of Health, voluntary agencies and non-governmental organization that adequate intervention programs such as health campaigns, seminars, lectures, symposiums, and workshops can be put in place to mitigate outbreak of cholera in the state. This study would as well be useful to state governments in line with identifying the knowledge gap and empowering health educators and public health officers to bridge the knowledge gap and advocate for practices that can motivate cholera prevention.
It would contribute to the existing body of knowledge on cholera
preventionstrategies in Katsina State and Nigeria through mass media such as radio programs, television programs, online blogs, libraries, social medias and community town hall meetings.
1.7 Basic Assumptions
The basic assumptions of this study were assumed to be as follows:
- Junior secondary school students in Katsina State have adequate knowledge on cholera prevention strategies.
- Knowledge of cholera prevention will influence desirable practices of junior secondary school students in Katsina state.
- Demographic characteristics will differ in the knowledge of cholera prevention strategies among junior secondary school students in Katsina State.
- Demographic characteristics will differ in practice of cholera prevention strategies among junior secondary school students in Katsina State.
1.8 Delimitations of the Study
This study was delimited to;
- the knowledge of cholera prevention strategies among junior secondary school students in Katsina State, Nigeria. ii. the practice of cholera prevention strategies among junior secondary school students in Katsina State, Nigeria.
- the difference of demographic characteristics (gender, age and class) on the knowledge of cholera prevention strategies among junior secondary school students in Katsina State, Nigeria.
- the difference of demographic characteristics (gender, age and class) on the practice of cholera prevention strategies among junior secondary school
students in Katsina State, Nigeria
ASSESSMENT OF KNOWLEDGE AND EXERCISE OF CHOLERA PREVENTION POLICIES AMONG JUNIOR SECONDARY SCHOOL STUDENTS IN KATSINA STATE, NIGERIA