INFLUENCE OF POOR SANITATION ON THE INCIDENCE AND PREVALENCE OF CHOLERA IN CHIKAJI

WARD

CHAPTER ONE

1.0Back ground of the study

cholera remains a global threat to public health and a key indicator of lack of social development.
cholera an acute diarrhea caused by gram negative bacteria vibro cholerae which is associated with high
mortality and morbidity.

The onset of cholera often start with stomach cramp, vomiting and diarrhea and if left untreated may
progress fliud loss of up to one litter per hour, resulting in severe dehydration and metabolic acidosis
and consequently kidney failure,shock,coma, and death. about 50% of cholera cases are asymptomatic.
asymptomatic causes shed vibros in their stool and serve as a potential source of infection to others.
symptomatic patient may also shed vibros before the unset of illness and Will continue to shed the
organism for about 1to 2wewks.

Cholera is transmitted through the fecal oral route with contaminated food carrier and unsanitary
environment condition. cholera out break tend to occur as a result of contamination of food, or water
with vibro cholerae organism due to poor environmental sanitation condition compounded by lack of
potable water supply, internal displacement of persons.

How ever environment play a vital role on the incident and prevalence of cholera. According to
(Ganesh et al 2011) definition environmental sanitation is the promotion of health of the community by
providing clean environment and breaking the cycle of hygiene status of the people appropriate
technology according to the requirements of the country, cultural capacity including of the concerned
sector, including behavioral and parttern of the community legislative measure adopted and sanitation
refers to the safer disposal and treatment of human waste to avoid affecting the health of the people
(mara, lane, Scott and Trorba 2010).

Mara at el (2010) said that adequate sanitation together with good hygiene and safe water are
fundamental component for good health can sustainably reduce the rate and severity of various disease
and improve the quality of life or large number of people particularly in developing countries.

environment in sanitation requires newer strategy and evaluation. the need of the hour is to identify the
existing system of environmental sanitation however for human to break the cycle of disease clean
environmental sanitation need priorities and particularly important because of issues of water
constraints, environmental related health problem, rapid population growth, inevitable distribution of
water resource issues related to administration of population and rapid economic development,
adequate sanitation in conjunction with good hygiene and safe water are essential to good health.(mara
at el 2010) they future and said that lack of poor sanitation causes disease resulting from sanitation
have a direct relation to property. the lack of clean water and poor sanitation has caused many disease
and spread of the disease. sanitation is very important to keep good health, one of the most significant
disease that arise is cholera cause by bacteria vibro cholerae. death resulting from diarrhea is estimated
to be between 1.6 and 2.5 million every year, sanitation is a service issues that is affecting most part of
the developing countries.

Beth(2006) sanitation has marked impact on the transmission of fiscal oral disease through prevention
of contamination of the environment and water resource and the removal of breeding ground for
contain insect vector, while clear that sanitation break the transmission of many disease and number of
influence.

The degree of which disease protection is afforded these factors include the sanitation domain (public
versus private and impact). the sanitation technology used and maintainance pattern urban/rural
contact and seassionally.

Ganesh et al (2011) when environment sanitation condition are poor water quality improvement, many
have minimum impact regardless of the amount of water contamination. they further said lack of water
supply, poor personal hygiene help to perpetuate and spread diarrhea disease,since diarrhea is caused
by 2025 pathogens through attractive disease by vibro cholerae,shellac dysentery type seven,rote high
morbidity and mortality.

The positive impact to improve water quality is greatest for family living under good sanitary
condition with the effects statistically significant when sanitation is measured at the community level
but not significant when sanitation is measured at house hold level.improving drinking water quality
would have no effect in neighborhood with very poor areas with better community sanitation.

STATEMENT Of THE STUDY

previous world health organization (WHO) studies the aggregated disease attributed to key
environmental risk globally and regionally quantifying the amount of death and disease are caused by
poor environmental sanitation which cholera is also among them. it is caused by factor such as unsafe
drinking water and sanitation, improper disposal of human and poor personal hygiene help to
perpetuate and spread disease.,(Ganesh et al 2011).

PURPOSE Of THE STUDY

The idea of writing this was purposely to examine how poor environmental sanitation influence the
incidence and prevalence of cholera.

Therefore this study is to look into:

1. The level of awareness of people living in chikaji on environmental sanitation

2. identify reason for poor environmental sanitation in chikaji ward sabon gari LGA kaduna state

3. To find out the possible solution to poor environmental sanitation influencing the occurrence of
cholera in chikaji community.
 OBJECTIVE Of THE STUDY

1. To identify the effects of poor environmental sanitation on the incident and prevalence of cholera

2. To create awareness on poor environmental sanitation among people living in chikaji ward.

3. To know how environmental sanitation influence the occurrence of cholera.

SIGNIFICANCE Of THE STUDY

This study aimed at examining the influence of poor environmental sanitation in the incident and
prevalence of cholera among people living in chikaji community. therefore hoping the result will serve as
first line information about the effects of environmental sanitation.

RESEARCH QUESTION

in order to accomplish this research study the research post the following questions as follows.

1. what are the causes of poor environmental sanitation?

2. How does environmental sanitation influence the incidence and prevalence of cholera.

3. What are the way of preventing poor environmental sanitation in chikaji community.

SCOPE AND DELIMITATION OF THE STUDY

The study will focus on how poor environmental sanitation influence the incidence and prevalence of
cholera in chikaji community sabon gari LGA kaduna state.

DEFINITION OF TERMS

1. Environment maybe define as region or habitation of an organism.

2. Sanitation is define as the condition relating to public health, especially the provisions of clean
water for drinking and adequate sewage disposal.

3. Cholera is an infectious and often fatal bacterial disease of small intestine, typically contracted
from infected water supplies and cause severe vomiting and diarrhea.
4. prevalence is define as the commonest of something in an area

5. Incidence is define as the occurrence rate or frequency of disease or something undesirable.

6. Waste:- it is an unwanted by products of manufacturing process, refuse from human and animals
habitation.

7. Hygiene: -science of conductive or practice of maintenance of good health through cleaniness.

CHAPTER TWO

Iitereture review,milenium development goals, implications of the finding, constraints to success in

sanitation,limitations of the study.
Litereture Review

Introduction

This part of the chapter will contain the following definitions of cholera, environmental sanitation,
incidence and prevalence. It's also include the causative agent of cholera, incubation period,
predisposing factors, signs and symptoms, characteristics of infected persons,mode of transmission,
treatment and prevention.

Definitions:

Cholera:- is an acute infectious disease of the small intestine caused by the bacteria called vibro
cholerae by eating food or drinking water contaminated with the bacterium. The disease is
characterized by profuse watery diarrhea, vomiting, muscle cramp severe dehydration and depletion of
electrolytes (WHO2017).

The disease is most common in place with poor environmental sanitation, crowding and famine.
Symptoms may range from none, mild and severe.

Environmental Sanitation:- is a set of action geared toward improving the quality of environment and
refusing the amount of disease by doing so with the sole aim improving good living conditions and
health problems will be decreased. The management of water, solid waste and industrial waste, waste
air pollution and noise pollution all fall under the umbrella of environmental sanitation (Burnett,2006).

Incidence and prevalence:- these are two different things in totality where incidence can be seen as the
number of new cases of disease in given area and at a specific period. Where as prevalence involved
both the summation of new and old cases of disease condition at a given area and also at a given time.

Causative agent of cholera:-

Cholera is caused by a bacteria called vibro cholerae found in contaminated food and water in dirty
environment.

Incubation period of cholera:-

Cholera has a short incubation period from two to five days and produce on neurotoxin that causes a
copious, painless, watery stool that can quickly lead to severe dehydration, deflation of electrolytes and
death if treatment is not promptly given.

PREDISPOSING FACTORS

1. Poor sanitary condition

2. Reduced or non-existent stomach acid
3. Raw or under cooked selfish
4. Contaminated surface or well water
5. Contaminated raw fruit and vegetables
SIGNS AND SYMPTOMS

1. Sudden unset of abdominal pain

2. Profuse diarrhea
3. Severe vomiting
4. Muscle cramps
5. Toxemia and shock

CHARACTERISTICS OF INFECTED PERSONS

1. There is abstrupt onset of vomiting and purging of large amount of watery stool [about one litter per
hour]
2. Patient is very thirsty
3. Eye and check are sunken
4. Skin is pale and fingers are shriveled [washerman finger]

MODE OF TRANSMISSION OF CHOLERA

The infectious agents of cholera is spread through contaminated water, food and drinking water from
infected persons to another person. Eating and drinking utensils are the vehicles for transmission of
cholera.

TREATMENT OF CHOLERA

Cholera requires immediate treatment because the disease can cause death within hours.

1. Rehydration:- the goal is to replace lost fliud and electrolytes using a simple rehydration solution,
oral rehydration solution (ORS). The ORS solution is available as a powder that can be reconstituted
in boiled or bottle water. Without rehydration approximately half of the people with cholera will die.
With treatment the number of fatalities drops to lessthan one percent.
2. Intravenous fliuds÷ during cholera epidemic most people can't be helped by oral rehydration
alone, but severely dehydrated may need intravenous fliud
3. Antibiotics÷ while antibiotics are not a necesary part of cholera treatment but some of these drugs
may reduce the amount and duration of cholera related diarrhea for people who are severely I'll
4. Zinc supplement÷ Research has shown that zinc supplement decreased and shorten the duration of
diarrhea in children with cholera (mayo foundation.org.2017)

PREVENTION AND CONTROL OF CHOLERA

1. Diagnosis, isolation, notification and prompt treatment with antibiotics

2. Identify source of infection and eliminate it
3. Concurrent and terminal disinfectant
4. Environmental Sanitation
5. Immunization of people at risk and travelers
6. Health education on environmental health, food handling and maintenance of personal hygiene.

MILLENNIUM DEVELOPMENT GOALS [MDGs]

In September 2000, leaders of 189 countries gathered at the United Nations headquarters and signed
the historic Millennium Declaration, in which they committed to achieving a set of eight measurable
goals that range from halving extreme poverty and hunger to promoting gender equality and reducing
child mortality, by the target date of 2015.

The Millennium Development Goals (MDGs)

Goal 1

Eradicate extreme poverty and hunger

Goal 2

Achieve universal primary education

Goal 3

Promote gender equality and empower women

Goal 4

Reduce child mortality

Goal 5
Improve maternal health

Goal 6

Combating HIV/AIDs, malaria, and other diseases

Goal 7

Ensure environmental sustainability

Goal 8

Develop a global partnership for development

IMPLICATIONS OF THE FINDING

Poor sanitation which has been associated with African as a 49% of all reported sickness and injuries
are related to poor sanitation. Lack of adequate sanitation is a major threat to the environment which
includes the degeneration of urban environment by indiscriminate disposal of solid and liquid waste and
the pollution of fresh water and lakes by untreated human waste the results being smaller
contaminated fish catch the cost of environmental damage include discouragement of the tourist of
trade, for fish products reduce production from fisheries and increase purchase cost of chemicals and
mechanical cleanup operation. The cause of this area Al sanitation related, either from poor lake water
quality or poor hygiene the catching process. In the 90s down 2000 there were more government aided
primary school for public in their schools 44% had water supply (mustapha 2007)

Further study and gender analysis are required to determine the need of men, women,boys and girls
to determine the optimum course of strategy to involve the active participation of them all. Raising the
profile of sanitation the national constitution state it is the duty of every citizens in the country to create
and protect a clear and healthy environment. The first step improving sanitation in the country was to
gather all existing data on sanitation though there is effective, is that particular documents and how
many they're. [Mustapha , 2007]

CONSTRAINTS TO SUCCESS IN SANITATION

 The lack of national police is constraints to success in sanitation, government in general serves as
facilitators and regulators of sanitation that increase focus on household behaviour and community
action, that promote demand creation and that enable health system growth and increasingly high
population densities in urban and pre urban area of developing countries.

Further more, most if the people who lack improved sanitation live than two per day, which makes high
cost, high technology sanitation is prevention of contamination of water distribution system, growing
water scarcity and the potential for water reuse and conservation, implementing innovative low cost
sanitation system providing sustainable water areas reducing disparities within the region in the country
sustainability (Ganesh et al, 2010)

Improving sanitation simply refers to the management of human faces at household level. This
terminology is the indicators used to distribute the target of the millenium development goals on
sanitation by world health organization united nation international child emergency find joint
monitoring program for water supply and sanitation of WHO and UNICEF has defined improved
sanitation as follows. Flush toilet, connection to septic system flush to a pit latrine ventilated improved
put (vip) latrine, pit latrine with slab compositing toilets some special cases (WHO/UNICEF, 2012).
Improving access, the united nation millennium development goals include target to reduce by half the
proportion of people without access to basic sanitation by 2015. Index 2006, the united nation general
assembly declear 2008. The international years of sanitation in rendition of the show progress made
towards the the MDGs sanitation and action to meet the target particularly concern is removing the
stigma around sanitation so that the importance of sanitation can be moved easily publicly discussed.

LIMITATIONS OF THE STUDY

A resent study highlights that policy shift to include better household water quality management to
complete the continuing expansion of coverage and upgrading of service would appear to a cost
effective health. The intervention in many developing countries include multiple intervention hygiene
and water quality was found significantly reduce the level of diarrhea illness with the greatest impact
being seen for hygiene and household treatment intervention (Ganesh et al,201q)

Intervention to prove water quality at the household level are more effective than those at the source
unfortunate, in developing countries public health concerns are usually raised on the institution there is
a reluctance to acknowledge the home as a setting of equal importance along with the public institution
in the chain of disease transmission in the community. Managers of home hygiene and community
hygiene must act in unision to optimize return from to promote health.(Ganesh et al,2011)

The role of WHO guidelines for drinking water quality emphasize on integrated approach to water
quality assessment and management from source to consumer. It emphasize on quality protection and
prevention of contamination and advice to be protective and participation address the need of those in
developing countries who have no access to piped community water supplies.

The guideline emphasize the maintenance of microbial quality to prevent water born infection from
chemical and toxicant and other contaminant of public health concerns (Ganesh et al,2011).
 Providing private excretal disposal would be expected to reduce cholera by 42% while eliminating
excreta around the house would lead to 30% reduction in cholera. The finding suggest that
improvement in both water supply and sanitation are nessesary if infant health in developing countries
is to be improved. This also implies that it is not epidioligical but behavioral institution and economic
factors that should correctly determine the priority of intervention (Ganesh et al,2011).

CHAPTER THREE

INTRODUCTION

This chapter deals with the procedure that will be used in the conduction of the research. Hence for
the purpose of this research dessertaion, the following steps and approach will be adopted

Research design

Population of the study

Sample and sampling technique

Instrument for data collection

Validity and reliability of the instrument

Method of data analysis

RESEARCH DESIGN

Purpose of this work is to investigate the influence of poor environmental sanitation on the incident and
prevalence of cholera in chikaji ward sabon gari Zaria kaduna state. To the end descriptive survey
method will be used. Q survey method according to Charles (2008) is making use of sample of the
respondant from the target population.

POPULATION OF THE STUDY

John (2007) defined population as any group of individuals who have one or more characteristics in
common that are of Interest to the research.

The total population in chikaji ward is 34460 according to the 2006 population census

SAMPLE AND SAMPLING TECHNIQUES

John (2007) define sample as a group chosen from a large population with the aid of yielding
information about the population as a whole, while sampling is taking any portion of a population or
universe.(fred,2007) the sample for this study consisted of one hundred respondant drafted from the
study area (chikaji ward). A random sampling was used to choose the respondents.

INSTRUMENT FOR DATA COLLECTION

The instrument used for the study was structured questionnaire of items divided into the section base
on the Reshearch question that guide the study.

PROCEDURE FOR DATA COLLECTION

The data was collected by the researcher from the respondents at their respected clinic

VALIDITY OF THE INSTRUMENT

The instrument used is a valid instrument of the structured questionnaire.

RELIABILITY OF THE INSTRUMENT

In order to determine the reliability of the instrument used for the study test re~test method of
reliability was applied and the results was correlation, coefficient and reliability of 0.68 was gotten.

METHOD OF DATA COLLECTION

The method questionnaire was administered to the target population of the study. The research give
explanation and how the respondents were to complete the questionnaire that was administered to the
study sample. The questionnaire was filled and collected back immediately so as to avoid lost of
questionnaire.

METHOD OF DATA ANALYSIS

Four grade scale will be used to analyze the data.

The scales are as follows

A: Agreed

SA: strongly agreed

DA: Disagree

SDA: Strongly disagree

In this respect each scale has a mean of value attached to it as shown below

A mean of 2.5 is for SA

A mean of 2.0 is for A

A mean of 1.5 is for D

A mean of 0.5 is for SDA