HOSTEL SANITATION PRACTICES AND ITS EFFECT ON

STUDENT’S HEALTH

Abstract

In every human environment, students’ health has been the major contributory

factor to their academic performances over the years because it determines their

ability to read and prepare for examination. This study was conducted to investigate

the sanitation conditions and its impact on the health status of Hostellers in

University of Calabar. Using a random sampling technique, 100 students were

selected for the study. Data were collected with the aid of self – administered

questionnaire and analysed using descriptive statistical techniques. The majority of

the students (58%) were impressed with services rendered by the cleaners with

respect to keeping the bathrooms and its environs clean. 62% of the students’

respondents stated that the environments and the hotel toilets is cleaned on daily

basis. Although from the research there were indications that the cleaners have

issues in acquiring their materials for executing their duties. About 75% of the

respondents who at one time had complaints with the conditions of the hostel

experienced delayed responses; 69 percents of the student respondents reported

that at one point in time they had suffered some health issues which includes

malaria, typhoid, dysentery, although no case of food poisoning was recorded. It

was concluded that there are few sanitation problems in the institution. Availability

of cleaning materials has been a problem as well as other health related issues.
 TABLE OF CONTENT

CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF STUDY

1.2 STATEMENT OF PROBLEM

1.3 OBJECTIVES OF STUDY

1.4 RESEARCH QUESTIONS

1.5 RESEARCH HYPOTHESIS

1.6 SIGNIFICANCE OF STUDY

1.7 SCOPE/LIMITATIONS OF STUDY

LIMITATION OF STUDY

1.8 DEFINITIONS OF TERMS

CHAPTER TWO

REVIEW OF RELATED LITERATURE

Overview of Health and Sanitation

•Environment and Hygiene Practices

•Effects of Poor Sanitation on Health

•Poor Sanitation and Diarrhoea infection

•Poor Sanitation and Malaria diseases

•Poor Sanitation and Cholera diseases

•Poor Sanitation and Typhoid diseases

•Other Effects of Poor Sanitation on Health

•Sanitation and School Attendance

•The Needs for Hygiene and Sanitation Management

•Approaches Towards Improving Sanitation Services Delivery

•Barriers to Sanitation Services Delivery

•Appraisal of Literature Reviewed

CHAPTER THREE

RESEARCH METHODOLOGY

Introduction

Research Design

Population of the Study

Sample and Sampling Technique

Research Instrument

Validity of the Instrument

Procedure of Data Collection

Method of Data Analysis

CHAPTER FOUR

RESULTS AND DISCUSSION OF FINDINGS

CHAPTER FIVE

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Summary

Conclusions

Recommendations
 CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF STUDY

Student’s health has been a major contributing factor to their

academic performances over the years because it determines the

student’s ability to read and prepare for his examinations; it even

defines the ability of the student to write very well inside the hall

which are primary aim of a student going to school. Health

defined by WHO is the level of functional and metabolic efficiency

of a living organism. In humans it is the ability of individuals or

communities to adapt and self-manage when facing physical,

mental or social changes.

It is a widely accepted fact that students are known for their

laziness and ego, many of them tend to leave their area of

residence without taking care of it only to be waiting for cleaners

to clean it for them but even as that the hostels are always very
dirty because things are not done appropriately for example a

student urinating in the front of the hostel where it shouldn’t be is

indirectly calling for mosquitoes to breed around the hostel and

this is also the case in the area of focus for this study, which is

the University of Calabar.

Waste generation is a major cause of dirtiness in the hostel due to

the large number of students and if not properly manage may

cause a lot of harm than good, wastes are generated on daily

basis through different activities of human being and if not

disposed of properly the way it should,they lead to pollution of the

environment having serious implications on the health of the

students residing in the hostel (Earthwatch, 2007). Different

institutional bodies have been set up at different levels for

environmental sanitations and tertiary institution like the

University of Calabar is of no difference so as to ensure that

students waste are properly disposed in a quest for the students

residing in the hostel to be in good health. In a study carried out

by Ogeah and Ikelegbe (2007) reveals that students are

nonchalant about the cleanliness of their hostels and their

environment generally. They further illustrated that even with

availability of cleaners that students contribute to the poor hostel

sanitation practices and this go a long way to affect the students’

health. Students contribute to poor hostel sanitation practicesby

the laziness of students to use facilities provided by the school

authority for waste disposal in the hostels. Outside cleaning their

rooms in the hostels most of the students feel it is humiliating for

them to tidy their surroundings. Even though the University

system has hired cleaners to clean the hostels these cleaners are

poorly supervised and with them not doing their jobs properly the

hostel surrounding becomes a breeding site for all sorts of

dangerous insects and pests such as mosquito which can expose

the students to malaria, tsetse fly which when a student is bitten

by will cause sleeping sickness and some many more insect with

different health complications, even some students go as far as

urinating and defecating indiscriminately outside the hostels

because they cannot clean the dirty toilets themselves and in the

long run they will still come to those polluted areas to carry out

their daily activities like cooking, washing of clothes etc.

World Health Organization defined sanitation as the means of

collecting and disposing excreta and community liquids, waste in

a hygienic way so as not to endanger the health and welfare of

beings and also for the social and environmental effects, it may

have on people; people have been suffering from one disease to

another without knowing the problems of their illness, the

situation and due to distress or dirty environment (Earthwatch,

2007).

Good sanitation practices occurs where the environment is clean

concurring with the School Sanitation Consultative Meeting Report

(1999) which defined it as personal and universal cleanliness.

Burnet (1995) clearly stated that living and learning conditions in

institutions affect the critical thinking, intellectual development

and aesthetic appreciation of students. In school hostels;where

one of the major problems is overcrowding and this has gone a

long way to affect students’ health. More than 200 students share

four (4) toilets. Mostly girls in hostel have inadequate sanitation

facilities. Inadequate sanitation in school hostel has jeopardized

student’s health; girls in the hostel are even affected more in this

situation. From the foregoing, it is of upmost importance to find

out the effect of hostel sanitation practices arising as a result of

the scenario on student’s health.

1.2 STATEMENT OF PROBLEM

Knowing fully the importance of cleanliness, sanitation and its

effect on one’s health, one still find that the school hostels in

Nigeria universities are very dirty. It becomes necessary to find

out to what extent particularly students, in the universities are

involved in hostel environmental sanitation considering the

increase in the prevalence of diseases that are hygiene related

However, this research will focus on the examination of the hostel

sanitation practices using the University of Calabar as a case

study, and the its effect on the health of students. This study will

also find out how to encourage hostel sanitation practices

amongst the students. This study will be approached by identify

the mechanism adopted in ensuring the cleanliness of the

students hostel both by the management and students

themselves. This study will also analyze the frequency of student

illnesses that can be associated poor sanitary practices as way of

identifying the effect of hostel sanitary practices on student’s

health.

1.3 OBJECTIVES OF STUDY

The general objective of this study is to analyze the concept of

hostel sanitation practices and its effect on student’s health in the

University of Calabar. The specific objectives are to;

1. To identify the hostel sanitation practices in University of

Calabar

2. To examine the effect of hostel sanitation practices on

student’s health in the University of Calabar

3. To examine the effectiveness of hostel sanitation practices in

the University of Calabar

4. To identify the challenges facing hostel sanitation practices in

the University of Calabar

5. To examine the view of students towards hostel sanitation

practices in the University of Calabar

1.4 RESEARCH QUESTIONS

1. What are the hostel sanitation practices in University of

Calabar?

2. What is the effect of hostel sanitation practices on student’s

health in the University of Calabar?

3. What is the effectiveness of hostel sanitation practices in the

University of Calabar?

4. What are the challenges facing hostel sanitation practices in

the University of Calabar?

5. What are the views of students towards hostel sanitation

practices in the University of Calabar?

1.5 RESEARCH HYPOTHESIS

HO1: There is no significant effect of hostel sanitation practices

on students’ health in the University of Calabar

1.6 SIGNIFICANCE OF STUDY

The following are the significance of this study:

1. The outcome of this research will create awareness to

both the general public and students staying in any tertiary

institution hostel about the effect of hostel sanitation practices on

their health.

2. This research will be a contribution to the body of

literature in the area of the hostel sanitation practices and its

effect on student’s health, thereby constituting the empirical

literature for future research in the subject area.

1.7 SCOPE/LIMITATIONS OF STUDY

This study is limited to the student’s hostel in University of

Calabar. It will also cover the opinion of the students about hostel

sanitation practices and its effect on student’s health.

LIMITATION OF STUDY

Financial constraint- Insufficient fund tends to impede the

efficiency of the researcher in sourcing for the relevant materials,

literature or information and in the process of data collection

(internet, questionnaire and interview).

Time constraint- The researcher will simultaneously engage in this

study with other academic work. This consequently will cut down

on the time devoted for the research work.

1.8 DEFINITIONS OF TERMS

Hostel: Hostels provide budget-oriented, sociable

accommodation where guests can rent a bed, usually a bunk bed,

in a dormitory and share a bathroom, lounge and sometimes a

kitchen

Sanitation: Sanitation is the hygienic means of promoting health

through prevention of human contact with the hazards of wastes

as well as the treatment and proper disposal of sewage or

wastewater.

Practice: a theoretical term for human action in society

Effect: A result or change of something

Health: Health is the level of functional and metabolic efficiency

of a living organism. In humans it is the ability of individuals or

communities to adapt and self-manage when facing physical,

mental or social changes.

Student: is a learner, or someone who attends an educational

institution
 CHAPTER TWO

REVIEW OF RELATED LITERATURE

The focus of this study is on perceived effects of poor sanitation

on health of undergraduate students in hall of residents,

University of Calabar. The concepts reviewed are as follows:

• Overview of Health and Sanitation

• Environment and Hygiene Practices

• Effects of Poor Sanitation on Health

• Poor Sanitation and Diarrhoea infection

• Poor Sanitation and Malaria diseases

• Poor Sanitation and Cholera diseases

• Poor Sanitation and Typhoid diseases

• Other Effects of Poor Sanitation on Health

• Sanitation and School Attendance

• The Needs for Hygiene and Sanitation Management

• Approaches Towards Improving Sanitation Services Delivery

• Barriers to Sanitation Services Delivery

• Appraisal of Literature Reviewed

Overview of Health and Sanitation

Sanitation is a complex topic with links to health and both social

and economic development. Although it affects many, it is

championed by few (Mara, Lane, Scott & Trouba, 2010). Globally,

sanitation is recognized as any system that promotes proper

disposal of wastes, use of toilet and avoiding open space

defecation (African Development Bank [ADB], 2011; Bartram &

Cairncross, 2010). Ideally, a sustainable sanitary system should

provide a clean environment that protects and promotes human

health, break the disease cycle and is socio-economically viable

and appropriate (Okot-Okumu & Oosterveer, 2010).

WHO (2010) stated that ‘health’ is a state of complete physical,

mental and social well-being but not merely the absence of

disease or infirmity. Health is a fundamental human right and the

attainment of a highest possible level of health was crucial

(Lancet, 2010). Generally people who have a duty to promote

health saw it as resource for everyday life and not the object of
living. It was a positive concept that emphasizes social and

personal resources and physical capabilities (Lancet, 2010). In

rural areas and small towns, there are often no vehicles for

collection of waste, hence uncontrolled dumping occurs within the

built up areas with all its attendant health hazards and negative

environmental impact (Mensah & Larbi, 2005).

Sanitation refers to the promotion of hygiene and prevention of

disease through the provision and access to safe water, adequate

sanitation facilities and good individual hygiene practices (Enoh,

2010). There is high morbidity and mortality related to lack of

water, poor sanitation and poor hygiene globally, with the

developing countries bearing the greatest load. Sanitation related

diseases debilitate and kill one million Africans every year (WHO,

2010). The numbers of people without improved sanitation

facilities globally stands at 2.6 billion and of these 533 million are

in sub-Sahara Africa (WHO & UNICEF, 2010).

The health, academic performance and retention rates of school

going children is greatly affected by the availability, accessibility

and quality of sanitation facilities. Studies indicated that an

estimated 400 million children have diminished learning abilities

due to intestinal worm infestation (Hall & Andrew, 2008); while

according to the International Resource Centre on Water and

Sanitation (IRC, 2005) 75 percent of adolescent girls in

marginalized areas dropped out of school due to the lack of

adequate private sanitation facilities in school. Sanitation

generally refers to the provision of facilities and services for the

safe disposal of waste. It also means the maintenance of hygienic

conditions, through service such as garbage collection and waste

paper disposal (WHO, 2010). Sanitation could also be described

as the process where people demand, effect and sustain a

hygienic and healthy environment for themselves and others by

erecting barriers to prevent the transmission of disease agents in

order to lay foundation for sustainable development (Lancet,

2010).

The presence of parasitic diseases in a community is closely

related to a lack of sanitation and 88% of diarrhoeal diseases are

attributed to unsafe water supply and inadequate sanitation (IRC

& McIntyre, 2006). Addressing sanitation and applying good home

hygiene has been demonstrated to lower the rate of such

diseases by approximately 35% (Waterkeyn & Cairncross 2005;

IRC & McIntyre, 2006). In addition, not only do improved

sanitation and hygiene conditions provide increased health

benefits, they also provide significant secondary benefits to the

overall livelihood of the community (Cairncross & Kolsky, 2003).

These include: Saving time; lowering basic cost of living; reducing

stress; better learning capacities of children and increased school

attendance; emancipation of women; and greater agricultural

productivity due to greater time availability.

Environmental sanitation is practices that contribute to keeping

the surroundings where people live clean, tidy and safe. In its

widest sense, environmental sanitation refers to the measures

taken to control or change the physical environment to prevent

the transmission of diseases to human beings (Sumampouw &

Risjani, 2014). Thus, environmental sanitation means

interventions intended to improve access to safe and adequate

water supply, to encourage the sterile disposal of human excreta

and household wastes, and to change human behaviours through

hygiene education.
Poor sanitation in non-family unit settings, for example schools,

human services offices and working environments affect the

wellbeing, education, welfare and efficiency of populaces,

especially in low- middle income nations. These impacts

excessively influence certain sorts of individuals. For instance, an

absence of gender separated toilets at schools impacts

attendance of girls and vice versa. However, people with special

needs make up 15% of the worldwide populace that also face

physical and social obstructions identified with getting to poor

sanitation, conceivably keeping them from going to class, picking

up livelihood, and utilizing social amenities and conveniences

(Kumar, Kar & Jain, 2011).

However, bearings on student accomplishment mirror the clear

impact of the management of a school toilet: new students might

perform well on the exams; past students might perform better

because of enhancements in the school environment, and/or past

students might perform poorer due to congestion of such facility

(Spears & Lamba, 2013).

School Water, Sanitation and Hygiene Education (SWASH) refers

to the collaborative efforts of various stakeholders; government,

NGOs and international institutions to ensure safe and healthy

schools through the provision of clean water, latrines for both girls

and boys, and appropriate hygiene education. Estimated 1.1

billion people worldwide lack access to improved water supplies

and 2.6 billion people lack adequate sanitation (UNICEF, 2010).

Less than two thirds of the global population and approximate 2.6

billion people do not use improved sanitation. The greatest

numbers are found in Southern Asia followed by large populations

in Eastern Asia and Sub-Saharan Africa. Access to water is better

with 87% of the world population and 84% in developing countries

getting their drinking water from improved sources. But sub-

Saharan Africa fares poorly with only 60% of its population using

improved sources of drinking water, (WHO & UNICEF, 2010).

Studies indicated that annually, 272 million school days are lost

by children due to diarrhoea (Hutton, Guy & Laurence, 2004). This

has obvious detrimental effects on academic performance. The

availability of water and sanitation facilities in schools has been

shown to reduce diarrhoea and hygiene related diseases amongst

school children (Curtis & Caincross, 2003; Pruss-Ustun & Annette

2008).

An estimated one in three school–aged children in the developing

world is infested with intestinal worms (Savioli, Lorenzo &

Albonico, 2002). Estimated 400 million school children and 47% of

5–6 year olds in the developing world are affected by worms (Hall

& Andrew, 2008). The same study indicated that 100% of annual

soil transmitted worm infestation cases are attributable to

inadequate sanitation and hygiene. The reduction of open

defecation through adequate latrine provision especially at

schools; may definitely reduce and eventually break the cycle of

infection and re-infections. Where sanitation is poor and water

supply is inadequate and unsafe, outbreaks of disease with

severe health consequences tend to occur.

Water and sanitation related diseases include diarrhoea, cholera,

typhoid, dysentery, hepatitis A, Poliomyelitis, acute respiratory

infections and soil-transmitted-helminth infections. The global

Disability Adjusted Life Years (DALYs) for diarrhoeal diseases is

estimated to be 4.1% and it’s also estimated to be the cause of

death for 1.8 million people annually with most of them being

children in developing countries (WHO, 2010).

Other than providing adequate latrines, the availability of water

and soap for hand washing further enables the reduction of

diarrhoeal disease and respiratory infections. Studies indicated

30% reduction in diarrhoea cases when hand washing is practised

in day care centres and primary schools (Ejemot, Ehiri,

Meremikwu & Critchely, 2008). In addition, other studies also

indicated that washing hands with soap could reduce acute

respiratory infections including pneumonia, which is the highest

cause of child mortality, by 25% (WHO, 2008). Availability of

latrines and water improves school attendance and is especially

important for adolescent girls who are menstruating as they

require the privacy of separate latrines and also water. When this

is lacking there is consistent absenteeism during their monthly

period and this can reach up to 20% of school time (IRC, 2005).

Types of Sanitation
Sanitation types are many. The various types of sanitation

include, community led total sanitation, dry sanitation, ecological

sanitation, and environmental sanitation (Sanni, 2015).

Community-Led Total Sanitation (CLTS) is an approach to achieve

behaviour change in mainly rural people by a process of

triggering behaviour change, leading to spontaneous and long-

term abandonment of open defecation practices. CLTS takes an

approach to rural sanitation by ensuring communities recognize

the problem of open defecation and take collective action to clean

up and become "open defecation free.

Dry sanitation usually means sanitation systems with dry toilets

which have urine diversion, in particular the urine-diverting dry

toilet.

Ecological sanitation commonly abbreviated to ecosan, systems

safely recycle excreta resources (plant nutrients and organic

matter) to crop production in such a way that the use of non-

renewable resources is minimised. When properly designed and

operated, ecosan systems provide a hygienically safe,

economical, and closed-loop system which converts human

excreta into nutrients to be returned to the soil, and water to be

returned to the land.

Environmental sanitation encompasses the control of

environmental factors that are connected to disease transmission.

Subsets of this category are solid waste management, water and

wastewater treatment, industrial waste treatment and noise and

pollution control.

Environment and Hygiene Practices

Environment (from the French word: to circle or surround) is the

social and cultural conditions that affect an individual or

community (Curringham & Scaefer, 2002). In its widest use, it

refers to all the biophysical features, organic and inorganic

resources and all bio-diversity disposable to humankind.

Acheampong (2014) defined environment as the sum total of

conditions within which organisms live. The concept of

environment encompasses all the natural resources which

interlink in a complex global ecosystem embodying many sub-

systems. Disruption in such systems, which is as a result of

cumulative indiscriminate degradation which takes place in

localized environments such as villages, towns and cities, distort

the delicate ecological balance and have dire consequences for

mankind, and thus provide a compelling justification for the

preservation of the environment.

Health of an individual depends solemnly on the healthfulness of

the environment. A healthful environment devoid of risky

substances allows the individual to attain complete physical,

emotional and social potential. Hygiene is articulated in the

efforts of an individual to safeguard, sustain and enhance health

status. Measures of hygiene are vital in the fight against

diarrhoea diseases, the major fatal disease of the young in

developing countries (UNICEF, 2008). The most successful

interventions against diarrhoea diseases are those that break off

the transmission of contagious agents at home. Personal and

domestic hygiene can be enhanced with such trouble-free actions

like ordinary use of water in adequate quantity for hand washing,

bathing, laundering and cleaning of cooking and eating utensils;

regular washing and change of clothes; eating healthy and clean

foods and appropriate disposal of solid and liquid waste.

WHO (2014) defined hygiene to the conditions and practices that

help to maintain health and prevent the spread of diseases.

Medical hygiene therefore includes a specific set of practices

associated with this preservation of health, for example

environmental cleaning, sterilization of equipment, hand hygiene,

water and sanitation and safe disposal of waste. Progress in

sanitation and improved hygiene has greatly improved health, but

many people still have no adequate means of appropriately

disposing off their waste. This is a growing nuisance for heavily

populated areas, carrying the risk of infectious disease,

particularly to vulnerable groups such as the very young, the

elderly and people suffering from diseases that lower their

resistance. Poorly controlled waste also means daily exposure to

an unpleasant environment.

Effects of Poor Sanitation on Health

Poor Sanitation and Diarrhoea Diseases

Diarrhoea is defined as the passage of three or more loose or

liquid stools per day (WHO, 2013). But globally, diarrhoeal

diseases are caused by infectious agents such as bacteria (e.g. E.

coli, salmonella, shigella, campylobacter), viruses (e.g.

rotaviruses, noro-viruses and adenoviruses), and protozoa (e.g.

cryptosporidium, amoeba and giardia).

However, the aetiology of diarrhoeal diseases varies from region

to region. Rotavirus is the main cause of severe and moderate

diarrhoea (Lozano, Naghavi, Foreman, Lim, Shibuya, Aboyans &

Cross, 2013; Kotloff, Nataro, Blackwelder, Nasrin, Farag,

Panchalingam & Levine, 2013). Only a small proportion of

diarrhoea cases result from non-infectious conditions (such as

intoxication or non-infectious inflammatory diseases) (WHO,

2015).

Most diarrhoeal deaths are among children under the age of five

(Pruss‐Ustün, Bartram, Clasen, Colford, Cumming, Curtis &

Cairncross, 2014), and within low-income countries, the very poor

suffer much more from diarrhoea than others (Howling & Kunst,

2010). In both low and middle-income countries, diarrhoeal

disease is the second leading cause of morbidity and mortality

among children under the age of five (Lim, Vos, Flaxman, Danaei,

Shibuya, Adair-Rohani & Davis, 2013; Walker, Rudan, Liu, Nair,

Theodoratou, Bhutta & Black, 2013; Murray, Barber, Foreman,

Ozgoren, Abd-Allah, Abera & Badawi, 2015), and the leading

cause of death in sub-Saharan Africa (Prüss-Üstün et al., 2014).

Approximately 1.5 million children under the age of five died of

diarrhoeal disease in 2012 (Prüss-Üstün et al., 2014). Diarrhoeal

disease can also affect a child’s nutritional status, with the

associated health and socio-economic consequences. One

multiple country study found that 25% of stunting in children

under the age of two could be due to five or more diarrhoeal

episodes (Checkley, Buckley, Gilman, Assis, Guerrant, Morris &

MØlbak, 2008). Long-term exposure to faecal pathogens may also

partially explain environmental enteric dysfunction (EDD)

(Humphrey, 2009).

Water and sanitation interventions to reduce diarrhoea disease

incidence in developing countries fall into four general categories:

Water provision, household water treatment, hand washing

promotion and sanitation. Each of these interventions is proven to

reduce diarrhoeal disease incidence. Selecting the most

appropriate interventions for a specific location depends on

existing water and sanitation conditions, cultural acceptability,

hydrology and water quality, implementation, feasibility and local

conditions (Waterwiki, 2010). There are four types of diarrheal

disease, according to World Health Organisation (2013):

Acute watery diarrhoea (including cholera), which lasts several

hours or days: the main danger is dehydration; weight loss also

occurs if feeding is not continued.

Acute bloody diarrhoea (also called dysentery): the main dangers

are intestinal damage, sepsis and malnutrition; other

complications, including dehydration, may also occur.

Persistent diarrhoea (which lasts 14 days or longer): the main

danger is malnutrition and serious non-intestinal infection;

dehydration may also occur.

Diarrhoea with severe malnutrition (marasmus or kwashiorkor):

the main dangers are severe systemic infection, dehydration,

heart failure and vitamin and mineral deficiency.

A number of measures can prevent diarrhoea diseases from

manifesting. They include breast feeding, which provides infants

the antibodies to protect against infections. Improved weaning

practices, proper usage of water for hygiene and drinking, hand

washing, disposal of feaces properly, vaccinations and proper

nutrition (Jailson, Correa, Manish, Patel & Osamumu, 2010). To

implement these strategies, the people must be educated about

proper practices and utilize the community health workers and

village health workers.

For case management, oral rehydration therapy (ORT) is the oral

administration of water and electrolytes (sodium, chloride,

potassium and bicarbonate) to replace existing losses, primarily

accomplished by giving oral rehydration salt (ORS) solutions.

Addition of glucose to salt solution resulted in absorption of salt

and water across the intestines (WHO, 2005). In the absence of

glucose no absorption of salt or water was observed. Super ORS

have recently been developed which reduce stool and increase

water absorption in the gut.

Drug therapy of diarrhoea should be avoided. This is because

some drugs may be potentially toxic to some patients leading to

adverse reactions. Non-compliance with therapy may also lead to

antibiotic resistance (WHO, 2008). The WHO therefore

recommends that anti-diarrhoea drugs be strictly avoided as they

may prolong infection and mask signs of dehydration.

Poor Sanitation and Malaria

Sanitation is important because it helps in the prevention of

diseases (in this case malaria). This is so because poor sanitation

such as waste products dumped in canals, rivers, streams, ponds,

and lakes can inhibit the flow of water, and as a result the water

remains stagnant. This attracts mosquitoes because they dwell in

areas with stagnant waters. Malaria is a vector-borne disease

caused by a parasite called Plasmodium. This parasite is carried

and transmitted by a mosquito bite from one person to another.

The parasite is said to be present in the mosquito's salivary

glands after 10-18 days (Center for Disease and Control

Prevention [CDC], 2010). Once the parasite gets into the human

system, it travels to the liver, where it matures and is released

into the bloodstream and infects the red blood cells (CDC, 2010).

The spread of malaria through an Anopheles mosquito depends

on climatic factors such as temperature, humidity, and rainfall

(CDC, 2010). Mosquito are mainly found in tropical and

subtropical areas (CDC, 2010). Those who are more at risk of

getting malaria include pregnant women, patients with HIV/AIDS,

non-immune travelers, and less than five years of age (WHO,

2011). Malaria is transmitted when an infected mosquito bites

and infects a healthy person and also when an un-infected

mosquito feeds on the blood of the infected person. This results in

a cycle of mosquito and human hosts. The symptoms of malaria

include body ache, fever, decreased strength, headache, and

bitter taste in the mouth. If left untreated, patients may develop

severe complications and die (CDC, 2010). 50% of the population

of Nigeria suffers from at least one episode of malaria each year

and it accounts for over 45% of all out-patient visits (Jimoh,

Sofola, Petu & Okorosobo, 2007). Breeding of mosquitoes can be

prevented by clearing out waste product dumped in waters. Also

sleeping under mosquito nets could help prevent mosquito bite.

Another solution is to have window nets to serve as a barrier to

prevent mosquitoes from entering a room. Clothes that are long

enough to cover the whole body should also be worn. Lastly, the

use of repellents, insecticides, and anti-malaria medication such

malarone, chloroquine, doxycycline, mefloquine, or primaquine

are alternative measures to help prevent malaria (CDC, 2010). In

order to reduce the case of malaria, elimination of standing water

is a good practice for good sanitation; this helps to eliminate

breeding of mosquitoes. Other recommendations include the use

of insecticides, sleeping net, and also window and door net.

Travelers are encouraged to take anti-malaria medication before

travelling to countries that are prone to malaria. As a safe

practice, biweekly enviromental cleaning should be conducted in

the community.

Poor Sanitation and Cholera

Cholera is an intestinal infection caused by the bacterium Vibrio

cholerae that affects both children and adults, and where

improved water, sanitation, food safety and hygiene practices are

inadequate (Mehrabi, Fallah & Ataee, 2006). Cholera is an acute

diarrhoeal disease that can kill within hours if left untreated, and

it is a continual public health problem in many parts of the world.

Researchers have estimated that every year there are roughly 1.4
million to 4.3 million cases, and 28,000 to 142,000 deaths per

year worldwide (Ali et al., 2012).

Its symptoms characterized by a sudden onset of severe watery

diarrhoea with traces of critical dehydration (Barve, Javadekar,

Nanda, Pandya, Pathan & Chavda, 2012). Unlike other

communicable diseases, cholera can kill individuals with lower

immunity and malnourished children people within an hour by

cholera (Jordan & Tauxe, 2011). Its short incubation between

2hours and 5days enhances cholera spreads very quickly.

Eating infected food, vegetables and fruit washed with water

contaminated by sewage or drinking water that has been

contaminated by the faeces of infected persons makes people or

community prone the cholera risk. Today, one of the key

indicators of social development is cholera and its occurrences

remain a global threat and challenge to countries with minimum

hygiene standards and poor access to improved domestic water

and inadequate sanitation (WHO, 2013).

Cholera epidemics vary in intensity and could last for months to

more than a year (Oxford Economic, 2010). This epidemic is

functioning amongst Asia, Africa and South America countries

(Gaffga, Tauxe & Mintz, 2007). The majority of reported cholera

cases and deaths occur in Africa (Gaffga et al., 2007).

Furthermore, the continent suffers from explosive outbreaks that

result in high levels of both morbidity and mortality. With regard

to cholera, although it is largely perceived to be a waterborne

disease, person-to-person transmission, limited access to

sanitation, an inadequate water supply and poor hygienic

practices may contribute to the rapid progression of an epidemic.

Cholera risk can be lessened by purifying drinking water, preserve

food from bacterium contamination and sewage

treatment/monitoring as it is being done in the developed

countries (Cutler & Miller, 2005). In 2010 and 2011, Nigeria

recorded 6,400 and 23,366 cases of cholera with 352 and 742

deaths respectively, and almost 3 persons died while 42 others

were hospitalized in cholera outbreak in Ede North and South

LGAs of South-western Nigeria in November, 2012 (National Daily

Newspaper, 2013). The causes of the incidence had been

triggered by poor housing, malnutrition, overcrowding among

others (Gambo, Idowu & Anyakora, 2012).

The WHO promotes safe drinking water, sanitation, personal

hygiene, health education and food safety as specific control

measures. However, this approach is not always implemented or

indeed feasible in low-income settings, particularly in the context

of an outbreak.

Poor Sanitation and Typhoid

A persistent blight at this intersection of environmental change

and public health is Typhoid fever, an exclusively human, faeco-

orally transmitted, systemic disease caused by infection with the

bacterium Salmonella enterica subspecies enterica serovar Typhi

(S. Typhi). Typhoid causes an estimated 21 million cases and

223,000 deaths annually, primarily in south Asia and sub Saharan

Africa (Mogasale, Maskery, Ochiai, Lee, Mogasale, Ramani &

Wierzba, 2014). S. Typhi transmission recognises humans as the

only known reservoir and individuals with acute typhoid and

carriers as the primary risk for infection to others.

Due to a high infectious dose of around 104 organisms (Levine et

al. 2001), direct transmission of S. Typhi without some type of

vehicle is thought to be uncommon and has only been rigorously

described during oral-anal sexual practices (Reller et al. 2003).

Indirect transmission involving vehicles is understood to be the

most common form and is further subdivided into “short-cycle”

and “long cycle” transmission (González-Guzmán, 1989).

Short cycle transmission occurs when a household member

excreting S. Typhi contaminates food or water leading to local

transmission often within the same household. Long cycle

transmission occurs when infected human faeces or urine makes

its way into environmental reservoirs such as water sources or

food production systems and infects people through these

vehicles. The relative contribution of carriers versus those with

acute typhoid to transmission pathways is still poorly understood

and context dependent (Saul et al., 2013) and the notion that

particular ecological settings could act as sites of carriage has yet

to be seriously explored.

While largely controlled in the affluent world, typhoid remains a

serious public health issue in much of the developing world,

particularly in low income, high density settings. Also, from 2 to

5% of Typhoid fever sufferers will remain long-term asymptomatic

“carriers” and excrete the pathogen into the environment from

their stool and urine for years (Baker, Holt, Clements, Karkey,

Arjyal, Boni & Farrar, 2011; Watson & Edmunds, 2015). The

delivery of potable water, adequate sanitation infrastructure and

hygiene promotion (WASH) remain the foundations of typhoid

prevention and control, while vaccination is also recommended by

WHO for use in endemic and epidemic settings (WHO, 2008).

Despite a continued history as one of the major water related

plagues, much is still unknown about the biology of this bacterial

pathogen and the complexity of the disease in endemic areas

(Wain, Hendriksen, Mikoleti, Keddy & Ochiai, 2015).

Others Effects of Poor Sanitation on Health

Soil transmitted helminthes (STH): The most common STH

infections are roundworm (Ascaris lumbricoides), whipworm

(Trichuris trichiura) and human hookworm (Necator americanus

and Ancylostoma duodenale). These infections together affect

over 1 billion people globally (Bethony, Brooker, Albonico, Geiger,

Loukas, Diemert & Hotez, 2006). Inadequate sanitation is

important for the transmission of STH. The majority of worm

infections are transmitted through contact with soil contaminated

with worm eggs coming from the faeces of infected humans. They

enter the human host either through penetration of the skin

(hookworm) or ingestion from contaminated hands or agricultural

produce (roundworm and whipworm). Adequate sanitation

prevents release of faeces into the environment, thereby

preventing transmission.

Trachoma: is caused by the bacteria Chlamydia trachomatis and

is the leading cause of infectious blindness in the world. The

infection is transmitted through contact with eye and nose

discharge of infected people, particularly young children who are

the principal reservoir of infection. The filth fly (Musca sorbens) is

considered an important mechanical vector of the disease, by

feeding on ocular and nasal secretions of infected people (WHO,

2015). It has been estimated that Musca sorbens flies that breed

in scattered human faeces account for over 70% of trachoma

incidence (Emerson, Lindsay, Alexander, Bah, Dibba, Faal &

Bailey, 2004; Montgomery & Bartram, 2010). Inadequate personal

hygiene, which is often predicated on the lack of enough water,

leads to transmission of trachoma as well as attracting the

trachoma-carrying flies to unclean faces.

Schistosomiasis: is transmitted when people come into contact

with fresh water infested with the larval forms of parasitic blood

flukes known as schistosomes (WHO, 2015). It can cause chronic

and often irreversible liver and kidney failure. Inadequate access

to water plays a significant role in the transmission of

schistosomiasis, as this can force households to rely on surface

water sources for their domestic water needs. Snails that live in

surface water are an essential intermediate host for the

transmission to a human. They shed infected larvae into the

water that will penetrate skin when a potential host comes into

contact with contaminated water.

Sanitation and School Attendance

School absenteeism is related to decrease in academic

performance, dropout rates and delays in academic development

(Moonie, Sterling, Figgs & Castro, 2008; Baxter, Royer, Hardin,

Guinn & Devlin, 2011). The social and economic knock-on effects

of reduced academic performance or, in some cases, dropout, are

likely to be far-reaching for the individual, but also at the

community, region and country. For example, under-attainment in

school can affect a child’s job prospects and their livelihood, as

well as their social development, which in turn can hold back

economic growth and social development in the locality. The

effect of sanitation on school attendance or educational

performance can manifest itself through five main pathways:

Student absence due to diarrhoeal disease or respiratory

infections: It was estimated that 194 million school days would be

gained due to less diarrhoeal disease if MDG targets for sanitation

were met (WHO, 2004).

Girls’ absence due to difficulty of managing menstrual hygiene

management: One contributing factor is a lack of appropriate

sanitation facilities, without which many girls are likely to miss

school while they menstruate. Without the appropriate facilities

girls cannot adequately manage their menstrual hygiene,

resulting in fear of embarrassment or teasing associated with

unpleasant odours or stains (Sommer, 2010; McMahon, Winch,

Caruso, Obure, Ogutu, Ochari & Rheingans, 2011).

Reduced cognitive function and performance associated with

infections and dehydration: Some of the most severe

consequences of chronic worm infections, which are strongly

associated with sanitation are those related to education, and

intellectual achievement. Students subject to intense infections

with whipworm miss double the number of school days compared

to their infection-free peers (WHO, 2005). Similarly, heavy-

intensity hookworm infections in children have been shown to

produce growth retardation, impaired learning, increased

absences from school and decreased future economic

productivity (Miguel & Kremer, 2004). Dehydration is another

potential cause of reduced cognitive function and performance

(Hunter, Risebro, Yen, Lefebvre, Lo, Hartemann & Jaquenoud,

2014).

Truancy associated with fear of assault: Student in schools where

sanitation facilities do not provide adequate privacy and safety

may fear assault or violence, which could lead to a decision not to

attend school;
Student absence due to the need to fetch drinking water: This can

lead to missed classes, in particular if students have to make

more than one trip per day to collect water (Fisher, 2004;

Hemson, 2007). One study in 25 countries in sub-Saharan Africa

estimated that, collectively, children spent 4 million hours per day

collecting water, which made them unable to attend school (WHO,

2012).

The Need for Hygiene and Sanitation Management

Poor sanitation gives many infections the ideal opportunity to

spread: plenty of waste and filth for the flies to breed on, and

unsafe water to drink, wash with or swim in. Among human

parasitic diseases, schistosomiasis (sometimes called bilharzias)

ranks second behind malaria in terms of socioeconomic and

public health importance in tropical and subtropical areas. The

disease is endemic in 74 developing countries, infecting more

than 200 million people. Of these, 20 million suffer severe

consequences from the disease (UNICEF & IRC, 2008). Sound

environmental sanitation management ensures that appropriate

intervention are introduced and implemented to promote

behavioural change.

Poor environmental sanitation or hygiene also has tremendous

economic costs. The health impact of inadequate environmental

sanitation leads to a number of financial and economic costs

including direct medical costs associated with treating sanitation-

related illnesses and lost income through reduced or lost

productivity and the government costs of providing health

services. The significant economic benefits of good environmental

sanitation are not well known; the media often emphasize on

health benefits, but the time savings and opportunity cost are

equally important stories. Environmental sanitation management

ensures that there is prudent allocation of limited resources

tailored to the needs of the people to ensure economic

sustainability.

Poor environmental sanitation practices also affect the

environment in diverse ways. In regions where a large proportion

of the population are not served with adequate water supply and

sanitation, sewage flows directly into streams, rivers, lakes and

wetlands, affecting coastal and marine ecosystems, fouling the

environment and exposing millions of children to disease.

Particularly in the context of urbanization, indiscriminate littering,

domestic wastewater, sewage and solid waste improperly

discharged presents a variety of concerns as these promote the

breeding of communicable disease vectors as a result of air,

water and soil pollution. Poor waste management also contributes

to a loss of valuable bio-diversity. Improved environmental

sanitation management reduces environmental burdens,

increases sustainability of environmental resources and allows for

a healthier, more secure future for the population.

Solid waste management is an integral part of urban and

environmental management, like most of other infrastructural

services has come under great stress, consider low priority areas,

solid waste management was never taken up seriously either by

public or by concerned agency or authorities and now the piled up

waste is threatening our health, environment and wellbeing.

Barriers to Sanitation Services Delivery

The delivery of sanitation services has not been the best in

developing countries. Because of this unpleasant situation there

is a lot of sanitation and hygiene related diseases. There are

various factors that hinder development in the sanitation and

hygiene sector. Factors that impede enhanced sanitation services

delivery in the developing world include the following:

Lack of information

Problems may be caused in many developing countries by lack of

recent, reliable information on the condition of existing sanitation

and hygiene infrastructure, including whether or not it is actually

functioning. Official statistics on sanitation coverage are often

inconsistent or even hopelessly inflated. Needs and demands,

particularly in more remote rural areas, are frequently unknown,

making the task of setting a coherent and balanced agenda more

difficult.

Lack of coordination

Lack of clarity in some developing countries over which

institutions coordinate the provision of sanitation is another factor

that impede sanitation services. The most commonly adopted

arrangement is that the institutional home of sanitation is located

within ministries of environment. A second option can be to place

sanitation within the remit of the ministry of health as there is a

natural link therefore between sanitation and health (particularly

preventive health). Since, however, the range of water, sanitation

and hygiene-related activities is so wide, searching for the right

institutional home may not be fruitful. Arguably more important is

establishing links between institutions, e.g. via planning

processes which bring together departments from several

responsible ministries.

Lack of political and budgetary priority

Another limiting factor is lack of funds for investment. Both water

and sanitation have been losing out to other sectoral interests in

the competition for scarce public funds. For example, in a 2003–

2004 survey of Poverty Reduction Strategy Papers (PRSPs) and

budget allocations in three countries in sub-Saharan Africa, other

social sectors, such as education and health, attracted much

larger budgetary allocations than water, and sanitation was

especially under-funded. It prompts the question as to whether

the political will exists to increase budget priority of sanitation.

Donors’ agendas

In aid-dependent developing countries, donor priorities will tend

to be influential in setting sectoral agendas, and if pursued

individually they will undermine efforts to promote collaborative

planning.

Lack of human and technical capacity

In many developing countries, lack of capacity in terms of human

resources inhibits development, particularly at a decentralized

level. The multi-faceted nature of sanitation means that a wide

range of different disciplines and skills is required to improve

sanitation and hygiene provision. While the water sector has

tended to be dominated by engineers who feel comfortable with

technical problems and tend to lean towards technical solutions

(Jenkins & Scott, 2006), household sanitation requires softer,

people-based skills (Evans, 2005).

Methods/technology
Suitable sanitation services/facilities will vary according to

context: there will be differences between urban and rural

contexts, large and small towns, planned and unplanned

settlements as well as between different ethnic and social

settings (e.g. communities with more or less collective

organization and identity). Since different products embody

different technology choices, technology options which prove

inappropriate will constitute practical barriers. There is broad

consensus in the literature that the right choice of technology is

an important determinant of take-up and use of sanitation

facilities.

Access to credit

Limited access to credit is a common phenomenon in sub-Saharan

African countries, particularly micro-credit for small service

providers, whether Community-based or private. Loans available

are often only for income generating activities, rather than for

improving community and household infrastructure (both

sanitation and water facilities). If such credit is available, they are

not affordable as interest rates are usually high. Financial

institutions do not normally make loan repayment periods long

enough for poor borrowers.

Lack of strong messages

Promoting sanitation and hygiene presents a substantial

communication challenge. Improving sanitation messages must

not be focused on building latrines alone but on all aspects of

sanitation and hygiene and the associated diseases.

Inadequate arrangements for cleaning and maintenance

Adequate arrangements are usually not made for the operation

and maintenance of community sanitation facilities. A key aspect

of the financial viability of shared and communal sanitation

facilities is payment for maintenance, cleaning and pit-emptying.

Sustained demand for use of latrines will depend on their being

clean and without smell. Schaub-Jones, Eales and Tyers (2006),

suggested for communal facilities that engaging a caretaker is

strongly recommended, preferably a local person paid from user

fees, rather than a public employee. To cover operation and

maintenance expenses a user fee must be charged.

Complexities of behaviour change

The societal reasons for investing in sanitation include among

others , reduced disease burden, reduced public health costs,

increased school attendance for girls and greater economic

productivity. However, the private motivations of individuals for

better sanitation at home may be different. An individual is likely

to be prompted to improve his/her sanitation facilities by a mix of

motives, including some which are not linked to a concern for

health and they include: privacy; convenience; safety;

status/prestige; cost savings; and income generation.

Cultural factors

Indeed, beyond individual motivations, further potential barriers

are cultural factors which make the intended beneficiaries of

sanitation and hygiene promotion projects resistant to new

facilities. Cultural difference arises from gender: variations in the

perspectives of women and men on sanitation facilities are noted

by many commentators. The views of adults and children vary

too. Household circumstances are also diverse. Different ethnic

groups may have varying beliefs and customs, while attitudes to

sanitation and hygiene may vary substantially between urban and

rural contexts.

Approaches toward Improving Sanitation Services Delivery

Improved sanitation facility, together with safe water and proper

personal hygiene, is fundamental to good health. According to the

World Health Organization, “no single type of intervention has

greater overall impact upon national development and public

health than the provision of safe drinking water and the proper

disposal of human excreta” (WHO 1996). Lack of adequate

sanitation facility can cause diarrheal and other diseases which

can be transmitted via the fecal-oral route. Access to safe and

adequate drinking water alone is not enough to decrease the

disease burden because improved sanitation is also crucial

deseases prevention. Improved sanitation technology (e.g., toilet

and sewerage systems) creates the primary barriers to prevent

fecal pathogens from reaching the environment and can reduce a

number of health risk factors. There are some approaches that

have helped in enhancing sanitation services delivery especially

in the developing world. Such approaches include:

Community-Led Total Sanitation (CLTS)

Bangladesh is the home of a new approach to increasing

sanitation coverage, called Community-Led Total Sanitation

(CLTS), first introduced in 2000 in a small village in the Rajshabi

District by Dr. Kamal Kar in cooperation with Water Aid

Bangladesh and the Village Education Resource Centre (VERC).

Most traditional sanitation programmes rely on the provision of

subsidies, sanitation promotion, and hygiene education. The

shortcomings of the established programmes led to the

development of the new CLTS approach in Bangladesh, shifting

the focus on personal responsibility and low-cost solutions.

CLTS aims to totally stop open defecation within a community

rather than facilitating improved sanitation only to selected

households. Awareness of local sanitation issues is raised through

a walk to open defecation areas and water points (walk of shame)

and a calculation of the amount of excreta caused by open

defecation. Combined with hygiene education, the approach aims

to make the entire community realize the severe health impacts

of open defecation. Since individual carelessness may affect the

entire community, pressure on each person becomes stronger to

follow sanitation principles such as using sanitary toilets, washing

hands, and practicing good hygiene.

To introduce sanitation even in the poorest households, low-cost

toilets are promoted, constructed with local materials. The

purchase of the facility is not subsidized, so that every household

must finance its own toilets. CLTS does not identify standards or

designs for latrines, but encourages local creativeness. This leads

to greater ownership, affordability and therefore sustainability

(Kamal, 2003).

Participatory Hygiene and Sanitation Transformation

(PHAST)

PHAST is an innovative approach to promoting hygiene, sanitation

and community management of water and sanitation facilities. It

builds on people’s innate ability to address and resolve their own

problems. It aims to empower communities to manage their water

and to control sanitation-related diseases, and it does so by

promoting health awareness and understanding which, in turn,

lead to environmental and behavioural improvement (WHO,

2000).

Behaviour Change Communication (BCC)

BCC has become a central objective of public health interventions

over the last half decade, as the influence of prevention within

the health services has increased. The increased influence of

prevention has coincided with increased multi-lateral and bi-

lateral aid in the area of human development, and the increased

need for the international development community to show cost-

effectiveness for allocated dollars spent.

Behaviour change programmes, which have evolved over time,

encompass a broad range of activities and approaches, which

focus on the individual, community, and environmental influences

on behavior. The term Behaviour Change Communication (BCC)

specifically refers to community health seeking behaviour, and

was first employed in HIV and TB prevention projects.

However, its ambit has grown to encompass any communication

activity whose goal is to help individuals and communities select

and practice behaviour that will positively impact on their health,

such as immunization, cervical cancer check-up, employing

single-use syringes, and so on. BCC is a process that motivates

people to adopt and sustain healthy behaviours and lifestyles.

Sustaining healthy behaviour usually requires a continuing

investment in BCC as part of an overall health programme (United

States Agency for International Development [USAID], 2008).

Social /Sanitation Marketing

Sanitation marketing is a new approach that ensures that people

get toilets and is done using a commercial marketing approach.

Sanitation marketing uses commercial marketing techniques to

promote the adoption of behaviour that will improve the health or

well-being of the target audience or of society as a whole. The use

of a marketing approach to sanitation is not just about

advertising; it also ensures that appropriate sanitation options are

made available and that suppliers have the necessary capacity to

provide the desired services.

Social marketing offers a more promising approach to promoting

positive hygiene behaviours compared to traditional, health

education-based approaches. Sanitation marketing relies on

commercial marketing concepts and tools to influence the

voluntary adoption of adequate sanitation. It discourages

subsidies but where subsidies are applied they could be used to

promote demand. Subsidy is not applied in a way which

undermines the existing private providers in the market.

Sanitation marketing has four main components, the 4 Ps which

include: Product; Price; Place; and Promotion.

Sanitation marketing creates opportunity for users, public sector,

private sector, and NGOs all to get involved / to work together.

Sanitation marketing does not neglect hygiene education but

includes hygienic behaviour based on an understanding of the

effect on health of good hygiene practice and safe excreta

disposal.

Using sanitation marketing does not mean that the government

should wean itself from sanitation provision rather, the public

sector still has important role like creating the right policy

environment including regulation (for price, quality,

environmental impact, protection of water resources, etc.),

incorporating subsidies for hygiene promotion, sanitation

marketing, supporting small-scale-providers, school sanitation,

institutional sanitation, etc.

The role of government, especially local government is

stimulating demand, understanding and fostering development of

appropriate products, and regulating transportation and final

waste disposal. Public resources for sanitation also need to be

committed to research and development, promotion and

advocacy and training and capacity building (WSP, 2004).

APPRAISAL OF LITERATURE REVIEWED

The foregoing literature review has analyzed the view of various

authors on the concept of knowledge study. The review has

shown the needs of having adequate sanitation and

understanding of the health effects associated with poor

sanitation. The subject of sanitation has been reviewed in its

different ramification. These include the types, impacts as well as

health effects. The scholars’ contributions delved into the need

for hygiene and sanitation management, barriers to sanitation

services delivery as well as approaches towards improving

sanitation services.

The reviewed studies have variously submitted that there exists

effect of poor sanitation on health of students. Poor waste

disposal system, poor water source as well as students’ laziness

among others was noted to be the causes of poor sanitation

among students. The reviewed literature affirmed that the

barriers to sanitation services delivery revolved around lack of

information, lack of coordination, lack of political and budgetary

priority, donors’ agendas, lack of human and technical capacity,

methods/technology, access to credit, lack of strong messages,

inadequate arrangements for cleaning and maintenance,

complexities of behaviour change as well as cultural factors

among others

The review suggested Community-Led Total Sanitation (CLTS),

Participatory Hygiene and Sanitation Transformation (PHAST),

Behaviour Change Communication (BCC) as well as Social

/Sanitation Marketing as the approaches towards improving

sanitation services delivery. The literature reviewed recommends

that the government, the educational institution and NGOs take

proper responsibility and be actively involved in the hygiene

education and sanitation delivery for students. The subsequent

chapters of this research work will build on the reviewed scholarly

contributions and further cover the lacuna on the subject of the

perceived effects of poor sanitation on health of undergraduate

students in hall of residents, University of Calabar.

 CHAPTER THREE

RESEARCH METHODOLOGY

Introduction

This chapter discusses the method and procedure adopted in

carrying out this study. It comprises of research design,

population of the study, sample size and sampling technique,

research instrument, validity of the instrument, reliability of the

instrument, procedure for data collection and method of data

analysis.

Research Design

Descriptive research design of survey type was used for this

study. Abiola (2007) opined that this type of research design

involves a clear definition of the problem, collection of relevant

and adequate data, careful interpretation of the data and skillful

reporting of the findings.

Folawiyo (2007) explained that descriptive survey type involves

the collection of data for the purpose of describing existing

conditions. This research design was used for the study because it
involves clear definition of the problem, collection of relevant and

adequate data and reporting of findings. Also, the design is

appropriate because it requires sample of the population.

Population of the Study

Daramola (2005) defined population as a set of element, people,

objects or even events in a given research. The target population

for this research work revolved around the males and females

respondents in the study area with common characteristics to

which the researcher wants to generalize the results of the study.

As such, the total population of hall of residents in University of

Calabar, Calabar, Nigeria is twenty four (24) in which eighteen

(18) are private owned and six (6) are university owned with total

number of seven thousand, five hundred and thirteen (7,513)

undergraduate students. In this study, the target population

consists of four hostels comprising two private hostels and two

university owned hostel with a total of two thousand two hundred

and twenty (2220) (Student Affairs Unit, 2018).

Sample and Sampling Technique

Sample is designed by Daramola (2006) as a fair representative

group selected from the target population. A multi-stage sampling

technique was adopted for this study. It consists stratified

sampling, purposive sampling, simple random sampling technique

and convenience sampling technique.

In stage 1, stratified sampling technique was used to group the

hall of residents in University of Calabar, Calabar, Nigeria into two

groups. i.e private owned hall of residents and university owned

hall of residents

In stage 2, purposive sampling technique was used to select two

private owned hall of residents (i.e one male, one female) and two

university owned hall of residents (i.e one male, one female) in

University of Calabar, Calabar, Nigeria. Purposive sampling

technique is a sampling procedure in which a researcher

purposively selects certain groups as samples because of their

relevance to the investigation under consideration (Daramola,

2006). The private hostels to be selected are; Gulf Pearl female

hostel and Pyramid male hostel, while the university owned

hostels to be selected are; Lagos male hostel and Zamfara female

hostel.

In stage 3, simple random sampling technique was used to select

two hundred and twenty two (222) respondents which amounted

to 10% of the total population of two thousand two hundred and

twenty (2220).

Table 1: Population Distribution of Respondents

S/ Names Owners No. of Sample
N hip students selected
Per Per Hostel
hostel (10%)
1. Lagos male Universi 1,040 104.00
hostel ty
2. Zamfara Universi 610 61.00
female hostel ty
3. Gulf pearl Private 330 33.00
female hostel
4. Pyramid Private 240 24.00
male hostel
Total 2220 222.00

Lastly, in stage 4, convenience sampling technique was used to

approach two hundred and twenty two (222) respondents from

two thousand two hundred and twenty (2220) in their respective

hall of residents which is the target population to participate in

the study.

Research Instrument

Hornby (2008) defined instrument as an apparatus used in

performing an action. Instrument in research are often called

assessment or evaluation tools. The Instrument used for this

study is a Researcher designed Questionnaire consisting of

structured items. The Instrument was tagged ‘perceived effects of

poor sanitation on health of undergraduate students in hall of

residents, University of Calabar’. The Questionnaire comprised of

two sections, A and B. Section “A” focused on Demographic Data

of the respondents based on variables such as gender, age and

hall of resident. Section “B” consists of items on formulated

hypotheses. The four-point Likert rating scale with alternatives of

Strongly Agree (SA) = 4 points, Agree (A) = 3 points, Disagree (D)

= 2 points and Strongly Disagree (SD) = 1 point was used.

Validity of the Instrument

Validity is the degree to which a test measures what it intends to

measure (Gravetter, 2012). In order to find out the validity of this

instrument, copies of the questionnaire were given by the

researcher to three experts in the Department of Health

Promotion and Environmental Health Education, Faculty of

Education, University of Calabar, so as to carry out both the face

and content validity of the instrument. Comments and

suggestions made by the experts was carefully studied and used

to improve the quality of the instrument before the reliability of

the instrument was carried out and this was used for final

administration to the respondents.

Reliability of the Instrument

Abiri (2007) described reliability as the consistency, accuracy,

stability and trust worthiness of a measuring instrument or score

obtained there from, that is how far the same instrument would

give the same score on different occasions or with different sets

of equivalent items under the same condition. Margaret (2003)

noted that reliability is the stability or the consistency of

information i.e. the extent to which similar information is supplied

or obtained when a measurement is performed more than once. If

a reliable instrument is two or three to the same sample, each

person in the group should approximately get the same score on

different occasions (Kulbir, 2007). To determine the reliability of

the instrument, the researcher adopted a test re-test method by

which the questionnaire was administered to respondents outside

the study area but similar to the study area. This was done in two

weeks interval on twenty respondents. Thereafter, the researcher

used Pearson’s Product Moment Correlation co-efficient to

compare the correlation between the two totals ‘set’ scores, A

reliability coefficient ‘r’ of 0.81 was obtained and this was

considered appropriate and reliable for the study since it’s above

the minimum of 0.7.

Procedure of Data Collection

Data collection is defined as a systematic process of gathering

information relevant to the study in order to answer the

researcher questions. A letter of introduction was obtained by the

researcher from the Department, signed by the Head of

Department, Health Promotion and Environmental Health

Education, Faculty of Education, University of Calabar. This

enabled the researcher gain access to the respondents for the

purpose of instrument administration and data collection.

The researcher worked with two trained research assistants who

attempted to answer any question that is not clear to the

respondents. The questionnaire was administered to each

respondent in their respective hall of resident. The researcher and

research assistants made sure that the questionnaires were

collected immediately to avoid loss of the instrument.

Method of Data Analysis

The completed copies of the questionnaire for this study were

collected, sorted, coded and subjected to appropriate statistical

analysis. Section A which contains demographic data of the

respondents were analyzed using descriptive statistics of

frequency counts and percentage, while inferential statistic of chi-

square (X2) was used to analyze the stated hypotheses at 0.05

level of significance using the Statistical Package for Social

Sciences (SPSS) version 20.0.

 CHAPTER FOUR

RESULTS AND DISCUSSION OF FINDINGS

Introduction

This chapter presents the results and discussion of finding on the

perceived effects of poor sanitation on health of undergraduate students in

hall of residents, University of Calabar. These are reported in two sections.

Section A deals with the personal data of respondents which were analyzed

using frequency count and simple percentages, while section B presents the

analysis of respondents’ opinion on the four variable of the research work.

Data relating to the hypotheses were tested for overall significance using

inferential statistics of chi-square at 0.05 alpha level.

Demographic Characteristics of Respondents

Table 2: Demographic Distribution of Respondents by Gender, Age

range and Hall of Resident.

S/N VARIABLES FREQUENCY PERCENTAGE (%)

1 Gender

Male 128 57.7

Female 94 42.3

Total 222 100.0

2 Age

Below 18 years old 71 32.0

18-24 years old 113 50.9

 25 years old and 38 17.1

above

Total 222 100.0

3 Hall of resident

Lagos (male) 104 46.8

Pyramid (male) 24 10.8

Zamfara (female) 61 27.5

Golf pearl (female) 33 14.9

Total 222 100.0

Table 2 shows that 128 of the respondents representing 57.7% were

male, while female were 94 representing 42.3% of the population. It also

shows that respondents below 18 years of age were 71 representing 32.0%,

age 18-24 were 113 (50.9%) and respondents that are 25 and above were 38

representing 17.1%. It also shows that 104 respondents representing 46.8%

were from Lagos hostel (male), 24 (10.8%) were from pyramid (male), while

61 respondents representing 27.5% were from Zamfara (female), and 33

respondent representing 14.9% were from Golf pearl (female) hostel..

Answer to Research Questions

Research Question 1: will diarrhea infection be an effect of poor sanitation

on health of undergraduate students in hall of residents, University of

Calabar?
Table 3: Percentage and frequency analysis of Diarrhea infection as

an effect of poor sanitation on health of undergraduate students in

hall of residents, University of Calabar.

S/ Items Yes No

1 Diarrhea is an effect of poor sanitation in the hostel 155 67

(69.7%) (30.3%)

2 Diarrhea as a result of poor sanitation leads to dehydration 160 62

(72.0%) (28.0%)

3 Diarrhea as a result of poor sanitation in the hostel causes 171 51

frequent stooling (77.0%) (23.0%)

4 Untreated water as a result of poor sanitation will lead to 180 42

diarrhea (81.1%) (18.9%)

(X) 167 55

(75.0) (25.0)

Table 3 shows that 75% of undergraduate students have positive

response to diarrhea infection as an effect of poor sanitation in hall of

residents, University of Calabar, while 25% of undergraduate students have

negative response to diarrhea infection as an effect of poor sanitation in hall

of residents, University of Calabar.

Research Question 2: Will malaria disease be an effect of poor sanitation

on health of undergraduate students in hall of residents, University of

Calabar?

Table 4: Percentage and frequency analysis of Malaria disease as an

effect of poor sanitation on health of undergraduate students in hall

of residents, University of Calabar.

S/ Items Yes No

1 Malaria is an effect of poor sanitation in the hostel 176 46

(79.3%) (20.7%)

2 Malaria as a result of poor sanitation leads to body weakness 211 11

(95.0%) (5.0%)

3 Malaria as a result of poor sanitation leads to fever 211 11

(95.0%) (5.0%)

4 Malaria as a result of poor sanitation leads to headache 207 15

(93.2%) (6.7%)

(X) 201 21

(90.7) (9.3)

Table 4 shows that 90.7% of undergraduate students have positive

response to malaria disease as an effect of poor sanitation in hall of

residents, University of Calabar. While 9.3% of undergraduate students have

negative response to malaria disease as an effect of poor sanitation in hall of

residents, University of Calabar.

Research Question 3: Will cholera disease be an effect of poor sanitation

on health of undergraduate students in hall of residents, University of

Calabar?

Table 5: Percentage and frequency analysis of Cholera disease as an

effect of poor sanitation on health of undergraduate students in hall

of residents, University of Calabar.

S/ Items Yes No

1 Cholera is an effect of poor sanitation in the hostel 159 63

(71.6%) (28.4%)

2 Cholera as a result of poor sanitation leads to vomiting 202 20

(91.0%) (9.0%)

3 Cholera as a result of poor sanitation leads to fever I63 59

(73.0%) (27.0%)

4 Cholera as a result of poor sanitation leads to body weakness 199 23

(89.6%) (10.4%)

(X) 181 41

(81.4) (18.6)
 Table 5 shows that 81.4% of undergraduate students have positive

response to cholera disease as an effect of poor sanitation in hall of

residents, University of Calabar. While 18.6% of undergraduate students

have negative response to cholera disease as an effect of poor sanitation in

hall of residents, University of Calabar

Research Question 4: Will typhoid disease be an effect of poor sanitation

on health of undergraduate students in hall of residents, University of

Calabar?

Table 6: Percentage and frequency analysis of Typhoid disease as

an effect of poor sanitation on health of undergraduate students in

hall of residents, University of Calabar.

S/ Items Yes No

1 Typhoid is an effect of poor sanitation in the hostel 184 38

(82.9%) (17.1%)

2 Typhoid as a result of poor sanitation leads to body weakness 151 71

(68.0%) (32.0%)

3 Typhoid as a result of poor sanitation leads to fever I57 65

 (70.7%) (29.3%)

4 Typhoid as a result of poor sanitation leads to constant 154 68

headache (69.4%) (30.6%)

(X) 162 60

(72.7) (27.3)

Table 6 shows that 72.7% of undergraduate students have positive

response to typhoid disease as an effect of poor sanitation in hall of

residents, University of Calabar. While 27.3% of undergraduate students

have negative response to typhoid disease as an effect of poor sanitation in

hall of residents, University of Calabar.

Hypotheses Testing

Hypothesis 1: Diarrhea infection will not significantly be an effect of poor

sanitation on health of undergraduate students in hall of residents,

University of Calabar.

Table 7: Chi-square analysis investigating diarrhea infection as an

effect of poor sanitation on health of undergraduate students in hall

of residents, University of Calabar.

S/ ITEMS SA A D SD ROW df CAL. TABLE REMARK

N TOTAL VALUE VALU S

E
1 Diarrhea is 93 62 38 29 222

an effect of
(41.8 (27.9 (17.2 (13.1
poor
%) %) %) %)
sanitation

in the

hostel

2 Diarrhea as 78 82 41 21 222

a result of
(35.1 (36.9 (18.5 (9.5%
poor
%) %) %) )
sanitation

leads to

dehydratio

3 Diarrhea as 104 67 28 23 222 9 412.84 16.92 Ho1

a result of
(46.8 (30.2 (12.6 (10.4 Rejected
poor
%) %) %) %)
sanitation

in the

hostel

causes

frequent

stooling

4 Untreated 121 59 30 12 222

water as a
(54.5 (26.6 (13.5 (5.4%
result of
%) %) %) )
poor

sanitation
 will lead to

diarrhea

Total 396 270 137 85 888

@0.05 alpha level of significance

Table 7 shows that the calculate Chi-square value is 412.84 and the

table/critical value is 16.92 with the degree of freedom 9 at 0.05 level of

significance. Since the calculated value of 412.84 is greater than the table

value of 16.92 at 9 degree of freedom, the null hypothesis is rejected. This

implies that diarrhea infection will significantly be an effect of poor sanitation

on health of undergraduate students in hall of residents, University of

Calabar.

Hypothesis 2: Malaria disease will not significantly be an effect of poor

sanitation on health of undergraduate students in hall of residents,

University of Calabar.

Table 8: Chi-square analysis investigating malaria disease as an

effect of poor sanitation on health of undergraduate students in hall

of residents, University of Calabar.

S/ ITEMS SA A D SD ROW df CAL. TAB REMARKS

N TOTAL VALUE LE

VAL

UE

5 Malaria is 87 89 30 16 222
 an effect (40.1

of poor %)
(39.2 (13.5 (7.2
sanitation
%) %) %)
in the

hostel

6 Malaria as 127 84 8 3 222

a result of
(57.2 (37.8 (3.6% (1.4
poor
%) %) ) %)
sanitation

leads to

body

weakness

7 Malaria as 142 69 6 5 222 9 348.44 16.9 Ho2

a result of 2
(64.0 (31.1 (2.7) (2.2) Rejected
poor
%) %)
sanitation

leads to

fever

8 Malaria as 109 98 9 6 222

a result of
(49.9 (44.2 (4.2% (2.7
poor
%) %) ) %)
sanitation

leads to

headache

Total 465 340 53 30 888

@0.05 alpha level of significance

Table 8 shows that the calculate Chi-square value is 348.44 and the

table/critical value is 16.92 with the degree of freedom 9 at 0.05 level of

significance. Since the calculated value of 348.44 is greater than the table

value of 16.92 at 9 degree of freedom, the null hypothesis is rejected. This

implies that malaria disease will significantly be an effect of poor sanitation

on health of undergraduate students in hall of residents, University of

Calabar.

Hypothesis 3: Cholera disease will not significantly be an effect of poor

sanitation on health of undergraduate students in hall of residents,

University of Calabar.

Table 9: Chi-square analysis investigating cholera disease as an

effect of poor sanitation on health of undergraduate students in hall

of residents, University of Calabar.

S/ ITEMS SA A D SD ROW df CAL. TABL REMARK

N TOTA VALU E S

L E VALU

9 Cholera is 91 68 42 21 222

an effect of
(41.0 (30.6 (19.0 (9.4
poor
%) %) %) %)
sanitation
 in the

hostel

10 Cholera as 79 123 14 6 222

a result of
(35.6 (55.4 (6.3% (2.7
poor
%) %) ) %)
sanitation

leads to

vomiting

11 Cholera as 82 81 37 22 222 9 410.56 16.92 Ho3

a result of
(37.0 (36.5 (16.6 (9.9 Rejected
poor
%) %) %) %)
sanitation

leads to

fever

12 Cholera as 88 111 19 4 222

a result of
(39.6 (50.0 (8.6% (1.8
poor
%) %) ) %)
sanitation

leads to

body

weakness

Total 340 383 112 53 888

@0.05 alpha level of significance

Table 9 shows that the calculate Chi-square value is 410.56 and the

table/critical value is 16.92 with the degree of freedom 9 at 0.05 level of

significance. Since the calculated value of 410.56 is greater than the table

value of 16.92 at 9 degree of freedom, the null hypothesis is rejected. This

implies that cholera disease will significantly be an effect of poor sanitation

on health of undergraduate students in hall of residents, University of

Calabar.

Hypothesis 4: Typhoid disease will not significantly be an effect of poor

sanitation on health of undergraduate students in hall of residents,

University of Calabar.

Table 10: Chi-square analysis investigating typhoid disease as an

effect of poor sanitation on health of undergraduate students in hall

of residents, University of Calabar.

S/ ITEMS SA A D SD ROW d CAL. TABL REMARKS

N TOTAL f VALU E

E VALU

13 Typhoid is 95 89 23 15 222

an effect
(42.8 (40.1 (10.4 (6.7%)
of poor
%) %) %)
sanitation

in the

hostel

14 Typhoid as 59 92 47 24 222

a result of
(26.6 (41.4 (21.2 (10.8
poor
 sanitation %) %) %) %)

leads to

body

weakness

15 Typhoid as 64 93 23 42 222 9 311.62 16.92 Ho4

a result of
(28.8 (41.9 (10.4 (18.9 Rejected
poor
%) %) %) %)
sanitation

leads to

fever

16 Typhoid as 93 61 41 27 222

a result of
(41.9 (27.5 (18.5 (12.1
poor
%) %) %) %)
sanitation

leads to

constant

headache

Total 311 335 134 108 888

@0.05 alpha level of significance

Table 10 shows that the calculate Chi-square value is 311.62 and the

table/critical value is 16.92 with the degree of freedom 9 at 0.05 level of

significance. Since the calculated value of 311.62 is greater than the table

value of 16.92 at 9 degree of freedom, the null hypothesis is rejected. This

implies that typhoid disease will significantly be an effect of poor sanitation

on health of undergraduate students in hall of residents, University of

Calabar.

Discussion of Findings

The research work was carried out to investigate the perceived effects

of poor sanitation on health of undergraduate students in hall of residents,

University of Calabar.

Hypothesis 1: Diarrhea infection will not significantly be an effect of poor

sanitation on health of undergraduate students in hall of residents,

University of Calabar. The hypothesis which was tested at 9 degree of

freedom of 0.05 level of significance was rejected because the calculated

chi-square value (412.84) is greater than the critical table value (16.92). The

result revealed that diarrhea infection will significantly be an effect of poor

sanitation on health of undergraduate students in hall of residence,

University of Calabar. The finding is in accordance with the findings of

Waterwiki (2010), who affirmed that water and sanitation intervention to

reduce diarrhea disease incidence in developing countries fall into four

general categories: Water provision, household water treatment, hand

washing promotion and sanitation. Each intervention is proven to reduce

diarrhea disease incidence. Failure to have all adopt and follow these

interventions will cause diarrhea.

Hypothesis 2: Malaria disease will not significantly be an effect of poor

sanitation on health of undergraduate students in hall of residents,

University of Calabar. The hypothesis which was tested at 9 degree of

freedom of 0.05 level of significance was rejected because the calculated

chi-square value (348.44) is greater than the critical table value (16.92). The

result revealed that malaria disease will significantly be an effect of poor

sanitation on health of undergraduate students in hall of residence,

University of Calabar. The finding is in accordance with the findings of Center

for Disease Control and Prevention (2010), who affirmed that sanitation is

important because it helps in the prevention of malaria. This is so because

poor sanitation such as waste product dumped in canals, rivers, streams,

ponds and lakes can inhibit the flow of water, and as a result the water

remains stagnant. This attracts mosquitoes because they dwell in areas with

stagnant water which can lead to malaria.

Hypothesis 3: Cholera disease will not significantly be an effect of poor

sanitation on health of undergraduate students in hall of residents,

University of Calabar. The hypothesis which was tested at 9 degree of

freedom of 0.05 level of significance was rejected because the calculated

chi-square value (410.56) is greater than the critical table value (16.92). The

result revealed that cholera disease will significantly be an effect of poor

sanitation on health of undergraduate students in hall of residence,

University of Calabar. The finding is in line with the findings of World Health

Organization (2013), who affirmed that eating infected food, vegetable and

fruit washed with water contaminated by sewage or drinking water that has

been contaminated by the fasces of infected person makes people or

community prone the cholera risk. Also Gambo, Idowu and Anyakora (2012)

ascertained that the causes of cholera revolved around poor housing,

malnutrition as well as overcrowding among others.

Hypothesis 4: Typhoid disease will not significantly be an effect of poor

sanitation on health of undergraduate students in hall of residents,

University of Calabar. The hypothesis which was tested at 9 degree of

freedom of 0.05 level of significance was rejected because the calculated

chi-square value (311.62) is greater than the critical table value (16.92). The

result revealed that typhoid disease will significantly be an effect of poor

sanitation on health of undergraduate students in hall of residence,

University of Calabar. The finding is in line with the findings of Mogasale,

Maskery, Ochiai, Lee, Mogasale, Ramani and Wierzba (2014) that typhoid as

a result of poor sanitation causes an estimated 21 million cases and 223,000

deaths annually, primarily in south Asia and sub Saharan Africa.

CHAPTER FIVE

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the summary of the entire study carried out

by the researcher, drew conclusion as well as recommendations

on the perceived effects of poor sanitation on health of

undergraduate students in hall residents, University of Calabar.

Summary

The study examined the perceived effects of poor sanitation on

health of undergraduate students in hall residents, University of

Calabar. Relevant literatures from different authorities,

professional organisations, ministries, scholars and agencies were

reviewed. The overview of health and sanitation, effects of poor

sanitation on health; poor sanitation and diarrhea infection, poor

sanitation and malaria disease, poor sanitation and cholera

disease, poor sanitation and typhoid diseases, sanitation and

school attendance, the needs for Hygiene and sanitation

management approaches towards improving sanitation services

delivery as well as barriers to sanitation services were examined.

The descriptive research of survey type was adopted. The

populations for the study were all undergraduate students in hall

of residents, University of Calabar. Two hundred and twenty two

respondents were sampled for the study. A researcher-structured

questionnaire which was validated and tested for reliability was

adopted for the study. The instrument was administered by the

researcher and research assistants. The data collected in the

study were analyzed using the descriptive statistics of both

frequency count and percentage. Inferential statistics of chi-

square was used to analyse the hypotheses postulated for this

study at 0.05 alpha level of significance.

Conclusions

Based on the finding of the study, the following conclusions were

drawn:

1. Diarrhea infection is an effect of poor sanitation on health of

undergraduate students in hall of residents in University of

Calabar.
2. Malaria disease is an effect of poor sanitation on health of

undergraduate students in hall of residents in University of

Calabar.

3. Cholera disease is an effect of poor sanitation on health of

undergraduate students in hall of residents in University of

Calabar.

4. Typhoid disease is an effect of poor sanitation on health of

undergraduate students in hall of residents in University of

Calabar.

Recommendations

Based on the conclusions drawn from this study, the following

recommendations were made;

1. Undergraduate students staying in hall of residents should

keep clean and sanitized environment to avoid diarrhea infection.

2. Students should eliminate stagnant water to keep mosquito

which cause malaria away from the environment and also adopt

the use of mosquito net to prevent mosquito bite.

3. Students should promote safe drinking water, sanitation and

food safety to prevent cholera disease.

4. Undergraduate students should ensure they drink potable

water and preserve food from bacterium contamination to avoid

typhoid disease.
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