RAJIV GANDHI UNVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS

:

MR.SOLOMON.M.SANGASI

1ST YEAR M.SC NURSING,

INDIAN COLLEGE OF NURSING,

TILAK NAGAR, BYPASS ROAD,

CANTONMENT,

BELLARY – 583104

2. NAME OF THE INSTITUTION :INDIAN COLLEGE OF NURSING,

TILAKNAGAR, BYPASS ROAD,

CANTONMENT,

BELLARY – 583104

3. COURSE OF STUDY AND

SUBJECT

:IST YEAR DEGREE OF MASTER

OF NURSING ,

COMMUNITY HEALTH NURSING

4. DATE OF ADMISSION TO

COURSE

: 16-6-2011

5. TITLE OF THE TOPIC :

“A STUDY TO ASSESS THE

KNOWLEDGE AND PRACTICE

ON SANITATION AMONG

PEOPLE OF BANDI HATTI

RURAL AREA AT BELLARY

DISTRICT”.

BRIEF RESUME OF THE INTENDED WORK

6. INTRODUCTION:

The rural population of India comprises more than 700 million people residing

in about 1.42 million habitations spread over 15 diverse ecological regions. It is true

that providing drinking water to such a large population is an enormous. Our country

is also characterized by non-uniformity in level of awareness, socio economic

development, education, poverty, practices and rituals which add to the complexity of

providing water1.

Sanitation is the hygienic means of promoting health through prevention of

human contact with the hazards of wastes. Hazards can be physical, microbiological,

biological or chemical agents of disease. Wastes that can cause health problems are

human and animal feces, solid wastes, domestic wastewater like sewage, sullage,

greywater, industrial wastes and agricultural wastes. Hygienic means of prevention

can be by using engineering solutions e.g. sewerage and wastewater treatment, simple

technologies e.g. latrines, septic tanks, or even by personal hygiene practices e.g.

simple hand washing with soap2.

The World Health Organization states that Sanitation generally refers to the

provision of facilities and services for the safe disposal of human urine and faeces.

Inadequate sanitation is a major cause of disease world-wide and improving sanitation

is known to have a significant beneficial impact on health both in households and

across communities. The word sanitation also refers to the maintenance of hygienic

conditions, through services such as garbage collection and wastewater disposal3.

The term sanitation can be applied to a specific aspect, concept, location or

strategy, such as:

a)Basic sanitation

It refers to the management of human faeces at the household level.

b)On-site sanitation

The collection and treatment of waste is done where it is deposited. Examples

are the use of pit latrines, septic tanks.

c)Food sanitation

It refers to the hygienic measures for ensuring food safety.

d)Environmental sanitation

The control of environmental factors that form links in disease transmission.

Subsets of this category are solid waste management, water and wastewater treatment,

industrial waste treatment and noise and pollution control.

e)Ecological sanitation

It is an approach that tries to emulate nature through the recycling of nutrients

and water from human and animal wastes in a hygienically safe manner.4

The health burden of poor water quality is enormous. It is estimated that around

37.7 million Indians are affected by waterborne diseases annually, 1.5 million children

are estimated to die of diarrhea alone and 73 million working days are lost due to

waterborne disease each year. The resulting economic burden is estimated at dollar

600 million a year. The problems of chemical contamination is also prevalent in India

with 1,95,813 habitations in the country are affected by poor water quality. The major

chemical parameters of concern are fluoride and arsenic. Iron is also emerging as a

major problem with many habitations showing excess iron in the water samples.1

Geographic information systems of sanitation, sewage, water contamination,

water storage has been estimated that diarrhea morbidity can be reduced by an average

of 6-20 per cent with improvements in water supply and by 32 per cent with

improvements in sanitation. In India, approximately 72.7 per cent of the rural

population does not use any method of water disinfection and 74 per cent have no

sanitary toilets5.

Open air defecation, a common practice among villagers, may lead to

contamination of the water supply system and result in outbreaks of diarrhoeal

disease. The practice of tethering animals close to human dwellings and the

consequent proximity to animal faecal matter further enhances the risk of

contamination of drinking water. The key to providing microbiologically safe drinking

water lies in understanding the various mechanisms by which water gets

contaminated, and formulating interventions at critical points to decrease and prevent

contamination of drinking water6.

6.1 NEED FOR THE STUDY

In India, investments in community water supply and sanitation projects have

increased steadily from the 1st plan to the 10th plan. However, the health benefits in

terms of reduction in waterborne disease have not been commensurate with the

investments made. Though health sector is bearing the burden of water and sanitation

related infectious diseases, presently it does not have adequate institution or expertise

for monitoring and surveillance of community water supply programmes in the

country. However, awareness, surveillance, monitoring and testing, mitigation

measures, availability of alternate water sources and adoption of hygienic practices

continues to remain roadblocks. There is a need to promote sanitary inspection along

with the community based water quality monitoring and surveillance at the grass root

level as a mechanism to identify problems and to take corrective measures7.

Survey was conducted by Arghyam covered 17,200 households in 172 gram

panchayats in Bangalore, high fluoride and nitrate levels in drinking water, dismal

sanitation with rampant open defecation, high incidence of chikungunya, and a higher

risk of fungal and other infections in women. These are some of the key findings of

Arghyam, a survey of household water and sanitation in rural Karnataka, conducted

by Arghyam, an organization working in the water sector. the result of a survey

covering 28 districts in the State all districts except Bangalore Urban found that 87 per

cent of households depended on groundwater. Although 78 per cent reported

availability of drinking water throughout the year, a majority of the remainder samples

said they procured water from unprotected sources8.

The study explored that quality of water sources tested in the villages on 2,114

samples, 60 per cent were found to have high fluoride levels, it is more than one ppm

of the Bureau of Indian Standards norm on permissible fluoride. While 20 per cent of

the sources tested positive for nitrate contamination, 38 per cent had bacteriological

contamination. The survey pointed out that 72 per cent of people still defecated in the

open and the figure was as high as 98 per cent in Raichur district8.

The study results also suggest that India’s sanitation problems lie not just on the lack

of facilities or funding, but on cultural attitudes and behavior towards hygiene. In the

areas where open defecation is the norm, such as in many large Hindi states, people

must make a radical shift in their cultural practice of disposing human waste and learn

to take charge of their water supply and sanitation needs, without waiting for the

government to provide everything. In many poor slums and rural villages, it is

difficult to convince people to stop open defecation and try using indoor facilities,

along with other hygienic practices e.g., washing of hands, safe preparation of food. A

combination of factors traps them into this practice, including tradition, lack of

awareness about the importance of sanitation, and misconceptions about the costs

involved9.

6.2 REVIEW OF LITERATURE:

The report Asia Water Watch 2015 projected that India will likely achieve its

millennium development goals sanitation target in both urban and rural areas if they

continue expanding access at their 1990–2002 rates. By 2015, the percentage of

people in urban areas served by improved sanitation is expected to reach 80%, up

from 43% in 1990. In rural areas, the projection is 48%, an incredible improvement

over the coverage rate of just 1% in 1990. In real numbers, that means more Indians

will have improved their sanitation situation from 1990 to 2015 than the total number

of people currently residing in the United States—quite an achievement.10

Recent progress, access to improved sanitation remains far lower in India An

estimated 55% of all Indians, or close to 600 million people, still do not have access to

any kind of toilet.5 Among those who make up this shocking total, Indians who live in

urban slums and rural environments are affected the most.11

The study described that in rural areas, the scale of the problem is particularly

daunting, as 74% of the rural population still defecates in the open. In these

environments, cash income is very low and the idea of building a facility for

defecation in or near the house may not seem natural. And where facilities exist, they

are often inadequate. The sanitation landscape in India is still littered with 13 million

unsanitary bucket latrines, which require scavengers to conduct house-to-house

excreta collection. Over 700,000 Indians still make their living this way.12

Sewerage systems, if they are even available, commonly suffer from poor

maintenance, which leads to overflows of raw sewage. Today, with more than 20

Indian cities with populations of more than 1 million people, including Indian

megacities, such as Kolkata, Mumbai, and New Delhi, antiquated sewerage systems

simply cannot handle the increased load. In New Delhi alone, existing sewers

originally built to service a population of only 3 million cannot manage the

wastewater produced daily by the city’s present inhabitants, now close to a massive 14

million. 13

As of 2003, it was estimated that only 30% of India’s wastewater was being treated.9

Much of the rest—amounting to millions of liters each day—find its way into local

rivers and streams. According to the country’s Tenth Five-Year Plan, three-fourths of

India’s surface water resources are polluted, and 80% of the pollution is due to sewage

alone.14

The impacts on human health are significant. Unsafe disposal of human excreta

facilitates the transmission of oral-fecal diseases, including diarrhea and a range of

intestinal worm infections such as hookworm and roundworm. Diarrhea accounts for

almost one fifth of all deaths nearly 535,000 annually among Indian children under 5

years.12 Also, rampant worm infestation and repeated diarrhea episodes result in

widespread childhood malnutrition.15

Religion-based differentials are also significant. Hindu households have the lowest

percentage of households with a toilet (41%), followed by Muslim households (60%).

Christian and Sikh households fare much better, at 70% and 74% respectively. It is

also worth noting that, of the ten poor performing states listed above, eight of them

have Hindu populations exceeding 88% of their total populations. Hindus account for

80.5% of the total population in India.16

According to study conducted by united nation international child welfare fund unless

immediate action is taken, the number of people without adequate sanitation will

climb to more than 4.5 billion in just 20 years. Diarrhoeal dehydration claims the lives

of nearly 2 million children every year and has killed more children in the last 10

years than all the people lost to armed conflict since World War II. Bacteria, viruses

and parasites are common environmental hazards linked to poor sanitation, and they

cause diarrhea, one of the two most deadly diseases in developing countries. A study

in Burkina Faso showed that children’s risk of being hospitalized with severe diarrhea

increased 30 to 50 per cent when their stools were not discarded safely. Infestation

with parasitic worms (helminths) is another major health problem stemming from

unsanitary conditions. Children in developing countries commonly carry up to 1,000

hookworms, roundworms and whipworms at a time, which can cause anemia and

other debilitating conditions. 17

A major responsibility for achieving the Millennium Development Goals in sanitation

by 2015 rests with the countries in the South Asia region. The baseline for sanitation

coverage here has been well below the average for the world 20% compared to a

global figure of 49% in 1990 and subsequent progress has also been very slow. A

significant proportion of the 2.6 billion people in the world who do not use improved

sanitation live in South Asia. While open defecation has declined worldwide to 17%,

in South Asia it remains as high as 44%. The urban to rural disparities are also high –

seven out of ten people without improved sanitation facilities reportedly live in rural

areas in the region. It is not that countries in South Asia have not been doing anything

about the crisis; rather, it is that what is being done is often inadequate and not always

appropriate. Governments may have been overly policy-centric with relatively little

effective action taking place on the ground. 18

A study conducted on poor sanitation, fecal-oral contamination and diarrhea in

children under five in India. Nearly half of humanity 2.5 billion people in the world

lives without access to adequate sanitation. Out of which 650 million people live in

India. Almost one out of two persons lives without a toilet in India.(UNICEF2009)

The study results shows that more than80 percent of the cases of diarrhea worldwide

of faecal oral contamination. 19

6.3 STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE ON

SANITATION AMONG PEOPLE OF BANDI HATTI RURAL AREA AT

BELLARY DISTRICT.

6.4 OBJECTIVES OF THIS STUDY

To assess the knowledge on sanitation among the people.

To assess the practice on sanitation among the people .

To correlate the knowledge and practice on sanitation among the people.

To determine the association between knowledge and practice score on

sanitation with selected socio demographic variables.

6.5 Hypothesis

There is no significant association between knowledge and sanitation

among people of bandi hatti rural area bellary district.

6.6 Assumption

The people may have inadequate knowledge on sanitation.

The rural people may not practice safe sanitation because of inadequate

knowledge.

Knowledge and practice on sanitation will have influence with Socio

demographic variables.

6.6 OPERATIONAL DEFINITIONS OF TERMS

Assess

It refers to measure the level knowledge and practice on sanitation which is measured

through the interview questionnaire prepared by the researcher.

Knowledge

In this study knowledge refers to the correct responses of people to the item on the

knowledge interview questionnaire regarding sanitation.

Practice

In this study practice on sanitation refers to the people of bandi hatti rural area bellary

district people practice sanitation in day to day life.

People

In this study people refers to people who are residing at bandi htatti rural area bellary

district.

Sanitation

It refers to provision of facilities and services for the safe disposal of wastes such as

basic sanitation, environmental sanitation, food sanitation, and ecological sanitation.

6.7 DELIMITATIONS:

The sample size is limited to 60 samples.

The Study design is descriptive design method.

The study duration is only 4-6 weeks

7. MATERIALS & METHODS:

7.1 RESEARCH METHOD:

The research method used for this study is descriptive method.

7.2 RESEARCH DESIGN:

The research design adopted for this study is descriptive design.

7.3 SETTING OF STUDY:

The study will be conducted among people of bandi hatti rural area at bellary

district.

7.4 POPULATION:

In this study the population comprise of people residing in bandi hatti rural area at

bellary district.

7.5 VARIABLES:

INDEPENDENT VARIABLE

Independent variable is the presumed cause of the resulting effect on the

dependent variable. In the present study the independent variable is sanitation.

DEPENDENT VARIABLE

Dependent variable is the variable that the researcher is interested in

understanding, exploring or predicting. In present study the dependent variable is level

of knowledge and practice of people regarding sanitation

Extraneous variables

The extraneous variables in this study are age, sex, family income, educational

status, religion, and type of residence etc.

8 METHOD OF DATA COLLECTION:

8.1 SAMPLING TECHNIQUE:

The sample of the study will be selected by convenient sampling technique

method.

8.2 SAMPLING SIZE:

In this study the sample size will be 60 people belong to bandi hatti rural area

bellary district.

8.3 INSTRUMENT USED:

Structured questionnaires that consist of two sections:

Section A: Socio demographic variables consists of age, sex, family income,

educational status, religion, and type of residence etc.

Section B: A structured interview questionnaire will prepared to assess the

knowledge and practice regarding sanitation

Validity:

The content validity of the tool will be ascertained in consultation with

guide and experts in community health nursing.

Reliability:

The reliability of research tool will be done by using split half technique

in deviation method Spearman Brown prophecy formula and prior to the study written

permission will be obtained from the concerned authority.

8.4 CRITERIA FOR SELECTION OF SAMPLE:

INCLUSION CRITERIA

Both male and female residing at bandi hatti Bellary

The people above age group between 18-60 years

People who can understand and speak Kanada and English

People who are willing to cooperate with the study.

EXCLUSION CRITERIA

The people who are not available during data collection

The people who are not willing to participate in study.

The people who are not a permanent resident of banti hatti Bellary.

8.5 DATA ANALYSIS METHOD

Section A: Data analysis will be done by using description and

inferential statistics mean, median, frequency and percentage distribution will

be used for descriptive data analysis.

Section B: A chi square test will be done to find out the association

between the mean knowledge score and practice on sanitation with the selected

demographic variable.

8.6 DOES THE STUDY REQUIRE ANY INTERVENTION OR

INVESTIGATION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMAN OR ANIMALS

YES

Only a prepared assessment interview questionnaire will be used and no other in

varies physical or laboratory procedures will be done on the samples.

8.7HAS ETHICAL CLEARANCE BEEN OBTAINED

YES

1) Confidentiality and anonymity of the subject will be maintained.

2) Consent will be obtained from the samples regarding their willingness to

participate in the study.

3) A written permission from concern authority will be obtained.

9. BIBILOGRAPHY

1.Indira Khurana and Romit Sen, WaterAid , www.wateraid.org Drinking water

quality in rural India: Issues and approaches

2.Sarkar R, Prabhakar AT, Manickam S, Selvapandian D, Raghava MV, Kang G, et

al. Epidemiological investigation of an outbreak of acute diarrhoeal disease using

geographic information systems. Trans R Soc Trop Med Hyg 2007; 101 : 587-93.

3. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation.

Meeting the MDG drinking water and sanitation target: a mid-term assessment of

progress. World Health Organization, Geneva and United Nations Childrens Fund,

New York; 2004.

4.World Health Organization and UNICEF. Progress on Drinking Water and

Sanitation: Special Focus on Sanitation

5. World Health Organization. Water Sanitation and Hygiene Links to Health Facts

and Figures. Geneva, World Health Organization; 2004. Available from:

http://www.who.int/water_sanitation_health/factsfigures2005, Accessed on November

14, 2007.

6.Bora D, Dhariwal AC, Jain DC, Sachdeva V, Vohra JG, Prakash RM, et al. V.

cholerae O1 outbreak in remote villages of Shimla district, Himachal Pradesh, 1994. J

Commun Dis 1997; 29 : 121-5.

7.Drinking Water and Sanitation Status in India, WaterAid India, 2005

8.The hindu news paper ,Tuesday July 2009,poor sanitation in Karnataka villages,A

survey conducted by arghyam.

9. Dueñas, Christina. 2009. Country Water Action: India - Changing the Sanitation

Landscape. February. Actions/IND/Sanitation-Landscape.asp

10. Indias sanitation for all, Asian development bank,2009

11. World Development Indicators. 2006.

12. Dueñas, Christina, April 2008. Crusading for Human and Environmental Dignity.

www.adb.org/Water/Champions/pathak.asp.

13. Tigno, Cezar. April 2008. Country Water Action: India, Toilet Technology for Human

Dignity. ADB.

14. Nair, Santha Sheela. 2008. SACOSAN and India’s Experience. Presented at Third

South Asian Conference on Sanitation,18–21 November 2008 in New Delhi..

15. Boschi-Pinto, C., L. Velebit, and K. Shibuya. 2008. Estimating child mortality due

to diarrhoea in developing countries. Bulletin of the World Health Organization, 710-717.

www.who.int/bulletin/volumes/86/9/07-050054/en/index.html.

16. Census of India, 2001.

17. Sanitation for all Promoting dignity and human rights, UNICEF 2009

18. South Asian people’s perspective on sanitation Synthesis review Bangladesh,

India, Nepal, Pakistan and Sri Lanka 2010

19. Nair, Santha Sheela. 2008. SACOSAN and India’s Experience. Presented at Third South Asian Conference on Sanitation, 18–21 November 2008 in New Delhi.

10. SIGNATURE OF THE STUDENT :

11. REMARKS OF THE GUIDE : The study is feasible and

relevant is helpful for to

maintain good sanitation in

community people.

12. NAME AND DESIGNATION OF :

12.1 GUIDE NAME AND ADDRESS : Mrs. J. Lakshmi

Prof. Indian college of Nursing,

Bellary

12.2 SIGNATURE OF GUIDE :

12.3 CO – GUIDE (IF ANY) : Mrs. Glory Asha Latha

Lecturer, Indian college of

Nursing, Bellary

12.4 SIGNATURE :

12.5 HEAD OF THE DEPARTMENT : Mrs. J. Lakshmi

Prof. Indian college of Nursing,

Bellary

12.6 SIGNATURE :

13.1 REMARKS OF THE PRINCIPAL :

13.2 SIGNATURE OF THE PRINCIPAL :