Effectiveness Of Health Education In Prevention Of Diarrhea Among The Refugees In Osire Refugee Camp, Namibia

TABLE OF CONTENT PAGES

DECLARATION ……………………………………………………………… i

DEDICATION ……………………………………………………………....... ii

ACKNOWLEDGEMENT ……………………………………………………. iii

LIST ABBREVIATIONS …………………………………………………….. iv

LIST OF TABLES …………………………………………………………….. x

LIST OF FIGURES …………………………………………………………… xi

ABSTRACT ……………………………………………………………………. xii

CHAPTER 1: Rationale and background ………………………… 1

1.1 Introduction ……………………………………………………………. 1

1.2 Formulation of the problem …………………………………………… 1

1.2.1 Background to the problem …………………………………………… 1

1.2.2 Problem statement …………………………………………………….. 7

1.2.3 Research question …………………………………………………….. 7

1.3 Purpose and objectives of the study …………………………………… 7

1.4 Significance of the study ………………………………………………. 8

1.5 Ethical considerations ………………………………………………… 8

1.6 Operational definitions ………………………………………………. 9

1.7 Summary ……………………………………………………………….. 10

CHAPTER 2: Literature review and conceptualization …………. 11

2.1 Introduction ……………………………………………………………. 11

2.2 Conceptualization of the study ……………………………………….. 11

2.3 Selection of CHPs…………………………............................................. 15

2.4 Training Curriculum for CHPs ……………………………………….. 15

2.5 Training of CHPs……………………………………………………….. 16

2.6 Concept of health education …………………………………………… 17

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2.6.1 Some misunderstanding about health education …………………….. 18

2.6.2 Improving health education ………………………………………….... 19

2.7 Water and sanitation ………………………………………………….. 20

2.7.1 Sources water contamination …………………………………………. 21

2.7.2 Excreta disposal ……………………………………………………….. 22

2.7.3 Social and cultural beliefs …………………………………………….. 24

2.7.4 Advantages of pit latrines ……………………………………………… 25

2.7.5 Pit latrines and public hygiene ………………………………………… 25

2.7.6 Prevention measures for diarrhea control ……………………………. 26

2.7.7 Domestic refuse disposal ………………………………………………. 27

2.8 Food as a source of infection …………………………………………... 28

2.9 Community participation ……………………………………………… 29

2.10 Summary ……………………………………………………………….. 30

CHAPTER 3: Research design and methodology ………………….. 32

3.1 Introduction ……………………………………………………………… 32

3.2 Research design …………………………………………………………. 32

3.3 Study area ……………………………………………………………….. 32

3.4 Study population and sample ………………………………………….. 32

3.5 Sampling …………………………………………………………………. 33

3.6 Development of research instruments …………………………………. 35

3.7 Pilot study ……………………………………………………………….. 36

3.8 Validity and reliability of the research instruments ………………….. 37

3.8.1 Validity …………………………………………………………………... 37

3.8.2 Reliability ………………………………………………………………... 38

3.9 Data collection method …………………………………………………. 39

3.9.1 Training of field workers ……………………………………………….. 39

3.10 Data processing and analysis …………………………………………… 39

3.11 Ethical consideration ……………………………………………………. 40

3.11.1 Permission to conduct a study …………………………………………. 40

3.11.2 Informed consent ……………………………………………………….. 40

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3.11.3 Voluntary participation ………………………………………………… 41

3.11.4 Confidentiality and privacy ……………………………………………. 41

3.12 Summary ………………………………………………………………… 42

CHAPTER 4: Findings of the study and discussions of results ……... 43

4.1 Introduction ……………………………………………………………… 43

4.2 Section A: Findings from household’s questionnaires …………43

4.2.1 Biographical information ……………………………………………….. 43

4.2.1.1 Age distribution of respondents ………………………………………… 43

4.2.1.2 Gender distribution ……………………………………………………... 44

4.2.1.3 Country of origin ………………………………………………………... 45

4.2.1.4 Duration of the respondents stay in the camp ………………………… 45

4.2.1.5 Educational level of the respondents ………………………………….. 46

4.2.2 Availability of CHPs in Osire refugee camp …………………………… 46

4.2.3 Households visited by CHPs …………………………………………… 47

4.2.4 Teaching done by CHPs ……………………………………………….. 47

4.2.4.1 Teaching about washing hands each time after having used the latrine 48

4.2.4.2 Teaching about washing hands before preparing food and eating …. 49

4.2.4.3 Teaching people to use pit latrine for defaecation ……………………. 50

4.2.4.4 Teaching people to dispose of childre’s faeces into a pit latrine …….. 50

4.2.4.5 Teaching people to bury faeces of infants …………………………….. 50

4.2.4.6 Teaching people to store water in jerry cans with lids ………………. 51

4.2.4.7 Teaching people to collect drinking water in jerry cans with lids ….. 52

4.2.4.8 Teaching people to store food in cooking pots kept on food rack …… 53

4.2.4.9 Teaching people to cover food to prevent flies ……………………….. 53

4.2.5 Teaching methods used ………………………………………………… 54

4.2.5.1 Individual teaching …………………………………………………….. 54

4.2.5.2 Focus Group Discussion ……………………………………………….. 54

4.2.5.3 Using leaflets and posters ……………………………………………… 55

4.2.5.4 Block meetings …………………………………………………………. 55

4.2.5.5 Teaching done through other means …………………………………. 55

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4.2.6 Availability of water …………………………………………………… 56

4.2.6.1 Households with access to water ……………………………………… 56

4.2.6.2 Water collected with buckets and basins ……………………………. 57

4.2.7 Availability of pit latrines …………………………………………….. 58

4.2.7.1 Cleaning of shared latrines …………………………………………… 60

4.2.8 Common diseases in households ………………………………………. 60

4.2.8.1 Diarrhea as common disease ………………………………………….. 61

4.2.8.2 Beliefs about causes of diarrhea ……………………………………… 61

4.3 Section B: Findings from checklist ……………………………. 63

4.3.1 General cleanliness of households ……………………………………. 63

4.3.2 Cleanliness of kitchens and food stores ……………………………… 64

4.3.3 Water stored in covered containers ………………………………….. 64

4.3.4 Cleanliness of households’ water containers ………………………… 64

4.3.5 General cleanliness of private latrines ………………………………. 65

4.3.6 Households with refuse pits …………………………………………… 65

4.3.7 General appearance of respondents …………………………………. 66

4.4 Section C: Findings on community health promoters …………. 67

4.4.1 Biographical information ……………………………………………… 67

4.4.1.1 Age distribution of CHPs ……………………………………………… 67

4.4.1.2 Gender distribution ……………………………………………………. 68

4.4.1.3 Country of origin ………………………………………………………. 68

4.4.1.4 Educational level ………………………………………………………. 68

4.4.2 Training of CHPs ……………………………………………………… 68

4.4.3 Content of training curriculum of CHPs …………………………….. 69

4.4.4 Methods used by CHPs in teaching the community

about the prevention of diarrhea ……………………………………… 69

4.4.5 Conducting health education sessions ………………………………… 70

4.4.6 Challenges experienced during delivering health education activities.. 71

4.4.7 Duration of employment as CHPs in Osire refugee camp ……………. 71

4.4.8 Effectiveness of health education in the prevention of diarrhea …….. 72

4.4.9 Incentives for CHPs …………………………………………………….. 72

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4.5 Correlations of variables ……………………………………………….. 73

4.6 Summary ………………………………………………………………… 73

CHAPTER 5: Conclusion, Recommendations and Limitations …… 74

5.1 Introduction ……………………………………………………………... 74

5.2 Conclusions ……………………………………………………………… 74

5.3 Recommendations ………………………………………………………. 79

5.4 Study limitations ………………………………………………………… 81

5.4.1 Participation effect ………………………………………………..... 81

5.4.2 Population …………………………………………………………….. 81

5.4.3 Language barrier …………………………………………………….. 81

5.4.4 Data collection and analysis …………………………………………. 82

5.5 Final conclusion ……………………………………………………….. 82

Reference List ………………………………………………………………… 83

ANNEXURE A: PERMISSION LETTER FROM UNAM RESEASRCH COMMITTEE………… 89

ANNEXURE B: QUESTIONNAIRES …………………………………………………………………. 92

ANNEXURE C: MAP OF OTJOZONDJUPA REGION SHOWS HEALTH FACILITIES………. 115

ANNEXURE D: MAP OF OTJOZONDJUPA SHOWING OSIRE REFUGGE CAMP …………… 116