I. Introduction
I.1 Background of the Study
Water is one of the basic physiologic needs of every human being. It’s usage for personal consumption such as hydration, hygiene and daily activities are the main needs that compel humans to seek water, hence the sources of these necessities are important to analyze as to their safety and sanitation. It is significant to consider its correlation to any possible widespread of water borne diarrheal diseases considering the practice and knowledge of people in the community who consume water source from untreated supplies. The selected site for study is a locale place named Palaui Island, it lies within the Cagayan Special Economic Zone, a protected area with a few conducted researches. These considerations pushed the researchers to investigate the concerns of establishing a study which will determine the knowledge of the people in the community. An evaluation of the knowledge, attitude and practices of people in the community would reflect their utilization of water. The results are meant to more clearly identify the specific needs of the community from the Island. In addition to gathering the baseline KAP data, the survey will be used as baseline information for the planning of feasible environmental health activities. The pilot design team will identify the initial environmental health problems through a series of field visits, observations and interviews.
A related study assessing the knowledge, attitude and practices of students of selected schools in Vhembe District, South Africa was conducted by providing questionnaires and inspecting the facilities of the school. The results of this study reveal that students have adequate knowledge about waterborne diseases but their knowledge about transmission of diseases was inadequate. The study also shows that the attitude and practice on hygiene was high. They also found out that the water supply and sanitation facilities were not enough in rural schools. The only water source was not enough for the whole school community (Gumbo and Sibiya, 2013).
Another study entitled “Household Hygiene Improvement Survey in Yemen: Knowledge,
Practices, and Coverage of Water Supply Sanitation, and Hygiene” was done and findings showed that the major cause of childhood morbidities, include diarrheal disease, acute respiratory infection, and parasitic diseases. The said survey evaluated the households’ environmental knowledge, attitudes/perceptions, and practices (KAP) was conducted in relation to water, sanitation, and hygiene for them to understand better specific needs of the district’s communities. It was concluded that the major contributive factor for these diseases are lack of access to safe water in at least half of the surveyed communities; improper handwashing and sanitation measures; inadequacy of community solid waste disposal practices; and general lack of awareness and information about healthy school environments and ways how to improve the environments of their local schools (Briggs, Emtinan and Keane, 2005).
Nationally, the latest report on state of water resource in the Philippines by Green Peace gathers available information regarding water resources in the Philippines, focusing on the issues of pollution, especially of drinking water and freshwater sources, and water scarcity. On the said report Region II or Cagayan Valley has the highest potential source of groundwater, while Region X or Northern Mindanao has the highest potential source of surface water. This same report projects that by year 2025, water availability deficit would take place in several river basins such as in Pampanga and Agno, in Pasig-Laguna, in Cagayan Valley, all other regions in Luzon, in Jalaur and Ilog Hilabangan, and in the island of Cebu in Visayas. (Greenpeace Southeast Asia, October 2007)
I.2 Statement of the Problem
Ensuring safe drinking water remains a big challenge in developing countries where waterborne diseases cause burden in many communities. A major challenge is limited knowledge, misinformation and attitudes that work against ensuring that drinking water is safe. The problem of the study is that what is the current status with regards to the knowledge, attitudes and practices of a fishing community in Palaui Island Barangay San Vicente, Sta. Ana, Cagayan concerning water safety and sanitation particularly the collection, treatment and storage of drinking water. Furthermore, this we will also examine the role of solid waste disposal and other potential sources of contamination in water safety.
I.3 Objectives of the study
The general objective of the study is to gain a better understanding of current knowledge, attitudes and practices of households in Palaui Island, in relation to water safety, sanitation and hygiene.
Specifically, the study aims: 1. To determine the demographic and socio-economic profile of the respondents 2. To evaluate existing local knowledge, practices and attitude concerning water safety, sanitation and hygiene. 3. To determine the health status of the community particularly in water safety, sanitation and hygiene. 4. To identify potential sources of water contaminants
I.4 Conceptual Framework INPUT PROCESS OUTPUT
Identification of weak points and gaps in existing local knowledge, practices and attitude concerning water safety and sanitation
Significant results on microbial water analysis (laboratory exams and health records)
KAP Assessment: 1. Initiation of pilot work 2. Survey tools—interview questionnaires
1st component: Demographic and socioeconomic profile
1. Age 2. Sex 3. Gender
4. Level of Education
6. Tribe 7. No. of Children
8. Source of Income
2st component: Assessment of the study population concerning water safety and sanitation
1.Knowledge
2. Attitude
3.Practice
1.
Research Paradigm
I.5 Research Paradigm
SUBJECTS:
Knowledge
Attitude
Practices
I.6 Scope and Delimitation
This study will focus mainly on the existing local knowledge, attitude and practices of the study population (N= estimated 50 households) concerning water safety and sanitation. The knowledge component will cover water utilization, consumption, storage, treatment and contamination; and water borne diarrheal disease. As for attitude, it will center on powerlessness, ownership, involvement and relevance. For practices it will tackle solid waste management; collection, storage and treatment; and hand washing practices. Knowledge, attitude and practices
Water borne disease will exclusively focus on water diarrheal diseases defined as the passageway of three or more loose or liquid stools per day or more frequent passage than is normal for the individual. Clinical types of diarrhea is acute watery diarrhea which lasts several hours or days, acute bloody diarrhea called dysentery and persistent diarrhea lasts 14 days or longer.
I.7 Operational Definition of Terms
I.7.1 Water supply - water use for consumption either be rain water, ground water ( e.g. springs, and wells,) and surface water ( e.g. lakes and ponds, streams and impoundments, rivers)
I.7.2 Water sources- classified into 3 levels, level 1 point source, level 2 communal faucet system of standposts, level 3 water works system or individual house.
I.7.3 Water Quality- measured based on chemical constituent can be broadly categorized as desirable, acceptable and unacceptable.
I.7.4 Water consumption- typical water needs for personal use and for various activities.
I.7.5 Knowledge - the information, understanding or skill that is acquired from education or experience.
I.7.6 Practices - activities that are done often or regularly.
I.7.7 Attitude - a settled way of thinking or feeling about something.
I.7.8 Hygiene - conditions and practices that are done to keep one clean to maintain good health
I.7.9 Sanitation - promotion of hygiene and prevention of disease by maintaining sanitary conditions
I.7.10 Likert scale - rating scales that are developed used to measure attitudes directly by asking people to respond to series of questions and statements in terms of the extent to which they agree with them.
I.7.11 Powerlessness -measures the respondent’s sense of control over water sources and stand on issues like changes in water use policies.
I.7.12 Relevance-centers on social applicability and bearing
I.7.13 Deference-evaluate the degree of the respondent’s disposition or tendency to comply with government interventions/policies
I.7.14 Involvement- gauges the respondent’s sense of concern and inclusion on subjects involving water problems
II. Review of Related Literature
II.1 Water as primary resource and Water-borne diseases
“Water sustains life and health”- quoted from the World Health Organization Director-General Dr. Margaret Chan during her keynote address at the Budapest Water Summit. Doctor Chan further emphasized that there various ways by which water, sanitation, and hygiene interact with health. On the most direct level, water can be the vehicle for the transmission of a large number of pathogens.
Pollution of our water resources such as untreated wastewater discharges affects human health through the spread of disease-causing bacteria and viruses. Examples of diseases that may spread through improper wastewater discharge are gastro-enteritis, diarrhea, typhoid, cholera, dysentery, and, recently, Severe Acute Respiratory Syndrome (SARS) (PEM, 2003).
The global picture of water and health has a strong local dimension with some 1.1 billion people still lacking access to improved drinking water sources and some 2.4 billion to adequate sanitation. Today we have strong evidence that water sanitation and hygiene-related diseases account for some 2,213,000 deaths annually and an annual loss of 82,196,000 Disability Adjusted Life Years (DALYs) (Bos, 2004). Moreover, several studies have confirmed that water-related diseases not only remain a leading cause of morbidity and mortality worldwide, but that the spectrum of disease is expanding and the incidence of many water-related microbial diseases is increasing. Since 1970, several species of microorganism from human and animal feces and from environmental sources, including water, have been confirmed as pathogens. Examples include Cryptosporidium, Escherichia coli O157 (E. coli O157), Rotavirus, and Norovirus (www.who.int/water_sanitation_health/emerging /emerging . pdf).
Bradley (White et al., 1972) developed the first environmental classification for water-related diseases introducing the very important category of water-washed diseases whose transmission is facilitated by insufficient quantities of water (regardless of its quality) for personal and domestic hygiene; in addition to the other three classifications of water-borne diseases according to their mode of transmission namely; water-borne diseases, water-based diseases and water-related diseases. In water-borne diseases, the agent of the disease is found in water which is drunk by the host so that infection is spread through water supplies, although it is not the only way of transmission. Water-based diseases /non-fecal contamination involve worm infections having agents spending part of their life cycles in an aquatic organism, then goes out of the intermediate host and swim in water until it finds a suitable host. Water-related diseases are spread through vectors that depend on water such as mosquitoes that breed in water. In connection to this, Table 1 (Unitary Environmental Classification of Water- and Excreta-Related Diseases) of the study entitled “Water-borne diseases and access to safe water for Sub-Saharan Africa populations” showed that Vibriocholerae, Escherichia coli, Salmonella, Amoeba, and Cryptosporidium are some of the pathogens identified under feco-oral waterborne and water-washed diseases. On the other hand, leptospirosis, schistosomiasis and fasciolopiasis are some diseases caused by pathogens recorded on the category water-based diseases.
In developing countries 4/5 of all the illnesses are caused by water-borne diseases, with diarrhea being the leading cause of childhood death (lenntech.com/library/diseases/diseases/waterborne-diseases.htm). Statistically, 88% of diarrhea cases worldwide are linked to unsafe water, inadequate sanitation or insufficient hygiene (Centers for Disease Control and Prevention, USA, 2012). In addition, UNICEF further revealed that poor water, sanitation and hygiene conditions lead to diarrhea which is one of the major causes of deaths among children below five years old. Moreover, long-term exposure to an unsanitary environments due to poor sanitation access and not hand washing with soap can also cause stunting, which impacts brain development and could lead to very poor educational outcomes. Lastly, intestinal worm infection rates in the Philippines go up to as high as 67 per cent—higher than most countries in Southeast Asia.
II.1.1 Types of diarrheal disease according to World Health Organization (WHO):
There are three clinical types of diarrhea:
a.Acute watery diarrhea – lasts several hours or days, and includes cholera
b. Acute bloody diarrhea – also called dysentery; and
c.Persistent diarrhea – lasts 14 days or longer.
II.2 State of water system in rural areas
According to the “2005 Little Green Data Book” of the World Bank, one out of five Filipinos does not obtain water from formal sources. Only 77 percent of the rural population and 90 percent of those in urban areas have access to an improved water source while only 44 percent have direct house connections. Those without house connections access water from wells, springs, communal faucets, and/or from small scale informal providers (Madrazo, A., 2002).
Designation of water system in one place is determined by the quantity of water needed by the population. It must supply all the demands of all the consumers. In the Philippines, water service levels are classified into three types. Level I (Point source) facility is appropriate in rural areas where houses are few and most people are after an inexpensive water source. In this type of water service where no distribution systems are used, a protected well is provided or a developed spring is utilized. This water system can only serve an average of 15 households within 250 meters radius. On the other hand, level II (Communal Faucet System or Stand Posts) is composed of source, reservoir, piped distribution network and communal faucets. In this type, consumers still obtain water from the common supply point (communal faucet). Lastly, level III (Waterworks System or Individual House Connections) is the type appropriate to overpopulated urban areas. It includes a source, reservoir, piped distribution network and individual household taps hence, there is no need for the consumers to go to the water source (Water Partnership Program, 2012).
In the Philippines, there are different classifications of water source. These can be rainwater, surface water or groundwater. In rural areas, the preferred water source is groundwater, a part of rainwater which penetrated to the ground surface, forming aquifers. It is often clear and free from organic matter and bacteria because the soil filters the water upon penetration. Types of groundwater includes spring, well and infiltration galleries or wells (Water Partnership Program, 2012).
A well is a dug, driven or drilled hole for the purpose of extracting ground water. Nowadays, it is still used as a water source in some parts of the Philippines especially in farms and rural areas (Water Partnership Program, 2012). It can be classified in 3 groups based on design and construction methods as to driven, drilled and dug. Driven wells are simple and economical, and can be of two types; the hand-driven wells (constructed 30 ft deep) and machine- driven wells (constructed 50 ft deep or more). In this type of well, only shallow water can be tapped and since they are not sealed with grouting material, they can be easily contaminated. On the other hand, constructing drilled wells requires rotary- drilling machines or cable tool thus, can be up to more than 1,000 ft deep. In here, a grouting material (neat cement or bentonite clay) seals the spaces around the casing of drilled wells to prevent contamination. Lastly, dug wells, the simplest of the three, are dug using hand shovel. They are covered with stones, bricks, or tile to prevent the soil from collapsing. Since it is shallow and does not have casing, it is susceptible to contamination. Moreover, a dug well also dries during drought seasons (Wellowners.org).
Water wells can also be classified based on the aquifer tapped as to shallow, deep and artesian wells. In shallow wells, source of water is near the ground surface (less than 20 meters deep) thus, easily contaminated. Furthermore, water supply capacity is also unreliable and sometimes intermittent because water supply is dependent on seasonal rainfalls. Moreover, deeper wells are constructed more than 20 meters deep hence, less susceptible to contamination. Lastly, artersian wells are like deep wells but the water extracted is from a confined aquifer (Water Partnership Program, 2012).
Island states/communities depend, as other mainland countries, upon the quality and quantity of their water for existence and economic activities. However, in islands, water management is unique as it is constrained by the size of the island, isolation from the mainland, fragility, and limited human, natural and financial resources (Pacific Islands Forum, 2005; Khaka, 1998).
Islands, although different in many features such as size, isolation, geology and topography, climate and hydrology, economic development, etc., share common water-related problems and challenges. The size of islands limits the availability of resources, including water resources. Limited resources (such as water resources) mean that any resource development in islands require sustainable management approach (Kadiman et al).
III.3 Palaui Island
Palaui is an island that lies off the northwestern part of a large promontory in San Vicente, in the municipality of Santa Ana, Cagayan province. It is 10 kilometres (6.2 mi) at its longest and about 5 kilometres (3.1 mi) at its widest and of moderately high altitude. Moreover, it is within the Cagayan Special Economic Zone and Freeport and was declared a marine reserve under Proclamation No. 447, issued on Aug. 28, 1994.
The major source of water in Punta Verde, a sitio at Palaui Island, is dug wells. Other water source in the island is the Barangay Water and Sanitation Association (BAWASA) which supplies only 30% of the population of sitio Punta Verde.
IV.4 Water quality and standards
It is a basic human right of the people to have an access to safe drinking water. A safe drinking water is essential for the promotion and protection of public health. Hence, standards on water supply prevents occurrence of waterborne diseases and reduces the possibility of the individuals to be exposed to chemical and physical hazards that could be ingested through contaminated drinking water.
III. Methodology
III.1 Research design
Descriptive study design will be utilize to allow the researchers to investigate the events that will assess the possible cause and effect relationships on knowledge, attitude and practices on water usage, consumption and utilization of the subjects to their hygiene and sanitation. Furthermore, this design will test to will evaluate the available water sources in the community and associate it to possible diarrheal diseases.
III.2 Sampling Design
Cluster sampling will be used as the sampling design for the research study.
III.3 Sampling Population
The respondents of the study are the fishing community in Palaui, San Vicente, Sta. Ana, with the total of 50 households. The head of the household will answer the given survey questionnaire.
III.4 Locale of the Study
The research study will be conducted in Punta Verde, Palaui island, San Vicente, Sta. Ana, Cagayan. A protected area under the Cagayan Special Economic Zone.
III.5 Data Collection
Primary data will be obtained from the subjects using devised questionnaires that will evaluate their Knowledge, Practices and Attitude towards water usage and storage. The questionnaire is devised to follow the likert scale which provides options for the respondents (Strongly agree, Agree, Undecided, Disagree, Strongly disagree).
III.6 Statistical Analysis
Descriptive data analyses using Statistical Package for the Social Sciences, SPSS® version 18 with 0.05 as the level of significance. The assessment of knowledge and practices was designed following likert scale, and the data collected from the respondents will be analyze using F-test ( ANOVA) to test the homogeneity of answers, and T-test in Independent means ( testing the significant difference between two variables).
V. Works cited
Journals and books
Al-Medhwahi, Emtinan, Catherine Briggs, and Susan Keane. September 2005. Household Hygiene Improvement Survey in Yemen: Knowledge, Practices, and Coverage of Water Supply Sanitation, and Hygiene. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates Inc.
Gumbo, J. and Sibiya, J. 2013. Knowledge, Attitude and Practices (KAP) Survey on Water, Sanitation and Hygiene in Selected Schools in Vhembe District, Limpopo, South Africa. International Journal of Environmental Research and Public Health ISSN 1660-4601
Kadiman, T. a.-T. (The Center for Clean Technology and Environmental Policy). Water Management on Islands – Common Issues and Possible Actions. 1-30.
Merriam- Webster . (2014). "Knowledge". Retrieved March 30, 2014, from http://www.merriam-webster.com/dictionary/knowledge.
Merriam- Webster . (2014). "Practice". Retrieved March 30, 2014, from http://www.merriam-webster.com/dictionary/practice.
Merriam- Webster . (2014). "Hygeine". Retrieved March 30, 2014, from http://www.merriam-webster.com/dictionary/hygiene.
Merriam- Webster . (2014). "Sanitation". Retrieved March 30, 2014, from http://www.merriam-webster.com/dictionary/sanitation.
Internet
Chan, M. (2013). WHO Director-General addresses Budapest Water Summit. Retrieved from http://www.who.int/dg/speeches/2013/water_sanitation/en/
Coliform Bacteria in Drinking Water Supplies. (2011, June). Retrieved March 18, 2014, from Healthy New York: http://www.health.ny.gov/environmental/water/drinking/coliform_bacteria.htm
Defensor, M. Philippine Sanitation Sourcebook and Decision Aid. Retrieved from http://esa.un.org/iys/docs/san_lib_docs/Philippines_sanitation.pdf
Department of Health. Philippine National Standards for Drinking Water 2007.
J. Bartram, J. C. (2003). Heterotrophic plate counts and drinking-water safety: The significance of HPCs for water quality and the human health. Retrieved March 18, 2014, from World Health Organization: http://www.who.int/water_sanitation_health/dwq/hpc/en/
Oxford University Press. (2014). "Attitude". Retrieved March 30, 2014, from http://www.oxforddictionaries.com/us/definition/american_english/attitude
Saul McLeod. (2008). "Likert Scale". Retrieved March 30, 2014, from http://www.simplypsychology.org/likert-scale.html
Pacific Islands Forum, (2005), “Pacific Cooperation Plan - Preliminary Sector Analysis for Water, Sanitation and Hygiene”, www.sopac.org/tiki/tiki-download_file.php?fileId=417
Salaam- Blyther, T. (2010). Global Access to Clean Drinking Water and Sanitation: U.S. and International Programs. Retrieved from https://www.fas.org/sgp/crs/misc/R42717.pdf
Spanou, A. (2011). Water-borne diseases and access to safe water for Sub-Saharan Africa populations. Retrieved from http://crisis.med.uoa.gr/elibrary/WATER-%20BORNE%20DISEASES%20AND%20ACCESS%20TO%20SAFE%20WATER%20FOR%20SUB-SAHARAN%20AFRICA%20POPULATIONS.pdf
UNICEF (2003). Water, Sanitation and Hygiene. Retrieved from http://www.unicef.org/wash/index_wes_related.html
Water Partnership Program, (2012). "Rural Water Supply Volume I Design Manual" Wellowner.org, "Types of Wells", http://wellowner.org/basics/types-of-wells/
World Health Organization, 2010. Water Sanitation. Retrieved from www.who.int/water_sanitation_health/emerging /emerging . pdf
VI Appendices
VI.1 Dummy Table
VI.2 Questionnaire
VI.3 Letters/ Communication
VI.4 Proponents’ Profile
VI.5 Time line
VI.6Procedure
VI.7 Certificate
