Patterns and factors associated with environmental health practices in households of rural Mozambique
2006
Analytical quantitative studies
focusing
on
health-related behaviours
as
the final outcomes are scarce, especially
in the field
of
Environmental
Health.
They have mostly focused on behaviours as risk
factors for
disease
and
have
rarely dealt with determinants of
such
behaviours.
This study examines the relationship
between
socio-economic,
psycho-social, demographic, and environmental
factors
and
Environmental
Health
practices at the household level. It further
explores,
qualitatively,
lay
perceptions of such practices and
illnesses
associated with them.
An analytical cross-sectional study, complemented
by
a qualitative
study, was the approach chosen
for this
purpose.
Fieldwork took
place
in
Manhiqa, a rural district in Southern Mozambique, from
October
2002 to
November 2003. The cross-sectional study comprised the following
data
collection methods: a socio-economic and
demographic
questionnaire,
spot-check observations, and a questionnaire
on women's
autonomy
covering
405
households, and structured observations covering
102 households.
The
qualitative study comprised 12 focus group
discussions
(involving
134
people
in total) namely with mothers, grandmothers and
fathers
of
children
under
5,
and 25 semi-structured interviews with caretakers of children
under
5.
Using factor analysis,
three
dimensions
of
wealth
(characterising
households) and five autonomy constructs
(characterising
caretakers
of children
under-5) served as the main predicting
factors that the
study sought to
explore
in relation to Household Environmental Health (HHEH)
practices.
Other
predicting factors of interest were type
and
domain
of water source, child's age,
and caretaker's age.
Prevalence of latrine ownership was
high
(95%),
and
so was soap
availability (86%). Sixty-two percent
of
households
had
access to
water
from taps (either private or public). However, hand-washing
with soap
was observed
on 6% of occasions after potential
faecal
contact, and
children's stools
were
disposed of in the latrine on 6% of occasions after open
defecation
events.
In terms of access to hygiene and
sanitation
hardware,
only caretaker's
education predicted latrine ownership,
and access to
soap
was associated
with
caretaker's education, caretaker's exposure
to information
and
socio-economic
status of the head of household.
With regards to hygiene and sanitation
practices, there
was
no strong
evidence for the influence of any of the
predicted
factors
on
hand-washing.
Socio-economic status of the head of
household
and type
of water
source
were
the only variables significantly
associated
with safe
disposal
of stools.
Infants
under 1 and children between 2
and
5
years of age were the
most
likely to
contaminate the household environment with
faeces.
Regarding mosquito deterrence practices,
it
was
found that the
likelihood that children under
5
were protected
by
any
deterrence
method
increased with increased caretaker's education and
with caretakers
decreased
proximity to maiden family. Use of traditional fumigation in the
child's
bedroom was associated with
decreased
accumulation
of
modern
assets,
increased accumulation of traditional assets,
and
increased
caretaker's
age.
Protecting children under 5 with commercially
available
products
other than
bednets was associated with caretaker's education
and
her financial
independence. Bednet use by children was
predicted
by increased head
of
household socio-economic status,
accumulation
of modern
assets, and
decreased proximity of caretaker
to
her
maiden
family.
It was also found that certain
hygiene
and
sanitation
practices are
highly
clustered and that there are greater psychosocial
connotations carried
by
sanitation practices than by mosquito
deterrence
practices.
The qualitative study revealed that, from the
study participants'
perspective, HHEH practices,
in
particular
latrine
possession status were
associated with the following factors: authority,
social commitment, value
for
self, self-reliance, self-organisation, and
completeness.
Good fortune
was
particularly related to bednet possession.
Lack
of
initiative
and modernism
were personal attributes viewed
to
be
associated
with
both
not
having bednets
and not having latrines.
Through its detailed examination
of the
associations
between individual
and household characteristics and
behaviour
outcomes this
study makes an
original contribution to our understandiing
of
how
risk and protective practices
are produced at household level.
This is
of
interest to those
who seek to
understand human behaviour from an
academic perspective
and to those
who
seek to influence it in order to improve
health
outcomes.
For
example, the
study
adds a contribution to HHEH behaviour change
initiatives,
especially those that
require criteria in order to carry out selective
targeting
of
households
according
to their social, economic, demographic, or environmental characteristics.
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