Household Hygiene Improvement Survey in Yemen: Knowledge, Practices, and Coverage of Water Supply Sanitation, and Hygiene

One mandate of the USAID-funded Partners for Health Reformplus (PHRplus) in Yemen is to design pilot interventions that focus on environmental issues impacting health. An early assessment in the Thula district, in Amran governorate, identified diarrheal disease, acute respiratory infection, and parasitic diseases as major causes of child morbidity; these ailments are caused by or related to environmental factors. A household environmental knowledge, attitudes/perceptions, and practices (KAP) survey was conducted to gain a better understanding of current knowledge, beliefs, and practices of district households in relation to water, sanitation, and hygiene so that specific needs of the district’s communities may be better understood.

Survey findings indicate a serious lack of access to safe water in at least half of the surveyed communities; a frequent lack of knowledge and protective practices related to effective handwashing and sanitation measures; the existence of householder concerns about the inadequacy of community solid waste disposal practices; and indications of a general lack of awareness and information about healthy school environments and ways to improve the environments of their local schools. As a result of the findings, pilot project activities will be initiated, in cooperation with local participants, in communities identified as most in need of a targeted. A set of cost-effective interventions including hygiene promotion, cistern rehabilitation/unprotected spring management, solid waste management/recycling, and healthy schools will be made available.

Table of Contents:

Acronyms and Glossary

Acknowledgments

Executive Summary

1. Introduction

1.1 Survey background

1.2 Survey objectives

2. The Survey

2.1 Characteristics of survey and survey instrument

2.2 Pilot testing of the survey

2.3 Survey content

2.4 Survey administration and logistics

2.5 Profile of survey sample − Communities and households

2.5.1 Head of household information

3. Survey Methods

3.1 Design

3.2 Sample

4. Results

4.1 Health − Survey results on respondent reports of illness in their family and 

      community and their perceptions on preventing/avoiding diarrhea

4.1.1 Respondents with children under 5 years of age – reports of the child having

         experienced diarrhea (a) within the past 24 hours and (b) the past two weeks

4.1.2 Respondents’ reports of illnesses in any age groups that they had heard of in their

         area within the past two weeks

4.1.3 Perceptions of the causes of the recent diseases in their area

4.1.4 Householder reports of sickness ascribed to drinking or using water from locally

         available sources

4.1.5 Perceptions on preventing/avoiding diarrhea

4.2 Water − Water sources for drinking/household uses, water transport and storage

       practices, and attitudes and community practices related to local cisterns

4.2.1 Water sources

4.2.2 Availability of main source water throughout the year

4.2.3 Practices related to how water reaches the households

4.2.4 Practices related to storage and treatment of water in the household

4.2.5 Householder attitudes and community practices related to local cisterns

4.3 Sanitation – Solid waste and human waste management

4.3.1 Solid waste practices and perceptions

4.3.2 Human waste/toilets/sewage

4.3.3 Toileting practices of under 5s in the household and disposal of toddler/small child

         stools (questions H37-38 were asked about each child under 5)

4.4 Hygiene

4.4.1 Handwashing practices

4.4.2 Perceptions of the importance of washing hands and of the role of personal hygiene

         in being healthy

4.4.3 Practices regarding food preparation and storage

4.5 Healthy Schools

4.5.1 School-age children and school attendance

4.5.2 Exploring the ideas of healthy schools with the community respondents

4.5.3 Cleaning of the local school

4.5.4 How respondents describe the roles of the school, parents, students, local leaders,

         and local council in developing/maintaining a healthy school

5. Summary of Main Points

5.1 Main survey results overall

5.1.1 Findings pointing to poor water quality

5.1.2 Findings pointing to inadequate handwashing

5.1.3 Findings pointing to inadequate community solid waste and sanitation measures

5.1.4 Findings pointing to poor conditions for healthy school environments

5.1.5 Main points of survey results in individual communities

6. Recommendations

6.1 Hygiene promotion training to combat disease

6.2 Water sources

6.3 Community hygiene

6.3.1 Solid waste management

6.3.2 Healthy schools

6.4 Summary of recommended interventions

Annex A: Maps

Annex B: Tables

Annex C. Survey Questionnaire