MEDICAL SCHOOL OF IFAKARA ( ST.

FRANCS REFFERAL HOSPITAL

)

LOGO

.
UNDERSTANDING THE CHALLENGES WHICH RISE DUE TO SANITATION AND
HYGIENE OUTCOMES IN A COMMUNITY BASED INTERVENTION IN LUMEMO
WARD SINCE 10th FEBRUARY TO 10 th JUNE 2018.

COMMUNITY FIELD WORK PROJECT

Student’s Names: EVANCE JOHN MAHUNDI

Supervisors’ Names: DR.HASSAN NJETE

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 DR.A.MOGELLA
ACKNOWLEDGEMENTS

I would like to extend my special gratitude to my almighty God who enabled me to conduct my
project, my dear parents (Mr and Mrs.John Mahundi) for supporting me morally,spiritually
materially and financially.

Particular thanks go to my supervisors Dr. Mogella and Dr. Hassan Njete ( our course
coordinator ) for their contribution in directing us during the whole period of the project. Also,
my special gratitude goes to Professor Kessy and Dr. Esther Kyungu for their guidance and
support.

Sincerely gratitude is expressed to the local government of Lumemo ward, Mr. Omar Panzi,
(community development officer) Wilfred Nanage (village executive officer), Victor Mwihava
(Ward executive officer), Modesta Nakeuri (Ward health officer), Prisca Swai (Assistant Village
Executive Officer of Ihanga Village), Mr. Mgunywa Ndegesi (Agricultural officer), Miss Johari
Nyanga for their warmly welcome, introducing us in the village and their willingness to provide
us with the information we needed.
I would also like to thanks my colleagues for their support and time they took to help me
finish and accomplish my field work .

I very much appreciate the contributions of community for their acceptance and cooperation
during the whole process of collecting data and finally my colleagues for their commitment
throughout the field work.

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 ABBERIVIATIONS

TTCIH Tanzania training center international health

WHO World health organization

UTI Urinary tract infection

HIV Human immunodeficiency virus

AIDS Acquired immunodeficiency syndrome

HHs House Holds

SDG Sustainable development goals

SSA Sub Saharan Africa

MDG Millennium development goals

MSABI Maji safi kwa afya bora Ifakara

MoHSW Ministry of health and social welfare

MKUKUTA National strategies for growth and poverty reduction in Tanzania

WASH Water Sanitation and Hygiene Programme

SFRH St.Francis Re-feral Hospital

VEO Village Executive Officer .

CHF Community Health Fund

TASAF Tanzania Social Association Fund

NIHF National Health Insurance Fund

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 TABLE OF CONTENTS
Update the entire table once all chapters are finalized.

ACKNOWLEDGEMENTS ii

ABBERIVIATIONS iii

TABLE OF CONTENTS iv

INTRODUCTION 1
Description of the community 1
LITERATURE REVIEW 1

2. Hygien and sanitation practices for toilet use 2

COMMUNITY ENTRY PROCESS 4

PROBLEMS IDENTIFICATION 5
Research questions (probe questions) 7
Secondary data; 8

PROBLEMS ANALYSIS AND PRIORITIZATION 9

Problems analysis. 9
Prioritization of problems 11

SOLUTIONS FOR HEALTH PROBLEMS/NEEDS 13

HEALTH PROMOTION INTERVENTION PLAN 14

SWOC ANAYSIS 16

CONCLUSIONS AND RECOMMENDATIONS 17

REFERENCES 18

ANNEXES 19
Questionnaire Form: 19

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Group Discussion Focus 23

EXECUTIVE SUMMARY

The field work survey we conducted in Lumemo ward which has a total number of 9368
people (men 4522 and 4841 women with 3120 man power), the most tribes founds are
wingindo, wandamba, wapogolo, wambunga and wandwewe. They mostly engage in
agriculture as their main activity but also livestock keeping, grocery and marketing
business and other small business. We also did our survey at Mahutanga which has 270
households and Ihanga with 370 households in total.
During the field survey we used different methods to Identify their main
concern, community assessment was prior to us before using our questionnaires for
baseline data, we were able to interviewed 150 people by random sampling for Lumemo,
Mahutanga and Ihanga inclusively, we then conducted two focus group discussion and
probing questions where we were able to identify the main problems to be.
Unimproved latrines and no latrines at all, poor supply of water that resulted
to disease eruption such as diarrhea, UTI, and typhoid also malaria (they don’t use
mosquito nets). Other problems were; the use of untreated water ( they don’t boil ,use
water guard or decantation process), Lack of health facilities ( dispensaries ) in the
villages in both Lumemo ,Mahutanga and Ihanga, were also reported to be community
problem since they travel far distance to Kibaoni and Michenga dispensaries for
treatment . Poor hygiene practices also affects the health of the community members and
Political crisis which leads to lack of unity among the community and the leaders
We came about different solutions and interventions for our stated problems
according to our assessed community, which were: providing awareness to the
community leaders and members by educating them about health issues such as the
importance of boiling water and use of water guard. If can’t Afford ,we recommended
the use of decantation process and three pot system , building and using improved latrines
that are long lasting and built on higher grounds , also campaign process on “ nyumba ni
choo “ and “Kula mavi sasa basi “. And lastly is follow up on the intervened solutions as
prioritized.
Lumemo, Mahutanga and Ihanga are actually filled with various
opportunities that are both provided by the government and non-government organization
such opportunity that would provide accesses to success’s to the people of Lumemo,
Mahutanga and Ihanga. Such opportunities include: land opportunity, Lumemo River for
irrigation scheme and fishing activity, man power (youth) and good leaders that are
responsible to their people.
We recommend on a thorough community assessment ( not by random
sampling),social mobilization on solving community problems through active
participation in village meeting and the local government should create and enact
by-laws that will simulate the use of toilets regularly and use of clean water in the
community mainly to reduce infections and diseases. Provision of loans to the people of
Lumemo, Mahutanga and Ihanga to be able to engage themselves on entrepreneurship
projects such as chicken rarely and agricultural activities in small community groups to

5
increase their economy and solve their daily problems also training and re-training
community on how to create toilets and how to get clean water through own resource.

6
 INTRODUCTION
Description of the community

Lumemo is a ward located in Kilombero district at Morogoro region with three villages:
Lumemo village (7 sub villages) 3km from Ifakara town, Mahutanga (6 sub villages)
4.5km from Ifakara town, Ihanga (4 sub villages) 18.5km from Ifakara town. The
distance from Lumemo to St Francis referral hospital is 3.km.
The population size distribution in Lumemo ward .
Name of the No of No of No of No of No of No of
village population households Men women children man
power
LUMEMO 9363 2198 4522 4841 2921 4000
MAHUTANGA 6144 768 2772 3372 1848 2242
IHANGA 9600 1200 4600 5000 2900 4300

The Native tribes at Lumemo are Nginda, Ndamba, Pogoro, Mbunga, and Ndwewe. The others
are Sukuma, Ngoni, Luguru, and Wanyakyusa. Main activities conducted are agriculture
(55%), fishing (25%) and business (20%).

Most people in the community of lumemo are influenced with political matters thus leading to
lack of unity and cooperation among them.

LITERATURE REVIEW

1. water supply and sanitation intervention

Water is at the center of economic and social development; it is vital to maintain health, grow
food, manage the environment, and create jobs. Despite water’s importance, over 663 million
people in the world still lack access to improved drinking water sources. However, increasing
access is not enough. The Sustainable Development Goals (SDGs) proposes a broader agenda
as set out in the draft definition. By 2030, universal and equitable access to safe and
affordable drinking water for all.

Different researches have been done to show the different factors on water supply and sanitation
intervention. Poor water supply and sanitation can cause different water borne diseases like
cholera, diarrhorea and typhoid.

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Good sanitation and clean water are basic human rights yet they remain elusive to many rural
communities in Sub-Saharan Africa (SSA). We carried out a cross sectional study to examine the
impact of a four-year intervention aimed at improving access to water and sanitation and
reducing waterborne disease, especially diarrhea in children under five years old. The study was
carried out in April and May 2015 in Busangi, Chela and Ntobo wards of Kahama District of
Tanzania. The interventions included education campaigns and improved water supply, and
sanitation. The percentage of households (HHs) with access to water within 30 min increased
from 19.2 to 48.9 and 17.6 to 27.3 in the wet and dry seasons, respectively. The percentage of
HHs with hand washing facilities at the latrine increased from 0% to 13.2%. However, the
incidence of diarrhea among children under five years increased over the intervention period, RR
2.91 95% CI 2.71-3.11, p < 0.0001. Availability of water alone may not influence the incidence
of waterborne diseases. Factors such as water storage and usage, safe excreta disposal and other
hygiene practices are critical for interventions negating the spread of water borne diseases. A
model that articulates the extent to which these factors are helpful for such interventions should
be explored.

2. Hygien and sanitation practices for toilet use

A study conducted in South Africa Jan 2016 showed that there was lack of provision of tools for
proper hygiene practice at the site of the toilet. As at the time of inspection, there was lack of
soap for hand washing after toilet use. There was unavailability of water though there was
presence of a wash-hand basin. It was also noted that the wash-hand basin was dirty. This shows
that users do not practice proper toilet hygiene which can expose users to toilet diseases such as
cholera and typhoid. They also stand the chance of contacting viral and bacterial diseases
causing numerous infections. It was also noted that there were presence of flies in the toilet
facility. The sight of flies and the irritating sounds and noise are offensive to users, thus users
tend to prefer alternative toilets. Presence of flies in the toilet facility also shows lack of adequate
maintenance. That is, it is a visible evidence of poor maintenance of the toilet facility. Houseflies
are vectors capable of transmitting deadly diseases such as cholera, typhoid fever, dysentery and
a number of other diseases. Although only one of the respondents claimed that he might have
contacted a disease from the toilet, it is a fact that there is a high tendency of users being infected
with any of the deadly diseases mentioned above.

MSABI FOUNDATION 2013 stated hand washing at critical times in Tanzania has been shown
to be a rapid and reliable indicator of general hygiene behaviour in households. Critical times
were determined to be after defaecation, after handling children's faeces, before handling food,
before feeding young children and before eating. Hand washing with soap after using the toilet
was reported at 62 % in low income urban areas. Other studies in Dar es Salaam and rural
districts of Mpwapwa and Rufiji report that only 4 % of mothers and 5 % of children wash their
hands with soap after using the toilet. A Ministry of Health and Social Welfare (MoHSW) study
in 2004 reported that only 31.3 % of latrines had hand washing facilities (Ministry of Health and

8
Social Welfare, 2011). Additionally, although soap is found commonly in the household it is
more frequently used for bathing and laundry than hand washing. In a study of women’s hand
hygiene, faecal bacteria on hands were significantly associated with the length of time since last
washing hands with soap and water. The MKUKUTA goal for 2015 is that at least 25 % of
households have hand washing facilities with soap and water (Ministry of Health and Social
Welfare, 2011)

This field work aimed to evaluate about the issues of water and sanitation as well as personal
hygiene and practices of toilet use among people who reside at Lumemo ward. It also aimed to
evaluate the distribution and the burden of diseases that were associated with poor availability of
water, sanitation and poor personal hygiene together with poor practices of toilet use. .

9
 COMMUNITY ENTRY PROCESS
We were introduced by our supervisor Dr. Njete from our college TTCIH through the formal
letter that was sent to the ward office (Date). Secondly Dr. Mogella through meeting up with
ward office leaders 19th February 2018,apart from introduction done by Dr Mogella also we
discussed about what the main problems in that society, how the problems affecting the society
and how they deal with them.

On 20th of February, around 2:30pm we were then introduced to the community through the
community meeting that was organized by council man. We then spoke at the meeting about who
we are, why we came, what we are going to do and for how long we are going to be there.
Finally, we asked for the consent which we were warmly granted.

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 PROBLEMS IDENTIFICATION
We involved the community leaders and the community in getting the information of the
problems that faced the community through:

Focus group discussion conducted between leaders and us, and the community through the
community gathering to which we were able to notice and identify that most the problems were
attributed by: health factors, social –economical factors as well political factors

The health factors are: The leaders reported that there were no dispensaries in lumemo ward
instead there is a special day for health services where women and children are given vaccines,
clinics for pregnant women, measurement weight for age and height for children. Special health
workers come from Kibaoni and St.Fransis who often provide services monthly at lumemo .They
also said that their community has both trained and traditional midwives, who are recognized by
the local government and are given equipments (such as Gloves, razor blade, scissors, syringes,
spirits,) who also disseminate information and findings at Kibaoni dispensary but not for the
traditional midwives who are now mobilized to be trained and educated.

The leaders also reported that the major diseases that affecting children include malnutrition
anemia, malaria, typhoid, pneumonia, hepatitis, diarrhea diseases (caused by people characters
behaviors). In adults it was reported that major diseases include HIV, TB, DM, Malaria, and
diarrhea diseases.

Mortality rate in children and pregnant women is due to malaria, pneumonia, diarrhea diseases
(infants less than 6 months not breastfed exclusively) and given fluids such as water from wells
and taps. At the age of two months.) Malnutrition diseases. Early pregnancy at the age of 11yrs.
Poor clinical attendance, delay in clinical visits where only 10% women do attend the clinics
without their husbands,

Generally, the community response in health services is poor and most people attend at Kibaoni
hospital. Few have joined community health funds (CHF), TASAF, NHIF. No any governmental
support to the people unable afford, instead.

In Social and political factors the leaders reported that, Poverty i.e. people are unable to afford
for their daily requirements, lack of health education, poor cultural beliefs such as early marriage
and lack of willingness of most of the youth to engage in productive activities like fishing,
farming were the main problems affecting the community. Politically, the community is facing
conflicts among different parties which leads to different ideologies, hence lack of unity and
cooperation among them.

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MALARIA 2017 2016 2015 2014 2013

JANUARY 116 713 211

MALARIA 2017 2016 2015 2014 2013

JANUARY 116 713 211

FEBRUARY 257 611 277

MARCH 188 696 290

APRIL 222 612 302

MAY 130 520 288

JUNE 154 482 265

JULY 100 523 241

AUGUST 151 824 344

SEPTEMBER 189 404 376

OCTOBER 96 233 304

NOVEMBER 182 201 242

DECEMBER 229 328 222

DIARRHOEA 2017 2016 2015 2014 2013

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JANUARY 33 26 13

FEBRUARY 15 33 17

MARCH 37 49 2

APRIL 26 25 8

MAY 18 14 10

JUNE 38 30 19

JULY 18 24 21

AUGUST 32 29 50

SEPTEMBER 28 7 24

OCTOBER 46 38 32

NOVEMBER 48 10 24

DECEMBER 57 40 23

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Above tables; Data from SFRH shows the prevalence of Malaria and Diarrhoea diseases.

Research questions (probe questions)

1. What are the advantage and disadvantage of water supply and sanitation intervention
based on the community?
2. What are the advantage and disadvantage of poor water supply and sanitation based
on the community?
3. What could be the risk factors based on water supply and sanitation in the
community.
4. How unimproved and improved latrines could affect the community health.
5. What common likely diseases do you think could erupt from poor water supply,
storage, use and sanitation process

Secondary data;

This was the data that was proved by the village local government office that came in handy to
our provided questionnaires so as to correlate the information. given by the locals in term of
population size and diseases prevalence

Name of the No of No of No of No of No of No of
village population households Men women children man
power
LUMEMO 9363 2198 4522 4841 2921 4000
MAHUTANGA 6144 768 2772 3372 1848 2242
IHANGA 9600 1200 4600 5000 2900 4300

Cross-tabulation of toilet cleanliness against education level.

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toilet cleanliness * Education level

toilet CERTIFICAT FOR FOR FOR PRIMAR UNEDUCATE TOTA

cleanliness E MI M II M IV Y D L

ADEQUAT
1 0 1 8 29 4 43
E

NONE 0 0 0 0 1 0 1

POOR 0 1 1 14 67 5 88

TOTAL 1 1 2 22 97 9 132

PROBLEMS ANALYSIS AND PRIORITIZATION

Problems analysis.
From problem identification methods conducted through focal group discussion, interviews and
questionnaires, the results obtained revealed that, the major problems facing the
community of Lumemo are;
Diarrhea, Malaria, Urinary Tract Infection, Typhoid, Respiratory diseases.

The possible causes of the above problems are;

● Lack of knowledge on hygienic practices

● Insufficient supply of water
● No or unimproved toilets
● Cultural beliefs to some of the people
● Large number of people living in the same household

Risk factors of the problems;

● Poverty
● Large number of people living in the same household

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 ● Unfavorable weather conditions eg during the rainy season most of the toilets
tends to flood out
● Poor household hygiene practices
● Poor sewage system

Attitudes of people concerning health related issues;

● Wrong perceptions concerning health education and services eg; some of the
people refused to take medication for skin diseases believing that it causes
impotence,
● Tribalism among the people mostly of Mahutanga
● Political conflicts among the people in the community
● Poor response concerning community health issues(in meetings)

Behaviors of the people concerning health issues;

● Drinking unboilled water

● People do not wash hands before eating and after visiting toilets
● Poor preparation of foods
● Prefer traditional healers rather hospital due to beliefs and costs
● Poor dispose of wastes
● The use of bushes rather than toilets

Short term consequences of the problems;

● Eruption of diseases
● loss of man power because of diseases among members of the community
● Malnutrition due to poor feeding secondary to loss of appetite at the course of
illness

Long term consequences of the problems

● underdevelopment due to luck of unit

● Death
●

Cultural practices and values are;

● Gender imbalance in decision making especially during community gathering

● Strong beliefs in traditional midwives rather than going to the hospital for
delivery
● Over-dependent in traditional herbs rather than hospital medications

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 ● False beliefs in sharing toilets between married couples with their in-laws

Solutions to the problems in the community;

● Promoting the constructions of improved latrines and in the households and farms
● Provision of health education to the midwives to prevent death of the maternal
● Motivating women of reproductive age to attend clinic to screen for cervical and
breast cancer
● Motivate the youth to recognize and utilize the available resources
● Ensuring sufficient and reliable water supply in the villages
● Provision of mosquito nets and education on its importance
● Regular follow up of hygiene practices of the household toilets by the local
government
● Consult the local government on the adherence of the community general
cleanliness apart from the national cleanliness days
● Formulation of village by-laws to ensure that community members practice
hygiene
● Special care for handicapped and the aged as a means to reduce infections and
prioritized their needs.
In terms of data collecting tools, we basically used questionnaire forms,
interviews, probing questions and focus group discussion. We found out that they
were more applicable to this community, as a way of giving us information, this
system was more effective to the leaders rather than the community members, the
response to the people were mostly women, children and elderly people (special
group). Where the total number of people who were able to attend was 40 and 25
for two different dated (26/02/2018 and 28/02/2018) focus group respectively out
of 2198 households.

Prioritization of problems

According to the field research that was conducted at Lumemo ward and the problems that
we faced, based on the prioritization on the following criteria: magnitude of the top 5
diseases in Lumemo

Frequency table to show the burden of diseases

Common diseases Frequency Percent

DIARRHOEA 45 34 %

EYE INFENCTION 9 7%

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MALARIA 35 27 %

NONE 7 5%

RESPIRATORY INFECTION 1 1%

UTI 21 16 %

WORMS INFESTATION 14 11 %

TOTAL 132 100.00 %

The above table try to show the burden of diseases according to the different factors seem in the
community through different questions asked as explained in the questionnaire.

The groups that are at risk on getting diarrhea disease are; are those with no latrines, those with
poor hygiene practices (such, who don`t wash hands before and after visiting the toilets, and
before and after eating), those with poor water supply system and lack of education on health
issues

Table A&B;

toilet cleanliness Frequency Percent

ADEQUATE 43 33 %

NONE 1 1%

POOR 88 67 %

TOTAL 132 100.00 %

Boiling water Frequency Percent

NO 130 98 %

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YES 2 2%

TOTAL 132 100.00 %

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 SOLUTIONS FOR HEALTH PROBLEMS/NEEDS

Promoting the constructions of improved latrines in the households and farms.This is so

important due to the fact that most of the people when they are at the farm, they tend to defecate
in the busses and thus leading to eruption of diseases. Also households should ensure
construction of more durable toilets to reduce the risks of flooding during the rainy seasons.

Provision of health education to the midwives to prevent maternal death. Most of women at
lumemo village tend to deliver at their homes with the help of midwives and thus due to lack of
knowledge of the danger signs of obstruction to those midwives it tend to lead into maternal
death .Thus, the government should recognize them and provide them with more knowledge to
ensure safe delivery and prevent death.

Motivating women of reproductive age to attend clinic to screen for cervical and breast cancer.
This is also so important for more of the women at reproductive age they tend to be at greater
risk to get problems such as cancer of the cervix. And thus it’s important they should be screened
to ensure early detection and treatment so as to prevent death and other complications.

Motivate the youth to recognize and utilize the available resources. Most of the youth at the
village tend only to stay idol in the streets instead of engaging in different productive activities
,as the result they tend to increase the number of robbers .This is mostly contributed by the bad
perceptions that agricultural activities is only for the elderly and thus, they should be motivated
to increase productivity.

Ensuring sufficient and reliable water supply in the villages. This is one of the major problem in
the villages and it become one of the major factor for health problems ,thus the government
should assist in the construction of wells so as to ensure the availability of water for both of the
households so as to prevent waterborne diseases.

Regular follow up of hygiene practices of the household toilets by the local government. This
will help motivate people to maintain cleanliness in their household toilets since gifts, money are
given to the households with the best toilets

Proper waste and sewage disposal from household level to community level.

This will help the prevention and eradication of various erupting diseases ( such as diarrhoea ,
typhoid , warm infestation , malaria and bilharzia) in the community and would also make their
environment safe and clean .

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 HEALTH PROMOTION INTERVENTION PLAN
The health problems during assessment were;

During the field work that we did and interviewed the community members in Lumemo,
Mahutanga and Ihanga we found that most people had poor water supply system , unimproved
household latrines and some had no latrines ,so they generally had poor sanitation and hygiene
practice.This is attributed by lack of finance, lack of knowledge, bad cultural practices.

Also inadequate water supply in the village since there are no enough wells (mdundiko).

Also, we found that most of the people are using untreated water i.e. they neither boil nor
use water guard.

Lack of health facilities in the village is also a problem to the community since they travel
far distance to Kibaoni and Michenga dispensaries.

Political crisis which leads to lack of unity among the community and the leaders.

The objectives are;

Creating awareness to the community on the importance of latrines by providing health

education for three weeks from 19th February up to 9th march 2018

Motivating community participation in (meeting and community activities) through use of

attendance register book.

To control and reducing eruption of epidemics diseases by 45% such as cholera ,diarrhea and
bilharzias by increasing reservation areas for infected people for the coming 2 yrs

To motivate people to build the households in higher grounds to escape from seasonal floods in
waterlogged areas

To increase community opportunity chances by enhancing and facilitating to reach the needs and
demands

To promote behavior change on hand washing, water sanitation and use of latrines by conducting
a campaign program for three weeks

The target group was the whole community specifically aged between (11 - 90) yrs

The strategies/methods are;

Use of radio Pambazuko in providing health education to people

Conducting community meetings that involves leaders and community members for discussing
the health issues

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The use of village leaders in motivating and encouraging the community to build latrines

o Conduct campaigns that objectify possible solutions for the community problems
such as ‘’NYUMBA NI CHOO’’ and ‘’KULA MAVI SASA BASI’’.
Work plan;
This Is the overall targeted work plan ,that we ought do in the field work at lumemo ward .
Date Objective Plan of activities Targeted group
19th, February Community entry -To introduce our self to the -All members of
process executive and community community
-To establish good rapport
with the community
20th- 24rd, Community scan -To conduct community -Health committee
February assessment members
-To meet with health
committee members together -All members of
with VEO in identifying health community
problem
- To identify health problems
in community
26th-27th, Problem analysis, -To meet with health -Health committee
February priotization and committee and executive members
develop officer for feedback
intervention -Headmaster of
lumemo p/school
28th feb-2nd March Planing -To meet with household, -All members of
intervention parents, focused gropes for community
process. health education and to meet
with pupils of lumemo
,mahutanga and ihanga
p/school for health education
Our work plan for the intervention was conducted on 5th and 6th march 2018 whereby
during the morning at 10:00am it will be at Lumemo and during the afternoon at 02:30pm will be
at Mahutanga and at Ihanga will be at 10:00am respectively. This will be after organizing for the
community gathering with the leaders so as to provide health education concerning importance
of the use of latrines and treated water based on the WASH program so as to make sure all
people acquire some knowledge about hand washing sanitation and hygiene , this to help them
escape and prevent various erupting diseases and other different outbreak that would jeopardize
the community health status .
Monitoring and evaluations;
Follow up will be done after 1year to see if they are practicing what we advised them do.also
making sure that if there were adoption of the different programes that we initiated to them , that
would help them improve their health and living standards .

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 SWOC ANAYSIS
Strengths.
The one among the many factors we enrolled was there great achievement in comodity sales
and enterprenuereship other factors include :

a) Availability of fertile land

b) Man power(youths)
c) Lumemo river for agricultural activities
d) Good and responsible leaders

Weaknesses.
Lumemo people are faced by losts of negativity and perception of things that brings about
there health,social economical and political states, such as;

a) Political conflicts
b) Lack of unity
c) Illiteracy, since most people are uneducated and standard seven leavers.
d) Poor response in community meetings
e) Lack of health facilities eg dispensaries
f) Poor infrastructures
g) Insufficient water system supply
h) Poor transport

Opportunities.
The coverage of the opportunity according to the people was the meeting with influential
people such as council man and have the privilege to :

a) Availability of fertile land that support agricultural activities

b) Lumemo river that support fishing
c) Availability of youth who will participate in developmental activities
d) Presence of radio Pambazuko that can provide health education

Challenges

a) Political crisis
b) Lack of unity among the community and leaders
c) Inadequate water supply
d) Tribalism
e) Cultural beliefs
f) Unwillingness of the youth to participate in productive activities

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 g) Low income

CONCLUSIONS AND RECOMMENDATIONS

The study was only generalized to rural and per-urban areas of Tanzania mainland in Ifakara
district .We conducted the field work on a small sample size that was randomly taken since there
was allot of house holds and ground to cover but the time was limited ( short and congested ).
while from the field the results provide insight on the factors to adopt latrines , good and reliable
water supply , sanitation and hygiene practices that were all genuinely covered .

From the report, the common problems facing people of Lumemo Ward are; political conflicts,
lack of health care facility eg. Dispensary, inadequate water supply, poor participation of the
community members in different community activities, presence of unimproved latrines and the
use of untreated drinking water in their households. Thus these problems lead to diarrhea,
Malaria and UTI as the major health issues in the village

Among the solutions that we discussed were; Promoting the constructions of improved
latrines and in the households and farms, Provision of health education to the midwives to
prevent maternal death, Motivating women of reproductive age to attend clinic to screen for
cervical and breast cancer, Motivate the youth to recognize and utilize the available resources,
Ensuring sufficient and reliable water supply in the villages, Provision of mosquito nets and
education on its importance, Regular follow up of hygiene practices of the household toilets by
the local government, Consult the local government on the adherence of the community general
cleanliness apart from the national cleanliness days , Formulation of village by-laws to ensure
that community members practice hygiene, Special care for handicapped and the aged as a
means to reduce infections and prioritized their needs.

I would also prefer and recommend to increase the field work for more weeks that would help
us get a proper analysis, evaluation and feedback about the assessed community .Also we
recommend that to be provided with necessary equipments and tools, funds and more human
resources (skilled and unskilled labor) this is to make the work easier but more efficient and
attainable.

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 REFERENCES
● Freedman et al. 2017. Cost analysis of the implementation of portable handwashing and
drinking water stations in rural Kenyan health facilities. Journal of Water Sanitation and
Hygiene for Development.
● A review on sanitation and hygiene in Tanzania April 2013 (msabi) by Dr.Jackline
Thomas ,Dr.Nicklaus Holbro and Mr.Dale Young .
● Ending open defaecation in rural Tanzania ;which factors facilitate latrine adoption
November 2014 by Stephen Sara and Jay Graham.
● Assessment of waterless toilets January 2015 by OLawale Olanrewaju.
● Understanding the challenges of improving sanitation and hygiene outcomes in
community based intervention pubmed ncbi.
● Kohler et al. 2017. WASH and gender in health care facilities: The uncharted territory.
Healthcare for Women International.
● Moffa et al., 2017. A systematic review of nosocomial waterborne infections in neonates
and mothers. International Journal of Hygiene and Environmental Health 220:
1199-1206.
● Li et al., 2017. A systematic review of waterborne infections from nontuberculous
mycobacteria in health care facility water systems. International Journal of Hygiene and
Environmental Health 220: 611-620.
● Cronk and Bartram, 2018. Environmental conditions in health care facilities in low- and
middle-income countries: Coverage and inequalities. International Journal of Hygiene
and Environmental Health. https://doi.org/10.1016/j.ijheh.2018.01.004.
● WaterAid, January 2018. Engaging healthcare workers to prevent and control infections
in healthcare centres in Malawi.

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 ANNEXES
Questionnaire Form:

SECTION A: DEMOGRAPHIC INFORMATION

1. The household head is …………………………………………………………………………...

2. Age of household head in complete year………………………………………………………...
3. What is the occupation of the household head?.............................................................................
4. What is the highest level of education of the household head?.....................................................
5. How many people in total live permanently in this household?) ……….……………………….

SECTION B: LATRINE USE

6. What kind of toilet do you have (Observe and confirm if household has ownership and use of
improved latrine facilities)
● Ventilated Improved Pit (VIP) latrine.1 Pit latrines without a slab or platform that is
● open pit.2 Pit latrine with slab.2
● Hanging latrines or toilets.4 Composting toilet.3
● Bucket latrines.5
SPECIFY if Improved Latrine Facilities.1
Unimproved Latrine Facilities.2

7. Does your household have skills necessary for constructing latrines? Yes.1 No.2
8. Who is responsible for constructing latrines in your household? Men.1 Women.2
9. If your household does not have a latrine, what are the main reasons why you’re household
does not have a latrine?
● Don’t want one.1 the family does not own the land.6
● It is not a priority.2 Terrain is not appropriate.7
● Don’t have enough money.3 it’s not part of our culture.8
● Don’t know how to construct.4 Lack of knowledge/skills on how to
construct/use it.9
● Don’t have enough physical space.5 Lack of construction materials.10
● Not Applicable.11,
● Others (Specify

THE FOLLOWING QUESTIONS (10 TO 22) ARE ONLY FOR THOSE HOUSEHOLDS
WITH A LATRINE. IF THE HOUSEHOLD HAS NO LATRINE, SKIP THE FOLLOWING
QUESTIONS AND GO TO SECTION C

10. Overall, how many people use this latrine facility? ……………………………………………

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11. Do members of your household Share this latrine facility with other Households? Yes.1
No.2
12. With how many households do you share this latrine facility with?...........................................
13. Are there people in your household who do not use the latrine? Yes.1 No.2
If Yes Men.1 Women.2
14. Is the latrine currently being used? -check through observation Yes.1 No.2
15. If no, why is the latrine not being used?
● The latrine is collapsed / fear of collapsing.1
● Latrine is too far.2
● The pit is already filled.3
● Poor privacy.4
● Poor cleanliness (insects, bad smell, etc.).5
● Other (specify)
16. Does the latrine hygienically separate human excreta from human contact? (Check through
Observation)
17. Does the interviewer observe presence of a convenient source of water and soap around the
latrine (< 3 meters)? (Check through Observation)
● None.0
● Hand washing device (with water and Soap).1
● Hand washing device (with water only).2
● Hand washing device (with water and ash).3
● Other (Specify)
18. Does the latrine present adequate conditions of cleanliness? (check through observation)
● Not clean (Visible feces or urine on the floor).0
● Adequately clean (no visible feces or urine).1
● Poorly clean (some dirt, but no visible feces or urine).2
19. Does the latrine present adequate conditions of privacy? - (check through observation)
● No privacy.0
● Adequate privacy.1
● Poor privacy.2
20. How did you finance the construction of your current latrine?
● Own Resources,1
● Loan.2
● Others - specify
21. Who is responsible for cleaning latrines in your household? Men.1 Women.2
22. What was the Main Motivation for constructing and using this latrine?
● No Motivation.0
● Health education received.1
● Disease prevention.2
● Don’t Know.3
● Influence from my neighbor/social pressure.

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 ● Others (Specify)
SECTION C: LATRINE USE ASSOCIATED FACTORS
THE FOLLOWING QUESTIONS (23 TO 36) ARE FOR ALL HOUSEHOLDS WITH OR
WITHOUT A LATRINE FACILITY

23. What do you consider to be the Main Benefits of using a latrine?

● No Benefit.0
● Disease prevention.3
● Privacy.1
● Status or prestige.4
● Convenience.2
● Don’t Know.5
● Others (Specify)
24. Who are some of the people who promote construction and use of latrines in your
community?
● None.0
● Local Leaders.4
● Neighbor.1
● NGOs.5
● Community volunteers.2
● Don’t Know.6
● Government.3
● Others (Specify)
25. Are there any factors that are known to negatively influence latrine use in your community?
Specify……………………………………………………………………………………………...
28. If yes, please tell me what are some of the factors that are known to negatively influence
latrine use in your community- (multiple answers allowed. Probe do not prompt) Outline
any…………………………………………………………………………………………………..
26. In your opinion, what are the Major Obstacles to latrine ownership and utilization in your
community?
● Culture.1
● Lack of Skills/Knowledge.4
● Finances.2
● Lack of land/Space.5
● Unsuitable hydro-geological conditions.3
● Don’t Know.6
● Others (Specify)
27. Do you think you are at risk of getting diarrhea if your neighbor does not use a latrine that is
practices open defecation? Yes.1 No.2

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28. What is the effect of open defecation?
● Causes shame/Disgust.1 Don’t Know.3 Causes diseases.2
Others (Specify)
29. Do you think Children’s feces can cause diarrhea? Yes.1 No 2 don’t know. 3
30. Do you think human feces are a principle source of diarrhea? Yes.1 No 2 don’t know. 3
31. Do you think washing your hands everyday with soap and water could prevent diarrhea?
Yes.1 No 2 don’t know. 3
32. In your opinions, what problems could be attributed to lack of latrine facilities in your
community?
● None.0 Absenteeism from school.2
Diseases.3
Smell.4 Stigma.5 Flies.6
Indignity.37 Loss of productive time.8 Shame.9
Don’t Know10
Medical Expenses.11Other (Specify)
33. Which diseases have members of your household suffered from in the past 2 weeks?
Malaria.1 Eye infections.4 Diarrheal diseases.2
Respiratory Tract Infections.5 Skin related diseases.3 TB, HIV and AIDS.6
Others (Specify)
34. Can you please tell me some of the ways that one can get diarrhea?
No.0 Yes.1 Don’t Know. Others
35. Can you please tell me some of the ways that one can prevent diarrhea?
Good Food Hygiene Practices (Proper cooking and covering of food, washing
fruits and vegetable etc).1
Use of latrines.2
Good Water Hygiene Practices (Treating drinking water, proper storage in clean
containers etc).3
Don’t Know.4
Proper hand washing with soap and water.5
Others (Specify)

…………END OF SURVEY. THANK THE RESPONDENT

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Group Discussion Focus

We conducted focus group discussions that were able to provide us with reliable and updated
information about the community of lumemo ,these focus discussion were based on the
approach,perception and understanding of the different villages and events.

The Focus Group Discussion conducted on 20th February 2018 in Lumemo.

The discussion was attended by the village chairperson,ward executive officer and the
community members that summed up to 107 ( women 39 and men 68 in total ) ,
In term of age according to there attendance : i) 5-18 years NIL
ii)19-45 years ( men 45 and women 14)
iii) 46-90years (men 33 and women 14)
The people of lumemo have the saying “lumemo kwanza” said by village executive officer .
The main challenges discussed were:
i)water supply system to be renovated and the increase of building wells to satisfy the peoples
needs , clean and safe water for drinking to avoid the eruption of diseases (such diarrhoea,
cholera and worm infestation .
ii)The construction of health dispensaries since most people at lememo are treated at kibaoni
hospital .
iii)The need of good and reliable long lasting latrines, standard latrines and people should stop
the behavior of open defaecation and not washing hands after visiting the latrines or before a
meal .(personal hygiene practice).

The Focus Group Discussion conducted on 22nd February 2018 in Mahutanga.

The discussion attended by the village chair person Mr.Geofrey Nyanyema , the council man
Mr.Selemani Mahama , th eward executive officer Mr.Victor and the community members with
a total of 70 people ( men 41 and women 29) where there attendance according to age was :
i) 5-18years was NIL
ii) 19-45 years ( men 27 and women 20)
iii) 46-90 years (men 14 and women 9).

Were the talked about agendas were :

i) water supply system , clean and safe , people should boil water and practice water sanitation
process.
ii) health state of the people in terms of constructing a dispensary were they would be treated ,
the use of standard latrines and improved sewage- waste disposal system to ensure a clean
environment .
iii) Also talked about education needs to the people , electrical supply and improving
infrastructures which were most covered by the council man.

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 The focus group discussion conducted on 27th February 2018 in Ihanga .
This was an interesting discussion since , we firstly were able to organize it ourselves and the
mostly we found women ( some were widows , single and married ones ) and children at homes ,
that made a total of 10 women who were between 19 and 40 years . Most of these women were
entrepreneurs based on small business ( selling food ).
They stated there problems to be
i) In convenient and Un reliable water source and supply
ii) no health facility such as a dispensary for treatment
| iii)Eruption of diseases ( diarrhoea ,typhoid ,uti and warm
infection).
iv) No proper hygiene given practiced knowledge by the ward
health team on water and sanitation , proper use and construction of latrines ,why open
defaecation is bad for health .

Generally what we come to understand and learn from the conducted focus group
discussion was , only elderly and old people do attend events like meeting in vallages like
Lumemo Mahutanga and Ihanga , such a discouragement since this young aged group depended
in their society is irresponsible
secondly we were able to notice the variance practice on there cultures since we noticed
that most of their women were house wives and most childrens never went to school.This
actually show how irresponsible these people are, thou the effort of the local government in
emphasizing on such an act .
we lastly were able to view most of their households , their latrines and general surroundings
most of them had unpleasant homes dirty and untidy , to those with clean homes were wives of
local government leaders . we did some interventions , accordingly to there stated problems and
they were received to which we were offered a revisit to check if they did what we agreed on .
This was for the all focus group discussion that we conducted .

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