• Sanitation, water and hygiene, among the forgotten foundations of health –Experts



Clean water, basic toilets and good hygiene practices are essential for the survival and development of children. Without these basic needs, the lives of millions of children are at risk. For children under five, water and sanitation-related diseases are one of the leading causes of death. ISIOMA MADIKE, who just returned from Bangai in Riyom Local Government Area of Plateau, tells a story of how primary school pupils have become change agents in saving lives from preventable diseases caused by poor water, lack of sanitation and hygiene



“It is dawn. The first rays of sunlight break over the horizon. In the haze one can see the silhouette of a small rural village. A newlywed couple is asleep in bed when there is a knock at the door. Outside, two women with lanterns wait. They are here for the bride — to take her out for a morning trip to the toilet.

That means to the bushes at the edge of the village. The bride is shocked and runs away from her husband in horror.” The above is a scene from the 2017 Bollywood film “Toilet: A Love Story,” the true account of a man whose wife left him because he was missing a piece of plumbing, and his fight to build a sanitation system for his village. It is one story that has been told over and again.

It happened in India but the message is related to happenings in many Nigerian communities nowadays. One of such communities is Bangai,where a 12-year-old pupil of Bangai Primary School, identified simply as Sunday, played in dirty, stagnant water; got wounded on the leg and suffered from diarrhoea. His mother practised very bad hygiene and together with Sunday’s father, left the poor boy’s wound untreated.

By the time he was finally taken to the community health centre, a guinea worm infection was diagnosed, leaving him with a permanently bad leg. Bangai is in Riyom Local Government Area of Plateau State.

It looked like a conspiracy among the people as many practised bad hygiene and open defecation. But, when the community school was liberated by the United Nations Children’s Fund (UNICEF), the populace decided to learn.

They had become less ignorant when Sunday suffered from diarrhoea. So, UNICEF gather the people, and taught them about the 5 Fs – Fields, Fingers, Flies, Faeces, Food. Today, Sunday washes his hands. It is not for the fun of it; it is a critical step in reducing infection and saving his life. “I have seen children discharged from the health facility and then come back to the same facility with severe infections and high-temperatures,” he said. “Many of these children do not survive.”

In Bangai and many low and middleincome communities in Plateau State, practising good hand hygiene is not easy. Sunday, like many other children in Bangai, often do not have access to water, toilet, or soap. Even when they have access to water and soap, many children simply forgot to wash their hands, despite regular demonstrations and monitoring.

“In some places, water has been so dirty and is unusable,” said Sunday. “It is very difficult to practise good hygiene in these circumstances.” However, the European Union (EU) funded UNICEF programme, has changed all that in Bangai.

It did not only provide borehole for the school but has built a modern toilet for it. So far, the facilities have started to improve hand-washing compliance and water and sanitation standards in the school.

The students in turn have turned change agents as they spread the good news to their parents, educating them of the benefits accruable to such practise. As at the time of the visit to Bangai, the community had caught the bug. It now helps the school to maintain these facilities. According to the chief of the community, who identified himself simply as Yakubu, they have gradually but steadily keyed into this devel-opment. He said the community had agreed to make it mandatory for every household to provide toilet facility.

“Those who do not comply with this directive, which is monitored periodically, are fined N2000 as penalty for not doing so. Such money collected is used to provide public toilet for the community so that everyone could be part of this live-saving intervention from UNICEF. This has reduced the incidents of death occasioned by bacteria-induced infections by over two third. And we are grateful to EU/UNICEF,” he told Saturday Telegraph.

But, somehow, some landlords locked the household latrines and told their tenants to go to the bushes because the water sources were dry. They blamed the dry streams on women based on the belief that if a woman visits the stream, well or borehole while she is having her period, the water goes dry. They tried to find a way to appease their gods, until a youth corps member visited and told them about climate change and how environmental habits might have affected the climate.

They were also lectured on the dangers of open defecation. Safe water and adequate sanitation and hygiene facilities are critical to the survival, growth and wellbeing of the child. The reason is clear: Safe water is essential for life and sanitation and hygiene enhances good health. In Nigeria, however, access to clean water and sanitation is generally improving – but at a slow pace.

The Multiple Indicator Cluster Survey (MICS), conducted by the government in 2016/17, showed that about 40 per cent of households and over 69 million people do not have access to potable water sources.

UNICEF made this revelation as Nigeria joined other nations to mark the International World Water Day of that year, which holds annually on March 22. The day is set aside as a means of focusing attention on the importance of freshwater and advocating for the sustainable management of freshwater resources. In the rural areas, according to the survey, 19 million people walk long distances to collect unsafe water from lakes, streams and rivers.

However, UNICEF said that children without access to safe water are more likely to die in infancy, and throughout childhood from waterborne diseases. It also said that diarrhea remains the leading cause of death among children under five years of age in Nigeria.

It said: “Lack of safe water and sanitation makes children vulnerable to other threats beyond health. Many children in rural areas spend hours daily collecting water, missing out on the opportunity to go to school. Waterborne diseases also contribute to stunting.

A stunted child is shorter than she or he could have been and will never be able to reach her or his full cognitive potential.” Chief of Water, Sanitation and Hygiene, UNICEF Nigeria, Zaid Jurji, also said: “Improving water and sanitation services, as well as basic hygiene practises in Nigeria, calls for a strong commitment from all partners – the government, the civil society, the private sector and communities.

“For Nigeria to achieve the global goal of providing access to safe water for every citizen by 2030, it needs to make water, together with sanitation and hygiene, a national priority. This goal is closely linked with three key results for the country – good health, environment sustainability and economic prosperity.” UNICEF, in collaboration with the federal, state and local governments, has provided safe water during the past years to over 8 million Nigerians living in rural areas.

But, access to potable water, according to the world body, remains a challenge to the majority of Nigerians, especially those living in the rural areas. But again, the EU/UNICEF programme in Bangai has, somewhat, solved the irritating problem of open defecation in the community.

“The situation of sanitation in Nigeria is alarming. Nigeria is only second to India when it comes to open defecation, one-third of the population practise it. It does not go well to know that open defecation is being practised widely in various communities in a strong country like Nigeria.

So, we need to do something about that beyond the traditional approach to improve on the situation,’’ Jurji said. The UNICEF WASH chief said his organisation would continue to provide funds that would be merged with counterpart funds from state governments to render the much needed services.

He urged leaders and other stakeholders to intensify efforts toward enlightening people on the dangers associated with the ugly trend. Jurji said that eradicating open defecation would also assist to improve sanitation, being one of the Sustainable Development Goals (SDGs). He stressed the need for every household to ensure installation of a standard pit latrine. Open defecation is the practise of people excreting outside and not into a designated toilet.

The term is widely used in literature about water, sanitation, and hygiene issues in developing countries. Kanann Nadar, UNICEF WASH Specialist, at a Community-Led Total Sanitation (CLTS) Conference in Abuja in 2016, said that open defecation-free Nigeria was possible.

He said it could achieve its target of meeting the National Roadmap of Ending Open defecation by 2030 if it put policies in place to encourage behavioural change for sanitation and hygiene. But how did Nigeria come to this sorry pass? It happens almost everywhere around the country.

A few days back in the city of Lagos, for instance, a young man dashed out of his room with clenched teeth, pulled open his zippers, took a quick look to his right and left, retired to a small bush by the school building, and dropped off lumps of smelly faeces.

The action surprised no one, for it is a tradition of sort in many parts of the country. In virtually every open space in and around rural communities, heaps of faeces literally jostle for space with human beings.

From the homes, faeces wrapped up in newspapers are thrown from windows, scattering into a spatter mess; it piles the streets as though they are articles of ornament. Yet, no one seemed to bother about it. “This is how we do it here.

You can hardly find a toilet in most homes and where you find one it is untidy; not good for any decent use. Most times, what you find is a makeshift toilet in which wooden plank platform are constructed with buckets under it.

The sight of such is quite disgusting. For all these, we consider it convenient and comfortable doing it in the open, and since it suits us, it should not be anybody’s headache,” said a young man in another Lagos suburb, who identified himself simply as Uwa.

He said that the “practise is common in our society, especially in cities where toilet facilities are a luxury. When nature calls, everyone responds differently.” Though, Uwa and his likes seem to have a fascination for defecating in public places and in bushes, they appeared not to be aware of the inherent dangers in such practise. Sanitation, water and hygiene are among the “forgotten foundations of health,” causing millions of children to die every year, studies showed.

Papers released by leading medical journal Public Library of Science (PLoS) Medicine revealed that unsafe sanitation and water, as well as bad hygiene, lead to the death of more than two million kids annually or almost 20 per cent of all child deaths worldwide.

Citing the study, UNICEF said almost one-fifth of the world’s population still defecate in the open, with over 2.6 billion people not having access to a basic toilet. “Children are dying every day from diseases such as diarrhea, even though we know how to prevent them,” said Clarissa Brocklehurst, chief of water and sanitation for UNICEF. “We must work hand in hand — health professionals alongside engineers — to ensure that improvements in water supply, sanitation and hygiene reach everyone.”

UNICEF noted that diarrhea, cholera, typhoid and other diseases can easily be prevented with cheap and proven interventions such as pit latrines and handwashing with soap. Despite this, progress has been “painfully slow” in many developing countries, the organisation said. According to the organisation, one gramme of human faeces may contain 10 million viruses, 1 million bacteria, 1,000 parasite cysts and 100 parasite eggs.

Many, living in houses without identifiable toilets, are compelled to defecate at open spaces such as dumpsites and on the bank of slowly flowing streams and rivers. However, owners of such houses have come to believe that toilets would be an additional burden since money would be needed to keep them clean and usable.

There are others in such neighbourhoods, who also believe, though wrongly, that faecal material should incinerate or be allowed to decompose on such sites. Poor sanitary condition resulting from absence of proper human waste management facilities has haunted residents of many communities around the country.

The low-cost settlements, a magnet for thousands of poor Nigerians and low-income earners, has all the compliments of a typical ghetto with most houses lacking toilets, water, electricity and other basic social amenities that make life worth living. It is, indeed, obvious that sanitation is a major challenge in the country.

The evidence is everywhere. Nigeria appears to be one huge field, where people defecate, without shame, and without putting into consideration the impact of their action on the health of others. Travellers are not left out of this “madness.” According to a WaterAid report, the consequences of open defecation are many: it pollutes underground water sources, contaminates agricultural produce, breed diseases such as cholera, diarrhea and bilharzias. WaterAid is an international non-governmental organisation, focused on water, sanitation and hygiene.

It was set up in 1981 as a response to the UN International Drinking Water decade (1981–1990). In the words of Jurgi, “Open defecation is increasingly dangerous and can cause diseases such as cholera, typhoid, hepatitis, polio, diarrhoea, and under nutrition in children. The fastest killer of children under the age of five in Nigeria is caused by it.

Good personal hygiene can check the spread of this disease, especially among children. So, we must double our current efforts to put an end to open defecation, ensure there is access to clean water and a safe environment for children by 2030.”

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