Thesis Final

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  • Water and Sanitation Accessibility and the Healthof Rural Ugandans

    byJonathan E. Mellor

    A ThesisSubmitted in Partial Fulfillment of the Requirements

    For the Degree ofMaster of Science in Environmental Engineering

    Michigan Technological University2009

    Copyright c Jonathan E. Mellor 2009

  • This thesis, Water and Sanitation Accessibility and the Health of Rural Ugandans,is hereby approved in partial fulfillment of the requirements for the degree of MAS-TER OF SCIENCE in the field of Environmental Engineering.

    DEPARTMENT:

    Civil and Environmental Engineering

    Masters International Program

    Signatures:

    Thesis Advisor

    Dr. David Watkins

    Department Chair

    Dr. William M. Bulleit

    Date

  • Contents

    1 Background 11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.2 Geography and Natural Resources . . . . . . . . . . . . . . . . . . . . 21.3 Cultural and Linguistics . . . . . . . . . . . . . . . . . . . . . . . . . 41.4 Rakai District and Kalisizo Town Council . . . . . . . . . . . . . . . . 41.5 NGO Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.6 Water Usage Survey NGO and Regional Information . . . . . . . . . 7

    2 Literature Review 82.1 Water Accessibility and Usage . . . . . . . . . . . . . . . . . . . . . . 82.2 Causes and Prevention Strategies of Diarrheal Disease . . . . . . . . . 12

    3 Research Methods 203.1 Water Usage Survey Methodology . . . . . . . . . . . . . . . . . . . . 21

    3.1.1 Survey Questions . . . . . . . . . . . . . . . . . . . . . . . . . 213.1.2 Limitations and Possible Sources of Error of Survey . . . . . . 233.1.3 Statistical Analysis . . . . . . . . . . . . . . . . . . . . . . . . 25

    3.2 What Works Best in Diarrheal Disease Prevention Methods . . . . . . 263.2.1 Project Goals and Objectives . . . . . . . . . . . . . . . . . . 273.2.2 Community Selection Criteria . . . . . . . . . . . . . . . . . . 283.2.3 Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303.2.4 Health Survey Questions in Detail . . . . . . . . . . . . . . . . 323.2.5 Water and Sanitation Questions in Detail . . . . . . . . . . . . 34

    4 Implementation of WWB Improvements 374.1 Initial Community Selection . . . . . . . . . . . . . . . . . . . . . . . 384.2 Needs Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384.3 Intervention Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . 404.4 Community Planning Meetings . . . . . . . . . . . . . . . . . . . . . 424.5 Shallow Wells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434.6 Latrines Improvement Campaign . . . . . . . . . . . . . . . . . . . . 48

    ii

  • CONTENTS iii

    4.7 Water Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 514.8 Hand-Washing Stations . . . . . . . . . . . . . . . . . . . . . . . . . . 554.9 Health Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 584.10 Playing Catch Model of Development . . . . . . . . . . . . . . . . . . 604.11 Sustainability Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

    5 Water Accessibility Verses Usage Results 635.1 Water Usage Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

    5.1.1 Average and Variation of Household Usage . . . . . . . . . . . 645.1.2 Water Protection Status . . . . . . . . . . . . . . . . . . . . . 665.1.3 Distance and Time to Source and Seasonal Variation . . . . . 705.1.4 Time vs Distance Measurements . . . . . . . . . . . . . . . . . 73

    5.2 Collection Effort and Usage Correlation . . . . . . . . . . . . . . . . . 755.2.1 Simple Correlations and Histograms . . . . . . . . . . . . . . . 755.2.2 Regional Variation . . . . . . . . . . . . . . . . . . . . . . . . 795.2.3 Pearsons Coefficient of Correlation . . . . . . . . . . . . . . . 805.2.4 Analysis of Variance . . . . . . . . . . . . . . . . . . . . . . . 825.2.5 Synthesis and Conclusions of Usage and Effort Correlations . . 82

    5.3 Socioeconomic Indicators . . . . . . . . . . . . . . . . . . . . . . . . . 855.3.1 Household Size . . . . . . . . . . . . . . . . . . . . . . . . . . 855.3.2 Housing Type and Educational Level . . . . . . . . . . . . . . 87

    6 WWB Results 936.1 Diarrhea Rates for Varying Water and Sanitation Practices from Base-

    line Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 946.1.1 Baseline Survey Analysis . . . . . . . . . . . . . . . . . . . . . 97

    6.2 Measures of Program Effectiveness . . . . . . . . . . . . . . . . . . . 986.2.1 Water Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . 996.2.2 Water Source . . . . . . . . . . . . . . . . . . . . . . . . . . . 996.2.3 Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1016.2.4 Latrines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1026.2.5 Hand-Washing . . . . . . . . . . . . . . . . . . . . . . . . . . 1036.2.6 All Interventions . . . . . . . . . . . . . . . . . . . . . . . . . 104

    6.3 Prevalence of Diarrheal Disease . . . . . . . . . . . . . . . . . . . . . 1056.4 ANOVA Analysis of Results . . . . . . . . . . . . . . . . . . . . . . . 1086.5 Synthesis and Conclusion of WWB . . . . . . . . . . . . . . . . . . . 110

    7 Conclusion 113

    A Rainwater-Harvesting Baseline Survey 121

    B What Works Best Survey 127

  • CONTENTS iv

    C Community Contract 130

    D Copyright 133

  • List of Figures

    1.1 A map of Uganda. Rakai District, where the What Works Best projectwas carried out and was the location of the authors residence is locatedin south central Uganda bordering both Tanzania and Lake Victoria.The water usage survey was also carried out in Bugiri District in thefar east and Kamwenge District in the west. Map reproduced fromUSAID publication [26]. . . . . . . . . . . . . . . . . . . . . . . . . . 3

    2.1 The F-diagram showing the basic mechanisms by which feces from oneindividual, passes through the environment, and into the mouth ofanother. Barriers that inhibit this process can be classified as primaryand secondary barriers. . . . . . . . . . . . . . . . . . . . . . . . . . 13

    2.2 Relative risk of the various intervention strategies as compiled by Fewtrellet al.[11]. It is clear from this diagram that there is a significantamount of variability in the data, but, overall water hygiene and san-itation interventions are more effective than other interventions. Fig-ure reprinted from Lancet Infectious Diseases. Volume 5. Edition 1.By Fewtrell, L., R. B. Kaufmann, D. Kay, W. Enanoria, L. Haller,and J. M. Colford. Water, Sanitation, and Hygiene Interventions toReduce Diarrhoea in Less Developed Countries: A Systematic Reviewand Meta-Analysis. Page 48. (2005). with permission from Elsevier.Copyright permission reprinted in Appendix D. Available online at:http://www.sciencedirect.com/science/journal/14733099. . . . . . . 18

    v

  • LIST OF FIGURES vi

    2.3 A comparison of the Fewtrell study [11] with previous studies by Esreyet al. [9] and Curtis and Cairncross [4]. (a) All studies and (b) rigorousstudies. Shows some consistency, but large overall error bars make ab-solute comparisons difficult. Figure reprinted from Lancet InfectiousDiseases. Volume 5. Edition 1. By Fewtrell, L., R. B. Kaufmann,D. Kay, W. Enanoria, L. Haller, and J. M. Colford. Water, Sani-tation, and Hygiene Interventions to Reduce Diarrhoea in Less De-veloped Countries: A Systematic Review and Meta-Analysis. Page 50.(2005). with permission from Elsevier. Copyright permission reprintedin Appendix D. Available online at: http://www.sciencedirect.com/science/journal/14733099. . . . . . . . . . . . . . . . . . . . . . . . . 19

    4.1 (a) Digging was easy at first, (b) but became increasingly difficultwhen once we reached the water table. A gas-power water pump madeit much easier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

    4.2 Lowering the extremely heavy culverts was a tricky task. To accom-plish it we attached three ropes to each culvert and lowered them downslowly with the help of about 20 community members. . . . . . . . . 45

    4.3 (a) Reinforcement bars being cast into the pump-top along with waterinlet and outlet pipes, a maintenance hatch and bolts to secure thepump itself. (b) The finished pump-top. . . . . . . . . . . . . . . . . 46

    4.4 (a) Washers that are tied to the rope and act to push the water up thePVC piping. (b) The pump base that is lowered down to the bottomof the well. As the operator turns the crank, the rope with washerstied to it enters the widened PVC pipe on the right. The washersthen collect water in the open section of this block (not visible) beforereturning up through the PVC pipe on the left. . . . . . . . . . . . . 47

    4.5 (a) The water is pushed up by washers tied to the rope up the greyPVC pipe to the right. It then returns down to the left. (b) The pumpis operated by turning the crank as seen here. The flow was so goodthat we added a second outlet. . . . . . . . . . . . . . . . . . . . . . . 48

    4.6 (a) The pump is enclosed in its housing. (b) A finished pump! . . . . 494.7 Local handyman trained by COWESER staff members repairing the

    shallow well at Nsambya. . . . . . . . . . . . . . . . . . . . . . . . . . 504.8 My brother David operating the finished well at Manyama after the

    outlets had been encased in brick, lowered to a suitable height and splitinto two doubling the rate at which jerrycans can be filled. . . . . . . 50

    4.9 The latrine mould with two pieces of rebar tied to the wire mesh. . . 514.10 (a) The wire mesh being placed on the top of half the concrete mixture.

    (b) Two finished slabs. . . . . . . . . . . . . . . . . . . . . . . . . . 524.11 Daniel from CAWST describing fil