LMC journal Vol. 2.indd 93 Situa on of Environmental Health of Rural Communi es in Palpa District of Nepal Ghimire M and Ghimire M Department of Community Medicine, Lumbini Medical College, Palpa, Nepal Corresponding author: Mrs. Moushami Ghimire, Lecturer, Department of Community Medicine, Lumbini Medical College, Palpa, Nepal; e-mail: madhumds@gmail.com ABSTRACT Background: Sanita on refers to create and maintain hygienic condi ons, through services such as garbage collec on and its proper disposal, wastewater disposal, consump on of safe drinking water, housing condi on and its surrounding, an act or process of making sanitary, the promo on of hygiene and preven on of disease. Human being is a social animal and being a part of society, factors aff ec ng the society also aff ect human and his surroundings. The study is concerned to demographic variables and environmental prac ces in rural communi es. Objec ves: To fi nd out environmental situa on and observe an impact of demographic variables on environmental factors. Materials and methods: A cross-sec onal study was followed to conduct the study in palpa district of Nepal at 2012. Three hundred thirty nine households were selected through simple random procedure. Semi-structure interview schedule was used to collect informa on. Data were analyzed using so ware SPSS for windows version 16.0. Results: Most of the families were faithful to ethnic group. Prac ces of refuse and excreta disposable had unsa sfactory where percentages of throwing refuse and open fi eld defeca on was 39.2 and 9.1 respec vely. 77.6% households were consumed tap water. Most of the households (53.4%) did not have proper drainage system around their houses. Conclusion: Family type and caste of households were strongly associated with prac ce related to excreta disposal, drainage system and refuse disposable. Improper sanita on could be main threat to public health promo on and disease preven on in study areas. Keywords: Demographic variables, drainage system, open fi eld defeca on, Palpa, waste disposal INTRODUCTION Sanita on is the hygienic means of promo ng health through preven on of human contact with the hazards of wastes. It has been observed that the kinds of environment in which we live also depict our life- style and standards of living, like in which kind of place a par cular family is residing, the surrounding is clean, type of housing, type of fl ooring, type of roofi ng, proper ventilation, overcrowding present or not, practices regarding management of safe drinking water and water used for household purposes, proper disposing of garbage and eff ec ve management of household waste, proba on for safe and eff ec ve excreta disposing techniques and avoiding of breeding grounds for vectors leading to vector-borne and water-borne diseases. Environmental health is the branch of Public health that is concerned with all aspects of the natural and built environment that may aff ect human’s health. It addresses all the physical, chemical, and biological factors external to a person, and all the related factors impac ng behaviors. World Health Organiza on stated that “Environmental health comprises those aspects of human health, including quality of life that is determined by physical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preven ng those factors in the environment that can poten ally aff ect adversely the health of present and future genera ons.”1 Clean air, Safe and suffi cient water, Safe and adequate food, Safe and peaceful se lements and stable global environment are essen al factors for safe environmental health. Low socioeconomic status, women, children, elderly, ethnic minori es, disabled, indigenous peoples.2 Quality water should be free from chemical and biological contamina on and must be acceptable in terms of colour, taste and odour in accordance with the World Health Organiza on guidelines on the quality of drinking water.3 Wells, bore holes, ponds and streams need a great deal of protec on from pollu on and contamina on by poten al parasites, micro-organisms and harmful chemical substances. Unfortunately, these water sources have become sites for breeding and harbouring of many diseases - causing agents.4 Waste is an inevitable by-product of our use of natural resources. The amount and make-up of waste in any given area depends on factors such as the local Original Article L M Coll J 2013; 1(2): 93-97 94 Journal of Lumbini Medical College popula on density, economic prosperity, me of year, type of housing and whether there are local waste minimiza on ini a ves such as home compos ng. 5 From longstanding to emerging hazards, environmental factors are a root cause of a significant burden of death, disease and disability - globally and par cularly in developing countries. They range from poor water quality and access, vector-borne disease and air pollu on to toxic chemical exposures, climate change and degraded urban environments. The resulting impacts are es mated to cause over 25% of death and disease globally. 6 Much of this burden rests upon the shoulders of the poor and vulnerable. Many of these deaths are avoidable and much of this disease is preventable. However, eff ec ve ac on requires renewed moral commitment to sustainable development and determined poli cal ac on through interna onal and na onal partnerships.7 Water-borne diseases are usually acquired by the consump on of polluted water containing human and animal faecal ma er from pa ents or healthy carriers.8 Human excreta are important sources of pathogenic organisms, especially intes nal parasites which are causes of a high morbidity in the general popula on primarily due to inadequate disposal of excreta and lack of personal hygiene. Most urban and rural communi es in the developing countries do not have adequate disposal system for human waste, and many inhabitants defecate indiscriminately in places not far from their dwelling places, including directly on the soil and rocks, by the sides of the streams, home ponds, wells, and in some cases into the streams.9 Furthermore, excreta from children and free roaming animals are par cularly hazardous and a poten al source of health problems in both urban and rural communi es.10 Environmental health aims to prevent contamina on of the environment by excreta and, therefore, to prevent transmission of pathogens that originate in faeces of an infected person. A wide range of technologies and methods exists to achieve this, which include sophis cated and high-cost methods like waterborne sewage systems and simple low-cost methods like the cat method, which involves the digging of a hole and covering faeces with soil a er defeca on.11 MATERIAL AND METHODS A cross sec onal study was carried out in four villages (DAMKADA, DUMRE, GORKHEKOT and TELGHA) of Palpa district of Nepal. Four villages were randomly selected from the list of the total villages of the district. Sample size of 339 was calculated assuming margin of error 5%, nonresponse 10% with 95% confi dence interval (CI). Three hundred and thirty nine households were selected randomly from study area. Informa on was obtained on socio-demographic, housing, ven la on in house, water resources, and disposal prac ces of waste water, garbage and excreta. Anonymity of the respondent had preserved. The above informa on was collected by ques oning the head of the family through a structured ques onnaire during the me period of December 2012 to June 2013. Data were analyzed using so ware SPSS for windows version 16.0. RESULTS: Table-1 explain that more than one third (40.7%) were devoted to Magar only. Sixty nine percent households fall under the nuclear type of family and unemployment rate was 9.4%. Near about fi y fi ve percent houses were paccha. Around sixty six percent were covered house with smoke outlet kitchen. Prac ce of refuse and excreta disposable had unsa sfactory where percentages of throwing refuse and open fi eld defeca on was 39.2 and 9.1 respec vely. Most of surveyed households (77.6%) used tap water for drinking proposes but they were unaware about the safeness of consumed water. Most of the households (53.4%) did not have proper drainage system around their houses. Table-1: Demographic and environmental situa on (N=339) Frequency Percent Family type Nuclear 235 69.3 Joint 104 30.7 Caste Brahmin 63 18.6 Chhetri 67 19.8 Magar only 138 40.7 Schdueled cast 46 13.6 Janaja 25 7.4 Occupa on Unemployed 32 9.4 Teacher 31 9.1 Farmer 80 23.6 Business 115 33.9 Others 81 23.9 House type Kaccha 153 45.1 Pucca 186 54.9 Smoke outlet Present 223 65.8 Absent 116 34.2 Refuse disposal Throwing 133 39.2 Dumping 87 25.7 Manure pit 104 30.7 Burning 15 4.4 Excreta disposal Open fi eld 31 9.1 Sanitary latrine 282 83.2 Insanitary 12 3.5 Community Latrine 14 4.1 Overcrowding Absent 266 78.5 Present 73 21.5 Source of water Tap water 263 77.6 Tube well 61 18.0 River 15 4.4 Drainage system Yes 158 46.6 No 181 53.4 The study revealed that type of family could strongly associate (p= 0.000) with prac ce related to excreta disposal, drainage system and refuse disposable 95 M Ghimiri et al (0.004). It was also predic ve factors to determine overcrowding, smoke outlet, and consump on of water where p values of them were 0.016, 0.060, and 0.002 respec vely (Table-2). Table-2: Associa on between family type and environmental factors (N =339) Family type nuclear joint Overcrowding Absent 176 90 Pearson Chi-Square value=5.785, df = 1 p = 0.016Present 59 14 Smoke outlet Present 147 76 Pearson Chi-Square value=3.54, df = 1 p = 0.060Absent 88 28 Refuse disposal Throwing 87 46 Pearson Chi-Square value=13.065df = 3 p = 0.004 Dumping 68 19 Manure pit 65 39 Burning 15 0 Drainage Yes 154 4 Pearson Chi-Square value=1.102,df = 1 p = 0.000No 81 100 Excreta disposal Open fi eld 31 0 Pearson Chi-Square value=73.678,df = 3 p = 0.000 Sanitary latrine 204 78 Insanitary 0 12 Community Latrine 0 14 Source of water Tap water 171 92 Pearson Chi-Square value=12.402,df = 2 p = 0.002 Tube well 49 12 River 15 0 Table-3 shows that cast of households could signifi cantly impact (p = 0.000) on environmental prac ces as: refuse disposable, drainage system, excreta disposable and source of drinking water. Table-3: Associa on between caste and environmental prac ces (N =339) Caste Brahmn Chhetri Magar scheduld Janaja Smoke outlet Present 33 40 97 29 24 Absent 30 27 41 17 1 Pearson Chi-Square value = 17.668, df = 4, P = 0.001 Refuse disposable Throwing 18 0 54 45 16 Dumping 18 3 57 1 8 Manure pit 27 64 12 0 1 Burning 0 0 15 0 0 Pearson Chi-Square value = 2.660, df = 12, P = 0.000 Drainage Yes 34 37 82 0 5 No 29 30 56 46 20 Pearson Chi-Square value = 59.741 df = 4, P = 0.000 Excreta disposal Open fi eld 0 0 15 16 0 Sanitary Latrine 63 55 109 30 25 Insanitary 0 12 0 0 0 Community latrine 0 0 14 0 0 Pearson Chi-Square value = 1.129, df = 12, P = 0.000 Source of water Tap water 51 42 99 46 25 Tube well 12 25 24 0 0 River 0 0 15 0 0 Pearson Chi-Square value = 55.803, df = 8, P = 0.000 Analysis shows that lighting system, kitchen with smoke outlet, excreta disposable, drainage system and presence of rodent inside the house are determined by types of house (p = 0.000) but there is no associa on(p = 0.958) between house type and cross –ven la on (Table-4). Table-4: Impact of house type on environmental factors (N=339) House type Total kachha pacca Cross ven la on Adequate 72 87 159 Inadequate 81 99 180 Pearson Chi-Square value = 0 .003, df = 1, p =0 .958 ligh ng Adequate 109 169 278 Inadequate 44 17 61 Pearson Chi-Square value = 21.896, df = 1, p = 0.000 Smoke outlet Present 88 135 223 Absent 65 51 116 Pearson Chi-Square value = 8.463, df = 1, p = 0.004 Refuse disposal Throwing 60 73 133 Dumping 57 30 87 Manure pit 36 68 104 Burning 0 15 15 Pearson Chi-Square value = 31.583 , df = 3p = 0 .000 Excreta disposal Open fi eld 16 15 31 Sanitary latrine 111 171 282 Insanitary 12 0 12 Community latrine 14 0 14 Pearson Chi-Square value = 35.926 , df = 3, p = 0 .000 drainage Yes 57 101 158 No 96 85 181 Pearson Chi-Square value = 9.802 , df = 1, p = 0.002 rodent Present 95 165 260 Absent 58 21 79 Pearson Chi-Square Value = 33.278 , df = 1, P = 0.000 DISCUSSION Sanita on remains one of the biggest development challenges in all developing countries. Improving sanita on is the key to achieving the health-related Millennium Development Goals (MDGs) of reducing child mortality and combating disease. However, these outcomes will remain pressing and persistent concerns for many nations even as they approach the goal of halving the number of the world's poor by 2015.12 The study analysed an environmental situa on of rural villages of palpa district and tried to fi nd out associa on between demographic and environmental variables. Results from the study shows that most of the families (40.7%) in study area were devoted to Magar but these communi es had caste diversi es as: bhrahmin, Chhetri, other ethnic groups (except Magar) and scheduled cast were living together coopera vely. Sixty nine percent of respondent fall under the nuclear 96 Journal of Lumbini Medical College type of family and unemployment rate was 9.4%. 54.5% had their own puccha house. 65.8% were covered house with smoke outlet kitchen. A typical solid waste management system in a developing country displays an array of problems, including low collection coverage and irregular collec on services, crude open dumping and burning without air and water pollu on control, the breeding of fl ies and vermin, and the handling and control of informal waste picking or scavenging ac vi es. These public health, environmental, and management problems are caused by various factors which constrain the development of eff ec ve solid waste management systems.13 Poor solid waste management in the developing countries consists of a major threat to public health and environmental quality, and reduces the quality of life, par cularly for the poorer residents in both urban and rural areas.14 An es mated 2.6 billion people or 39% of the world’s popula on lack access to improved facili es for the disposal of human excreta, such as a basic pit latrine, a toilet connected to a sep c tank or piped sewer system, or a compos ng toilet according to the World Health Organiza on (WHO) and the United Na ons Children’s Fund (UNICEF). In low-income regions, where people are most vulnerable to infec on and disease, only one in two people is covered by improved sanita on. More than one billion people s ll prac ce open defeca on.15 Diarrhoea and water-borne diseases are leading causes of mortality and morbidity in developing countries.16 Approximately 88% of diarrhoeal diseases are a ributed to unsafe water supply, inadequate sanita on and hygiene.17 The propor on of popula on in rural areas with access to safe drinking water and sanitary latrines has a direct impact on the health of the masses. Water sources and sanita on facili es have an important infl uence on the health of household members, especially children.18 WHO/UNICEF joint monitoring report 2012 stated that 15 per cent of the global popula on prac ced open defeca on, Countries that account for almost three- quarters of the people who prac ce open defeca on as: India (626 million), Indonesia (63 million), Pakistan (40 million), Ethiopia (38 million), Nigeria (34 million), Sudan (19 million), Nepal (15 million), China (14 million), Niger (12 million), Burkina Faso (9.7 million), Mozambique (9.5 million) and Cambodia (8.6 million).19 Results from our study explain that prac ce of refuse and excreta disposable was unsa sfactory where throwing refuses and open fi eld defeca on were 39.2% and 9.1 % respec vely compared to the study conducted by Rajiv Ranjan Karn and their friends in in Katahari VDC of Morang district at 2011 showed that 64% of the houses didn’t had toilet facili es and they were exposed to open defeca on.20 The study also revealed that drainage system in these communi es had inadequate where 53.4% households did not have proper drainage system around their houses. Most of the households (77.6%) consumed tap water but the quality of water could be doubt to ensure safe drinking. All these condi ons may be responsible to develop epidemic of infec ous diseases which is due to faecal contaminated water. Similar situa on was observed in other developing countries as more than half of the popula on did not have access to safe drinking water and about two-thirds lacked good sanitary means of excreta disposal in African countries. Nigeria faced with the dilemma of inadequate disposal of excreta-related human waste discharged into the environment. Rural farming communi es of southeast Nigeria, promiscuous defeca on on open fi elds and farm lands had a common prac ce.21 Many researches stated that Inadequate sanita on, lack of access to clean potable water and poor domes c hygiene are the cause of 80% of all infec ous diseases (e.g. cholera, typhoid, hepa s, polio, cryptosporidiosis, ascariasis, and schistosomiasis) in the world and responsible for 10-25 million deaths each year, most them in the under 5 years age group. These diseases are mainly transmi ed via the faecal-oral route through faecally contaminated water, food or soil .22 The study analyzed demographic and environmental variables to find association between them so it revealed that the type of family and caste of households were strongly associated (p= 0.000) with practice related to excreta disposal, drainage system and refuse disposable (for association between family type and refuse disposable, p = 0.004). In the study family type could play role of predictive factors to determine overcrowding, kitchen with smoke outlet and consump on of water where p values of them were 0.016, 0.060, and 0.002 respec vely. It also found to be signifi cant associa on (p = 0.000) between type of house and other environmental factors as: ligh ng system, kitchen with smoke outlet, excreta disposable, drainage system and presence of rodent inside the house but there is no associa on (p = 0.958) between house type and cross –ven la on. CONCLUSION Unsatisfactory environmental condition of the communities observed during study period and it may create ideal condi on for spread of water borne diseases. Some demographic factors as family type and caste were highly associated with inappropriate drainage system, open fi eld defeca on and open fi eld waste disposal. 97 M Ghimiri et al REFERENCE 1. World Health Organiza on. Defi ni on of environmental h e a l t h . 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