INTRODUCTION:

“The secret of national health lies in the home of the people”

Sanitation is “the means of collecting and disposing of excreta and community liquid wastes in a hygienic way so as not to endanger the health of individual and the community as a whole”(WHO, 1987).

Sanitation is one of the determinants of quality of life and human development index. It is a fundamental health service without which there cannot be any improvement in the state of community health. It is both public and private elements, and the individual’s hygiene can affect the whole community. Improving the sanitation within a community leads to an improvement in health. Thus sanitation is an integral component of environmental protection which ensures a productive life.¹

Lack of sanitation and unhygienic practices facilitates the transmission of pathogens resulting in many potential diseases. Bacteria, parasites and worm that live in the excrement cause diseases like typhoid, dysenteries, diarrhoea, cholera, ascariasis, hookworm infections, viral hepatitis, poliomyelitis and other intestinal infections and parasitic infestation is hold responsible by the inadequate and unsanitary disposal of human excreta. Efforts to improve hygiene and sanitation must aim to reduce transmission of infectious agents.The quality of life of people can be improved by safe disposal of human excreta. It is the paramount important for health and welfare and also for the social and environmental effect it may have in the community involved.²

Excreta disposal is an important part of overall environment sanitation. Faecal borne diseases and worm infestations are the main cause of mortality and morbidity where they go for indiscriminate defecation.³

Transmission of all the endemic diseases can be controlled or prevented through good sanitation barriers and sanitary technology for safe human excreta disposal which is nothing but construction and use of sanitary latrine which prevent the access of the pathogens. Disposing of excreta safely, isolating it from flies and other insects, and preventing faecal contamination of water supplies would greatly reduce the spread of disease.⁴

Current estimation suggests that access to improve sanitation has not increased even in half of the population of developing countries. The lack of adequate sanitation is a key contributing factor to the ongoing high rates of diarrhoeal disease noted in developing countries. Improvement in sanitation has been consistently identified as being an important intervention to improve health.⁵

India is still lagging far behind many countries in the field of environmental sanitation. Most of the problems in the country are due to defective environment, which in turn rob people of their health, destroy their livelihoods and undermine their overall development potential. Sanitation is still an ignored issue in India.⁶

NEED FOR THE STUDY:

In rural areas, the practice of open field defecation is nearly universal. The practice is born out of a combination of factors, the most prominent of them being the traditional behaviour pattern and lack of awareness of the people about the associated health hazards. Prevention and control of parasitic infection (WHO, 1987) stressed that “the provision of sanitary facilities for excreta disposal and their proper use are necessary components of any programme aim at controlling intestinal parasites. In many areas, the sanitary is the most urgent health need and those concerned with the control of intestinal parasites authorities and those responsible for the provision of sanitation facilities and water supply at community level.⁷

The treatment and disposal of human waste is becoming increasing important as the world population increases. Human excreta should be managed as a potentially dangerous material. The construction of latrines is a relatively simple technology that may be used to control the spread of infectious diseases. Improvements in sanitation coverage are one of the key elements to ameliorate health around the world.⁸

Infestation with intestinal parasite is a worldwide problem. Current estimate suggest that at least one world quarter of the world’s is clinically infested with intestinal parasites and most of the infested people live in developing countries.⁹

Hookworm disease is also known to be highly prevalent: about 45 million people are estimated to be infested with hookworms. And the solution to the problem is through hygienic disposal of human excreta.¹⁰

Scistosomiasis is prevalent in 199 countries. There are 6600,000 cases of dysentery, many thousand cases of cholera. 190,000 cases of hepatitis A and 2000 cases of hepatitis E in the country every year due to open field defecations.In India nearly 74 per cent of the population live in the rural area and the majority of them “go to the field” for defecation. Statistics indicate that the intestinal group of diseases claim about 5 million lives every year and 50 million people suffer from intestinal infection.¹¹

The enormity of the problem reflected in the Global water Supply and Sanitation Assessment Report (2000) jointly prepared by WHO and UNICEF where the international data on the global status of sanitary is presented. The report estimated that 2.4 billion people still do not have access to safe sanitation facilities and as a consequence, the world carries the stupendous burden of mortality, morbidity, of communicable diseases. Sanitation is the single most intervention for the reduction of the prevalence of diarrhoeal morbidity.¹²

In a land-mark report by Steven Esrey (1991; 1994; 1996) surveyed data from 8 countries in Africa, Asia and South America found a median reduction in all- cause child mortality of 55% (range 20-82%) associated with safe excreta disposal. It was estimated that severe and moderate stunting may be reduced by 39% when sanitation improves. Five research studies from Bangladesh, Burkina Faso, Indonesia, Sri Lanka and Lesotho found a higher risk of morbidity ranging from 24% to 68% among children or families who did not dispose of faeces in toilets, compared to those who did.¹³

In an epidemic of cholera outbreak occurred in Lusaka city between November 28, 2003 and June 8, 2004. 6,542 cases with 187 deaths (case fatality rate: 2.86) were reported. Distribution of the cases, the mode of transmission, and the risk factors affecting cholera infection in the area was analyzed by using a geographical Information System (GIS) and a matched case-controlled method. It indicates a significant association between the lack of latrine and high incidence of cholera.¹⁴

In India, out of a billion of people approximately 750 million has no access to sanitary latrine. India has largest number of people that defecate in open (says United Nations). Out of 2.5 billion people worldwide that defecate openly, 665 million belong to India. Some 88 per cent of diarrhoeal deaths worldwide are attributed to inadequate sanitation and poor hygiene.¹⁵

The investigator herself felt and also came across the problem of environmental insanitation and poor hygiene in rural communities during her clinical experience. It is noticed the family members do not have basic knowledge on importance of sanitary Latrine, which will prevent the communicable diseases. Hence the investigator felt that there is a need to educate especially the head of the family member regarding importance of sanitary latrine and its uses, in order to motivate them to construct their own sanitary latrine.

STATEMENT OF THE PROBLEM:

This chapter deals with the statement of the problem and objectives of the study. Objectives are what the investigator proposes to accomplish in research, i.e the specific shorter measurable goals to be met. Explicit description of the objectives is essential to come out with the meaningful research. The statement of the problem and the objectives for the current study are as follows.

STATEMENT OF THE PROBLEM:

“A Descriptive study to identify the knowledge regarding awareness about sanitary latrine among people of herele village, Kolhapur District, with a view to develop an informational Booklet”

OBJECTIVE OF THE STUDY:

1. To identify the knowledge regarding awareness about sanitary latrine.

2. To find out an association between knowledge score with selected socio –demographical variables of people of herele village.

3. To prepare and provide informational booklet on awareness about sanitary latrine.

Operational Definition:

1. Identify:

It refer to statistical analysis of knowledge scores regarding awareness about sanitary latrine among people residing in herele village.

2. Knowledge:

This refers to the correct responses given by the people on their knowledge related to information regarding awareness about sanitary latrine which is measured by a structured knowledge questionnaire, and is expressed in terms of knowledge score.

3. Sanitary Latrine:

It refers to it means of collecting and disposing of excreta and community sanitary latrine liquid wastes in a hygienic way so as not to endanger the health of individual and the community sanitary latrine as a whole”

4. Informational Booklet:

It refers to planned and organized material, informational booklet for the people with specific guidelines and necessary information aimed at educating and improving the knowledge regarding awareness about sanitary latrine.

Hypothesis:

Hypothesis is tested at 0.05 level of statistical significance:

H₁-There will be significant association between level of knowledge and with their selected socio-demographic variables.

ASSUMPTIONS:

People may have some knowledge regarding awareness about sanitary latrine.

DELIMITATION:

The study is limited to 100 samples of herele village.

PROJECTED OUTCOME:

This study is effective to know the knowledge regarding awareness about sanitary latrine among people of herele village, Kolhapur district.

RESEARCH METHODOLOGY:

Research methods are the techniques / methods that the researchers used in performing research operations. Research methodology is the systematic way to solve the research problem. It deals with defining the problem, formulation of hypothesis, methods adopted for data collection and statistical techniques used for analyzing the data with logical reason behind it.¹³

The present study was aimed to identify the knowledge regarding awareness about sanitary latrine among people of herele village, Kolhapur district with a view to develop an information booklet.

This chapter deals with methodology adopted for the present study. It includes research approach research design, setting of the study, population, sample and sample size, sampling technique, development and description of the tool, method of data collection and plan for statistical analysis.

RESEARCH APPROACH:

Survey approach can be described as a formal process to observe, describe and document aspects if a situation as it naturally occurs and sometimes to serve as a starting point for hypothesis generation or theory development.¹³

In view of the nature of the problem under study and to accomplish the objective of the study evaluative survey approach was found to be appropriate.

RESEARCH DESIGN:

The research design is the plan, structure and strategy of investigator to answer the research questions. The research design provides answers to research questions and control variances. The research design and control variance.¹³

The descriptive research design was selected and used in this study. In this study the measure was structured knowledge questionnaire to identify the knowledge regarding awareness about sanitary latrine among people of herele village, Kolhapur district.

The research design selected for the study is non-experimental descriptive research design.

Symbolic Representation Pre-Test Only Design:

O₁---------------X

Where as

O₁- Pre Test

X- Intervention

(Informational Booklet)

SETTING OF THE STUDY:

The physical location and condition in which the data collection takes place in a study is called the research setting.

Study was conducted in herele village, Kolhapur Districts

POPULATION:

Population refers to the total category of person or objects that meet the criteria for study established by researcher, any set of persons, objects or measurements having an observable characteristic in common.

The population included in the study both male and female with age group of 15 – above 45 years people of herele village., Kolhapur district.

SAMPLE:

A subject of a population comparing those selected to participate in a study.

In this study, The sample consists of both male and female with age group of 15 – above 45 years people of herele village., Kolhapur district.

SAMPLE SIZE:

Sample size is the number of people who participate in a study.

The sample size in the study will be 100.

SAMPLING TECHNIQUES:

Sampling is an important step in the research process. It is a process of selecting representative units or subjects of population of the study in a research.

Non probability, purposive sampling technique was used to select the sample for the present study.

VARIABLES UNDER INVESTIGATION:

Research variables are concepts at various levels of abstraction that are measured, manipulated and controlled in a study.¹⁴

Independent Variables:

Independent variable was the variables that stands alone and does not depend on any other. It was presumed cause of action.¹³ In this study, the informational booklet on awareness about sanitary latrine was the independent variable.

Dependent Variables:

Dependent variables are the effect of action of the independent variable and cannot exist by itself.¹³In the study dependent variables are knowledge of people on awareness about sanitary latrine.

Attributed Variables:

Seasons characteristics, Age, Gender, Religion, Education, Marital status, and source of information.

CRITERIA FOR SELECTION OF SAMPLES:

INCLUSION CRITERIA:

The people who are:

· Present at the time of data collection.

· Read and understand Marathi language

EXCLUSION CRITERIA:

The people who are:

· Not willing to participate in the study.

DATA COLLECTION TECHNIQUE:

DEVELOPMENT OF TOOL:

An instrument is a device used to measure the concept of interest in a research project.¹³

A structured questionnaire on the knowledge regarding awareness about sanitary latrine among people of herele village.

The various review of literatures were done. An intense search of related literature was carried out, guided by guide for developing an appropriate tool items, and checked for ambiguity and error.

Modifications were made in consultation with guide and other expertise.

The tool was developed as follows

1. Review of literature, both research and non-research material was made in the area relevant to information regarding awareness about sanitary latrine.

2. Structured knowledge questionnaires related to awareness about sanitary latrine.

LITERATURE REVIEW:

Literature review from journals published and unpublished research studies, electronic media and websites were used to develop the research tool.

DESCRIPTION OF THE TOOL:

The tool consists of the two sections.

1. SECTION- I

It consisted of socio-demographic variable data.

2. SECTION-II

Structured knowledge questionnaire regarding awareness about sanitary latrine. It consist of 20 multiple choice questionnaire items.

The opinion and suggestion was elicited from the guide for the correction of tool.

SCORING TECHNIQUE:

For all the 20 multiple choice questionnaire item on knowledge of awareness about sanitary latrine among people of herele village, for multiple choice 4 options were given. A score of 1 was awarded to the correct response while a score of ‘0’ was given to an incorrect response.

PROCEDURE OF DATA COLLECTION:

Data collection is the precise, systematic gathering of information relevant to the research purpose or specific objectives, questions or hypothesis of a study.Prior permission was obtained from the concerned authority that is Sarpanch Gram Panchayath Herele and medical officer primary health centre Herle, the investigators introduced themselves to the respondents and willingness of the participants ware ascertained. The respondents were assured the anonymity and confidentiality of information provided by them. Informed consent was obtained from the subjects before the data collection and informational booklet were provided soon after the data collection procedure to the respondent.

The data collected were recorded systematically on each subject and were organized in a way that facilitates computer entry and data analysis.

The steps used for the data collection:

1. Formal permission to conduct the study was obtained from the concerned authorities.

2. The investigator introduced himself/herself and explain the purpose of study to subjects then informed consent was obtained from each subject.

3. The data was collected on 10 June 2017 which included identifying the knowledge among people of herele village about awareness of sanitary latrine.

4. The informational booklets were delivered to the all subjects.

5. The data collected was analysed and tabulated.

PLAN FOR DATA ANALYSIS:

The data obtained was analysed in term of the objective of the study using descriptive and inferential statistics the guide directed for the development data analysis plan which as follow:

1. Organizing the data on a master sheet.

2. Calculation of frequency, percentage of score and mean

3. Classified the knowledge score, using the percentage of score as follows.

Good knowledge 13-20

Average knowledge 06-12

Poor knowledge 0-5

For all the 20 multiple choice questionnaire item on knowledge of awareness about sanitary latrine, multiple choice 4 options were given. A score of 1 was awarded to the correct response while a score of ‘0’ was given to an incorrect response. This chapter on methodology as they explained all above the various activities carried one and planned by the investigator for present study.

RESULTS:

The data obtained was analyzed in terms of the objectives of the study using descriptive and inferential statistics. Experts in the field of nursing and statistics directed the development of data analysis plan which is as follows:

a. Organizing data on a master sheet.

b. Tabulation of the data in terms of frequencies, percentage, to describe the data.

Major Findings of the study were:

Section I: Findings related to selected socio-demographic variables.

The data presented in table no 1 indicates that maximum 34 (34%) of people were age group of 26 years to 35 years where as minimum 18(18%) of people were age group of 15years to 25 years. In gender majority of 67 (67%) people were male and minimum of 33(33%) were female. In religion maximum 78 (78%) people were belongs to Hindu religion and minimum 05 (05%) people were Christian. In marital status majority of 81 (81%) people were married and 16 (16%) were unmarried and minimum 03 (03%) were widower/widow. In education majority of 36 (36%) were had SSC education and minimum 16(16%) were graduates. In source of information majority of 51 (51%) were got information from television and minimum of 05 (05%) had got information from friends and neighbors.

Table 1: Frequency and Percentage Distribution of Socio-Demographic Variables among people of herele village n=100

Demographic variables		Frequency(f)	Percentage%
1) Age	a) 15 – 25 years	18	18%
	b) 26 – 35 years	34	34 %
	c) 36– 45 years	27	27%
	d) 46 and above	21	21%
2) Gender	a) Male	67	67%
2) Gender	b) Female	33	33%
3) Religion	a) Hindu	78	78%
	b) Muslim	09	09%
	c) Christian	05	05%
	d) Other	08	08%
4) Marital status	a) Married	81	81%
	b) Unmarried	16	16%
	c) Widow/widower	03	03%
5) Education	a) Primary	17	17%
	b) SSC	36	36%
	c) HSC	31	31%
	d) Graduate	16	16%
6) Source of Information	a) Television	51	51%
	b) Radio	26	26%
	c) News papers	06	06%
	d) Health personnel	12	12%
	e) Friend and neighbors	05	05%

Graph-1 Coloum graph showing distribution of subjects according to their Age

Graph-2 Pie graph showing distribution of subjects according to their Gender

Graph-3 Cylinger graph showing distribution of subjects according to their Religion

Graph 4 -Conical diagram shows distribution of subjects according to Marital Status

Graph 5- Clustered column diagram shows distribution of subjects according to their Education Status

Graph 6- Cylindrical diagram shows distribution of subjects according to their Source of Information

Graph 7- Column diagram shows distribution of subjects according to their Knowledge Score

Graph 7: reveals that distribution of subjects according to their knowledge scores among 100 subjects, 45 (45%) were good and 35 (35%) were average and 25 (25%) were poor.

Table 2: Frequency and percentage distribution of knowledge scores among people of herele village. (n=100)

Sr.No.	Level of knowledge	Score	Frequency	Percentage
1.	Good	>13-20	40	40%
2.	Average	06-12	35	35%
3.	Poor	<06	25	25%

Table 3: Mean and Standard Deviation of Knowledge score among people of herele village. (n=100)

Statistical Inference		Knowledge score
Mean		8.79
Standard Deviation		3.26

The mean score of knowledge regarding awareness about sanitary latrine among people of herele village was 8.79±3.26.

Section III: Findings on Association between level of knowledge regarding awareness about sanitary latrine and with their selected socio- demographic variables

To find out an association between the knowledge scores among people of herele village and with their selected socio – demographic variables a research hypothesis was formulated.

H1-There will be significant association between level of knowledge and selected socio-demographic variables at 0.05 level of significance.

Table 4 depicts that there is Significant Association found between knowledge score of subjects regarding awareness about sanitary latrine and selected socio-demographic variable such as Religion, Education, Marital status, source of information and H₁ Accepted.

There is no significant association with knowledge score of subjects regarding awareness about sanitary latrine and selected demographic variables such as Age, Gender.

Table: 4 Association between the knowledge score with socio- demographic variables (n=100)

Sr. No.	Demographic variables	Good	Average	Poor	X²cal. value	X²tab. Value	Df
1	Age ( in year)
	18-25	3	13	2
	26-35	3	26	5	8.64	12.59	6
	36-45	6	15	6
	46 and above
2	Gender
	Male	9	46	12	3.32	5.99	2
	Female	4	23	6
3	Religion
	Hindu	8	51	19
	Muslim	2	7	0	14.05	12.59	6
	Christian	2	2	1
	Other	2	6	0
4	Education
	Primary	0	17	0
	S.S.C.	2	26	8	44.33	12.59	6
	H.S.C.	2	19	10
	Graduate and above	10	6	0
5	Marital Status
	Married	3	13	0
	Unmarried	10	53	18	10.61	9.48	4
	Widow/Widower	0	3	0
6	Source of Information
	T.V.	11	39	1
	Radio	0	20	6
	Newspaper	1	4	1	53.79	15.51	8
	Friends and neighbors	1	3	1
	Health personnel	0	3	9

CONCLUSION:

Based on the findings of the study, the following conclusions were drawn knowledge scores among 100 subjects, Majority of 45 (45%) were having good knowledge score and 35 (35%) were having average knowledge score and 25 (25%) were having poor knowledge score regarding awareness about sanitary latrine.

There is need to provide informational booklet on awareness about sanitary latrine. It’s high time we should understand that awareness about sanitary latrine and prevention of communicable diseases due to open defecation.

NURSING IMPLICATION:

Implication of the study:

The findings of the present study have served implications in different areas which are discussed in following area:

1. Nursing Education

2. Nursing practice

3. Nursing administration

4. Nursing research

Nursing education:

The findings of the study revealed that the knowledge regarding awareness about sanitary latrine among people of herele village is comparatively average. So stress should be on inclusion of awareness about sanitary latrine in curriculum. The informational booklet can also be utilized by the people of herele village; the tool could also be used to identify the knowledge among people of herele village.

Nursing practice:

Nursing practice includes preventive, promotive, curative and rehabilitative services. The present study showed that majority people of herele village were having good knowledge regarding awareness about sanitary latrine. The use of the informational booklet can be used during educational session, which may help to improve knowledge regarding awareness about sanitary latrine. There was wide gap between existing and expected levels of knowledge of adults which indicates and immediate need for education regarding awareness about sanitary latrine.

Nursing Administration:

Nurses are vital source in educate public on various health related issues. The informational booklet can be considered as an awareness program from hospital authorities during community health program. The public health nursing administration can use informational booklet to provide knowledge regarding awareness about sanitary latrine to public in rural areas. The administrator can communicate these findings to practice. They can incorporate this in practice.

Nursing Research:

The present study conducted by the investigators can be a source of review of literature for others who are intending to conduct studies on awareness about sanitary latrine. Evidence based practice to improve the quality of life and this study focuses on awareness about sanitary latrine and provides information regarding awareness about sanitary latrine.

LIMITATIONS:

The limitations of the present study, is that no broad generalization could be made due to small size of samples in limited area of research setting.

RECOMMENDATIONS:

1. Similar study on large settings with more samples for a longer period of time would be pertinent in making broad generalization of the findings.

2. Similar studies can be conducted in future regarding knowledge and attitude towards awareness about sanitary latrine.

3. Pre- experimental studies can be conducted to evaluate the effectiveness of informational booklet.

4. Comparative study can be conducted to assess the knowledge regarding awareness about sanitary latrine among adults residing in rural area and adults residing in urban area with a view to develop an informational booklet

REFERENCES:

1. Nuzhat choudury, Mohammad Awlad Hossain. Exploring the current Status of Sanitary latrine use in shibpur Upazila, Narsingdi district. BRAC report. 2006 November.

2. Subhrendu K Pattanayak. Shame or subsidy revisited: social mobilization for sanitation in Orissa, India Bulletin of the World Health Organization (BLT) 2009 August; 87(8): 565-644.

3. R. Franceys, J. Pickford and R. Reed. Foundations of sanitary practice. The need for on-site sanitation Guide to the Development of On-site Sanitation (WHO) 1992; 245.

4. UNICEF. Handbook for Technology Options and Design, 2003-04: 3-6. Available from: http// www. Ddlws.nic.in

5. G. Howard et al. Human excreta and sanitation Potential hazards and information Needs. World Health Organization. London UK. IWA Publication; 2006.

6. Pandve HT. Environmental sanitation: An ignored issue in India. Indian Journal of Occupational Environmental Medication. 2008; 12(1): 40. Available from: http://www.ijoem.com/article.asp

7. Ruralsan Society May 2008. Available from: http// www.rural san.org.

8. J Mc Conville. How to promote the use of latrine in developing countries. 2003 April. Available from: http://www.cee.mtu.edu/ peacecorps

9. S A Sultana Azam, M M Rahman Bhuiyan, M Zaforulla Choudhury, K Ali Miah. The journal of teacher association RMC, Rajshahi. TAJ 2007; 20(1): 1-5.

10. Park k. Environment and health. Park’s Textbook of preventive and social medicine, 20^th ed, Jabalpur. Bhanot publication; 2004.

11. Liu jiayi. The practice, problem, and strategy of ecological sanitary toilets with urine diversion in china: 2002.

12. Dr. Bindeshwar Pathak. Endeavours in environmental sanitation. Twenty- second kelkar alumni lecture; 4 April; 2004. Available from: http://www.sulabinternational.org.

13. Kathleen Shordt, IRC International Water and Sanitation Centre, for the Hygiene Improvement Project, Academy for Educational Development (AED). 2006: 1-27.

14. Satoshi Sasaki, Hiroshi Suzuki, kumiko Igarashi, Bushimbwa Tambatamba and Philip Mulenga. Spatial Analysis of Risk Factor of cholera outbreak for 2003. The American Journal of Tropical Medicine and Hygiene; 2008; 79(3): 414-421.

15. Dr. Bindeshwar Pathak. United Nations report- The Times of India. October 15; 2009. Available from: http//times of India. indiatimes.com.

Received on 27.07.2018 Modified on 16.08.2018

Int. J. Nur. Edu. and Research. 2019; 7(1): 92-100.

DOI: 10.5958/2454-2660.2019.00019.X