Managing Diarrheal Illness at the Household Level: An Important Survey

By Divya Ramamurthy, Research Analyst – ICTPH

To many privileged people in the urban areas, diarrhea is a trivial ailment that is typically perceived as nothing more than a nuisance in their daily lives. It is therefore a shock to many that diarrhea is one of the most common causes of childhood death in India, and WHO data points out that nearly 20% of under-5 deaths in India are caused by gastrointestinal problems. Inadequate sanitation as well as unsafe drinking water is associated with diarrheal illness and improvements in water quality at the household level has consistently proved to be a deterrent in the occurrence of diarrheal illness.

Keeping this in mind, Neal Gupta, a 2010 GIP Intern for ICTPH, set out with a detailed survey to understand the causes and prevalence of diarrhea in two villages – Alakkudi and Karambayam. Initially, the plan was to conduct the survey only in one village, Alakkudi. However, we then decided to also compare the survey results in Alakkudi with Karambayam – a village in which no sanitation/drinking water interventions had been done by us so far. The survey would therefore assess the impact of CHW hygiene promotion programs (that were done in Alakkudi) as well as identify risk factors that were associated with the prevalence of waterborne diseases. Both these would help CHWs with their ongoing work in both villages (ICTPH’s baseline survey reports that 99% of households’ water sources are contaminated) – as well as guide ICTPH on future interventions in these villages.

Assigned to mentor Neal on his project, I sat with him to discuss how he could go about administering the survey in both villages. We started by mapping out the two villages. It was initially quite a challenge to figure out the sample size in the given time frame of a mere four weeks, but we decided that an average of about a 100 households from each village would do. These would be a representative sample of all households, covering all major streets/areas in the villages, and I suggested that we proceed with a systematic, random sampling method whereby Neal would administer the survey to every 7th household on a street. Wherever this was not possible however, a convenience sample would be obtained. The survey was to be given to only one member per household, and this was to be a female member primarily because water management at the household was generally done by women. Neal eventually managed to do a remarkable job of surveying a total of 225 households from both villages combined (this represented 13.6% and 12.8% of the total population of Alakkudi and Karambayam respectively, according to the 2001 Census).

Since Neal did not speak the local language, he took the help of our SughaVazhvu field coordinators to administer the questionnaires with him. One of my primary concerns had been the length of the survey, which had a total of 35 questions, making it seem like a fairly lengthy survey to conduct. I was not sure if Neal would be able to meet his target, but he managed to do so very well within the short time period. This was primarily because it was a well designed survey, with questions that were pertinent, easy to understand, and that required short answers. The survey primarily comprised of questions regarding water hygiene practices, water storage practices, and commonly practised treatments during diarrheal episodes, including the knowledge and use of Oral Rehydration Therapy (ORT).

Neal would walk through the streets everyday, counting every 7th household on a street and administering the survey. No doubt it was a tedious process, but he enjoyed it and told me that all the women he interviewed were very hospitable and willing to spare time to answer the questions. He faced only one household where he was not allowed to conduct the survey. Some points of inquiry in the survey included how water was stored and sanitised, what the common perceptions were about diarrhea and its causes, how it was treated, and the importance of water hygiene practices in the households.

The findings revealed many similarities between the two villages in terms of water storage and treatment. One important positive finding was that nearly all respondents reportedly separated drinking water from cleaning water; however treatment of water before use was low for both villages. It was also found that in Alakkudi (where CHW safe drinking water/chlorination promotion programs had been done prior to the survey), people were less trusting of their drinking water and primarily used Chlorination as a treatment method, whereas in Karambayam, people had more faith in their drinking water and used Boiling as a water treatment method. All of the findings cannot be listed here, but the survey also found that very few people engaged in hand washing (with soap), and similarly there was very low utilisation of ORT.

The survey was an important one, as it highlighted the scope for our CHWs to intervene in promoting better hygiene practices, safe drinking water, as well as better use of home therapies (for example, putting an end to the consumption of coloured sodas during diarrheal illness). It also highlighted the need to disseminate information on the symptoms of diarrhea and how it can be prevented and treated. We hope that in the future, through better understanding from surveys such as this one, ICTPH will move closer to achieving its mission – to positively impact its populations and create improved, healthy communities.