Evaluation of water, sanitation and hygiene program outcomes shows knowledge-behavior gaps in Coast Province, Kenya.
BACKGROUND
Water related diseases constitute a significant proportion of the burden of disease in Kenya. Water, sanitation and hygiene (WASH) programs are in operation nation-wide to address these challenges. This study evaluated the impact of the Sombeza Water and Sanitation Improvement Program (SWASIP) in Coast Province, Kenya.


METHODS
This study is a cluster randomized, follow-up evaluation that compared baseline (2007) to follow-up (2013) indicators from 250 households. Twenty-five villages were selected with probability proportional to size sampling, and ten households were selected randomly from each village. Follow-up data were collected by in-person interviews using pre-tested questionnaires, and analyzed to compare indicators collected at baseline. Cross-sectional results from the follow-up data were also reported.


RESULTS
Statistically significant improvements from baseline were observed in the proportions of respondents with latrine access at home, who washed their hands after defecation, who treated their household drinking water and the average time to collect water in the dry season. However, this study also observed significant decreases in the proportion of respondents who washed their hands before preparing their food, or feeding their children, and after attending to a child who has defecated. The analysis also revealed a knowledge-behavior gap in WASH behaviors.


CONCLUSIONS
SWASIP contributed to improvements from baseline, but further progress still needs to be seen. The findings challenge the assumption that providing infrastructure and knowledge will result in behavior change. Further understanding of specific, non-knowledge predictors of WASH related behavior is needed.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Michael Paul
MP
Schlegelmilch
Aga Khan University, East Africa.
Amyn
A
Lakhani
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Leslie Duncan
LD
Saunders
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Gian Singh
GS
Jhangri
D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D060766:Drinking Water / Q000592:standards; D005500:Follow-Up Studies; D006235:Hand Disinfection / Q000592:standards; D063373:Hand Hygiene / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006801:Humans; D006920:Hygiene / Q000592:standards*; D007630:Kenya; D012499:Sanitation / Q000592:standards*; D011795:Surveys and Questionnaires; D014038:Toilet Facilities / Q000592:standards; D014881:Water Supply / Q000592:standards*; D055815:Young Adult
D060766:Drinking Water
Water; behavior; coast; evaluation; gap; hygiene; knowledge; sanitation