Assessment of Water, Sanitation and Hygiene Practices in the Selected Primary Healthcare Centers in Owerri West Local Government Area, Imo State

Assessment of Water, Sanitation and Hygiene Practices in the Selected Primary Healthcare Centers in Owerri West Local Government Area, Imo State | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Water, Sanitation and Hygiene Practices in the Selected Primary Healthcare Centers in Owerri West Local Government Area, Imo State Orji S. Mercy, Ede A. Okorie, Anunonwu C.C. Okereke, Anyanwu E. Oluchi, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4632375/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Water, sanitation and Hygiene (WASH) practices remains an issue of global concern in every community level and larger society because several infections and illnesses are linked to water sanitation and hygiene. The study aimed to assess water, sanitation and hygiene practices in the selected primary healthcare centers in Owerri West LGA, Imo state. A descriptive cross sectional research design was adopted for this study. A multi stage sampling technique was used in recruiting a total of 387 respondents that participated in this study and a pre-tested questionnaire was used to collect data. Statistical package for social sciences (SPSS) version 23.0 was used in the analysis of the study. Results from the study showed that majority, 33.7% (131), of the respondents were between ages 25–34. This study revealed that 55.6% (215) of the respondents sometimes washed their hands daily, 23.0% (89) always washed hand. From the finding, 37.5% (145) reported removable plastic waste collection containers (Garbage bins) was used in disposing healthcare waste. Also, 21.4% (83) used water closets in disposing human waste in the healthcare facilities. The results showed a statistical difference between the socio demographic characteristics of respondents and hand washing practices in primary healthcare centers where cadre of health worker (p = 0.0035), length in service (p = 0.0023) were associated with hand washing practices. In conclusion, the study showed that the workers and patients in the healthcare centers had a moderate underrate of water sanitation and hygiene (WASH) practice. Therefore, they should provide proper enlightenment programmes on water sanitation and hygiene in all healthcare centers in Owerri West and beyond. Ccommunity Water sanitation and Hygiene (WASH) Practice Primary Healthcare Figures Figure 1 Introduction Water sanitation and hygiene practices has be regarded as a global issue because of improper management practices that leads to the health challenges [ 1 ]. At the community levels, World Health Organization [ 2 ] reported that to maintain a hygienic environment, health facilities require an acceptable amount and quality of water to keep a good environment. In a study conducted by Venkataramanan et al. [ 3 ], Platzer et al. [ 4 ] and United Nations Children Education Fund [ 5 ], reported that 45% of infections in a community is attributed or linked to poor water sanitation and hygiene practices. UNICEF [ 5 ] and Platzer et al. [ 4 ] concluded that diarrheal, schistosmiasis, water contact infections and nosocomial infections and some many other diseases can be control with improvements in sanitation, efficient waste disposal, and personal hygiene. In the community level, primary health centers are first point of contact for patients and also record with a high prevalence of infectious disease agents in which patients, staff, and neighbors of the health-care can face risks of infection if water sanitation and hygiene practices is inadequate [ 6 , 7 & 8 ] Following the report of WHO [ 1 ], every community health centers should have consistent running water, clean toilets, safe refuse disposal, clean beds and areas for birthing and they should improve on infrastructure and avoid overcrowding in community health facilities. Sustainable Sanitation Alliance (SuSanA) [ 9 ] supported the recommendations by World Health Organization (WHO), because increases the risk of infections may prevent patients from visiting the community health facilities, especially when hospitalization is necessary for the patient. Therefore, community health facilities should supply 40–60 liters of water per patient per day in emergency settings, and an extra 5 liters of water per outpatient per day in non-emergency settings [ 9 , 6 ]. After evaluating the impact of WASH on community health centers, Paranipe [ 10 ] issued a call to action for improved water, sanitation, and hygiene (WASH) for maternal and newborn health, stating that improved WASH should be: 1) integrated into infrastructure and supply budget priorities, 2) emphasized in maternal and child health campaigns, and 3) embedded in national and global targets and monitoring frameworks. Globally, the findings of a research study conducted on water, sanitation, and hygiene (WASH) showed that 74 countries lacked improved water supply and 34 of the 74 countries were in Africa and 13% of community health facilities lacked improved water supply [ 5 ]. The UNICEF further went to report the insufficient information on WASH impact in community health centers where majority of available data focuses on WASH in hospitals and recorded low data on the condition of WASH in secondary community health facilities [ 2 ]. According to a survey conducted by the United Nations World Water Assessment Programme [ 11 ], health facilities provide primary care in rural regions. In Nigeria, there are around 400 health clinics, each with a catchment population of over 20,000 people [ 7 ]. It is highly necessary to look at WASH practices at the community healthcare facilities because, most of semi-urban and rural health institutions record about 100 patients each day for basic emergency treatment, prenatal care, normal delivery, post-partum care, family planning, pediatric care and nutrition, and regular clinics [ 12 , 13 , 14 , 15 & 16 ]. The problem of poor WASH practices has attracted high attention of health practitioners globally, because of several infections and illnesses that are linked to water sanitation and hygiene [ 17 , 18 , 7 , & 1 ]. Poor water supply and hygiene have been attributed diseases such as diarrheal, schistosmiasis, water contact infections and nosocomial infections etc [ 13 , 14 & 15 ]. From the study conducted by Federal Ministry of Health [ 19 ], thirty seven (29) percent of health centers in Nigeria have piped water within the institution and 28 percent have year-round water provided by tap or available within 500 meters of the institution [ 11 ]. United Nations World Water Assessment Programme [ 11 ] also stated that 59 percent of health facilities had power or a backup generator with fuel during service hours, and 58 percent had a working client toilet, a waiting room shielded from the sun and rain, and basic standards of cleanliness. On comparison aspect, Nigeria has a national strategic plan for management of healthcare waste and has demonstrated better access to infection control materials in HCFs than other countries in Africa. Therefore, this study was considered necessary to help to bridge the knowledge gap through assessment of Water Sanitation and Hygiene Practices in the selected Primary Healthcare Centers in Owerri West Local Government Area (LGA), Imo State, Nigeria. Materials and Methods A descriptive cross sectional research design was adopted for this study on the assessment of water sanitation and hygiene practices in primary healthcare centers in Owerri West Local Government Area, Imo State. The study population for this study entailed both healthcare workers and patients at the community primary healthcare centers in Owerri West. The sample size for this study was determined using Leslie Kish (1965) formula. Where n =Desired sample size z=critical value at 95% confidence level of uncertainty (1.96) d=margin of error between the sample and the population= 5% p=estimated proportion of WASH =80.0%. p= 0.80 q=complimentary probability of p = (1-p)……., (i.e. 1-p) = 1- 50 =0.5 A multi stage sampling technique was adopted for this study on the assessment of water sanitation and hygiene practices in primary healthcare centers in Owerri west LGA Imo state. In the first stage; a probability random sampling technique was used to select three (3) communities in Owerri where the primary health centers are located for the study. In stage two, three (3) primary health facilities were selected for the study. In the third stage, patients and health workers were selected through purposive sampling technique at the community primary healthcare centers. A structured checklist was used to determine the sanitary condition of primary healthcare centers while structured questionnaire was used to get information from respondents at healthcare centers in Owerri west LGA Imo state. The questionnaire was classified into different sections; section A consist of socio demographic data, s ection B c onsist of questions hand washing practices and section C c onsisted the method of healthcare waste disposal in primary healthcare centers. The questionnaire was designed for easy comprehension by the respondents. The questionnaire was validated by public health experts and distributed face to face to the respondents (Patients and health workers) at the facilities with the aid of research assistants that was recruited by the researcher. Reliability of the instrument was determined using pre-test method of 10% of the sample size and a reliability coefficient of 0.79 was obtained. The collected data was analyzed using descriptive statistics after entry into computer software called Statistical Package for Social Science (SPSS 21.0). The results were presented in frequency and percentage. A letter of introduction and ethical clearance was obtained from the Department of Public Health Ethical clearance committee before the research was conducted. Results A total of three hundred and eighty-seven (387) copies of questionnaires were distributed for the study and 387 questionnaires were retrieved and they were properly filled and crosschecked for correctness and were used for the purpose of the analysis. Table 1 presented the socio-demographic characteristics of respondents; 33.7% (131) of the respondents were between ages 25-34, 24.3% (94) were aged 35-44 years of age, 23.3% (90) 15-24, and 18.6% (72) of the respondents were 45 years and above. Gender of the respondents; 61.3% (237) of the respondents were male while 38.7% (150) were female. Concerning the religion, 50.1% (194) of the respondents were Christians, 26.5% (103) reported others, 16.5% (64) Muslims, and 6.7% (26) were Traditional worshipers. The marital status; 42.8% (166) of the respondents were married, 34.9% (135) were single, 12.4% (48) got separated, and 9.9% (38) were widowed. Cadre of Heath Workers; 30.2% (117) of the respondents were Nurses, 28.0% (109) reported Pharmacists, 23.8% (92) reported Doctors, 15.5% (60) reported others, and 2.2% (9) were Med Lab Technicians. From the table, 55.9% (216) said yes they were patients while 44.0% (171) replied no. The duration in healthcare service, 33.2% (129) reported ‘less than 6 months’, 22.7% (88) said 6-12 months, 18.1% (70) reported 1-5 years, 17.2% (67) reported 5-10 years, and 8.5% (33) said above 10 years of service. Table 1: Socio-demographic Characteristics of Participants Characteristics Frequency (n=387) Percentage (%) Age of the Participants 15-24 90 23.3 25-34 131 33.7 35-44 94 24.3 45 and Above 72 18.6 Gender Male 237 61.3 Female 150 38.7 Religion Christian 194 50.1 Muslim 64 16.5 Traditional 26 6.7 Other 103 26.5 Marital Status Married 166 42.8 Single 135 34.9 Separated 48 12.4 Widowed 38 9.9 Cadre of Heath Worker Doctor 92 23.8 Nurse 117 30.2 Med Lab Technician 9 2.2 Pharmacist 109 28.0 Others 60 15.5 Are you a patient ? Yes 216 55.9 No 171 44.0 What is your duration in healthcare service? less than 6 months 129 33.2 6-12 months 88 22.7 1- 5yrs 70 18.1 5-10yrs 67 17.2 Above 10years 33 8.5 Table 2 showed the hand washing practices; 55.6% (215) reported sometimes they washed their hands daily, 23.0% (89) said always, and 21.2% (82) were never option. Cutting of finger nails; 41.3% (160) said always, 32.3% (125) said sometimes, and 26.2% (102) reported never cut their nails. Hands before eating; 46.7% (181) said sometimes they do washed their hands before eating 31.5% (122) said never washed their hands, and 21.7% (84) said always washed their hands before eating. Washing hands with soap after using toilet; 47.8% (185) said sometimes, 34.2% (133) said always and 17.8% (69) never washed their hands after using the toilet. Hand wash when returned from work; 54.4% (211) reported sometimes, 23.3% (90) said never and 22.1% (86) said always. From the result; 58.9% (228) said always washed their hands after blowing and wiping their nose, 28.9% (112) said sometimes, and 12.1% (47) reportedly never washed their hands after blowing and wiping their nose. Handling live animals; 46.2% (179) always washed their hands after handling live animals, 32.4% (126) said sometimes and 21.2% (82) said never did. Hand washing hands before touching genitals; 47.0% (182) said never washed their hands before touching their genitals, 41.4% (161) said sometimes and 11.3% (44) said always. Hand washing hands after touching genitals; 41.4% (160) said sometimes they washed their hands after touching genitals, 37.1% (144) said never did, and 21.4% (83) said always. Table 2 Hand Washing Practices among Participants Variables Options Always Sometimes Never Frq % Frq % Frq % Do you wash your hand daily? 89 23.0 215 55.6 82 21.2 How often do you Cut your Nails? 160 41.3 125 32.3 102 26.2 Do you wash your hands before eating? 84 21.7 181 46.7 122 31.5 Do you use soap to wash hands after using the toilet? 133 34.2 185 47.8 69 17.8 Do you wash your hands when you return from work? 86 22.1 211 54.4 90 23.3 Do you wash your hands after blowing and wiping your nose? 228 58.9 112 28.9 47 12.1 Do you wash your hands after handling live animals? 179 46.2 126 32.4 82 21.2 Do you wash your hands before touching genitals? 44 11.3 161 41.6 182 47.0 Do you wash your hands after touching genitals? 83 21.4 160 41.4 144 37.1 Frequency (Freq) and percentage (%) Table 3 presented method of healthcare waste disposal in primary healthcare centers; 51.7% (200) of the respondents reported always disposed healthcare waste after usage, 30.3% (117) reported sometimes, and 18.0% (70) of the respondents never disposed healthcare waste after usage. The reasons for not disposing healthcare waste include; 38.1% (27) reported they did not have time, 33.3% (23) reported others, 23.8% (17) said it is not in my jurisdiction, and only 4.7% (3) reported it did not suit their beliefs. Utilize waste disposal facilities; 34.7% (134) of the respondents said always utilized waste disposal facilities, 33.7% (130) sometimes, and 31.6% (122) never. Table 3 Method of Healthcare Waste Disposal in Primary Healthcare Centers Variable Frequency (n=387) Percentage (%) Do you dispose health care waste after usage? Always 200 51.7 Sometimes 117 30.3 Never 70 18.0 What is your reason It is not in my jurisdiction 17 23.8 I don’t have time 27 38.1 It doesn’t suit my belief 3 4.7 Others 23 33.3 Do you utilize waste disposal facilities? Always 134 34.7 Sometimes 130 33.7 Never 122 31.6 Figure 1 below presented the type of waste disposal facilities utilized, 37.5% reported use of garbage bins, 21.4% used water closets, 14.8% veronica buckets (for hand washing), and 10.9% said toilet wash hand basin 15.2% reported others. Table 4 below showed the results for the test of a statistically significant association between Socio-demographic characteristics of respondents and hand washing practices in primary healthcare centers in Owerri west LGA, Imo state. There was no statistically significant association between age of respondents and hand washing practices in primary healthcare centers at Owerri (p= 0.1686). Given the association between marital status of respondents and hand washing practices in primary healthcare centers among respondents in the study population, there was also no significant relationship (p=0.920). On the hypothesis between cadre of healthcare worker and hand washing practices in primary healthcare centers among respondents in primal population, there was a statistically significant association (p= 0.0035). Given the association between length in service and hand washing practices in primary healthcare centers in the study population, there was a statistically significant association (p=0.0023). Table 4 Association between the socio-demographic characteristics of participants and hand washing practices in primary healthcare centers in Owerri west LGA Imo state Socio Demographics Hand-washing Practices X2 P-value Decision Yes (%) No (%) Age 50.7% 49.3% 3.332 0.1686 NS Marital Status 55.8% 44.2% 8.57 0.920 NS Cadre of Health Worker 84.8% 15.2% 12 0.0035 S Length in Service 73.7% 26.3% 2.0 0.0023 S NS = Not significant, S = Significant Discussion Considering the socio-demographic characteristics of this study with regards to age, 33.7% of the respondents were within the age group of 25–34 years, the age seen in this study, is however in disagreement with a statement by Flores [ 17 ], that the average age of the participants in a healthcare study was 40 years but is comparable with a similar study conducted in Rivers state which found the average age of participants to be 29 years of age. Findings from this study showed that about half of the respondents (50.1%), were Christians and commonly found among Igbos. The reason was that the study was conducted in the Southern part of Nigeria where the primary healthcare centers were located [ 8 ]. Concerning hand washing practices, a little above half of the respondents (55.6%) sometimes understood the importance of hand washing their hands. This finding is in agreement to a study conducted by Mara [ 18 ], in an Ebonyi clinic that affirmed they washed their hands sometimes. Another study by [ 10 ] supported this finding where the participants sometimes used soap to wash their hands after using the toilet. According to Duncan [ 7 ], this could be attributed to the lack of information on proper hygiene practices. Another study by Platzer et al. , [ 4 ] reported that half of the participants actively utilized soap while washing their hands after using toilet facilities and blowing and wiping their nose. Venkataramanan et al. , [ 3 ], reported always washed their hands after handling live animals in a study conducted in Kenya which was linked to the recent pandemics and outbreaks that resulted from animals hence the caution in handling them. The study on assessment of water sanitation and hygiene practices in primary healthcare centers in Owerri also showed that moderate percentage (47.0%) of the participants reportedly never washed their hands before touching their genitals and it is in line with the study conducted by United Nations Children Education Fund [ 5 ] and they reported that close to half of the patients in that study did not wash their hands before touching their genitals. In terms of healthcare waste disposal, more than half of the respondents always disposed their healthcare waste after usage. Tilley et al., [ 20 ] supported the idea of always disposed of healthcare waste in a study carried out in Benue State and only very few of the respondents reported that poor healthcare waste disposal was due to lack of time [ 21 ] Another reason was understaffed as stated by Shepard et al., [ 22 ] and there a need to employ and designate staff specifically for waste disposal. This study found a positive association between cadre of healthcare worker and hand washing practices in primary healthcare centers (p = 0.0035). Ritchie (2018) supported this finding as they suggested in their study that nurses and doctors demonstrated better hand washing practices than laboratory technicians among respondents in primal population (p = 0.0012). The group which showed the least sanitation practice had their job descriptions as others. There was also a significant association between length in service and hand washing practices in primary healthcare centers in the study population (p = 0.0023). Length in service (p = 0.0036) showed significant association as suggested by a previous study according to a study conducted by George [ 16 ] in year 2018. Conclusion Findings from study, there is moderate understand of the importance of water sanitation and hygiene (WASH) practices as well as hand washing practices at the primary healthcare centers in Owerri West, Imo State. The findings also showed that lack of time is a factor affecting adequate disposal of waste in the primary healthcare centers. Recommendations The recommendations for this study include the following; Proper enlightenment programmes should be provided on water, sanitation and hygiene in all primary healthcare centers in Owerri West and beyond. Governments, NGOs and other relevant authorities should therefore help strengthen enlightenment programmes on poor hygiene and sanitation. Adequate waste management facilities should be provided in the primary healthcare centers (PHCs) for the patients, staff and visitors’ use. The HCs needs to also provide and ensure compliance to proper infectious waste disposal methods. There need to address the issue of understaffed to enhance effective practice of WASH and hand washing within the healthcare centers (HCs). Declarations Disclaimer: None. Conflict of interest: All authors of this article report no conflicts of interest throughout the work. Data Availability: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Funding source: No funding was obtained from any person or organization. Human Ethics Declarations: In this research study that involves human subjects, informed consent was given to the participants, each participants was adequately informed of the purpose of the study, methods, sources of funding, conflicts of interest, institutional affiliations of the researchers, expected positive outcomes and possible discomforts the study may cause or impose on human. The norms and standards of the study refrain from stealing, assault, rape, fraud and it embraces the ethical standard of honesty and loyalty. No human fluid or sample was required. Consent to Participate Declaration: The researcher(s) of this study solicit for voluntarily participation in this research work titled ‘ Assessment of Water, Sanitation and Hygiene Practices in the Selected Primary Healthcare Centers in Owerri West Local Government Area, Imo State ’. This study focused on Water, Sanitation and Hygiene and how to prevent and control its related diseases among healthcare workers at Community level. Since it is voluntarily, any participant can withdraw or refuse to answer question at any time without any consequences of any kind. Author's Contribution Declaration: Contributing authors assisted in different form such as collection of data, analysis of data, type setting and reviewing the manuscript while the lead author organized for the conduct of the study. The list of contributing authors are as follows; Orji S. Mercy, Ede A. Okorie, Anunonwu C.C. Okereke, Anyanwu E. Oluchi, Osuoji J. Nkechi, Kenechukwu-Dozie O. Queen, Duru Chima, Ngumah J. Chinwe, Egbom Sylvia. Acknowledgements: We wish to acknowledge the Primary Healthcare Directors in Owerri West Local Government Area, Imo State, Nigeria and Head of Department of Public Health, Federal University of Technology, Owerri, Imo State, Nigeria for their immense contribution in this research study. References World Health Organization. Sanitation and Diarrhoeal disease. Bull World Health Organ, 2019; 78–90. World Health Organization. Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. Geneva: World Health Organization (WHO); 2018. Venkataramanan V, Crocker J, Karon A, Batram J. Community-Led Total Sanitation: A Mixed-Methods Systematic Review of Evidence and Its Quality. Environ Health Perspect. 2018;21(2):026001. Platzer C, Hoffmann H, Ticona E. Alternatives to waterborne sanitation – a comparative study – limits and potentials. IRC Symposium: Sanitation for the urban poor – partnerships and governance. Environmental Health Perspectives. 2018; 2 (2), 444–449. 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The Relationship between Inadequate Sanitation Facilities and the Economic Well-Being of Women in India. J Econ Dev Stud. 2015;3(1):225–9. 10.15640/jeds.v3n1a2 . Shepard J, Stevens C, Mikhael G. Inadequate Sanitation Facilities and the Economic Well-Being of Women in India. J Econ Dev Stud. 2017;3(1):225–9. 10.15640/jeds.v3n1a2 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4632375","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":320197221,"identity":"085eca09-3dc3-458c-a27b-659e4ab28c1d","order_by":0,"name":"Orji S. 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Chinwe","email":"","orcid":"","institution":"Federal University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Ngumah","middleName":"J.","lastName":"Chinwe","suffix":""},{"id":320197240,"identity":"12bf92a4-33ef-48ec-ac58-1dc6b49a29a6","order_by":10,"name":"Egbom Sylvia","email":"","orcid":"","institution":"Federal University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Egbom","middleName":"","lastName":"Sylvia","suffix":""}],"badges":[],"createdAt":"2024-06-24 21:54:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4632375/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4632375/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60629095,"identity":"8e6c9e6d-4566-4a6d-8da1-fc692b5ab1e9","added_by":"auto","created_at":"2024-07-19 00:29:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":120288,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eType of Waste Disposal Facility Utilized\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4632375/v1/edcffa5cde5b10661d8da3a5.png"},{"id":62347480,"identity":"edf3ade5-666c-4d56-93f7-57053eea7d78","added_by":"auto","created_at":"2024-08-13 07:32:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":784445,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4632375/v1/1c802db6-8d3f-478e-9425-5e618b315c89.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Water, Sanitation and Hygiene Practices in the Selected Primary Healthcare Centers in Owerri West Local Government Area, Imo State","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWater sanitation and hygiene practices has be regarded as a global issue because of improper management practices that leads to the health challenges [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. At the community levels, World Health Organization [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] reported that to maintain a hygienic environment, health facilities require an acceptable amount and quality of water to keep a good environment. In a study conducted by Venkataramanan et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], Platzer et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and United Nations Children Education Fund [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], reported that 45% of infections in a community is attributed or linked to poor water sanitation and hygiene practices. UNICEF [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and Platzer et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] concluded that diarrheal, schistosmiasis, water contact infections and nosocomial infections and some many other diseases can be control with improvements in sanitation, efficient waste disposal, and personal hygiene. In the community level, primary health centers are first point of contact for patients and also record with a high prevalence of infectious disease agents in which patients, staff, and neighbors of the health-care can face risks of infection if water sanitation and hygiene practices is inadequate [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e \u0026amp; \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFollowing the report of WHO [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], every community health centers should have consistent running water, clean toilets, safe refuse disposal, clean beds and areas for birthing and they should improve on infrastructure and avoid overcrowding in community health facilities. Sustainable Sanitation Alliance (SuSanA) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] supported the recommendations by World Health Organization (WHO), because increases the risk of infections may prevent patients from visiting the community health facilities, especially when hospitalization is necessary for the patient. Therefore, community health facilities should supply 40\u0026ndash;60 liters of water per patient per day in emergency settings, and an extra 5 liters of water per outpatient per day in non-emergency settings [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. After evaluating the impact of WASH on community health centers, Paranipe [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] issued a call to action for improved water, sanitation, and hygiene (WASH) for maternal and newborn health, stating that improved WASH should be: 1) integrated into infrastructure and supply budget priorities, 2) emphasized in maternal and child health campaigns, and 3) embedded in national and global targets and monitoring frameworks.\u003c/p\u003e \u003cp\u003eGlobally, the findings of a research study conducted on water, sanitation, and hygiene (WASH) showed that 74 countries lacked improved water supply and 34 of the 74 countries were in Africa and 13% of community health facilities lacked improved water supply [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The UNICEF further went to report the insufficient information on WASH impact in community health centers where majority of available data focuses on WASH in hospitals and recorded low data on the condition of WASH in secondary community health facilities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to a survey conducted by the United Nations World Water Assessment Programme [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], health facilities provide primary care in rural regions. In Nigeria, there are around 400 health clinics, each with a catchment population of over 20,000 people [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is highly necessary to look at WASH practices at the community healthcare facilities because, most of semi-urban and rural health institutions record about 100 patients each day for basic emergency treatment, prenatal care, normal delivery, post-partum care, family planning, pediatric care and nutrition, and regular clinics [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e \u0026amp; \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The problem of poor WASH practices has attracted high attention of health practitioners globally, because of several infections and illnesses that are linked to water sanitation and hygiene [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u0026amp; \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Poor water supply and hygiene have been attributed diseases such as diarrheal, schistosmiasis, water contact infections and nosocomial infections etc [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e \u0026amp; \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom the study conducted by Federal Ministry of Health [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], thirty seven (29) percent of health centers in Nigeria have piped water within the institution and 28 percent have year-round water provided by tap or available within 500 meters of the institution [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUnited Nations World Water Assessment Programme [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] also stated that 59 percent of health facilities had power or a backup generator with fuel during service hours, and 58 percent had a working client toilet, a waiting room shielded from the sun and rain, and basic standards of cleanliness. On comparison aspect, Nigeria has a national strategic plan for management of healthcare waste and has demonstrated better access to infection control materials in HCFs than other countries in Africa. Therefore, this study was considered necessary to help to bridge the knowledge gap through assessment of Water Sanitation and Hygiene Practices in the selected Primary Healthcare Centers in Owerri West Local Government Area (LGA), Imo State, Nigeria.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA descriptive cross sectional research design was adopted for this study on the assessment of water sanitation and hygiene practices in primary healthcare centers in Owerri West Local Government Area, Imo State. The study population for this study entailed both\u0026nbsp;healthcare workers and patients at the community primary healthcare centers in Owerri West.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe sample size for this study was determined using Leslie Kish (1965) formula.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cimg 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width=\"238\" height=\"101\"\u003e\u003c/p\u003e\n\u003cp\u003eWhere\u003c/p\u003e\n\u003cp\u003en =Desired sample size\u003c/p\u003e\n\u003cp\u003ez=critical value at 95% confidence level of uncertainty (1.96)\u003c/p\u003e\n\u003cp\u003ed=margin of error between the sample and the population= 5%\u003c/p\u003e\n\u003cp\u003ep=estimated proportion of WASH =80.0%. p= 0.80\u003c/p\u003e\n\u003cp\u003eq=complimentary probability of p = (1-p)\u0026hellip;\u0026hellip;., (i.e. 1-p) = 1- 50 \u0026nbsp; =0.5\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" width=\"894\" height=\"350\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eA multi stage sampling technique was adopted for this study on the assessment of water sanitation and hygiene practices in primary healthcare centers in Owerri west LGA Imo state. In the first stage; a probability random sampling technique was used to select three (3) communities in Owerri where the primary health centers are located for the study. In stage two, three (3) primary health facilities were selected for the study. In the third stage, patients and health workers were selected through purposive sampling technique at the community primary healthcare centers.\u003c/p\u003e\n\u003cp\u003eA structured checklist was used to determine the\u0026nbsp;sanitary condition of primary healthcare centers while structured questionnaire was used to get information from respondents at healthcare centers in Owerri west LGA Imo state. The questionnaire was classified into different sections; section A consist of\u0026nbsp;socio demographic data, s\u003cstrong\u003eection B c\u003c/strong\u003eonsist of questions hand washing practices and \u003cstrong\u003esection C c\u003c/strong\u003eonsisted the method of healthcare waste disposal in primary healthcare centers. The questionnaire was designed for easy comprehension by the respondents.\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eThe questionnaire was validated by public health experts and distributed face to face to the respondents (Patients and health workers) at the facilities with the aid of research assistants that was recruited by the researcher.\u003c/p\u003e\n\u003cp\u003eReliability of the instrument was determined using pre-test method of 10% of the sample size and a reliability coefficient of 0.79 was obtained. The collected data was analyzed using descriptive statistics after entry into computer software called Statistical Package for Social Science (SPSS 21.0). The results were presented in frequency and percentage. A letter of introduction and ethical clearance was obtained from the Department of Public Health Ethical clearance committee before the research was conducted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of three hundred and eighty-seven (387) copies of questionnaires were distributed for the study and 387 questionnaires were retrieved and they were properly filled and crosschecked for correctness and were used for the purpose of the analysis.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eTable 1 presented the\u0026nbsp;socio-demographic characteristics of respondents;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e33.7% (131) of the respondents were between ages 25-34, 24.3% (94) were aged 35-44 years of age, 23.3% (90) 15-24, and 18.6% (72) of the respondents were 45 years and above. Gender of the respondents; 61.3% (237) of the respondents were male while 38.7% (150) were female. Concerning the religion, 50.1% (194) of the respondents were Christians, 26.5% (103) reported others, 16.5% (64) Muslims, and 6.7% (26) were Traditional worshipers. The marital status; 42.8% (166) of the respondents were married, 34.9% (135) were single, 12.4% (48) got separated, and 9.9% (38) were widowed. Cadre of Heath Workers;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e30.2% (117) of the respondents were Nurses, 28.0% (109) reported Pharmacists, 23.8% (92) reported Doctors, 15.5% (60) reported others, and 2.2% (9) were Med Lab Technicians. From the table, 55.9% (216) said yes they were patients while 44.0% (171) replied no. The duration in healthcare service, 33.2% (129) reported \u0026lsquo;less than 6 months\u0026rsquo;, 22.7% (88) said 6-12 months, 18.1% (70) reported 1-5 years, 17.2% (67) reported 5-10 years, and 8.5% (33) said above 10 years of service.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Socio-demographic Characteristics of Participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.88461538461539%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e \u003cstrong\u003e(n=387)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.955128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.846153846153847%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAge of the\u0026nbsp;Participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e15-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.955128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e33.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e24.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003e45 and Above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.846153846153847%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.955128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e61.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e38.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.846153846153847%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.955128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e50.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eTraditional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.846153846153847%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.955128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.846153846153847%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCadre of Heath Worker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003eDoctor\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.955128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eNurse\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eMed Lab Technician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003ePharmacist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.846153846153847%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you a patient\u003c/strong\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.955128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e55.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.846153846153847%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eWhat is your duration in healthcare service?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003eless than 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16025641025641%\" valign=\"top\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.955128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e33.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003e6-12 months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003e1- 5yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003e5-10yrs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.78378378378378%\" valign=\"top\"\u003e\n \u003cp\u003eAbove 10years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.36036036036036%\" valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.855855855855857%\" valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 showed the hand washing practices; 55.6% (215) reported sometimes they washed their hands daily, 23.0% (89) said always, and 21.2% (82) were never option. Cutting of finger nails; 41.3% (160) said always, 32.3% (125) said sometimes, and 26.2% (102) reported never cut their nails. Hands before eating; 46.7% (181) said sometimes they do washed their hands before eating 31.5% (122) said never washed their hands, and 21.7% (84) said always washed their hands before eating. Washing hands with soap after using toilet; 47.8% (185) said sometimes, 34.2% (133) said always and 17.8% (69) never washed their hands after using the toilet. Hand wash when returned from work; 54.4% (211) reported sometimes, 23.3% (90) said never and 22.1% (86) said always. From the result; 58.9% (228) said always washed their hands after blowing and wiping their nose, 28.9% (112) said sometimes, and 12.1% (47) reportedly never washed their hands after blowing and wiping their nose. Handling live animals; 46.2% (179) always washed their hands after handling live animals, 32.4% (126) said sometimes and 21.2% (82) \u0026nbsp;said never did. Hand washing hands before touching genitals; 47.0% (182) said never washed their hands before touching their genitals, 41.4% (161) said sometimes and 11.3% (44) said always. Hand washing hands after touching genitals; 41.4% (160) said sometimes they washed their hands after touching genitals, 37.1% (144) said never did, and 21.4% (83) said always.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Hand Washing Practices among Participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.76923076923077%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOptions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.26923076923077%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlways\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.108974358974358%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSometimes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.391025641025642%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrq\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrq\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrq\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eDo you wash your hand daily?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e55.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eHow often do you Cut your Nails?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e41.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eDo you wash your hands before eating?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eDo you use soap to wash hands after using the toilet?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e34.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e47.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eDo you wash your hands when you return from work?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e54.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eDo you wash your hands after blowing and wiping your nose?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e58.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eDo you wash your hands after handling live animals?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eDo you wash your hands before touching genitals?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e47.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eDo you wash your hands after touching genitals?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.653846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.455128205128204%\" valign=\"top\"\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFrequency (Freq) and percentage (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presented method of healthcare waste disposal in primary healthcare centers; 51.7% (200) of the respondents reported always disposed healthcare waste after usage, 30.3% (117) reported sometimes, and 18.0% (70) of the respondents never disposed healthcare waste after usage. The reasons for not disposing healthcare waste include; 38.1% (27) reported they did not have time, 33.3% (23) reported others, 23.8% (17) said it is not in my jurisdiction, and only 4.7% (3) reported it did not suit their beliefs. Utilize waste disposal facilities; 34.7% (134) of the respondents said always utilized waste disposal facilities, 33.7% (130) sometimes, and 31.6% (122) never.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 \u0026nbsp; Method of Healthcare Waste Disposal in Primary Healthcare Centers\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e \u003cstrong\u003e(n=387)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.884615384615383%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDo you dispose health care waste after usage?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28%\" valign=\"top\"\u003e\n \u003cp\u003e30.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28%\" valign=\"top\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.884615384615383%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eWhat is your reason\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eIt is not in my jurisdiction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eI don\u0026rsquo;t have time\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28%\" valign=\"top\"\u003e\n \u003cp\u003e38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eIt doesn\u0026rsquo;t suit my belief \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28%\" valign=\"top\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28%\" valign=\"top\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.884615384615383%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDo you utilize waste disposal facilities?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28%\" valign=\"top\"\u003e\n \u003cp\u003e33.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28%\" valign=\"top\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1 below presented the type of waste disposal facilities utilized, 37.5% reported use of\u0026nbsp;garbage bins, 21.4% used water closets, 14.8% veronica buckets (for hand washing), and 10.9% said toilet wash hand basin 15.2% reported others.\u003c/p\u003e\n\u003cp\u003eTable 4 below showed the results for the test of a statistically significant association between Socio-demographic characteristics of respondents and hand washing practices in primary healthcare centers in Owerri west LGA, Imo state. There was no statistically significant association between age of respondents and hand washing practices in primary healthcare centers at Owerri (p= 0.1686). Given the association between marital status of respondents and hand washing practices in primary healthcare centers among respondents in the study population, there was also no significant relationship (p=0.920). On the hypothesis between cadre of healthcare worker and hand washing practices in primary healthcare centers among respondents in primal population, there was a statistically significant association (p= 0.0035). Given the association between length in service and hand washing practices in primary healthcare centers in the study population, there was a statistically significant association (p=0.0023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003eTable 4 Association between the socio-demographic characteristics of participants and hand washing practices in primary healthcare centers in Owerri west LGA Imo state\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"654\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.3206106870229%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocio Demographics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.702290076335878%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHand-washing Practices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.770992366412214%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eX2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.59574468085106%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48.40425531914894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.3206106870229%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.80916030534351%\" valign=\"top\"\u003e\n \u003cp\u003e50.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e49.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.770992366412214%\" valign=\"top\"\u003e\n \u003cp\u003e3.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" valign=\"top\"\u003e\n \u003cp\u003e0.1686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.3206106870229%\" valign=\"top\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.80916030534351%\" valign=\"top\"\u003e\n \u003cp\u003e55.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e44.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.770992366412214%\" valign=\"top\"\u003e\n \u003cp\u003e8.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" valign=\"top\"\u003e\n \u003cp\u003e0.920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.3206106870229%\" valign=\"top\"\u003e\n \u003cp\u003eCadre of Health Worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.80916030534351%\" valign=\"top\"\u003e\n \u003cp\u003e84.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e15.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.770992366412214%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" valign=\"top\"\u003e\n \u003cp\u003e0.0035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.3206106870229%\" valign=\"top\"\u003e\n \u003cp\u003eLength in Service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.80916030534351%\" valign=\"top\"\u003e\n \u003cp\u003e73.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e26.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.770992366412214%\" valign=\"top\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" valign=\"top\"\u003e\n \u003cp\u003e0.0023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.603053435114504%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNS = Not significant, S = Significant\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eConsidering the socio-demographic characteristics of this study with regards to age, 33.7% of the respondents were within the age group of 25\u0026ndash;34 years, the age seen in this study, is however in disagreement with a statement by Flores [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], that the average age of the participants in a healthcare study was 40 years but is comparable with a similar study conducted in Rivers state which found the average age of participants to be 29 years of age. Findings from this study showed that about half of the respondents (50.1%), were Christians and commonly found among Igbos. The reason was that the study was conducted in the Southern part of Nigeria where the primary healthcare centers were located [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConcerning hand washing practices, a little above half of the respondents (55.6%) sometimes understood the importance of hand washing their hands. This finding is in agreement to a study conducted by Mara [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], in an Ebonyi clinic that affirmed they washed their hands sometimes. Another study by [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] supported this finding where the participants sometimes used soap to wash their hands after using the toilet. According to Duncan [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], this could be attributed to the lack of information on proper hygiene practices. Another study by Platzer \u003cem\u003eet al.\u003c/em\u003e, [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] reported that half of the participants actively utilized soap while washing their hands after using toilet facilities and blowing and wiping their nose. Venkataramanan \u003cem\u003eet al.\u003c/em\u003e, [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], reported always washed their hands after handling live animals in a study conducted in Kenya which was linked to the recent pandemics and outbreaks that resulted from animals hence the caution in handling them.\u003c/p\u003e \u003cp\u003eThe study on assessment of water sanitation and hygiene practices in primary healthcare centers in Owerri also showed that moderate percentage (47.0%) of the participants reportedly never washed their hands before touching their genitals and it is in line with the study conducted by United Nations Children Education Fund [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and they reported that close to half of the patients in that study did not wash their hands before touching their genitals.\u003c/p\u003e \u003cp\u003eIn terms of healthcare waste disposal, more than half of the respondents always disposed their healthcare waste after usage. Tilley et al., [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] supported the idea of always disposed of healthcare waste in a study carried out in Benue State and only very few of the respondents reported that poor healthcare waste disposal was due to lack of time [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Another reason was understaffed as stated by Shepard et al., [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and there a need to employ and designate staff specifically for waste disposal.\u003c/p\u003e \u003cp\u003eThis study found a positive association between cadre of healthcare worker and hand washing practices in primary healthcare centers (p\u0026thinsp;=\u0026thinsp;0.0035). Ritchie (2018) supported this finding as they suggested in their study that nurses and doctors demonstrated better hand washing practices than laboratory technicians among respondents in primal population (p\u0026thinsp;=\u0026thinsp;0.0012). The group which showed the least sanitation practice had their job descriptions as others. There was also a significant association between length in service and hand washing practices in primary healthcare centers in the study population (p\u0026thinsp;=\u0026thinsp;0.0023). Length in service (p\u0026thinsp;=\u0026thinsp;0.0036) showed significant association as suggested by a previous study according to a study conducted by George [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] in year 2018.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFindings from study, there is moderate understand of the importance of water sanitation and hygiene (WASH) practices as well as hand washing practices at the primary healthcare centers in Owerri West, Imo State. The findings also showed that lack of time is a factor affecting adequate disposal of waste in the primary healthcare centers.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eThe recommendations for this study include the following;\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eProper enlightenment programmes should be provided on water, sanitation and hygiene in all primary healthcare centers in Owerri West and beyond. Governments, NGOs and other relevant authorities should therefore help strengthen enlightenment programmes on poor hygiene and sanitation.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAdequate waste management facilities should be provided in the primary healthcare centers (PHCs) for the patients, staff and visitors\u0026rsquo; use.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe HCs needs to also provide and ensure compliance to proper infectious waste disposal methods.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThere need to address the issue of understaffed to enhance effective practice of WASH and hand washing within the healthcare centers (HCs).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclaimer:\u0026nbsp;\u003c/strong\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003e All authors of this article report no conflicts of interest throughout the work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source:\u003c/strong\u003e No funding was obtained from any person or organization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics Declarations:\u0026nbsp;\u003c/strong\u003eIn this research study that involves human subjects, informed consent was given to the participants, each participants was adequately informed of the purpose of the study, methods, sources of funding, conflicts of interest, institutional affiliations of the researchers, expected positive outcomes and possible discomforts the study may cause or impose on human. The norms and standards of the study refrain from stealing, assault, rape, fraud and it embraces the ethical standard of honesty and loyalty. No human fluid or sample was required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate Declaration:\u0026nbsp;\u003c/strong\u003eThe researcher(s) of this study solicit for voluntarily participation in this research work titled \u0026lsquo;\u003cstrong\u003e\u003cem\u003eAssessment of Water, Sanitation and Hygiene Practices in the Selected Primary Healthcare Centers in Owerri West Local Government Area, Imo State\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;.\u0026nbsp;\u003c/strong\u003eThis study focused on Water, Sanitation and Hygiene and how to prevent and control its related diseases among healthcare workers at Community level.\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003eSince it is voluntarily, any participant can withdraw or refuse to answer question at any time without any consequences of any kind.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026apos;s Contribution Declaration:\u003c/strong\u003e Contributing authors assisted in different form such as collection of data, analysis of data, type setting and reviewing the manuscript while the lead author organized for the conduct of the study. The list of \u0026nbsp;contributing authors are as follows; Orji S. Mercy, Ede A. Okorie, Anunonwu C.C. Okereke, Anyanwu E. Oluchi, Osuoji J. Nkechi, Kenechukwu-Dozie O. Queen, Duru Chima, Ngumah J. Chinwe, Egbom Sylvia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe wish to acknowledge the Primary Healthcare Directors in Owerri West Local Government Area, Imo State, Nigeria and Head of Department of Public Health, Federal University of Technology, Owerri, Imo State, Nigeria for their immense contribution in this research study.\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Sanitation and Diarrhoeal disease. Bull World Health Organ, 2019; 78\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. Geneva: World Health Organization (WHO); 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkataramanan V, Crocker J, Karon A, Batram J. Community-Led Total Sanitation: A Mixed-Methods Systematic Review of Evidence and Its Quality. Environ Health Perspect. 2018;21(2):026001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePlatzer C, Hoffmann H, Ticona E. Alternatives to waterborne sanitation \u0026ndash; a comparative study \u0026ndash; limits and potentials. IRC Symposium: Sanitation for the urban poor \u0026ndash; partnerships and governance. Environmental Health Perspectives. 2018; 2 (2), 444\u0026ndash;449.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited Nations Children Education Fund. UNICEF. Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. Geneva: World Health Organization (WHO) and the United Nations Children\u0026rsquo;s Fund (UNICEF); 2017. pp. 2\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Understanding Health Waste Management. World Health Organization; Geneva. Reports. 2019. Retrieved from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.wipo.int/amc\u003c/span\u003e\u003cspan address=\"http://www.wipo.int/amc\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuncan DP. The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals. 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J Econ Dev Stud. 2015;3(1):225\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15640/jeds.v3n1a2\u003c/span\u003e\u003cspan address=\"10.15640/jeds.v3n1a2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShepard J, Stevens C, Mikhael G. Inadequate Sanitation Facilities and the Economic Well-Being of Women in India. J Econ Dev Stud. 2017;3(1):225\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15640/jeds.v3n1a2\u003c/span\u003e\u003cspan address=\"10.15640/jeds.v3n1a2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ccommunity, Water, sanitation and Hygiene (WASH), Practice, Primary Healthcare","lastPublishedDoi":"10.21203/rs.3.rs-4632375/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4632375/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWater, sanitation and Hygiene (WASH) practices remains an issue of global concern in every community level and larger society because several infections and illnesses are linked to water sanitation and hygiene. The study aimed to assess water, sanitation and hygiene practices in the selected primary healthcare centers in Owerri West LGA, Imo state. A descriptive cross sectional research design was adopted for this study. A multi stage sampling technique was used in recruiting a total of 387 respondents that participated in this study and a pre-tested questionnaire was used to collect data. Statistical package for social sciences (SPSS) version 23.0 was used in the analysis of the study. Results from the study showed that majority, 33.7% (131), of the respondents were between ages 25\u0026ndash;34. This study revealed that 55.6% (215) of the respondents sometimes washed their hands daily, 23.0% (89) always washed hand. From the finding, 37.5% (145) reported removable plastic waste collection containers (Garbage bins) was used in disposing healthcare waste. Also, 21.4% (83) used water closets in disposing human waste in the healthcare facilities. The results showed a statistical difference between the socio demographic characteristics of respondents and hand washing practices in primary healthcare centers where cadre of health worker (p\u0026thinsp;=\u0026thinsp;0.0035), length in service (p\u0026thinsp;=\u0026thinsp;0.0023) were associated with hand washing practices. In conclusion, the study showed that the workers and patients in the healthcare centers had a moderate underrate of water sanitation and hygiene (WASH) practice. Therefore, they should provide proper enlightenment programmes on water sanitation and hygiene in all healthcare centers in Owerri West and beyond.\u003c/p\u003e","manuscriptTitle":"Assessment of Water, Sanitation and Hygiene Practices in the Selected Primary Healthcare Centers in Owerri West Local Government Area, Imo State","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-19 00:28:59","doi":"10.21203/rs.3.rs-4632375/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"05b4d69d-ccc9-413d-8a16-396ee416c677","owner":[],"postedDate":"July 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-13T07:24:53+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-19 00:28:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4632375","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4632375","identity":"rs-4632375","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}