|Ahead of print publication
A study on knowledge and practices regarding Swachh Bharat Mission among urban population of Agartala city, North East India
Anjan Datta, Aman Somani, Nabarun Karmakar, Kaushik Nag
Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
|Date of Submission||27-Feb-2020|
|Date of Decision||30-May-2020|
|Date of Acceptance||21-Sep-2020|
Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, Agartala - 799 014, Tripura
Source of Support: None, Conflict of Interest: None
Background: Swachh Bharat Mission (SBM) is a cleanliness mission by the Government of India with an aim to provide adequate facilities for safe water supply, sanitation hygiene, and waste disposal at community level. The present study aimed to assess knowledge and practices regarding water, sanitation hygiene, and waste disposal and the key components of SBM in an urban community of Agartala city and find out their associated factors. Methods: A community-based cross-sectional study was conducted on 100 people from randomly selected families living in the south zone of Agartala Municipal Corporation, Tripura, on June and July 2018. A predesigned, pretested interview schedule was used as the study tool, and data were analyzed by using Statistical Package for the Social Sciences (SPSS) version 16.0. A quantitative research was followed by three focused group discussions to have an in-depth idea. Results: Majority of the study participants showed good knowledge (59%) but poor practice (39%) regarding water, sanitation hygiene, and solid waste disposal. In this study, occupation (P = 0.012) and socioeconomic status (P = 0.003) were shown to have statistically significant association with knowledge of the participants. Conclusion: Poor practice by majority of the participants and inconsistent involvement by municipality department in solid waste disposal were found as the major concerns even though good knowledge regarding SBM was found in this study among the respondents.
Keywords: Hygiene, municipal, sanitation, waste, water
|How to cite this URL:|
Datta A, Somani A, Karmakar N, Nag K. A study on knowledge and practices regarding Swachh Bharat Mission among urban population of Agartala city, North East India. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Jun 13]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=316428
| Introduction|| |
”Swachh Bharat Mission” (SBM) (Clean India Mission) is India's biggest ever cleanliness drive which was launched in October 2, 2014, with the objective of having clean and hygienic India so that every Indian citizen can have access to healthy and hygienic facilities such as household sanitary latrines, community latrines, proper waste disposal system, cleanliness drive up to village level, and ensuring safe drinking water supply to every house.
The mission has two sub-missions, the SBM (Gramin) and the SBM (Urban), which aim to achieve Swachh Bharat by 2019, as a fitting tribute to the 150th Birth Anniversary of Mahatma Gandhi.
Improving the access to safe drinking water and adequate sanitation, as well as promoting good hygiene, are key components. A report by the World Health Organization in collaboration with the UNICEF indicated that in 2006 (the latest year for which data are available), an estimated 2.5 billion people were lacking improved sanitation facilities. Moreover, nearly one in four people in developing countries were practicing open defecation. The Millennium Development Goal number 7, for 2015, is aimed at reducing the proportion of people without sustainable access to safe drinking water and basic sanitation facilities by half, focusing mostly on the provision of infrastructure to meet the demands of communities in developing countries.
In India, approximately 53% of households and 624 million people defecate in the open area. Open defecation is more pervasive in rural versus urban areas (74% vs. 17%).
Knowledge, attitude, and practice studies are very important in community-level assessment of an ongoing health program. In the above scenario, the present study was aimed at assessing the knowledge and practices regarding water, sanitation hygiene, and waste disposal and the key components of SBM or Swachh Bharat Abhiyan (SBA) in an urban community of Agartala city.
- To assess knowledge and practices of water, sanitation hygiene, and solid waste disposal among people living in Agartala city
- To find out the factors affecting their knowledge and practices regarding the same.
| Methods|| |
A community-based cross-sectional study was conducted among people living in the south zone of Agartala Municipal Corporation (AMC) out of the four zones using lottery method, in the west district of Tripura. Focused group discussions (FGDs) were done in addition to improve the qualitative components of the study. The total population under the south zone is 148,257 as per the AMC reports up to December 31, 2015. The study period was of two calendar months (June and July 2018).
A total of 100 families from Hapania area were selected randomly, considering 50% as the prevalence of poor sanitation hygiene for taking a larger sample size and 20% of prevalence as relative precision using the formula for calculating the sample size, N = Z2 PQ/l2, (where N = total sample size, Z = standard normal variate = 1.96, P = prevalence of poor personal hygiene, and l = relative precision = 20% of P in our study).
Multistage random sampling was done to collect the required samples, where in the first stage, out of the four distinct zones (east, west, north, and south) under the AMC, the south zone was selected by simple random sampling (lottery) technique. Again, the south zone consisted of nine distinct areas and out of those only one (South Badharghat area) was selected randomly for the purpose of sampling. Systematic random sampling was done considering families behind Hapania market area as the starting point and every 10th house was surveyed on both sides of the road heading north. If a family refused to participate or was unavailable during the time of survey, the next 10th house was surveyed till the required sample size was achieved.
The inclusion criteria were families who were resident of this area for more than 6 months and those who gave consent for participation. Preferably, the head of the family was interviewed and in case of joint family or families having tenants, only the owner of the house (preferably head of the family) was interviewed. Those who were seriously ill or mentally not sound were excluded from the study.
A predesigned pretested semi-structured interview schedule was used as the study tool to collect the required information. The schedule contained sociodemographic information of the study participants and questions related to knowledge and practices regarding water and sanitation hygiene and household solid waste disposal separately.
For qualitative assessment, three FGDs were planned in three different Para/Mohollas. There were eight participants (male) in each FGD, representative of eight different families, who were willing to participate. A set of pre-selected questions in the presence of an experienced facilitator was used and discussion between participants was continued till no further new information was gathered. Each FGD continued for approximately 40 min. The transcripts written by the reporter were then classified under different codes and criteria and presented in a tabular format for better understanding.
Data collected from quantitative survey were entered in Statistical Package for the Social Sciences (SPSS Inc. SPSS for Windows, Version 16.0. Chicago, IL, USA) and expressed in terms of frequencies and percentages in appropriate tables.
A well-informed written consent was taken from all the participants before participating in the study. The study was permitted by the Institutional Ethics Committee of Tripura Medical College and Dr. BRAM Teaching Hospital.
| Results|| |
[Table 1] shows that majority (57%) belonged to less than a mean age of 41.41 years and were male (75%) in gender. Majority (63%) had education up to higher secondary (48%) and their occupation (45%) was private jobs predominantly. According to the modified BG Prasad's socioeconomic status (SES) classification (January 2017), majority (30%) of the families belonged to class II, followed by class III (27%).
|Table 1: Frequency distribution table showing sociodemographic characteristics of the study participants (n=100)|
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[Table 2] reveals that all the participants had knowledge regarding the cause of diarrheal diseases to be transmission via unclean water and in addition, 59% and 32% of them also believed the cause of dysentery and skin diseases to be transmission by unclean water, respectively. Surprisingly, 35% also believed the cause of malaria to be transmission through unclean water. Only 2% of the respondents reported an episode of diarrheal disease in the family in the previous 1 month. All the participants knew about boiling and filtration as effective water purification techniques at their household level, followed by water purifiers (41%), bleaching powder (36%), and alum (17%). Most of the respondents (86%) had sanitary latrines in their own house and the rest 14% had work under progress. Only 32% reported that community latrine was present within 500 m of their household, whereas 24% did not even know about community latrine. Only 3.1% of them said that there was running water present in community latrines. Very few (6%) respondents knew about the six steps of hand washing. Majority (78%) had tube wells as a source of drinking water in their households followed by piped supply by AMC (21%). All the respondents in the study kept drinking water in covered containers in their households and washed their hands with soap before eating and after defecation. Almost half of the respondents (49%) reported flies and other insects in the latrine within their households in this study.
|Table 2: Frequency distribution table showing knowledge and practices regarding water and sanitation hygiene of the study participants (n=100)|
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[Table 3] shows that majority (97%) of the study participants heard about SBA. Only 33% of the participants had heard about color coding of dustbins for solid waste disposal under SBA, and their source for this knowledge was television (TV) and newspapers for all. Among them, only 36.4% knew about the color coding, that is, blue and green, correctly. Majority (59%) of the participants reported availability of community dustbins in their area from the AMC. Majority (56%) also reported that garbage was indiscriminately thrown in their area and 39% reported to have blocked drains in their areas, where 27% also reported to have no proper drains in their area. They predominantly disposed household solid wastes in dustbins provided by the AMC (47%) followed by indiscriminate throwing (31%) and dumping (13%). Only 2% of them said that garbage from home were collected by AMC workers daily.
|Table 3: Frequency distribution table showing knowledge and practices regarding solid waste disposal of the study participants (n=100)|
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Recoding was done for all answers as right (as “2”) and wrong (as “1”), and participants scoring more than or equal to mean was considered as overall “good” and others as “poor” for study attributes, as shown in [Table 4]. Majority of the participants had good knowledge (59%) but poor practice (61%).
|Table 4: Frequency distribution table of category of knowledge and practice of the respondents (n=100)|
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[Table 5] shows the association of sociodemographic characteristics with knowledge and practice regarding SBA. Occupation and SES were found to have statistically significant association (P = 0.012 and 0.003, respectively) with the knowledge of the participants.
|Table 5: Association table between sociodemographic variables with knowledge, attitude, and practice regarding Swachh Bharat Mission (n=100)|
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The qualitative responses of the FGDs under different codes are listed in [Table 6].
|Table 6: Results of all the three focused group discussions among urban population of Agartala Municipal Corporation, Tripura (n=24)|
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| Discussion|| |
In the present study, majority of the respondents belonged to <41 years' age group (57%), were males (75%), and all are Hindus. Most of them lived in nuclear family (59%), had private job (45%), and completed higher education (48%). In addition, majority belonged to SES class II and class III. A similar study by Anuradha et al. revealed that majority of them were male (81.1%), 98.2% were Hindus, 23.6% of them were illiterates, 12.3% were unemployed, and 92% lived in nuclear family. In a similar study conducted by Karan et al. in Jharkhand, it was found that 39% of their study participants belonged to 21–30 years' age group. but majority were female participants (76%) and 34% were illiterates, unlike the present study where none was illiterate. In another study in Nalgonda district, Telangana, it was shown that 29.6% belonged to 21–30 years' age group, with predominantly female participants (56.1%), 96.6% were Hindus, 62.5% were literates, and 38.4% belonged to middle class. In another similar study by Yoada et al., nearly half (49.7%) were females, mostly 40.4% belonged to 31–40 years' age group, and 49.1% completed basic education, but 12.6% had no basic education and 26.6% were unemployed. In another study by Jeratagi et al., mostly 43.3% of the respondents belonged to 18–30 years' age group, and most of them (53%) were female. Majority of them (87.5) were illiterates. Almost all (99.5%) lived in joint family and 11% were farmers. Most of them (49.2%) belonged to SES Class IV followed by Class V (42.8%), whereas in the present study, no one belonged to SES Class V. In a study by Kuberan et al., majority were female (71%), lived in nuclear family (68%), and 36% completed study up to the 12th grade or above.
The present study revealed that most of the respondents (97%) had heard about SBA. In a study by Swain et al. conducted in Uttar Pradesh and Madhya Pradesh in 2015, it was found that only 24% of their study participants were aware of SBA, which was quite low as compared to the present study. Similar to the present study, it was found that 93.62% were aware of SBA in the study by Karan et al., 62.2% in the study conducted at Nalgonda district, and 91.31% in the study by Pradhan et al. In a study by Utpat et al., all the respondents were aware about SBA.
This study also showed that the source of knowledge about color coding of dustbins for all the respondents were TV and newspapers. Similar sources of knowledge were reported in studies conducted in Nalgonda district and those by Utpat et al. and Pradhan et al.
Similar to the findings of the present study, the study in Nalgonda revealed that majority (85.78%) of the participants felt that SBA was a useful program for their community. Similarly, the study by Utpat et al. in Pune revealed the majority (80.43%) believed that there was a need of SBA for their community and SBA was effective as well (72.82%). Again, the study by Pradhan et al. revealed that 76.08% of their study participants agreed that SBA helped in the development of country and 54.34% also agreed that SBA brought changes on ground level and made changes in sanitation, hygiene, and waste management. These findings reflect a nationwide positive perception of community toward SBA.
The present study also revealed that none of the families were practicing open-field defecation. Whereas, the study conducted at Nalgonda district reported 26.52% as prevalence of open-field defecation, similar to the study findings of Anuradha et al. (33.1%) and Kuberan et al. (17%) as well. Another study conducted by Jeratagi et al. in Karnataka revealed 99% to be the prevalence of open defecation, which was alarming. Again, Rah et al. and Bhardwaj et al. in Maharashtra reported very high prevalence of open-field defecation (74% and 67%, respectively). In a joint report by the WHO and UNICEF in 1990, it was found that 25% of the world's population practiced open-air defecation, which declined by almost one-third by 2008. In southern parts of Asia, open-air defecation practice had decreased from 66% in 1990 to 44% in 2008. In another study by Geeta et al., 90% of their study participants used to practice open-field defecation and over 40% households had working latrine but had at least one member who use to defecate in open.
In the present study, majority of the respondents had the source of drinking water as tube well (78%) followed by piped supply by the AMC (21%), and all of them knew that boiling and filtration were effective water purification techniques at household level. In contrast, the study by Karan et al. revealed that 72% of their participants reported sanitary well as the major source of drinking water. Majority of their study participants also reported boiling (90.57%) and filtration (81.13%) as water purification techniques in their households. Similarly, in a study by Kuberan et al., 42% of the participants had the major source as stand pipe or tap as water source and 37% had source as tube well or bore hole. Again, the prevalence of hand washing with soap before eating meal and after defecation in our study population was 100%. However, similar other studies reported much lower prevalence of hand washing with soap after defecation (69.81%, 83%, and surprisingly as low as 8.2%) as compared to the present study. In another study by Swain et al., 89% of their study participants used to wash their hands before eating and 92% of them washed after defecation. Whereas, 61% of them said that they washed their hands on a regular basis, but 51% of them were found to have visibly clean hands. Furthermore, 29% of their study participants used soap and antiseptic solution for hand washing. Similarly, the practices regarding disposal of household solid waste in community dustbins in the present study were higher (47%) as compared to the study conducted at Nalgonda district, where the prevalence was 34.75%. Although another similar study by Yoada et al. reported even higher proportion (61%) of waste disposal at appropriate sites (community dustbins and dump trucks), still 39% of them indiscriminately threw the waste, which is slightly higher than the present study (31%). The study by Swain et al. also revealed that only 4% were utilizing community dustbins and most of them (83%) disposed household waste in open field. Their study also revealed that the use of community dustbins was more common among those who were aware of the SBA. Again, in the present study, when interviewed about whether daily collection of household waste was being done by municipal workers, merely 2% reported daily collection, which is alarming from the perspective of Clean India Mission.
The present study revealed good knowledge (59%) among the participants regarding SBA. However, a report evaluating the success of SBA by Khan revealed no decrease in the number of outbreaks after implementation of SBA, rather some increase, which although was not statistically significant. Poor implementation and poor prioritization of targets were suggested to be the factors associated with lack of success of the program by Khan. Whereas, citizen assessment of 3 years of Swachh Bharat revealed a positive impact of SBA in urban areas as well, with 32% of citizens felt improved civic sense among children after the launch of SBA. Municipalities as per the citizens were lacking coordination and accountability with the SBA and were the main bottleneck of long-term success of the mission. In consistent to these, study results, poor practice among majority (61%) of the participants was also found in the present study. Occupation and SES of the participants were found to have statistically significant association (P = 0.012 and 0.003, respectively) with knowledge regarding SBA. Anuradha et al. in their study at rural Tamil Nadu revealed significant association of poor standard of living with practice of open-field defecation. There are lack of studies determining the factors associated with the knowledge and practice of urban population regarding SBA, like the present one.
Again, on qualitative assessment, majority reported their knowledge regarding cleanliness of the community and proper waste disposal (solid waste disposal especially) as the main component of the mission, but the participants showed lack of knowledge regarding sanitation hygiene as part of SBA even though quantitative assessment showed good knowledge of hand hygiene and sanitation practices. This could also mean that knowledge of hand hygiene and sanitation practices of the study participants might have had source other than SBA. A qualitative study done among Indian medical undergraduates in North India regarding SBA revealed good perception of cleanliness among the participants and highlighted the role of behavioral change communication and strong legislation to improve cleanliness practices.
| Conclusion|| |
This study revealed overall good knowledge but poor practice among majority of the study respondents regarding SBA and its core components. The present study also identified occupation and SES of the participants, as well as some specific areas of concern regarding knowledge of sanitation hygiene among specified urban population of Agartala city and irregular household collection of solid waste by municipal workers, as factors affecting their knowledge of SBA, which should be brought into notice of the policymakers and stakeholders for well-directed interventions in the form of health awareness campaigns and monitoring of all the key components to achieve the goal of SBA.
We would like to give our acknowledgment to ICMR, New Delhi, for their kind support to conduct this project. We also express our gratitude to all the respondents, who voluntarily participated in this study.
Financial support and sponsorship
This study was financially supported by ICMR, New Delhi.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]