Hygiene and Sanitation Practice among Chepang Community in Rapti Municipality, Chitwan, Province 3

Introduction: Safe drinking water, sanitation and hygiene (WASH) are the fundamentals for improved standard of living, health and environment, education, gender equality, greater convenience and dignity. The main aim of this study was to assess the status of Hygiene and Sanitation practice among Chepang community of Rapti municipality. Methods: Descriptive Cross-sectional household-based study was done in the Chepang community. The study was done with 422 households which were selected through convenient sampling and written consent was taken. The Knowledge and Practice of respondent towards Hygiene and Sanitation practice were assessed through semi-structured questionnaire and the data was entered and analyzed in SPSS version 20. Univariate and bivariate analysis was done. Univariate analysis was done and presented through frequency and percentage. Whereas bivariate analysis was done by using chi-square test (p<0.05) was considered for association between dependent and independent variable. Results: Out of 422 respondents, 234 had adequate knowledge on hygiene and sanitation. Among 234, only about 93 respondent had adequate practice about hygiene and sanitation. Variables such as education level (p≤0.01), occupation (p≤0.035), age (p≤0.001), gender (p≤0.50) & knowledge (p≤0.002) showed significant association with practice on hygiene and sanitation. Conclusions: Based on study findings, due to different socio-demographic factors such as poverty, lack of roads and transportation, illiteracy, the practice of Hygiene and Sanitation was found to be inadequate.


INTRODUCTION
Safe drinking water, sanitation and hygiene (WASH) are the fundamentals for improved standard of living, health and environment, education, gender equality, greater convenience and dignity. Poor and vulnerable populations have low access to improved water, sanitation and hygiene. Improvement in WASH can play a great role to reduce poverty, promote equality and to support socio-economic development. 1 Within the last 25 years, Nepal has made significant progress in expanding the coverage of improved water supply, sanitation and hygiene practices. 2 However, among many ethnic groups, the Chepang are quite backward. They are one of the most under privileged, backward, marginalized and primitive community of Nepal. Most of them resides near the forest and lack improved facilities of water, sanitation and hygiene. Thus, the main objective of this study was to analyze the status of sanitation and hygiene in Chepang community and examine the associated factors

METHODS
A descriptive cross-sectional study was conducted among Chepang population of Rapti municipality, Chitwan. Data were collected from June 2019 to July 2019. Ethical approval was taken from Nepal Health Research Council (Reg. no. 404/2019).
The study population were Chepangs residing in ward no. 10,11,12 and 13 of Rapti municipality, Chitwan. Systematic probability sampling was used as a sampling technique for selecting household. Informed consent was taken from the participants. The participants were interviewed face to face by the researcher using semi-structured questionnaire. The questionnaire was translated to the Nepali language. The pre-testing of the study was done in 42 household of Chautara sangachowkgadi municipality ward no.4.
The collected data was checked, reviewed and organized for their accuracy and completeness. Editing, coding and categorization of the collected data was done. The information collected from field survey was entered into the computer by using computer software packages SPSS (Statistic Package for Social Science) version 20. There were 12 questions regarding knowledge. Scoring was done (0 and 1) and the mean value calculated was 6. <6 was considered as inadequate knowledge and ≥6 was considered as adequate knowledge. Similarly, there were 14 questions regarding practice and the mean value calculated was 7. <7 was considered as inadequate practice and ≥7 was considered as adequate practice.
Univariate analysis was done and presented through frequency and percentage and for the bivariate analysis chi-square test(p≤0.05) was done to find out the association between study variables.

RESULTS
More than half of the population i.e. 55.4% had adequate knowledge about hygiene and sanitation where as 44.5% had inadequate knowledge on hygiene and sanitation. Among, 234 respondents, less than half of the population (39.7%) follows adequate practice for hygiene and sanitation whereas more than half of the population (60.3%) had inadequate practice on hygiene and sanitation.  Table 2 shows the socio-demographic profile of 422 Chepangs.  Table 3 shows the association between sociodemographic factors and knowledge with practice of hygiene and sanitation where association was seen with age (p≤0.001), gender (p≤0.050), level of education (p≤0.01) and occupation (p≤0.035).  Table 4 indicates that knowledge on Hygiene and Sanitation (p≤0.002) had significant association with Practice of Hygiene and sanitation. NDHS 2016, shows that access to sanitation was only 16%. Whereas this study shows that access to sanitation was comparatively higher (62.3%) than the national data whereas less than half of the household didn't had access to latrine (37.7%). 6 Among the respondent who didn't had latrine, most of them (32.5%) said they couldn't have latrine because of poor economic condition and they (25.4%) used to go near riverbank to defecate, in field (11.6%) and in road (0.3%). Though access to sanitation was higher in this study but still 37.7% didn't had access to latrine and goes to open area for defecation which is a big problem. To adequately address the equity in water and sanitation there is a need to understand where the poor live and what their level of access are. Greater focus is needed on how to increase access of hygiene and sanitation. More evidence is needed to support our emerging understanding of the wider health effects of water, sanitation and hygiene. There is a need to understand how improvement in hygiene and sanitation leads to greater economic sustainability.

CONCLUSIONS
This descriptive cross-sectional study findings had shown there doesn't exist adequate practice of hygiene and sanitation among the Chepang community. The study showed that sociodemographic factors such as family type, monthly income, religion, marital status & wealth quintiles had no significant association with practice of hygiene and sanitation whereas variables such as education level, occupation, age, gender & knowledge on Hygiene and Sanitation had significant association with the dependent variable. Thus, the study findings conclude that these identified impeding factors (such as poor economic condition, lack of transportation, illiteracy, lack of good roads, lack of latrines etc.) often act as barriers to transformation of hygiene-related knowledge into practice and practice into habit.