Patterns and factors associated with environmental health practices in households of rural Mozambique
Analytical quantitative studies focusing on health-related behaviours as the final outcomes are scarce, especially in the field of Environmental Health. They have mostly focused on behaviours as risk factors for disease and have rarely dealt with determinants of such behaviours. This study examines the relationship between socio-economic, psycho-social, demographic, and environmental factors and Environmental Health practices at the household level. It further explores, qualitatively, lay perceptions of such practices and illnesses associated with them. An analytical cross-sectional study, complemented by a qualitative study, was the approach chosen for this purpose. Fieldwork took place in Manhiqa, a rural district in Southern Mozambique, from October 2002 to November 2003. The cross-sectional study comprised the following data collection methods: a socio-economic and demographic questionnaire, spot-check observations, and a questionnaire on women's autonomy covering 405 households, and structured observations covering 102 households. The qualitative study comprised 12 focus group discussions (involving 134 people in total) namely with mothers, grandmothers and fathers of children under 5, and 25 semi-structured interviews with caretakers of children under 5. Using factor analysis, three dimensions of wealth (characterising households) and five autonomy constructs (characterising caretakers of children under-5) served as the main predicting factors that the study sought to explore in relation to Household Environmental Health (HHEH) practices. Other predicting factors of interest were type and domain of water source, child's age, and caretaker's age. Prevalence of latrine ownership was high (95%), and so was soap availability (86%). Sixty-two percent of households had access to water from taps (either private or public). However, hand-washing with soap was observed on 6% of occasions after potential faecal contact, and children's stools were disposed of in the latrine on 6% of occasions after open defecation events. In terms of access to hygiene and sanitation hardware, only caretaker's education predicted latrine ownership, and access to soap was associated with caretaker's education, caretaker's exposure to information and socio-economic status of the head of household. With regards to hygiene and sanitation practices, there was no strong evidence for the influence of any of the predicted factors on hand-washing. Socio-economic status of the head of household and type of water source were the only variables significantly associated with safe disposal of stools. Infants under 1 and children between 2 and 5 years of age were the most likely to contaminate the household environment with faeces. Regarding mosquito deterrence practices, it was found that the likelihood that children under 5 were protected by any deterrence method increased with increased caretaker's education and with caretakers decreased proximity to maiden family. Use of traditional fumigation in the child's bedroom was associated with decreased accumulation of modern assets, increased accumulation of traditional assets, and increased caretaker's age. Protecting children under 5 with commercially available products other than bednets was associated with caretaker's education and her financial independence. Bednet use by children was predicted by increased head of household socio-economic status, accumulation of modern assets, and decreased proximity of caretaker to her maiden family. It was also found that certain hygiene and sanitation practices are highly clustered and that there are greater psychosocial connotations carried by sanitation practices than by mosquito deterrence practices. The qualitative study revealed that, from the study participants' perspective, HHEH practices, in particular latrine possession status were associated with the following factors: authority, social commitment, value for self, self-reliance, self-organisation, and completeness. Good fortune was particularly related to bednet possession. Lack of initiative and modernism were personal attributes viewed to be associated with both not having bednets and not having latrines. Through its detailed examination of the associations between individual and household characteristics and behaviour outcomes this study makes an original contribution to our understandiing of how risk and protective practices are produced at household level. This is of interest to those who seek to understand human behaviour from an academic perspective and to those who seek to influence it in order to improve health outcomes. For example, the study adds a contribution to HHEH behaviour change initiatives, especially those that require criteria in order to carry out selective targeting of households according to their social, economic, demographic, or environmental characteristics.