CHAPTER ONE INTRODUCTION.

BACKGROUND TO THE STUDY.

Waterborne diseases are a major health issue, because of the burden they place on man. Waterborne diseases are caused by pathogenic microorganisms that most commonly are transmitted in contaminated fresh water (Wikipedia, free Online). According to this school of thought, waterborne diseases may result from bathing, washing, drinking, in the preparation of food or the consumption of food thus affected. Thus waterborne diseases can be described as all illnesses that results from having contact with or drinking contaminated water. According to World Health Organization-WHO (2012a), 88.0% of all infectious diseases worldwide and 90.0% of all infectious diseases in developing countries are water-related.

Studies have shown that the prevalence of water borne diseases is associated with poor, unhealthy sanitary conditions and polluted environment (UNICEF, 2003; Parbio and Violeta, 2008). The United Nations International Children‘s Education Fund UNICEF- (2012) reported that, globally as at 2010 over 780million people did not have access to improved water, with 37% of them living in Sub-Saharan Africa. The same report submitted that in the same period, 2.5billion people lack access to adequate sanitation. In the same vein, Vidal (2012a) submitted further that, over 300 million Africans lacked adequate sanitary waste disposal system and clean water for drinking, cooking and washing. Indeed Jabeen, Mahmood, and Tariq (2011) opined that the second most important risk factor for poor health is lack of clean water and poor sanitation and it has major health impacts. Hunter, MacDonald and Carter (2010) also agreed that a safe, reliable, affordable, and easily accessible water supply is essential for good health.

Availability of both potable water and adequate sanitation has potential to prevent at least 9.1% of the global disease burden and 6.3% of all deaths (Pruss, Bos, Gore,and Bartram,2012). Potable water can impact on health by preventing infectious diseases such as diarrhea and cholera, thus preventing economic loss (Fodgen, 2009). Irrespective of whether a disease is waterborne or not, diseases may have serious adverse  effects on human society. According to Food and Agricultural Organization (2001), disease can impose limit to enjoyment of life, reduce labour productivity, reduce quantity and quality of food supply and generally retard socio-economic development of a people. There is a link between water, sanitation and disease in the human society (Lee, 2004). The inadequacy of water supply to households leads to unsanitary conditions, resulting in severe health problems (Ariyo and Jerome, 2004: WHO, 2005). Thus, it is not an understatement that waterborne diseases and the consequences are of concern to many stakeholders. Mismanagement of the environment can lead to pollution of the available resources including water, with its adverse effects.

The effects of waterborne diseases cannot be overemphasized. It can lead to deaths as evidenced in Nigeria recently when cholera outbreak killed many people in many states (Smith, 2010; Cebedo, 2010). This is similar to many developing countries of the world (Oguntoke, Aboderin and Bankole, 2009). The case is even worrisome in children less than five years and WHO (2012b) affirmed the mortality in this age group to be, a death of a child in every minute. Similarly, waterborne diseases can cause great economic loss, as a result of disability that may ensue which may in turn lead to disruptions in trade and travel (Yvan, Luby and Paquet, 2003).

A number of studies have confirmed reasons for the prevalence of waterborne diseases in the human society (USAID, 2005; WaterAid, 2009; NPC, 2009). Most of these reasons centered on inadequate potable water, ignorance and unsanitary attitude.

Waterborne diseases are mostly confined to areas with low hygienic facilities and poor drinking water sources. In many developing countries, sewages are poorly treated, most of which end up in the water systems. USAID (2005) asserted that waterborne diseases become prevalent as a result of dearth of potable water in many parts of developing countries. Potable water is not available in many rural areas of developing countries. Even in the urban areas, available potable water has remained inadequate hence; people obtain water from questionable sources (Aderibigbe, Awoyemi, Osagbemi, 2008). Furthermore, the prevalence of waterborne diseases has also been linked to climate change. According to Shuman (2010), climate is one of the several factors influencing the prevalence of infectious diseases in the human society. Precipitation may have effects on the prevalence of diseases, as increase in it may multiply the presence of these diseases, because heavy rains can contaminate water sheds by transporting human and animal feacal products into water sources (WHO, 2014). In a survey in Kwara State, National Population Commission (2009) showed that 64.6% of the population has access to improved sources of water, while 90.0% of the people do not have access to improved sanitation. This assertion has been affirmed by Adeoye, Adeolu and Ibrahim (2013) in a  study of accessibly to potable water in Ilorin, Kwara State. Thus, the attainment of Millennium Development Goal 7 which lay emphasis on sanitation and quality water is at risk of not being met. Particularly, reducing  to half, the population without potable water and sanitation facilities by 2015 may be faced with difficulties (WaterAid, 2009). This makes issue of waterborne diseases of grievous concern.

In the last ten years, the Kwara State Government has been trying to improve the access to potable water in the State through the expanded water programmes with a view to ameliorating the problems.

Despite this, a large proportion of the people still do not have access to potable water supply and thus there are indications of increase in the prevalence of various water related diseases in various locations in the State.

This study is therefore centered on the spatio-temporal analysis of the prevalence of waterborne diseases, using Kwara State as a case study.

STATEMENT OF THE RESEARCH PROBLEM

Poor sanitary practice in Nigeria due to inadequate water supply is one of the major factors responsible for prevalence of waterborne diseases. According to the United Nations Environmental Programs (UNEP) (2000), Nigeria is one of the countries in Africa that may face water stress by 2025. In the same vein, Adeoye et al (2013) reported that, majority of the people collect their water from non-improved sources in the study area. Thus, the major challenge is provision of safe water and sanitation services which can reduce waterborne diseases in Kwara State.

Waterborne diseases can be a burden on human society, as it can retard the socio-economic development of people. Resources that are supposed to be deployed to the development of other sectors are diverted to solving epidemics, when there is an outbreak. Outbreak of waterborne diseases can also lead to agriculture shortfall, the effects of which may manifest in inadequate food supply and malnutrition.

Suffice to say that, the prevalence of waterborne diseases has been attributed to a number of factors in Kwara State. The poverty level is high, such that the disposable income cannot satisfy the need for safe water, adequate sanitation and improved standard of living.

In a survey of Kwara State by National Bureau of Statistics (2006), the poverty level for urban and rural parts stood at 95.5% and 97.3% respectively. Olusanya, Falola and Ogundeji (2011) confirmed that, poverty level in Kwara State has not changed, years thereafter. The NPC affirmed that about 50.0% of Kwarans are engaged in agriculture, which is mainly subsistence (NPC, 2009). Further worsening encouraging waterborne diseases situation in the study area is that over 52.0% of women in this state are not educated, even though the duty of sourcing water for domestics and sanitation needs in many homes in the study area lies on them.

Besides, there are other challenges that have encouraged the prevalence of these diseases in the study area. Chief among these is the problem of inadequate residential planning, which according to Olukoja,Adewusi and Ogungbenro (2013) has led to aggravation of health of the people. According to Kwara State Planning Commission (2006), majority of houses in the state were built a very long time ago and do not conform to modern safe, health and environmental requirement. Similarly, as a result of low maintenance culture, many sanitation and water facilities have broken down. For instance, Aganaba (2006) reported that of 1,851 boreholes provided by UNICEF through its Water and Sanitation Project (WATSAN) in Kwara State, 40.0% are not functioning. This is the case in developing countries where many water supply interventions do not last (Schouten and Moriarty, 2003).

Furthermore, many of the boreholes that were provided by the past administrations are either malfunctioning or in state of disrepair. A case in mind is Water and Sanitation (WATSAN) facilities provided by the Directorate of Food, Road and Rural Infrastructure (DFRRI). Available records showed that DFRRI by 1992, provided 30,000 boreholes across the length and breadth of Nigeria, but which have either broken down or are in the state of disrepair (Obasi, 2014).

Other challenges have to do with increase in population of Kwara State. Between 1991 and 2006, the population of Kwara State has increased by 800,000 people, without corresponding increase in both water and sanitation facilities.

The effect is that some of the existing water facilities are stretched and, eventually break down (Ajadi, 2010). Above all, most water facilities in the state are concentrated in the urban areas to the detriment of rural areas, which according to Oyebanji (2000) house large percentage of Kwarans.

This is not to say that the urban area of Kwara State is totally free from water crisis, as potable water is not available in adequate quantity (Aganaba, 2005; Aderibigbe et al, 2008). According to the National Population Commission (NPC, 2009), waterborne disease is a major problem in the human society. Carter Center (2014), estimated that 27 million Nigerians are infected with Onchocerciasis (River blindness) in different parts of 32 states. Similarly, Carter Center (2012) also affirmed that Nigeria is the most endemic country for Schistosomiasis (Bilhazir), with an estimated 20 million people affected, who are mostly children that are affected by this waterborne disease. Furthermore, Olokor (2013) opined that cholera is a scourge that has ravaged the Nigerian communities. In the same vein UNICEF (2013) affirms that the diarrhea prevalence rate in Nigeria is 18.8%, resulting in  an estimated 150,000 deaths among children under five. Adebayo (2013) submitted that an estimated 21million cases of typhoid occur yearly worldwide, resulting in 200,000 deaths in developing countries. According to Kwara State Ministry of Health (2012) cholera, typhoid, Onchocerciasis, Schistosomiasis, diarrhea and trypanosomiasis are the six major waterborne diseases in the state.

Although some isolated researches have been carried out on Kwara State in relation to health and water. For instance Aderibigbe et al (2008) worked on quality of water, its accessibility, adequacy and level of sanitation in Kwara State. A multi-stage sampling method was adopted, involving 750 respondents. It was discovered that majority had no access to daily recommended water requirement of 140 litres.

The result, in terms of quality and quantity showed that Kwara State has not met the national standard, leading to outbreak of waterborne diseases; thus the study recommended for provision of improved water. Aganaba (2006) conducted a GIS/Mapping in Kwara State on UNICEF Assisted Water and Sanitation projects and discovered that, many of the water projects were in the state of dysfunction.

This too is considered as an incentive for waterborne diseases in Kwara State to thrive. Babatimehin (2005) carried out study of Onchocerciasis in Patigi Local Government. The study adopted multi-stage sampling method, in which Patagi Local Government Area was stratified into three administrative districts. Six hundred (600) respondents were sampled in the study. The study attested to the fact that, both physical and socio-economic factors determine vulnerability to Onchocerciasis. It therefore recommended that rural development planning programmes should reflect spatial peculiarities accompanied by public enlightenment campaign on the vulnerability factors and perception of the diseases.

Abolarin, (1999) carried out research on Schistosomiasis in Kwara state. The study affirmed that, the incidence of Schistosomiasis is high among people who depend on rivers for domestic for their uses. It therefore recommended that provision of potable water for the control of not only Schistosomiasis, but other waterborne diseases.

Adeoye, et al (2013) studied the relationship between water and diseases in Kwara State. The state was divided into three zones and two Local Government Areas were selected from

each zone and two villages were selected from each Local Government Area. It was concluded that potable water remains inadequate in Kwara State, it recommended that, to prevent outbreak of waterborne diseases, provision of safe water is necessary.

However, there is no comprehensive work has been done on holistic spatial-temporal nature of waterborne diseases in the State to the best knowledge of the researcher. It is an issue  that worries the mind and this is the academic gap this study intends to fill. Thus, this study is aimed at the spatial-temporal pattern of waterborne diseases, using Kwara State as a case study and this is the academic gap this study intends to fill.

RESEARCH QUESTIONS

In view of the foregoing, this study seeks to answer certain pertinent questions which are

1.                                          What are the main waterborne diseases in Kwara State?

2.                                          Is there a spatial variation in the prevalence of waterborne diseases  in Kwara State?

3.                                          What are the environmental factors influencing the prevalence of waterborne diseases in Kwara State?

4.                                          What are the effects of waterborne diseases on the people of Kwara State?.

             AIM AND OBJECTIVES OF THE STUDY

The aim of this study is to analyze the spatio-temporal  prevalence  of  water  borne diseases over time in Kwara State, Nigeria. However the objectives are:

i.                                              identify the waterborne diseases in Kwara State.

ii.                                       examine the spatial pattern of selected water borne diseases over time in the State.

iii.                                        identify the factors that promote waterborne diseases in Kwara State.

iv.                                        examine the effect of waterborne diseases on the population of the state.

                         NULL HYPOTHESES.

H0 I: There is no significant relationship between the mean perception of water borne diseases and demographic variables.

H0 II: There is no significant difference between the perception on prevalence of water borne diseases and the three senatorial districts.

H0 III: There is no significant relationship in the prevalence and occurrence of waterborne diseases in the Senatorial districts of the study area.

                         SCOPE OF THE STUDY

The spatial coverage of the study is limited to Kwara State, Nigeria. In order to have precision and ensure adequate representation of the sample by avoiding bias, it is stratified into three on the bases of the existing senatorial districts - Kwara North, Kwara Central and Kwara South. From the senatorial districts, two Local Government Areas (LGAs) were purposively selected. In each LGA, the existing administrative districts were also explored to access settlements. From the settlements, the household heads were estimated using National Population Commission mean estimate of 4.7.

Suffice to add that, districts were chosen and not LGA, because districts have remained unaltered over the years like LGA. For instance, Ilorin LGA‘s administrative structure has been altered many times over the years.

Additionally, the 1991 population census data were used, because it remains the only population document in Nigeria in recent time that disaggregates into localities.

The households were also estimated, because data were not available on each settlement that makes up the sampled settlements. The study focused specifically on issues like types of waterborne diseases, their prevalence, influencing factors, impact of these diseases on the socio-economic sector among others. It covers a period between 2007 -2012, which is a period the data were collected.

                         JUSTIFICATION OF THE STUDY

That waterborne disease is a cog in the wheel of progress of human society is not in doubt. It has been shown that it can retard socio-economic development of people. In the light of the above, and at the end of this study, a number of benefits will accrue from the study and some of these are highlighted:

i.     It will assist in the determination of the state of waterborne diseases infestation in the study area. Our knowledge of their prevalence will to a large extent aid the control of these diseases and necessary steps required to prevent or control them. In other words, the most common waterborne diseases in the study area can be mapped and various steps needed to stem the spread of these diseases can easily be taken. For instance, the study area is noted for certain waterborne diseases, thus the provision of potable water which is panacea for the control or total elimination of these waterborne diseases can be encouraged.

ii.     Additionally, relevant education can also be introduced to aid the control of these diseases. The importance of these can go a long way in improving social economic status of the people of the study area and Nigeria at large, hence this study.