By Lwandamo Katondo
Namukulo Namukulo is a breastfeeding mother of a healthy 1-year-11-months old baby girl and 5-year old boy. Ms Namukulo, 24, lives in Siwa village, Chief 
area of Ndoka ward in Kalabo district and is a volunteer in charge of Simunyange NSG which comprises of 11 mothers. She is a beneficiary of social behavioral change communication messages under the Water, Sanitation and Hygiene (WASH) program. Ms Namukulo shares her delight of seeing mothers in the area take a proactive action against open defecation by erecting and using simple but adequate pit latrines.
“We had been suffering from diarrhoea and other intestinal infections due to contamination of the environment as faecal matter easily found its way into the water courses from where we draw our domestic water. Furthermore, the unhealthy practice of open defecation does not promote the use of handwashing facilities. So when the mother breastfeeds or prepares food for the child the contamination spreads resulting in recurrence of diseases arising from poor sanitation and unhygienic practices.”
Ms Namukulo is alive to the fact that open defecation has devastating consequences for public health. She says through the Nutrition Support Groups (NSGs), mothers in her area were taking a proactive action against open defecation.
“Child stunting and wasting are the most widespread consequences of open defecation and poor sanitation. Faecal matter contaminates the environment and provides a breeding ground for poor hygiene practices. These poor sanitation vices remain a leading cause of child mortality and morbidity arising from undernutrition and stunting which can potentially have negative effects on the cognitive development of children,” she said.
Ms Namukulo says as an NSG volunteer, she has since sensitized and encouraged every mother to mobilize local materials such as grass and poles for construction of basic pit latrines which must be adequate and must always be used by every household member when answering the call of nature.
“Households must always use an adequate pit latrine for safe disposal of faecal matter. It’s one of the best practices towards averting diarrheal diseases and promoting a healthy living among children who are mostly affected (by the scourge of open defecation).
“It hasn’t been easy to change the social behaviors of mothers but with persistence, most of the mothers are now fully enlightened and have taken a proactive action against open defecation. This is as it should be,” she said.
The proactive action by communities has inspired and elated Namasiku Situmbeko of Siwa village, Ndoka ward. Ms Situmbeko, a volunteer in charge of Kafue NSG, and young breastfeeding mother of a 1-year-old baby boy now recounts the adverse effects of open defecation.
“Open defecation can result into malnutrition due to persistent intestinal infections which compromise the feeding capacity among children. The nature of children is that they like to play around, and so when the environment is contaminated with faecal matter they get exposed to intestinal infections. With the onset of the rainy season, I wish to appeal to every mother to ensure that communities use latrines so that the environment is free of faecal contamination.”
Ms Situmbeko says mothers were not only dedicated to erecting and using basic pit latrines but have also adopted the use of handwashing facilities.
“Our pit latrines are equipped with handwashing facilities. I’m highly grateful to SUN (Scaling Up Nutrition) for empowering the mothers with social behavioral change messages on the need to uphold good sanitation levels in a bid to fight against stunting and other forms of malnutrition which result from unsanitary conditions,” she stated while appealing to fellow mothers to take responsibility upon themselves, take a proactive action and ensure that every household has a basic and adequate latrine so that children grow a healthy life free from faecal contamination of the environment.
To that effect, Government remains committed towards universal provision of basic, adequate and equitable sanitation facilities for all Zambians in a bid to eradicate open defecation by the year 2030 as envision under Sustainable Development Goal number 6 whose milestone target Zambia seeks to attain.
The measure towards provision of basic, adequate and equitable sanitation facilities for all Zambians is synonymous with phase two of the 1st 1000 Most Critical Days Program’s (MCDP II) theory of change which focuses on improved WASH related social behaviors towards good sanitation as one of the high impact interventions capable of averting child mortality. According to the theory of change, hygiene and sanitation practices and facilities promote for improved health and nutrition status, improved maternal nutrition status as well as reduced child stunting among target households.
In Kalabo district of Western province, the Ministry of Local Government and Rural Development has continued to strengthen action groups in a bid to fight against open defecation. The sustained efforts and CLTS intervention are directed towards reducing stunting among children, particularly those whose age falls within the 1st 1000 most critical days of life.
The WASH intervention further seeks to address gaps in a number of benchmark indicators as highlighted in the 2019 baseline survey which was conducted by Scaling Up Nutrition Learning and Evaluation (SUN LE). The study established that 9.6 percent of households in Kalabo district use improved adequate sanitation services while 5.2 percent of households use soap and water at a handwashing station commonly used by family members. Furthermore, 2.5 percent of households in the district were practicing correct use of recommended household water treatment technologies.
Miyombo Zhyinga, 43, of Sikutwi village, Chief Simioti’s area, in Ndoka ward is a Community Sanitation Champion. Ms Zhyinga, is committed to community work centered towards helping households live in hygienic environments. She now explains how the Community Led Total Sanitation (CLTS) under WASH seeks to address the underlying determinants of child malnutrition caused by unhygienic environment arising from open defecation.
“Access to adequate sanitation facilities among SUN II household beneficiaries in Ndoka ward has hugely improved. In the past, around the year 2016, open defection was widespread despite communities drawing domestic water from dug-out wells. There was strong resistance among households in terms of adopting usage of adequate sanitation services. The resistance was perpetuated by deep-rooted traditional norms and cultural beliefs which held that it was a taboo to construct a disposal facility for faecal matter.
“But due to repeated social behavioral change messages, and partnering with traditional leaders as well as other stakeholders, most of the households have now fully realized the adverse effect of open defecation,” she said.
Ms Zhyinga, who is also a Ward Nutrition Coordinating Committee (WNCC) member, has observed that most of the households in the area have erected and were using simple, basic but adequate pit latrines with locally tailored handwashing facilities. She adds that most of the villages in the area were ready to be declared Open Defecation Free (ODF).
“Most of the villages now have safe domestic water services with additional boreholes recently drilled in un-serviced areas and awaiting fitting of hand pumps. The increasing provision of drilled borehole water is because the villages have overcome open defecation.
“The need for every household to have a latrine for safe disposal of faecal matter cannot be over emphasized. Improved sanitation as well as usage of an adequate latrine plays a critical role in the promotion of good health especially among children and mothers. This is because these categories are severely affected by open defecation and highly susceptible to diseases when exposed to a contaminated environment and poor hygiene practices.
Ms Zhyinga reaffirmed that social, cultural and technological factors among other behaviours would continue to be monitored and addressed among SUN II households in Ndoka ward because they are critical if ODF status is to be sustained for future posterity. The Community Sanitation Champion also disclosed that most of the latrines are attached to the respective households’ homestead yard in order to avert sharing, misuse, and trespassers as each household is expected to have and use their own facility.
“Routine monitoring and learning has enabled the community to slowly but continuously build on existing practice. The progress is overwhelming. I managed to trigger every village in the two chiefdoms across Ndoka ward. The efforts have paid off as households now put themselves to task and erect a new pit latrine to replace a dysfunctional one or as need arise.
Ms Zhyinga has since appealed to traditional leaders to use their authority and serve as agents of change for improved sanitation in rural communities in a bid to avert child mortality, morbidity, undernutrition and stunting.
The proactive action by rural mothers living in Ndoka ward builds on the wealth of reports and studies which describe open defecation as one of the biggest public health concerns in developing nations.
According to Community Led Total Sanitation Foundation, children are often the most severely affected by inadequate sanitation and open defecation. By virtue of their developing immune systems, they are affected by a host of illnesses and conditions ranging from physical and mental stunting to cholera and malnutrition.
“Emerging evidence has a link between poor sanitation and chronic malnutrition in children through the spread of diarrhoea and other intestinal parasites. The World Health Organization estimates that 50 percent of malnutrition is associated with repeated diarrhoea or intestinal worm infections from unsafe water or poor sanitation. This is because children with diarrhoea eat significantly less food and are able to absorb fewer nutrients from their food, which perpetuates the cycle of catching bacteria-related illnesses.”
The Foundation further states that “diarrhea is also caused by lack of clean water for handwashing. It is also exacerbated by the lack of functional toilets which adequately dispose of fecal matter, as faeces on the ground contribute to contaminated drinking water and water resources. This means that millions of children are unable to attain a healthy body no matter how well they are fed; a classic sign of malnutrition.”
