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JOURNAL OF SCIENCE, Hue University, N0 61, 2010
RESEARCH ON ACTIONS OF COMMUNITY MOBILIZATION TO IMPROVE
SANITATION ENVIRONMENT FOR ETHNIC MINORITIES IN ESPECIALLY
DIFFICULT REGION OF DONG HY DISTRICT, THAI NGUYEN
Dam Khai Hoan
Thai Nguyen University of Medicine and Pharmacy
Hoang Anh Tuan
Thai Nguyen Medical College
SUMMARY
A two year- study on community mobilization for improving people’s behavior on
environmental hygiene in minority ethnic community at remote and disadvantage region in Cay
Thi Commune, Dong Hy district, Thai nguyen province. The findings are (1) the model of inter-
branches in community and responsibility shared with health personnel in communicating to
improve the people’s behavior on environmental hygiene, combine the task of each member of
stake holder. The model had been set up the concrete duties and tasks to ensure their task as
well as the integration of communication of environmental hygiene, (2) the findings show that
there are the changes in people’s behavior on environmental hygiene in Cay Thi Commune, the
knowledge is increased 63%, attitude is increased 33, 2%, practice is increased 14, 5%. The
interventional effectiveness is knowledge on environmental hygiene (323%), practice (253%)
and attitude (206%). After intervention in Cay Thi Commune, there are changes clearly,
especially in building and using hygiene latrines, built hygiene latrines are increased (26, 5%
households), the interventional effectiveness is 217, 22%. The recommendations: This model is
good solution, feasibility and need to be applied and continue to study by certain local authority
and health system.
Key words: The community mobilization; the environmental hygiene; the minority
ethnic community.
1. Introduction
Environmental hygiene is a problem that is not only of interest in the scope of a
country or a region, but also a matter of concern on a global scale because of its
importance to human health. Implementing good environmental hygiene to improve the
health and living conditions of rural people contributes to poverty alleviation, especially
in the uplands, deep and difficult areas as well as ethnic minority areas. However,
economic development, culture and society in these areas is still poor, the common
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people's living standards are low, their educational level has not improved,
transportation is difficult, and health care conditions and social welfare are still lacking.
In Dong Hy district, Thai Nguyen province, the behavior of environmental hygiene is a
problem. Therefore, we deem it necessary to improve environmental sanitation.
Mobilizing the community to participate in improving the behavior of environmental
hygiene is considered a good approach for solving these problems. Thus this research is
conducted to describe the actual situation of environmental hygiene behavior of ethnic
minorities in particularly difficult communes of Dong Hy district, Thai Nguyen
province, to build a model of community mobilization to improve environmental
hygiene behavior for people in Cay Thi commune, Dong Hy district, Thai Nguyen
province and to assess the effectiveness of the model for improving sanitation behavior
for ethnic minorities in Cay Thi commune after two years of implementation.
2. Methods
2.1. Subjects: All households, government leaders, government departments,
unions and medical workers.
2.2. Location: 4 communes (Cay Thi, Hop Tien, Van Lang and Tan Long) of
Dong Hy district, which are mountainous communes, in which Cay Thi is a intervention
commune and Hop Tien is a control commune
2.3. Time: From January 2006 to December 2007
2.4. Methods: A cross-sectional method was used to describe the actual situation
of environmental hygiene behavior and find the factors related to environmental
hygiene behavior. An Epidemiological intervention to build models to improve
sanitation behavior was also conducted.
2.4.1. Descriptive study Design: The combination of the properties. The sample
size was calculated for a cross-sectional survey of 800 but the actual survey sample was
830. Four communes of Dong Hy district were chosen intentionally, because they are
considered extremely difficult communes in Dong Hy. 200 households of ethnic
minorities in remote areas (the town center from 5 km) were selected from each
commune. Each household randomly selected one adult representative (as family
leader) from the list of households.
2.4.2. Intervention study design: The following interventions are confronting
the sample size was calculated based on a formula of epidemiological intervention n =
194, so the number of households in each commune was 200. We decided to choose Cay
Thi commune and Hop Tien commune because they have similar social characteristics.
2.4.3. The research indicators: Using Knowledge, Attitudes and Practice, (KAP)
on environmental sanitation as indicators. The KAP level distributed into three types of
variables, such as knowledge (K), attitude (A) and practice (P) for each problem will be
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studied. The total of points for each variable was 10 points. The classification of KAP
levels are as follows: Total points from 10-70 points: Good; from 5 to 6 points:
average; <5 points : weak
2.4.4. Build models of intervention.
- Establish a Steering Committee to adopt the model in Cay Thi (intervention
commune)
- Train participants in basic issues of hygiene and environmental media and
methods of operation in the model (duration of the training course is one week).
- Assign functions and specific tasks to the participants
- The Steering Committee meets monthly to review the implementation
progress of the model and supplement and update the knowledge of some of its
members
- Activities of the team: Conduct a surveillance to review progress on
implementating models and to detect additional problems which require direct support
every two months.
- The activities of the model are continuous for about two years.
2.4.5. Information gathering techniques
* Quantity: Interview households: investigators conducted interviews directly to
householders. Interviews were recorded on pre-printed forms which were designed in
accordance with the procedures and requirements of the research. These forms were
pre-tested at Cay Thi commune, then revised again before printing. Observations in
homes and information collected from health centre reports.
* Identification: Focus group discussions were used to explore cultural aspects,
hygiene habits of the people and the acceptability of the community model: There were
two discussion groups (one before and the one following the intervention) with the
steering committee members and community representatives (approximately 10 people
for each).
2.4.6. Assessment methods. Comparisons of KAP about environmental sanitation
change in Cay Thi and Hop Tien before and after intervention. Results were ranked
based on intervention effectiveness index and effective interventions.
2.4.7. Method of processing data. The software EPIINFO 6:04 was used.
3. Results
3.1. Knowledge attitude practice (KAP) about environmental sanitation of
people in the researched communes
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Table 3.1. KAP of the people who undertook water and management of water distribution.
KAP n %
Source water agreements: good knowledge 249 30.
Behaviour 176 21.20
Good Practice 134 16.14
Distribution management: good knowledge 168 20.24
Behaviour 159 19.16
Good Practice 89 10.72
The results revealed the KAP of people concerning water is very low: The
percentage of people with good knowledge only reached 30%, good attitudes and good
practices account for only 21.2% and 16.14 %. Concerning water management, the
percentage of people who had good knowledge of management was 20.24%, the
percentage of good attitudes and good practice was also lower: 19.16% and 10.72%
respectively
In the community, before our intervention was implemented a panel discussion
with local leaders and residents of Cay Thi was conducted. When discussing water
issues, according to Mr. K - Farmer's Market "local water sources are mainly used, as
dug wells, which are not sanitary, the cause of pollution is caused by grazing and
deforestation at the watershed ... "Mr. X - President of the National Social Front, said:"
As neighbors get water vascular plants from the mountain town to households and three
neighbors used deep troughs using water from streams to their homes... The cause of
water pollution was due to mining, a few households also raise stock, sanitation as
water wells near food. There are not hygienic latrines by customs still optimistic Miss.
When discussing the management of water sources, Mr. C – Cay Thi commune
said "Look at the toilet hygiene of the households in eight neighborhoods, I found most
of the households have sanitary latrines ..". Mr. H – from the commune health center
said: " There are no hygienic latrines in four remote hamlets of Cay Thi, this is caused
by backward habits of sanitation. The solution for this is to communicate in order to
change people's behavior...". In summary, water sanitation in the communes is not good,
polluted by negative behaviors of people like the indiscriminate exploitation of mineral,
water near the latrines, cattle pens .. People also use the slots, spring water ... and
largely indiscriminate release UE is common due to no hygiene toilet ...
Table 3.2. KAP of the people who had cattle pens and chemical plant protection
KAP n %
Animal cages: good knowledge 289 34.82
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Behaviour 249 30.
Good Practice 176 21.20
Chemical plant protection: good
knowledge 166 20.
Behaviour 158 19.04
Good Practice 89 10.72
In the KAP Synthesis of people on blankets, drop, construction of animal barns
we saw that: good knowledge of the people on these issues is still low, reaching only
34.82%. The scores of attitudes, and practice of the people was also low, only 30% and
21.2%. Knowledge, attitudes and practices of the population with chemical plant
protection is not yet possible. In our study, the proportion of people with good
knowledge of 20%, good attitudes and good practices as 19.04% and 10.72%
respectively...
According to Ms. M – Cay Thi primary school: "The farm animals and do not
just drop hygienic ...". According to Mr. K - Commune Farmer Association: "The
raising of cattle and cattle ranching also no longer present if the neighbors are mostly in
remote areas. The rate of latrine use is low due to the habits and practices ... "
Table 3.3. KAP of the people about sanitation
KAP n %
Good knowledge 179 21.57
Behaviour 157 18.92
Good Practice 79 9.52
General knowledge of environmental sanitation of the people is at a very low
level, at 21.57%. The results of good behavior and good practice on environmental
hygiene is also very low (18.93% and 9.52% respectively).
When discussing sanitation issues in general, according to Mr. T – Cay Thi
People’s Community: "Now latrines and hygiene of the households in the most remote
hamlets are a problem. The reason is their habits. The knowledge people have about
hygiene is very limited. Particularly in three remove hamlets people still feed free pigs ...
" So the proportion of households who have clean water, sanitary latrines, and
bathrooms are very low. The leading cause is due to the customs and obsolete traditions,
and poverty ... communication on sanitation is necessary. The party, government,
departments should motivate the active participation on the medical basis to ensure the
success ...