Báo cáo nghiên cứu khoa học: "Nghiên cứu về hành động của vận động cộng đồng để cải thiện vệ sinh môi trường cho các dân tộc thiểu số trong khu vực đặc biệt khó khăn của huyện Đồng Hỷ, Thái Nguyên"

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Tuyển tập các nghiên cứu khoa học của trường đại học Huế đề tài: Nghiên cứu về hành động của vận động cộng đồng để cải thiện vệ sinh môi trường cho các dân tộc thiểu số trong khu vực đặc biệt khó khăn của huyện Đồng Hỷ, Thái Nguyên...

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Nội dung Text: Báo cáo nghiên cứu khoa học: "Nghiên cứu về hành động của vận động cộng đồng để cải thiện vệ sinh môi trường cho các dân tộc thiểu số trong khu vực đặc biệt khó khăn của huyện Đồng Hỷ, Thái Nguyên"

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 201
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 202
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;
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 34.82 204
Behaviour 249 30. Good Practice 176 21.20 Chemical plant protection: good 166 20. knowledge 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 ... 205
3.2. Building a model of intervention 3.2.1. The results of model intervention. The model was built with the participation of key community organizations. Members of the model were assigned proper tasks 3.2.2. Operation results of the model: * Results of model training Table 3.4. Results of model training Pretest Postest Time p Level n % n % Pretty, Good 14 33.33 28 66.66 Average 15 35.71 12 28.57
CHC supervises the health volunteers and collaborators’ daily work in the medical professional field. * Results of communication activities Table 3.5. The results of specific activities of the participants concerning the model indicators Number of Number of Indicators Number of sessions communicati listeners transmitted on sessions in through Member households meetings Commune health station staff 10 105 198 Village health workers 51 423 982 Women 8 120 379 Youth Union 42 387 1.235 Farmer 8 45 125 Teachers 'plug' 13 78 234 University medical student 24 490 678 The other mass organizations 12 24 132 Total 168 1.672 3.963 The above results show the organizations involved in communication on sanitation works. the leading groups are health staff, medical students, youth union and teachers are plugging the organizations most active. 3.3. Effective models of intervention in changing people's environmental sanitation behavior Cay Thi and Hop Tien, Dong Hy district, Thai Nguyen province Table 3.6. Change KAP on environmental sanitation of the people to conform to social Time Before After intervention intervention Difference performance indicators p (%) hygiene (%) n % n % environment Good knowledge 39 19.5 165 82.5 63. 323. p
After the intervention the change in people's KAP on environmental sanitation is illustrated in table 3.6. Clearly the most effective interventions are knowledge of sanitation (323%), followed by sanitation practices (253%) and attitudes (206%) with p
Table 3.9. Change of use CTVS of Hop Tien commune Time Before After intervention Differenc performanc intervention e e indicators p hygienic (%) (%) n % N % work Clean Water 83 41.5 98 49.0 7.5 18.07 >0.05 Sanitary latrines 23 11.5 31 15.5 4 34.78 >0.05 Bathroom 95 47.5 113 56.5 9 18.95 >0.05 Move animal cages away from 39 19.5 47 23.5 4 20.51 >0.05 housing After nearly two years, Hop Tien commune had no significant change in the use of latrines. The percentage of CTVS in Hop Tien increased but this is small and had low efficiency (p> 0.05). Table 3.10. KAP on environmental sanitation after intervention Time Cây Thị Hợp Tiến (n.200) Difference work (n.200) Hygienic p (%) efficiency n % n % Work Good 165 82.5 76 38 44.5 185 p
Bathroom 128 64.0 113 56.5 7.5 33. >0.05 Move animal cages away from 45 22.5 47 23.5 1. 18. >0.05 housing After nearly two years in Cay Thi commune, hygiene work increased more than in Hop Tien commune, but only indicators of sanitary latrines are clear and significantly (p
to change behaviors of people on sanitation. Consequently, gradual improvement hygiene work will contribute to free health care for people and their family. In remote areas and special difficult areas, this is a difficult issue but very necessary. If we conduct activities well, people will understand this and therefore have the right attitudes and action to change behavior and maintain environmental sanitation as well as their health 4.3. On training: Because of the level of staff participation model and relatively evenly, the training of media knowledge to practice is very easy. Thus, after only a week, just theoretical but practical communications staff participation models has captured the basic content that can execute activities. Also on the second of January the team to monitor and add complementary knowledge for staff participated in the model. 4.4. About interests: Monthly the staff involved get an allowance of 20,000 VND. Compared with the allowance of health volunteers, such as 40,000 VND, this allowance is appropriate. In addition, officers participated in government social model is to facilitate the operation. The Steering Committee level model of communication materials are meeting with documents and meetings with the women's and youth Union. The results of staff activities involved government social model is classified into one of the criteria to consider emulation yearly. These are very basic rights, feasible and appropriate. 4.5. The operating model of supervision: The CHC is responsible for activities in the medical field., The head of government is responsible for monitoring and management activities. After training, the Steering Committee and CHC signed the contract with the commune officials to participate in the model (i.e specifying the commitment of time, obligations and interests of participants). Indeed in recent years, the staff involved were operating actively and have obtained good results. Monthly they conduct and report health education activities regularly to the CHC. They report clearly communicated the media content, media sessions in the family. In the meeting of the officials involved with health volunteers attended the content statements were planed, and work to do in the future while listening to comments of construction workers people to do the work better. These model activities are also consistent with models of community mobilization in Dr Dam Quang Khai in Hoan Son, Van Lang and the health room of the Nguyen Thanh Trung, Tran Trung Chien in 9 communes in Linh Son, Tan Long , Hop Tien, Dong Hy district in activities for people's health care . Primary health care is the social work which the Party and State has always been interested in. Mobilizing community participation in health education in environmental sanitation in Cay Thi, Dong Hy, Thai Nguyen is an innovative response to this policy of the Party and State. This is also probably inevitable because the propaganda and education help people understand that they have limited knowledge, thus they will practice much better. On the other hand, sanitation relates to everyone and every family 211
in the society so that the socialization of this work is essential. At the same time to achieve good results, we must work continuously and over a vast area and complex. So the arrangement of activities integrating this work with other programs on the same area and at the same time will bring better results and more benefits. Actual execution time in the market for our tree found: The staff involved models can perform both their primary job and health educational work. The staff model is a member of the Board of Primary Health Care with the remuneration of 20,000 VND per month. They have conducted many sessions in various forms of communication therefore their work is very effective. At the same time the results achieved in some areas were relatively clear, but not very much. People realized members who impart their knowledge in the way to be good to understand, easy to acquire, easy to implement. The participants were the same working and living with people. Today this team is quite large if we mobilize them to participate in the work of health communication and education will create a more powerful to support the work of medical staff in CSSK remote areas with problem sanitation. The research results showed when the impact of positive media KAP on the people had better change. Along with the similar conditions and members, but in Hop Tien members and government departments are not trained and not assigned to health communication and education on sanitation, the results are more slowly. In the above criteria, the better knowledge of this evolution is also reasonable because the attitudes and practices of the people are the basic components of behavior has existed for a long as traditions, customs, habits So It requires a long time to change them 5. Conclusion 5.1. The KAP scores of people with good sanitation is still low; Good Knowledge: 21.57% good Attitude: 18.92%; of Good Practice: 9.52%. A number of factors related to the sanitation practices of the people is the household economy, media, age, ethnicity, gender, education and social concerns for sanitation problems . 5.2. A model of community mobilization based on media sanitation was organized at local departments to share responsibility for improving health behaviors in the population about sanitation. The model adds to the task of the individual or unit ... Model studies be incorporated into the Board of Primary Health Care. To make the model feasible, a social Steering Committee integrated with the Primary Health Care needs to be established. When mobilizing the community to build functions, specific tasks while ensuring good work has recently re-integrated the U.S. Health Education of sanitation and ensured the management of health station expertise. 5.3. Operating results of the model is nearly two years in social activities to conform with behavior change in sanitation increased 63% as knowledge, 33.2% increase attitude and practice increased 14.5%. The most effective intervention is 212
knowledge of sanitation (323%), then practice (253%), and attitudes about sanitation (206%). After intervention in social Cay Thi commune, the most obvious change is the use of sanitary latrines (up 26.5% of households), effective intervention is 217.22%. 6. Recommendation This model of mobilizing communities to participate in health education about primary care and environmental sanitation is effective and feasible to perform, particularly for people in remote areas of the mountains. The model is a good solution and should be feasible for government leaders, health sector at all levels and applied research. REFERENCES 1. Khai Hoan Dam and colleagues, The work situation of health care for the initial Nung, Dao in four remote mountainous communes of Dong Hy district, Thai Nguyen, Hanoi journal Science Technology Medicine - Pharmacology, Medical University of Thai Nguyen, the young scientific conference number 3/2001, (2001), pp. 199-207. 2. Khai Hoan Dam and colleagues, Initially reviews some habits that affect health in some of the Dao region III Bac Kan province, Journal of Medical Practice, No. 03/475, Hanoi, (2003), pp. 22-25. 3. Khai Hoan Dam, Dam Thi Tuyet, Hac Van Vinh, Evaluation models of teacher initially plugged the TT-GDSK participate in reproductive health for people upland of Dong Hy district, Thai Nguyen, Hanoi Obstetric Medical technology - Mountain Pharmacy, Medical University of Thai Nguyen, Thai Nguyen, (2003), L. 55-63. 4. Hoang Khai Lap, Situations village sanitation, health and disease in northern mountainous areas of Vietnam and the direction of settlement, "Capacity building of health care for ethnic minority peoples Ethnic difficult areas in the northern mountainous area ", Proceedings of Workshop on Science and Technology of Medicine, University of Thai Nguyen, (2001), L. 100-105. 5. Le Thi Nguyet, Situations state of knowledge, attitude and practice on environmental hygiene of people in four mountainous communes of Dong Hy district, Thai Nguyen Province, graduated Topics Doctors Hospital, (2003). 6. Nguyen Thanh Trung, Tran Thi Trung Chien and colleagues, Experimental model of health care in mountain villages, the Project of Science and Technology Ministry, Medical University of Thai Nguyen, (1999), L. 4-25. 213