Behavioural and Cultural Factors That Influence Open Defaecation among First Cycle School Pupils in the Eastern and Volta Regions of Ghana

Abstract

The influence of human behaviour and culture on open defaecation has attracted global concern in recent times. As a way of placing the behavioural and cultural factors influencing open defaecation behaviour in Ghana on the public agenda, a school-based cross-sectional study was conducted in eight first cycle schools selected from eight communities within the Eastern and Volta regions of the country. The objective of the study was to explore the behavioural and cultural factors influencing open defaecation among the pupils aged between nine and eighteen years. Self-reported data on attitudes, subjective norms, perceived control behaviour, behavioural intentions, culture and situational factors associated with school toilet systems were collected from 400 pupils in the selected schools. The study employed mixed methods—questionnaires, focus group discussions, in-depth interview, and checklist observation. Quantitative data was analyzed using Structural Equation Modelling (SEM) path analysis with the aid of AMOS software version 20 (IBM), and the qualitative data was also analyzed using thematic data analysis procedures. The results of the study showed high level of open defaecation (64.3%) among the pupils with more female pupils (32.6%) than male pupils (29.4%) recording the higher open defaecation prevalence across the study schools. The overall knowledge level of risks associated with open defaecation behaviour was high (89.8%) among the pupils. Knowledge of health risks of open defaecation behaviour was, however, low among the greater number (53%) of the pupils. Pupils’ knowledge of environmental risks associated with the open defaecation behaviour was found to be fairly high (52%). Attitude was found to have significant direct influence on pupils’ intention to engage in open defaecation behaviour (standardized mean positive effect size = 0.708; p<0.05) compared to the subjective norm (standardized mean positive effect size =0.035; p>0.05 and PBC

(standardized mean effect size =-0.11; p< 0.05). The interaction effect size of subjective norms and perceived behavioural control variables was also found to be strong and statistically significant predictor (standardized mean positive effect size = 0.608, p<0.000) of pupils open defaecation behaviours. The interacting effect size of behavioural variables included on attitude, subjective norms and perceived behavioural control measuring scales on pupils open defaecation behaviours was also found to be strong and statistically significant determinant of open defaecation behaviours (standardized mean positive effect size (r) = 0.58; p<0.05). The study also noted that cultural factors-taboos and superstitions constituted the key variables influencing pupils’ open defaecation behaviours (63%) with the later exerting stronger and statistically significant influence (standardized mean positive effect size = 0.728, p <0.000). The interaction between behavioural and cultural factors was equally found to have greater effect size on pupils’ open defaecation behaviours (standardized mean positive effect size =0.682, p <0.000). The conditions of the school toilet system, oscillating from toilet inadequacy, lack of privacy, poor ventilation, inappropriate squat hole sizes, community and rodents encroachment on school toilets, to inappropriate location of school toilets, constitute key situational variables causing pupils to engage in open defaecation practices. The study findings revealed that open defaecation behaviour is being reinforced in the first cycle schools regardless of pupils’ high knowledge of health and environmental risks associated with the practice. Thus pupils’ open defaecation behaviour is largely policy and situation-driven which raises many questions about the level of attention the Ministry of Local Government and Rural Development (MLGRD), Ministry of Education (MOE), and Ghana Education Service (GES) give to open defaecation in schools. The MLGRD must make it a national policy that schools are provided with descent toilet facilities whose quality resonates with the benefits pupils attach to open defaecation practices. Secondly, the MOE, GES, Teacher Education Division (TED), Curriculum Research and Development Division (CRDD) must introduce new courses that can help pupils to acquire knowledge on the environmental and health implications of open defaecation practices. The pupils must also be educated on good sanitary practices.