CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Diarrhoeal diseases remain a leading cause of morbidity and mortality among children worldwide, accounting for roughly 8?% of deaths in those under five years of age (World Health Organization & UNICEF, 2021). School aged children are particularly vulnerable: inadequate water, sanitation, and hygiene (WASH) facilities in educational settings facilitate faecaloral transmission of pathogens and contribute to missed school days and impaired learning (WHO & UNICEF, 2021). In Nigeria, national surveys reveal that only 55?% of primary schools have functional handwashing stations with soap and water, and less than 50?% meet basic sanitation service levels (Nnaji et al., 2023). In Enugu State specifically, an exploratory study found that while 95% of schools possessed some form of toilet facility, ranging from improved pit latrines to pour flush systems, only 55% consistently provided handwashing amenities, and soap was available in fewer than 60% of those settings (Nnaji et al., 2023). Despite these infrastructural benchmarks, there is scant data linking school WASH conditions to actual diarrhoeal disease prevalence among pupils in Nsukka Local Government Area (LGA). Community based surveys in nearby rural communities of Enugu State reported a two week diarrhoea prevalence of 7.5% among all ages and 10.8?% among children under five, with handwashing at critical moments shown to be protective (Nwokoro et al., 2021). However, the specific context of primary schools where large groups of children share facilities and hygiene behaviours may differ—has not been systematically assessed in Nsukka LGA.

1.2 Statement of the Problem

Although several studies document WASH infrastructure gaps in Nigerian schools (Nnaji et al., 2023; WHO & UNICEF, 2021), local evidence on how these deficits translate into diarrhoeal disease burden among schoolchildren in Nsukka LGA is lacking. Without quantifying the prevalence of diarrhoea in relation to facility availability and pupil hygiene practices, interventions risk misalignment with on the ground needs. Furthermore, recent comparative assessments indicate that schools with poorer WASH services report significantly higher rates of open defecation, inadequate handwashing, and drinking water contamination—factors closely tied to increased diarrhoeal episodes (Adeyemi et al., 2025). The absence of school specific data in Nsukka LGA thus represents a critical gap in planning targeted public health and school health interventions.

1.3 Aim and Objectives of the Study

The primary aim of this study is to examine the relationship between WASH conditions and diarrhoeal disease prevalence among pupils in selected primary schools in Nsukka LGA, Enugu State.

1. 1.3.1 Specific Objectives
2. To assess the availability and functionality of water, sanitation, and handwashing facilities in sampled schools.
3. To determine the two week prevalence of diarrhoeal illness among schoolchildren.
4. To evaluate pupils’ reported handwashing and sanitation practices at critical times.
5. To identify the association between WASH facility status, hygiene behaviours, and diarrhoeal prevalence.

1.4 Research Questions

1. What proportion of sampled primary schools in Nsukka LGA provide basic WASH services (safe water source, functional toilets, and soap equipped handwashing stations)?
2. What is the two week prevalence of diarrhoeal disease among pupils in these schools?
3. How frequently do pupils perform handwashing at key moments (after toileting, before eating)?
4. Is there a statistically significant association between WASH service levels, pupil hygiene practices, and diarrhoeal disease prevalence?

1.5 Scope of the Study

This cross sectional study will be conducted in six randomly selected public and private primary schools across the three educational zones of Nsukka LGA, Enugu State. Data collection will occur over a three month period (September–November 2024) to avoid peak malaria season confounding. Facility audits using the WHO/UNICEF Joint Monitoring Programme service ladder tools will document the status of water, sanitation, and hygiene amenities. Simultaneously, a structured pupil questionnaire will capture self reported diarrhoeal episodes in the preceding two weeks and hygiene behaviours. Findings will be triangulated with school health records where available.

References

Adeyemi, I. O., Okeke, C. I., & Chukwu, J. U. (2025). A comparative assessment of WASH adherence among public and private school students in a rural district in Nigeria. BMC Public Health, 25, Article 23253. https://doi.org/10.1186/s12889-025-23253-7

Nnaji, C. C., Onwuliri, C. D., Obi, I. F., & Ugwu, O. (2023). AN EXPLORATORY INVESTIGATION INTO THE STATUS OF WATER, SANITATION AND HYGIENE (WASH) OF SCHOOLS IN ENUGU STATE, NIGERIA. Nigerian Journal of Technology, 42(2), 115–124.

Nwokoro, U. U., Ugwa, O., Onwuliri, C. D., Obi, I. F., Murphy?Okpala, N., & Agunwa, C. (2021). Water, sanitation and hygiene risk factors associated with diarrhoea morbidity in a rural community of Enugu, South East Nigeria. Pan African Medical Journal, 37, Article 115. https://doi.org/10.11604/pamj.2020.37.115.25678

World Health Organization, & UNICEF. (2021). Water, sanitation and hygiene standards for schools in low-cost settings. Geneva: World Health Organization.

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