Urban Water for Darfur Project - UNICEF

بسم الله الرحمن الرحيم

Urban Water for Darfur Project Knowledge, Attitudes and Practices towards WASH in

El Fasher and Zalingei, Darfur – Sudan

Faculty of Public and Environmental Health University of Khartoum

November 2016

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Acknowledgements

Our grateful thanks go to the many organizations and individuals who generously offered their support and

advice towards this final analysis. The Urban Water for Darfur Project, including this study is funded with aid

from the UK government. The Faculty of Public and Environmental Health, University of Khartoum (FPH),

would specifically like to acknowledge all those who contributed to the endeavour of completing the WASH

Knowledge, Attitudes and Practices Study.

We are very appreciative of the expert advice and support provided by the individuals, divisions and units

within UNICEF, who worked in close collaboration both at headquarters and the sub-offices in El Fasher and

Zalingei.

Special thanks go to UNICEF, and in particular, the WASH sector for the opportunity as well as the financial

support. We would also like to highlight the vital role played by all WASH partners in El Fasher and Zalingei

towns for their assistance, facilitation and logistical support for our fieldwork team. We also thank all

interviewees and communities who further enabled our work.

Finally, we thank the survey team for their commitment and dedication to completing the study in a timely

manner.

Photo Credit: Cover Photo: ©UNICEF/Sudan/2016/NickRiceChudeau All other photos in the report: taken by the survey team (See Annex 3)

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List of Abbreviations

CBO CLTS

Community-based Organization Community-Led Total Sanitation

FGD Focus Group Discussion FPH Faculty of Public Health IDPs Internally Displaced Persons KAP Knowledge, Attitude and Practices NGOs Non-Governmental Organizations OD Open Defecation ODF Open Defecation Free PSU SWC

Primary Sample Unit State Water Corporation

UNICEF United Nations Children’s Fund UofK University of Khartoum WASH WHO

Water, Sanitation and Hygiene World Health Organization

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Executive Summery

The objective of this study is to assess WASH Knowledge, Attitudes and Practices (KAP) in the urban, peri-

urban and settlement areas for Internally Displaced Persons (IDPs) in El Fasher and Zalingei towns. This is

part of the Urban Water for Darfur (UW4D) project process.

Before implementing the WASH programmes and activities, it is essential to measure knowledge, attitudes

and practices among the beneficiary community to set baseline data on KAP indicators. UNICEF and FPH

conducted a descriptive cross-sectional study in El Fasher and Zalingei to get baseline information on water,

sanitation and hygiene. Stratified random sampling was used and accordingly, 984 households were

selected. Data collection took place from June 7 – July 3, 2016, through household interviews and Focus

Group Discussions (FGD). The main findings are listed below.

Main Findings

No. Indicator

El Fasher

Zalingei

Urban Peri-urban

IDPs camps Urban

Peri-urban

IDPs camps

1 Percentage of households with access to improved water source 68.5% 21.9% 78.3% 66.7% 34% 43.3%

2 Percentage of households with access to sufficient water. 42.8% 19.1% 11.2% 22.2% 24.2% 5.7%

3 Percentage of households with access to improved sanitation facilities 87.7% 67.2% 37.5% 55.7% 55.4% 32.6%

4 Proportion of people practicing open defecation 0.9% 11% 9% 5.7% 3.7% 13.2%

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Percentage of household heads reporting always or frequently washing hands with soap 77.7% 75.8% 76.5% 70.8% 67.9% 50.9%

6 Percentage of the households which have members with diarrheal cases 20.8% 36.1% 26.5% 40.3% 35.8% 44.3%

7 Percentage of the households with hand washing facility 35.6% 26.3% 4.8% 5.6% 2.5% 2.8 %

8 Percentage of the households which received health messages 19.1% 12% 34.5% 11.8% 19.6% 22.1%

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Percentage of the households which preferred to receive health messages via direct communication methods 19.2% 42% 51.9% 50.7% 54% 67%

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Table of contents

Acknowledgements ............................................................................................................................................ 1

List of Abbreviations ........................................................................................................................................... 2

Executive Summery ............................................................................................................................................ 3

Table of contents ................................................................................................................................................ 4

List of Tables .................................................................................................................................................... 6

List of Figures ................................................................................................................................................... 8

List of Photos ................................................................................................................................................... 8

1. Introduction ................................................................................................................................................ 9

1.1. Background .......................................................................................................................................... 9

1.2. Objectives of the study ...................................................................................................................... 10

2. Methodology and sampling technique .................................................................................................... 11

2.1. Study Design ...................................................................................................................................... 11

2.1.1 Sample frame.................................................................................................................................... 11

2.1.2 Sample unit ....................................................................................................................................... 11

2.1.3 Quantitative Research Design .......................................................................................................... 11

2.2. Study Population ............................................................................................................................... 11

2.2.1 Sample technique ............................................................................................................................. 11

2.2.2 Sample size ....................................................................................................................................... 12

2.3. Methods of data collection ............................................................................................................... 13

2.3.1 Data collection tools ......................................................................................................................... 13

2.3.2 Selection and training of enumerators ............................................................................................. 13

2.4.1 Qualitative data collection ............................................................................................................... 14

2.4. Data analysis ...................................................................................................................................... 15

2.4.1 Quantitative data management and analysis: ................................................................................. 15

2.4.2 Qualitative data analysis................................................................................................................... 15

2.5 Limitation of the study ............................................................................................................................ 15

3. Results ....................................................................................................................................................... 16

3.1 Quantitative Data .............................................................................................................................. 16

3.1.1 General information ......................................................................................................................... 16

3.1.2 Household water supply ................................................................................................................... 17

3.1.2.1 Water source ............................................................................................................................. 17

3.1.2.2 Water consumption ................................................................................................................... 21

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3.1.2.3 Water collection ........................................................................................................................ 25

3.1.2.4 Distance to water source ........................................................................................................... 29

3.1.2.5 Knowledge ................................................................................................................................. 35

3.1.2.6 Attitude ...................................................................................................................................... 36

3.1.3 Household Sanitation ....................................................................................................................... 39

3.1.3.1. Knowledge ................................................................................................................................ 39

3.1.3.2 Practices .................................................................................................................................... 41

3.1.3.3 Attitudes .................................................................................................................................... 47

3.1.4 Health and personal hygiene ............................................................................................................ 49

3.1.4.1 Knowledge ................................................................................................................................. 49

3.1.4.2 Attitudes .................................................................................................................................... 54

3.1.4.3 Practices .................................................................................................................................... 55

3.1.5 Awareness ........................................................................................................................................ 62

3.1.6 Institutional WASH situation ............................................................................................................ 67

3.1.6.1 School WASH ............................................................................................................................. 67

3.1.6.2 Health Facility ............................................................................................................................ 69

3.2 Qualitative findings .................................................................................................................................. 70

4. Conclusion ................................................................................................................................................. 75

4.1 Current condition and Practice................................................................................................................ 75

Water ......................................................................................................................................................... 75

Sanitation ................................................................................................................................................... 75

Hygiene ...................................................................................................................................................... 76

4.2 Knowledge ............................................................................................................................................... 76

4.3 Attitude .................................................................................................................................................... 76

5. Recommendations .................................................................................................................................... 77

References ......................................................................................................................................................... 79

Appendices ........................................................................................................................................................ 80

Annex 1: WASH Knowledge, Attitudes and Practices (KAP) Survey Household (HH) Questionnaire ........... 80

Annex 2: Ranking of multi-optional questions used in Darfur KAP study questionnaire 2016 .................. 108

Annex 3: Names of survey team staff ......................................................................................................... 109

Annex 4: Focus Group Discussions Guideline ............................................................................................. 110

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List of Tables Table 1: Household survey minimum sample size ............................................................................................ 12

Table 2: Focus Group Discussion Details ........................................................................................................... 14

Table 3: Demographic profile of respondents in El Fasher and Zalingei towns ................................................ 16

Table 4: Demographic profile of respondents in El Fasher and Zalingei towns ................................................ 17

Table 5: Main sources of drinking water in El Fasher and Zalingei 2016 .......................................................... 18

Table 6: State of the survey *Improved source of water cross tabulation ....................................................... 20

Table 7: Context of the area *Improved source of water cross tabulation ...................................................... 20

Table 8: Association between gender of household head and use of improved water sources ...................... 21

Table 9: Daily water consumption in El Fasher and Zalingei ............................................................................. 22

Table 10: Association between gender of household head and daily water consumption .............................. 22

Table 11: Gender of householder * Daily water consumption * State of the survey cross tabulation ............ 23

Table 12: Association between use of improved water source and daily water consumption ........................ 23

Table 13: Responsibility of water collection in El Fasher and Zalingei .............................................................. 26

Table 14: Improved source of water * collection of water out the house * State of the survey Cross-

tabulation .......................................................................................................................................................... 28

Table 15: Association between water collection and daily water consumption .............................................. 28

Table 16: Distance to water sources in El Fasher and Zalingei 2016 ................................................................. 29

Table 17: Water collection containers in El Fasher and Zalingei 2016 .............................................................. 31

Table 18: Water cost in El Fasher and Zalingei 2016 ......................................................................................... 34

Table 19: Affordability of water fee or cost ...................................................................................................... 35

Table 20: Knowledge towards benefits of piped water inside house ............................................................... 35

Table 21: Perception of drinking water smell ................................................................................................... 37

Table 22: Reaction to the statement "the major benefit of piped water supply is to provide sufficient

quantity of water for household" ...................................................................................................................... 37

Table 23: Response to the statement "There is no relationship between water supply and spread of diseases"

........................................................................................................................................................................... 38

Table 24: Importance of safe drinking water supply in El Fasher and Zalingei ................................................. 38

Table 25: Whether people with access to safe drinking water suffer less from disease than those who do not

have access or not ............................................................................................................................................. 39

Table 26: Knowledge regarding latrine problems in El Fasher and Zalingei ..................................................... 39

Table 27: Knowledge regarding importance of latrine ...................................................................................... 40

Table 28: Knowledge regarding open defecation (OD) ..................................................................................... 40

Table 29: Availability of household latrine in El Fasher and Zalingei ................................................................ 41

Table 30: Association between availability of household latrine and context.................................................. 41

Table 31: Association between use of improved sanitation facilities and context ........................................... 42

Table 32: Frequency of cleaning household latrine .......................................................................................... 43

Table 33: Responsibility of cleaning household latrine ..................................................................................... 44

Table 34: Alternative sanitation facility when there are difficulties in using household latrine ...................... 44

Table 35: Alternative sanitation facility for people who do not have household latrine ................................. 45

Table 36: Children under 5 use of household sanitation facility ....................................................................... 45

Table 37: Places where children under 5 defecate routinely ............................................................................ 46

Table 38: Disposal methods of grey water ........................................................................................................ 46

Table 39: Disposal methods of household solid waste ..................................................................................... 47

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Table 40: Barriers for constructing household latrine ...................................................................................... 48

Table 41: Importance of household latrine recognition by respondents ......................................................... 48

Table 42: Main constructor of household latrine .............................................................................................. 49

Table 43: Knowledge regarding concept of hygiene in El Fasher and Zalingei 2016 ........................................ 49

Table 44: Knowledge towards importance of personal hygiene ....................................................................... 50

Table 45: Knowledge towards how to get infected by diarrheal disease ......................................................... 50

Table 46: Knowledge towards prevention of diarrheal disease ........................................................................ 51

Table 47: Knowledge regarding anal cleansing materials ................................................................................. 51

Table 48: Knowledge regarding critical points of hand washing ....................................................................... 52

Table 49: Knowledge towards healthy food ...................................................................................................... 52

Table 50: Detailed answers: critical moments of hand washing ....................................................................... 53

Table 51: Importance of personal hygiene ........................................................................................................ 54

Table 52: Benefits of keeping food hygienic (clean) ......................................................................................... 54

Table 53: Importance of covering food vessels ................................................................................................. 55

Table 54: One or more family members suffering from diarrhoea (within past 2 weeks at the time of survey)

........................................................................................................................................................................... 55

Table 55: Association between use of improved sanitation facilities and suffering from diarrhoea diseases . 56

Table 56: Association between use of improved water sources and suffering from diarrhoea diseases ........ 57

Table 57: Hand washing practiced as a habit (self-reporting) ........................................................................... 58

Table 58: Association between use of improved sanitation facility and availability of hand washing facility . 58

Table 59: Number of hand washing actions taken during a day (self-reporting) .............................................. 59

Table 60: Material used in hand washing .......................................................................................................... 59

Table 61: Availability of hand washing facility at household (observation by enumerators) ........................... 60

Table 62: Availability of soap at household hand washing facility (observation by enumerators) .................. 60

Table 63: Frequency of bathing in summer (March – October) ........................................................................ 60

Table 64: Frequency of bathing in winter (November - February) ................................................................... 61

Table 65: Place of food preparation .................................................................................................................. 61

Table 66: Practice of covering food vessels ....................................................................................................... 62

Table 67: Importance of safe drinking water in the house ............................................................................... 62

Table 68: Importance of sanitary disposal for wastewater ............................................................................... 63

Table 69: Importance of hygienic place for cooking ......................................................................................... 63

Table 70: Harmfulness of insects ....................................................................................................................... 64

Table 71: Ever attended health education sessions in health facilities ............................................................ 64

Table 72: Association between attendance of health education session and context ..................................... 65

Table 73: Contents discussed during health education session at health facility ............................................. 65

Table 74: Experience of having health educational discussion with community health workers .................... 66

Table 75: Preferred channel to receive health messages ................................................................................. 66

Table 76: Availability of health facilities in the community .............................................................................. 69

Table 77: Availability of water supply in health facilities .................................................................................. 69

Table 78: Availability of sanitation facility in health facilities ........................................................................... 70

Table 79: Qualitative findings regarding WASH practices mentioned during FGDs in El Fasher ...................... 71

Table 80: Qualitative findings regarding WASH practices mentioned during FGDs in Zalingei ........................ 72

Table 81: Factors perceived as bottlenecks of insufficient WASH services in FGDs in El Fasher ...................... 73

Table 82: Factors perceived as bottlenecks of insufficient WASH services in FGDs in Zalingei ........................ 74

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List of Figures Figure 1: Access to improved drinking water sources in El Fasher and Zalingei ............................................... 19

Figure 2: Sufficiency of drinking water in El Fasher and Zalingei 2016 ............................................................. 24

Figure 3: Need for collection of water in El Fasher and Zalingei 2016 .............................................................. 25

Figure 4: Average waiting time in queue for drinking water in El Fasher and Zalingei 2016 ............................ 30

Figure 5: Covering of water collection containers in El Fasher and Zalingei 2016 ............................................ 31

Figure 6: Cleaning of water collection containers in El Fasher and Zalingei 2016 ............................................ 32

Figure 7: Household water treatment in El Fasher and Zalingei 2016 .............................................................. 33

Figure 8: Appearance of water in El Fasher and Zalingei .................................................................................. 36

Figure 9: Availability of improved sanitation facilities in El Fasher and Zalingei .............................................. 42

Figure 10: Availability of latrine in school in El Fasher and Zalingei towns ....................................................... 67

Figure 11: Availability of water source in school in El Fasher and Zalingei ....................................................... 68

List of Photos Photo 1: Enumerator filling in a questionnaire in Zalingei ................................................................................ 11

Photo 2: Training workshop for enumerators and pilot survey in Abu Shouk IDPs camp ................................ 14

Photo 3: Quantitative data encoding and processing was carried out by Teaching Assistants in the FPH,

University of Khartoum ..................................................................................................................................... 15

Photo 4: Focus group discussions with community leaders, male pupils and health workers in Zalingei town

........................................................................................................................................................................... 18

Photo 5: School sanitation facilitieis in Zalingei town ....................................................................................... 19

Photo 6: Water points in El Salam and Teyiba IDPs camps constructed by WES .............................................. 26

Photo 7: Old hand pumps in Teyiba IDPs camp and in Zalingei town ............................................................... 27

Photo 8: Examples of unimproved water sources in Zalingei 2016 .................................................................. 34

Photo 9: Orientation of WASH partners and stakeholders in El Fasher, 2016 .................................................. 73

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1. Introduction

1.1. Background

Access to adequate supplies of good quality drinking water continues to be limited among many rural and

peri-urban communities in Sudan, despite several decades of water improvement programmes. The provision

of drinking water of acceptable quality and quantity remains to be a major public health need and concern in

Sudan, where diarrhoeal diseases continue to cause extensive morbidity and mortality. According to the MICS

2014 survey, the diarrhoeal disease prevalence rate among under five children was 37.2 percent in North

Darfur state (where El Fasher is located), and 31.1 percent in Central Darfur state (where Zalingei is located).

Through basic intervention methods to increase access to safe drinking water, improved sanitation and

hygiene, many more children could be saved and their quality of life made better.

The Urban Water for Darfur (UW4D) project, aims to achieve sustainable and more equitable access to

improved water and sanitation facilities and healthier hygiene behaviour among the urban, peri- urban and

IDPs communities. It will support the provision of an integrated package for tackling the unequal access to

water by extending services to the unserved areas, with linked promotion of sanitation and hygiene, and the

strengthening of the Urban Water Administrations (UWA) capacity. The project will develop a strategy

entailing components of sanitation behaviour change and demand generation, improved household

sanitation, School WASH and appropriate, low-cost sanitation and waste water treatment technology options,

sanitation marketing, supply chain and business development, and service delivery.

There are four inter-related project outputs:

Output 1 - Planning, management, and maintenance of water supply and service delivery

Output 2 - Water Supply (expansion of networked water supply to unserved areas)

Output 3 - Sanitation and Hygiene (behaviour change for improved sanitation and hygiene practices)

Output 4 - Stronger Knowledge base on effective approaches

The planned achievements can be better reached through information about Knowledge, Attitudes, and

Practices (KAP) regarding water, sanitation and hygiene from inhabitants of different communities. The

understanding of people’s KAP of WASH is essential in informing decisions on potential interventions and

measuring programme impact. The KAP study investigates how integrated benefits from better access to

water, sanitation and hygiene are expected to contribute to improving the health of the targeted population.

The KAP Study is part of the key activities of Output 3 – Sanitation and Hygiene (behaviour change for improved

sanitation and hygiene practices).

Sanitation is a basic human right. However, the current situation and availability of and access to affordable

clean drinking water remains precarious and beyond the means of the poor households in the urban, peri-

urban and IDPs settlements in El Fasher and Zalingei, Darfur.

Those living in peri-urban or are displaced in camps, are more vulnerable to exploitation as they are dependent

on buying expensive water from largely unregulated private vendors. This results in lower quantity and poorer

quality of water consumed per capita than in the better served urban areas.

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The various methods of food and water intake and personal hygiene in general, can have a major impact on

one’s health. Sanitation is defined as “Management and disposal of human urine, excreta and domestic

wastewater” (Cambodia Ministry of Rural Development, 2010). Furthermore, sanitation is the prevention of

human contact with wastes, for hygienic purposes. It also relates to the promotion of health through the

prevention of human contact with the hazards associated with the lack of healthy food, clean water, healthful

housing, the control of vectors, and a clean environment.

The KAP approach has historical roots in human health and management sciences (Ali, 2009). It measures the

Knowledge, Attitude and Practices of a community. A KAP survey, is a representative study of a specific

population to collect information on what is known, believed and done in relation to a particular topic

(Vandamme, 2009; WHO, 2008 ). It is conducted to investigate human behaviour and identifies what people

know (Knowledge), how they feel (Attitude) and what they do (Practice). KAP studies can be used for diagnostic

purposes for which they describe the population’s current knowledge, attitude and practice. Secondly, they

can be implemented to increase insights in a current situation and help design appropriate specific

interventions. Thirdly, they can be used as an evaluation tool to assess the effectiveness of certain

interventions or programmes.

Baseline surveys, intermediate evaluations and final impact assessment studies are necessary parts of all

WASH programmes (Ali, 2009). The KAP surveys will be conducted thrice during the course of the UW4D

project. This initial KAP at the start of the project provides baseline information. The purpose of baseline

survey is to establish a baseline figure on various indicators, to serve as a critical reference point for

measuring the progress and achievements of the project interventions.

1.2. Objectives of the study

The main aim of the study is to get baseline information on water, sanitation and hygiene practices in the

target areas of El Fasher and Zalingei.

The specific targets are to:

Identify current levels of community access to and practices related to water, sanitation and hygiene

facilities among targeted groups

Identify the determinant factors of community attitudes and practices related to WASH

Provide information on community knowledge, attitudes and practices that will allow the

development of WASH programme’s behavioural change and communication plan

Provide disaggregated data and information on WASH programme indicators in urban, peri-urban

and IDPs camps

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2. Methodology and sampling technique

2.1. Study Design

2.1.1 Sample frame

All Quarters (Hai) in targeted towns and sectors in selected IDPs camps were listed and subjected to sample

selection procedures.

2.1.2 Sample unit Primary Sample Unit (PSU) was Quarters. Secondary Sample Unit was Households.

Photo 1: Enumerator filling in a questionnaire in Zalingei

2.1.3 Quantitative Research Design

The study employed a cross-sectional research design to collect information from heads of households. The

research period spanned from November 2015 - August 2016. Data collection took place from June 7 – July

3, 2016.

2.2. Study Population

2.2.1 Sample technique

In accordance with the objective and planned project, the study was conducted in two towns (El Fasher and

Zalingei), which means the study sample represented two geographical areas. However, the socio-economic

and settlement statuses divided the population into three subgroups which are mainly: urban, peri-urban,

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and surrounding IDPs camps. Stratified random sample was used to select representative’s households from

each three groups and their subgroups.

2.2.2 Sample size

Statistical formula depends on the percentage of WASH indicators, and a confidence level was used to

determine the sample size. Sudan Household Health Surveys indicate that the average percentage of

households using a safe water source and improved sanitation is 20 percent.

n = z2*p*q / (d2)

Where:

n = Minimum required sample size.

z = Value that gives 95% confidence level (=1.96)

p = Key indicator selected = (0.2)

q = (1-p)

d = Desired margin of error = (0.05)

The sample size calculated by using this formula is 246 households. However, this is for a homogeneous

population, thus the main population variability was considered, i.e. urban, peri-urban and surrounding IDPs

camps. The design effect considered in this study is 4, which brings the total sample size to approximately 984

households. According to its household weight, the town’s context and quarters (Hai) were represented

proportionally as illustrated in the following Table:

Table 1: Household survey minimum sample size

Area No. of households Weight (percent) Sample size

El Fasher urban 45,205 44 282

El Fasher peri-urban 31,219 30 194

El Fasher IDPs camps 26,808 26 167

El Fasher town 103,232 65 643

Zalingei urban 11,617 21 72

Zalingei peri-urban 26,127 48 162

Zalingei IDPs camps 17,103 31 107

Zalingei town 54,847 35 341

Total 158,079 984

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Proportional weight of sample size for selected towns, context and quarters were determined by using the

following formula:

n = s*p/N

Where:

n = sample of proportion (subgroup)

s = total number of needed sample size

p = total number of households in subgroup

N = total number of households

During the survey, however, the survey team visited 648 households in total for El Fasher: 283 households in

the urban area, 194 households in the peri-urban area, and 171 households in IDPs camp area. Zalingei survey

team visited 341 households in total, as indicated in Table 1.

2.3. Methods of data collection

2.3.1 Data collection tools

The KAP approach to a survey is one of the methods used to collect data and information about beliefs,

practices and perceptions by asking a structured and predetermined set of questions. This produces

quantitative information and analysis from a large number of randomly selected individuals. In most KAP

surveys, data are collected orally by an interviewer using a structured, standardised questionnaire, focus

group discussions and observational check lists.

This study was conducted between June 7th and July 3rd, 2016, using both quantitative and qualitative

methodology to collect primary data for heads of households or their designees; and of men, women and

youth from two towns. A survey questionnaire was developed covering specific concerns on access to water,

sanitation and hygiene facilities, including health and hygiene practices. Focus Group Discussion guidelines

were also developed covering the qualitative side of the survey. The quantitative component was

implemented by enumerators from the local community under close supervision of UofK Faculty of Public

and Environmental Health team leaders and State coordinators. The qualitative instruments were

implemented by UofK Faculty of Public and Environmental Health team leaders.

2.3.2 Selection and training of enumerators

The baseline research team was composed of 28 members, holding different roles and responsibilities (see

Annex 3), which included overall team leaders (4), States coordinators (2), data collectors (12), data encoders

(8) and research assistants (2). All 12 enumerators plus the supervisors hired for this assignment were qualified

local residents who understand the socio-cultural dynamics of the study area. The enumerators participated

in a three-day training prior to the survey. The training program included sessions on the purpose of the

survey, the role and responsibilities of the enumerator, interviewing techniques, consenting respondents and

importance of randomness and bias during sampling. There was also a pre–testing exercise that was carried

out at both towns.

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Photo 2: Training workshop for enumerators and pilot survey in Abu Shouk IDPs camp

2.4.1 Qualitative data collection

Qualitative information gathered for this study was obtained through Focus Group Discussions (FGDs). FGDs

were meant to compliment main data collection from household survey, since a survey questionnaire is not

always an optimal way of data collection to understand people’s attitudes towards WASH related practices.

About 14 FGDs were selected as the most convenient size which totalled 154 participants across the two

towns. The FGDs were based on group homogeneity such as gender, age and occupation. They included

adult women, adult men, teachers, community leaders and pupils. Since the main research focused on

household survey, FGDs were the only opportunity for the research team to learn about WASH conditions in

institutions, such as in schools and health facilities. Table 2 below illustrates the arrangement.

The survey team in El Fasher could only conduct 4 FGDs in total, much less than the initially planned 10

FGDs. Meetings with community leaders and women’s groups did not realise in El Fasher urban and peri-

urban areas. This is due to limited time of the field survey and the timing of survey (towards the end of

Ramadan). Also, FGDs could not be held in schools in El Fasher IDPs camps since schools were on holiday.

Table 2: Focus Group Discussion Details

Area Type of FGD No. of FGD No. of participants

El Fasher urban Teachers 1 11

Mixed pupils 1 13

El Fasher peri-urban Teachers 1 7

El Fasher IDPs camps Community leaders 1 4

El Fasher town 4 35

Zalingei urban Community leaders 1 16

Adult female 1 8

Services providers 2 13

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(Cont. Table 2: Focus Group Discussion Details)

Zalingei peri-urban Adult male 1 12

Teachers 1 6

Male pupils 1 12

Community leaders 1 20

Zalingei IDPs camps Female pupils 1 12

Community leaders 1 20

Zalingei town 10 119

Total 14 154

2.4. Data analysis

2.4.1 Quantitative data management and analysis:

Collected data were subjected to Excel and SPSS version16 programs to analyse and present useful

information. Two research assistants and eight data encoders engaged in these activities.

2.4.2 Qualitative data analysis

Collected data were analysed manually by two research assistants using master sheets, and percentages

were calculated.

Photo 3: Quantitative data encoding and processing

was carried out by Teaching Assistants in the FPH,

University of Khartoum

2.5 Limitation of the study

Conducting the field survey during the rainy season may have serious effects on water related results. Many

factors may also vary greatly in the dry season: quantity of water consumption, time consumed in water

collection queues, and availability/scarcity of water.

Fieldwork during Ramadan may lead to less information obtained as a result of the respondent’s desire to

end the interview as soon as possible, particularly on hot days.

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3. Results

3.1 Quantitative Data

3.1.1 General information

Table 3 shows that 59.4 percent of household heads in El Fasher are male, compared to 37.5 percent in

Zalingei. Regarding respondents, the majority in El Fasher and Zalingei are female (49.5 percent and 72.1

percent) compared to the male (42.3 percent and 22.9 percent, respectively). Despite almost half of the

respondents in El Fasher (47.4 percent) earning a secondary or higher education compared to 36 percent in

Zalingei, some 13.3 percent in El Fasher and 27 percent in Zalingei were illiterate. The variation is also

reported clearly between urban, peri-urban and IDPs camps in all demographic variables in both towns.

Table 3: Demographic profile of respondents in El Fasher and Zalingei towns

El Fasher Zalingei Urban Peri-urban IDPs Total Urban Peri-urban IDPs Total

No. % No. % No. % No. % No. % No. % No. % No. %

Gender of Household head

Male 189 66.8 109 56.2 87 50.9 385 59.4 34 47.2 47 29.0 47 43.9 128 37.5

Female 78 27.6 71 36.6 71 41.5 220 34.0 38 52.8 89 54.9 57 53.3 184 54

No answer 16 5.7 14 7.2 13 7.6 43 6.6 0 0.0 26 16.0 3 2.8 29 8.5

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Gender of respondent

Male 139 49.1 88 45.4 47 27.5 274 42.3 20 27.8 28 17.3 30 28.0 78 22.9

Female 129 45.6 90 46.4 102 59.6 321 49.5 52 72.2 118 72.8 76 71.0 246 72.1

No answer 15 5.3 16 8.2 22 12.9 53 8.2 0 0.0 16 9.9 1 0.9 17 5.0

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Educational level

Illiterate 16 5.7 31 16.0 39 22.9 86 13.3 11 15.3 46 28.4 35 32.7 92 27.0

Adult edu 1 0.4 1 0.5 1 0.6 3 0.5 4 5.6 4 2.5 0 0.0 8 2.3

Khalwa 8 2.8 19 9.8 26 15.3 53 8.2 2 2.8 12 7.4 17 15.9 31 9.1

Basic 69 24.4 57 29.4 63 37.1 189 29.2 14 19.4 36 22.2 33 30.8 83 24.3

Secondary 95 33.6 58 29.9 34 20.0 187 28.9 22 30.6 41 25.3 20 18.7 83 24.3

Grd/postg 86 30.4 28 14.4 6 3.5 120 18.5 19 26.4 20 12.3 1 0.9 40 11.7

No answer 8 2.8 0 0.0 1 0.6 9 1.4 0 0.0 3 1.9 1 0.9 4 1.2

Total 283 100 194 100 170 100 647 100 72 100 162 100 107 100 341 100

17

Table 4: Demographic profile of respondents in El Fasher and Zalingei towns

El Fasher Zalingei

Urban

Peri-urban

IDPs

Total

Urban Peri-urban IDPs Total

No. % No. % No. % No. %

Age of respondent

Mean 42.08 34.5 34.4 37.8 30.7 30.1 33.3 31.2

S.D 14.9 12.4 13.8 14.4 9.5 11 12.7 11.3

Mann Whitney U (77309.5 , P value Less than 0.001) X2 (Kruskal: 47.9, P value less than 0.001)

Family size

Mean 7.1 7.8 6.8 7.2 8 7.3 7.1 7.4

S.D 3.6 3.2 2.8 3.3 3 2.6 2.3 2.6

Mann Whitney U (1.013 , P value 0.048) X2 (Kruskal: 8.9, P value 0.01)

Female family members

Mean 3.6 4 3.5 3.7 4.2 3.8 3.6 3.8

S.D 2.4 2.1 1.8 2.2 2 1.6 1.5 1.7

Mann Whitney U (100448 , P 0.03) X2 (Kruskal: 6.4, P value 0.04)

3.1.2 Household water supply

3.1.2.1 Water source

Table 5 reveals the sources of drinking water to the households in El Fasher; the main sources for urban

were piped water into the house (61.5 percent), followed by cart with drum (17.7 percent); in peri-urban,

the main sources were tanker (42.8 percent) followed by borhole (16.5 percent); in IDPs camps, the main

sources were borehole (46.5 percent) followed by hand pump (30 percent). Similar qualitative results were

obtianed through FGD Table 79), where participants mentioned that 36 percent – 100 percent of urban and

43 percent of peri-urban, were served by piped water into the house.

On sources of drinking water to the households in Zalengei, the main types for urban were piped water into

house (54.2 percent); in peri-urban the main sources were cart with drum (38.9 percent), followed by piped

water into house (24.7 percent), and in IDPs camps the main sources were ground water through borehole

(36.8 percent). This situation of water sources in both towns may explain the quantitative and qualitative

findings in Figure 3, Table 79, and Table 80.

Table 6 and Table 7, explain that the above variations in water sources and it’s improvement between states,

and context shown in Figure 1 is statisticly significant (P-value less than 0.001). This means there was strong

evidence that the avialability of improved water sources in North Darfur was better than in Central Darfur,

and urban areas were better than both IDPs camps and peri-urban areas. Table 8 showed that there were no

evidence regarding the association between gender of household head and use of improved water source (x²

and P value: 2.84, 0.09 and 0.05, 0.82) in El Fasher and Zalingei.

18

Photo 4: Focus group discussions with community leaders, male pupils and health workers in Zalingei town

Table 5: Main sources of drinking water in El Fasher and Zalingei 2016

Source of water

El Fasher Zalingei

Urban Peri-urban IDPs Total Urban Peri-urban IDPs Total


Piped water into house

174 61.5 6 3.1 0 0.0 180 27.8 39 54.2 40 24.7 0 0.0 79 23.2

Piped water to yard/plot of the house

2 0.7 0 0.0 0 0.0 2 0.3 0 0.0 3 1.9 0 0.0 3 0.9

Public tap/standpipe

0 0.0 0 0.0 4 2.3 4 0.6 0 0.0 0 0.0 2 1.9 2 0.6

Borehole 2 0.7 32 16.5 79 46.2 113 17.4 8 11.1 8 4.9 39 36.4 55 16.1

Protected dug well

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Hand pump 0 0.0 10 5.2 52 30.4 62 9.6 1 1.4 7 4.3 6 5.6 14 4.1

Unprotected dug well

0 0.0 0 0.0 0 0.0 0 0.0 3 4.2 1 0.6 5 4.7 9 2.6

Unprotected spring

1 0.4 2 1.0 0 0.0 3 0.5

0.0 0 0.0 0 0.0 0 0.0

Tanker 10 3.5 83 42.8 0 0.0 93 14.4 5 6.9 6 3.7 6 5.6 17 5.0

Cart with small tank/drum

50 17.7 29 14.9 4 2.3 83 12.8 5 6.9 63 38.9 3 2.8 71 20.8

Surface water (valley, dam, lake, pond, stream)

26 9.2 0 0.0 1 0.6 27 4.2 0 0.0 0 0.0 4 3.7 4 1.2

Other (multiple sources)

18 6.4 32 16.5 31 18.1 81 12.5 11 15.3 34 21.0 41 38.3 86 25.2

No Answer 0.0 0.0 0.0 0 0.0 0.0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

19

Figure 1: Access to improved drinking water sources in El Fasher and Zalingei

Photo 5: School sanitation facilitieis in Zalingei town

%68.5

21.9

78.3

31.5

%78.1

21.7

0 20 40 60 80 100 120

Urban

peri urban

IDPs camps

El Fasher

Improved

Unimproved

%66.7

34

43.3

33.3

%66

56.7

0 20 40 60 80 100 120

Urban

peri urban

IDPs camps

Zalingei

Improved

Unimproved

20

Table 6: State of the survey *Improved source of water cross tabulation

Chi-Square Tests

Value df

Asymp. Sig. (2-

sided)

Exact Sig. (2-

sided)

Exact Sig. (1-

sided)

Pearson Chi-Square 41.904a 1 .000

Continuity Correctionb 41.041 1 .000

Likelihood Ratio 42.502 1 .000

Fisher's Exact Test .000 .000

Linear-by-Linear

Association 41.862 1 .000

N of Valid Casesb 987

Table 7: Context of the area *Improved source of water cross tabulation

Chi-Square Tests

State of the survey Value df Asymp. Sig. (2-sided)

North Darfur Pearson Chi-Square 1.101E2a 2 .000


Linear-by-Linear Association 3.621 1 .057

N of Valid Cases 647

Central Darfur Pearson Chi-Square 6.586b 2 .037




a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 75.67.

b. 0 cells (.0%) have expected count less than 5. The minimum expected count is 24.35.

21

Table 8: Association between gender of household head and use of improved water sources

Chi-Square Tests

State of the survey Value df Asymp. Sig. (2-

sided) Exact Sig. (2-

sided) Exact Sig. (1-sided)

North Darfur Pearson Chi-Square 2.845a 1 .092




Linear-by-Linear Association

2.840 1 .092


Central Darfur Pearson Chi-Square .051c 1 .822

Continuity Correctionb .011 1 .918

Likelihood Ratio .051 1 .822



.050 1 .822



b. Computed only for a 2x2 table

c. 0 cells (.0%) have expected count less than 5. The minimum expected count is 43.08.

3.1.2.2 Water consumption

Without water, life is impossible. Lack of water will result in increased morbidity due to increased

transmission of germs and poor hygiene in a community.

Table 9 reveals that the majority of urban households in El Fasher (72.4 percent) have access to more than

150 litres per household per day, compared to 60.2 percent in peri-urban and only 30.4 percent in IDPs

camps. In Zalingei, the results were 65.3 percent in urban, 75.9 percent in peri-urban, and 36.4 percent in

IDPs camps. These findings may explain the quantitative results of Figure 2 and qualitative findings in Table

79 and Table 80. Most IDPs camps and peri-urban households in both towns believe that water quantity was

not sufficient.

22

Table 9: Daily water consumption in El Fasher and Zalingei

El Fasher Zalingei



Less than 50 litres

2 0.7 2 1.0 17 9.9 21 3.2 3 4.2 3 1.9 9 8.4 15 4.4

50 – 99 19 6.7 25 12.9 33 19.3 77 11.9 12 16.7 20 12.3 39 36.4 71 20.8

100 – 149 56 19.8 49 25.3 69 40.4 174 26.9 10 13.9 15 9.3 19 17.8 44 12.9

150 – 199 40 14.1 22 11.3 28 16.4 90 13.9 13 18.1 57 35.2 28 26.2 98 28.7

200 – 249 70 24.7 46 23.7 16 9.4 132 20.4 17 23.6 30 18.5 9 8.4 56 16.4

250 -300 35 12.4 14 7.2 4 2.3 53 8.2 6 8.3 17 10.5 1 0.9 24 7.0

More than 300 litres

60 21.2 35 18.0 4 2.3 99 15.3 11 15.3 19 11.7 1 0.9 31 9.1

No answer 1 0.4 1 0.5 0 0.0 2 0.3 0 0.0 1 0.6 1 0.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 10: Association between gender of household head and daily water consumption

Chi-Square Tests












23

Table 11: Gender of householder * Daily water consumption * State of the survey cross tabulation

State of the survey

Daily water consumption

Total

Less than 50

litres 50 - 99

100 - 149

150 - 199

200 - 249

250 - 300

More than 300

litres

North Darfur

Gender of householder

Male Count 12 40 98 53 89 27 65 384

% of Total 2.0% 6.6% 16.3% 8.8% 14.8% 4.5% 10.8% 63.7%

Female Count 9 34 57 40 35 19 25 219

% of Total 1.5% 5.6% 9.5% 6.6% 5.8% 3.2% 4.1% 36.3%

Total Count 21 74 155 93 124 46 90 603

% of Total 3.5% 12.3% 25.7% 15.4% 20.6% 7.6% 14.9% 100.0%

Central Darfur

Gender of householder

Male Count 5 32 20 32 23 9 7 128

% of Total 1.6% 10.3% 6.4% 10.3% 7.4% 2.9% 2.3% 41.2%

Female Count 9 36 21 57 30 12 18 183

% of Total 2.9% 11.6% 6.8% 18.3% 9.6% 3.9% 5.8% 58.8%

Total Count 14 68 41 89 53 21 25 311

% of Total 4.5% 21.9% 13.2% 28.6% 17.0% 6.8% 8.0% 100.0%

Table 12: Association between use of improved water source and daily water consumption

Chi-Square Tests












24

Figure 2: Sufficiency of drinking water in El Fasher and Zalingei 2016

11.2

19.1

42.8

18.8

9.3

21.2

70

71.1

36

0.5

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

El Fasher

Sufficient Sufficient to some extent Not sufficient I don't know

5.7

24.2

22.2

28.3

29.8

30.6

66

45.4

47.2

0.6

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

Zalingei

Sufficient Sufficient to some extent Not sufficient I don't know

25

3.1.2.3 Water collection

Figure 3: Need for collection of water in El Fasher and Zalingei 2016

Figure 3 reveals that collecting water in both towns is a major household task in peri-urban and IDPs camps,

irrespective of what distances are covered and the water point types.

Women and girls are traditionally responsible for collecting water in Sudan. Table 13 shows that the burden

of collecting water in both towns is mostly with women. Among the households that require daily water

collection, women represent more than two thirds (53.7 percent) of the household members responsible for

water collection in El Fasher and 54.4 percent in Zalingei, followed by men (13.8 percent) in El Fasher and 11.7

percent in Zalingei. Boys and girls who do help in collecting water total only 3.7 percent and 3.4 percent

respectively, in El Fasher and 4.9 percent and 5.3 percent respectively, in Zalingei. No girls collect water in El

Fasher IDPs camps.

10.221.9

78.3

89.878.1

21.7

0

20

40

60

80

100

120

Urban peri urban IDPs camps

El Fasher

No

Yes

36.148.1

96.2

63.951.9

3.8

0

20

40

60

80

100

120


Zalingei

No

Yes

26

Photo 6: Water points in El Salam and Teyiba IDPs camps constructed by WES

Table 13: Responsibility of water collection in El Fasher and Zalingei

El Fasher Zalingei



Adult male

7 2.5 24 12.4

14 8.2 45 6.9 5 6.9 13 8.0 6 5.6 24 7.0

Adult female

4 1.4 57 29.4

114 66.7

175 27.0

9 12.5

39 24.1

64 59.8

112 32.8

Boys 0 0.0 9 4.6 3 1.8 12 1.9 3 4.2 2 1.2 5 4.7 10 2.9

Girls 2 0.7 9 4.6 0 0.0 11 1.7 3 4.2 0 0.0 8 7.5 11 3.2

Anyone 14 4.9 5 2.6 0 0.0 19 2.9 4 5.6 7 4.3 7 6.5 18 5.3

Adult male & boys

0 0.0 17 8.8 17 9.9 34 5.2 0 0.0 14 8.6 4 3.7 18 5.3

Adult female & girls

1 0.4 4 2.1 23 13.5

28 4.3 2 2.8 3 1.9 6 5.6 11 3.2

Not applicable

253 89.4

69 35.6

0 0.0 322 49.7

46 63.9

84 51.9

5 4.7 135 39.6

No answer

2 0.7 0 0.0 0 0.0 2 0.3 0 0.0 0 0.0 2 1.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

27

According to Table 5, 28.1 percent of households in El Fasher and 24.1 percent of households in Zalingei, have

piped water connection in their house or yard. Table 14 reveals a statistically significant association between

the use of improved water source and collection of water in North Darfur (P-value 0.004), however, there is

no significant association in Central Darfur (P-value 0.31). This finding partially explains the assumption that

the burden of water collection activity decreases when piped water connection is available near or inside

household. In Zalingei, a higher percentage of households spend time fetching water daily compared to El

Fasher, in all three areas (urban, peri-urban, IDPs) according to Table 5. This may explain the qualitative

findings by FGD in Zalingei, where it is mentioned that even though the houses have piped water into the

house in urban areas, often people need to go out to collect water from other sources due to frequent

disconnection of water in the piped system.

Photo 7: Old hand pumps in Teyiba IDPs camp and in Zalingei town

28

Table 14: Improved source of water * collection of water out the house * State of the survey Cross-tabulation

Chi-Square Tests




sided)






8.399 1 .004


Central Darfur Pearson Chi-Square 1.029c 1 .310





1.026 1 .311


Table 15: Association between water collection and daily water consumption

Chi-Square Tests





95.377 1 .000





29.559 1 .000




29

3.1.2.4 Distance to water source

Table 16 shows that about 40.7 percent of households travel for more than half a kilometer to the water

source in the peri-urban areas of El Fasher, compared to 0.4 percent in urban areas and 31.6 percent in IDPs

camps. In Zalingei, the percentages increased to up to 26.4 percent , 30.9 percent, and 51.4 percent in urban,

peri-urban and IDPs camps, respectively.

These findings may explain the quantitative results obtained in Figure 2, which reveal that the majority of

people believe available water is not sufficient. Qualitative results obtained through Focus Group Discussions

found the far distance of water source, to be a reason for lack of water sufficiency at household level.

Table 16: Distance to water sources in El Fasher and Zalingei 2016

El Fasher Zalingei

Urban Peri-urban

IDPs Total Urban Peri-urban

IDPs Total


Less than 50 meters

4 1.4 6 3.1 25 14.6 35 5.4 1 1.4 12 7.4 5 4.7 18 5.3

50 - 99 5 1.8 6 3.1 6 3.5 17 2.6 1 1.4 8 4.9 4 3.7 13 3.8

100 - 199 16 5.7 12 6.2 32 18.7 60 9.3 1 1.4 3 1.9 12 11.2 16 4.7

200 - 299 2 0.7 6 3.1 17 9.9 25 3.9 0 0.0 3 1.9 13 12.1 16 4.7

300 - 399 2 0.7 10 5.2 10 5.8 22 3.4 1 1.4 0 0.0 7 6.5 8 2.3

400 -499 0 0.0 6 3.1 27 15.8 33 5.1 3 4.2 2 1.2 6 5.6 11 3.2

500 - 599 0 0.0 18 9.3 18 10.5 36 5.6 3 4.2 5 3.1 12 11.2 20 5.9

600 - 699 0 0.0 7 3.6 8 4.7 15 2.3 0 0.0 2 1.2 11 10.3 13 3.8

700 - 799 0 0.0 7 3.6 13 7.6 20 3.1 2 2.8 3 1.9 4 3.7 9 2.6

800 - 899 0 0.0 2 1.0 4 2.3 6 0.9 4 5.6 2 1.2 6 5.6 12 3.5

900 - 1000 0 0.0 21 10.8 3 1.8 24 3.7 1 1.4 9 5.6 10 9.3 20 5.9

More than 1000 meters

1 0.4 24 12.4 8 4.7 33 5.1 9 12.5 29 17.9 12 11.2 50 14.7

Not applicable

253 89.4 69 35.6 0 0.0 322 49.7 46 63.9 84 51.9 4 3.7 134 39.3

No answer 0 0.0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

30

Figure 4: Average waiting time in queue for drinking water in El Fasher and Zalingei 2016

Figure 4 highlights that more than three quarters (75.8 percent) of households in El Fasher urban areas, reported that they queue at

the water sources for more than 30 minutes, compared to 80.9 percent in peri-urban and 89.4 percent in IDPs camps. In Zalingei

urban, 82.6 percent queue for more than 30 minutes compared to 70.5 percent in peri-urban and 92.8 percent in IDPs camps.

Table 17 shows that nearly half of the respondent households in El Fasher peri-urban (49 percent) and most

of the respondent households in IDP camps (92.4 percent) were using a Jerry can as water collection

containers. Only few people collect water in El Fasher urban area, but the majority of those use jerry cans as

well. Similarly, most of the household heads who collect water daily in Zalingei urban, peri-urban and IDPs

camps (31.9 percent, 34.6 percent, and 61.7 percent, respectively) reported they use jerry cans. Jerry cans

are the most common way of collecting water. During emergency operations, UNICEF provides 20 litre jerry

cans to IDPs and refugees, which are all made in Sudan. This type of water collection container is also

available in the Darfur states. However, jerry cans are not always a safe option because the top part can

potentially become contaminated with blue algae with use over a long period of time. This is due to the fact

that they are difficult to clean inside.

0.6

7.5

10.4

9.4

10.8

10.4

15.9

21.7

58.6

73.5

59.2

17.2

0.6

0.8

3.4

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

El Fasher

<10 mins 10-30mins 30min-1 hr >1hr I don't know

3.3

7.2

24.6

17.4

27.9

21.3

56.5

64.9

49.2

26.1

1.6

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

Zalingei

<10 mins 10-30mins 30min-1 hr >1hr I don't know

31

Table 17: Water collection containers in El Fasher and Zalingei 2016

El Fasher Zalingei



Barrel 2 0.7 8 4.1 4 2.3 14 2.2 3 4.2 7 4.3 0 0.0 10 2.9

Jerry can 17 6.0 95 49.0 158 92.4 270 41.7 23 31.9 56 34.6 66 61.7 145 42.5

Bucket 1 0.4 8 4.1 6 3.5 15 2.3 0 0.0 2 1.2 0 0.0 2 0.6

More than one type

9 3.2 14 7.2 3 1.8 26 4.0 0 0.0 13 8.0 36 33.6 49 14.4

Not Applicable (no need for water collection)

253 89.4

68 35.1 0 0.0 321 49.5 46 63.9 84 51.9 4 3.7 134 39.3

No Answer

1 0.4 1 0.5 0 0.0 2 0.3 0 0.0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107

100 341 100

60.944 37.1

19.644.8

48.8

19.6 10.4 13.5

0

20

40

60

80

100

120


El Fasher

All not covered

Some covered other not

All covered

Figure 5: Covering of water collection containers in El Fasher and Zalingei 2016

32

Figure 6: Cleaning of water collection containers in El Fasher and Zalingei 2016

50

21.8 21.6

30.8

64.154.9

19.2 9 23.5

0

20

40

60

80

100

120


Zalingei

All not covered

Some covered other not

All covered

46%

15%

30%

3%

3% 3%

El Fasher Urban

17%

14%

39%

16%

10%4%

El Fasher Peri-urban

8%

21%

38%

21%

12%

El Fasher IDP camp

Before use

Daily

Several times a week

Several times a month

Once in few months

Never cleaned

I don't know

7%

54%

27%

8%4%

Zalingei Urban

41%

7%24%

7%

18%

1%2%

Zalingei Peri-urban12%

3%

65%

17%

2%

1%IDP camp

Before use

Daily

Several times a week

Several times a month

Once in few months

Never cleaned

I don't know

Figure 5 Cont.

33

Figure 5 and Figure 6 show that people do not always clean and cover water containers. Only 60.9 percent of

the households in El Fasher urban, 44 percent in peri-urban and 37.1 percent in IDPs camps have covered their

water containers, compared to 50 percent, 21.8 percent and 21.6 percent in Zalingei urban, peri-urban and

IDPs camps, respectively. Also, only 45.5 percent in El Fasher urban, 17.4 percent in peri-urban and 7.6 percent

in IDPs camps, cleaned their water collection containers before using it, compared to 7.7 percent, 40.9 percent

and 11.9 percent in Zalingei urban, peri-urban and IDPs camps, respectively. These practices may be due to a

lack of awareness, as mentioned in Table 20, Table 43, and Table 46.

Figure 7: Household water treatment in El Fasher and Zalingei 2016

Figure 1 shows that 78.1 percent, and 66 percent of water sources in El Fasher and Zalingei peri-urban areas

were classified not improved sources according to WHO/UNICEF criteria; However, Figure 7 revealed that the

majority of respondents (94.3 percent and 80.2 percent) in El Fasher and Zalingei peri-urban, were not

practicing household water treatment.

0.6

1.5

1.1

3.2

2.5

99.4

94.3

96.4

1

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

El Fasher

Yes, always Yes, sometimes No I don't know

2.9

1.9

2.8

4.8

17.3

11.1

92.3

80.2

84.7

0.6

1.4

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

Zalingei

Yes, always Yes, sometimes No I don't know

34

Examples of an unimproved source of water is either surface water (river, dam, lake, pond, stream, canal,

irrigation channels), or other unimproved sources of water that include unprotected dug well, unprotected

spring, cart with small tank/drum, tanker truck, bottled water.

Photo 8: Examples of unimproved water sources in Zalingei 2016

Table 18: Water cost in El Fasher and Zalingei 2016

El Fasher Zalingei



Did not pay

2 0.7 1 0.5 3 1.8 6 0.9 11 15.3 13 8.0 13 12.1 37 10.9

Less than 10 SDG

1 0.4 4 2.1 5 2.9 10 1.5 0 0.0 6 3.7 17 15.9 23 6.7

10 - 19 SDG

3 1.1 8 4.1 21 12.3 32 4.9 0 0.0 4 2.5 18 16.8 22 6.5

20 -49 SDG

111 39.2 5 2.6 40 23.4 156 24.1 9 12.5 22 13.6 10 9.3 41 12.0

50 - 99 SDG

45 15.9 22 11.3 33 19.3 100 15.4 28 38.9 47 29.0 27 25.2 102 29.9

100 -200 SDG

24 8.5 40 20.6 45 26.3 109 16.8 20 27.8 35 21.6 13 12.1 68 19.9

More than 200 SDG

96 33.9 113 58.2 24 14.0 233 36.0 4 5.6 34 21.0 8 7.5 46 13.5

No Answer

1 0.4 1 0.5 0.0 2 0.3 0 0.0 1 0.6 1 0.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 99.1 341 100

35

Table 19: Affordability of water fee or cost

El Fasher Zalingei



Yes 215 76.0 135 69.6 97 56.7 447 69.0 62 86.1 133 82.1 73 68.2 268 78.6

No 64 22.6 58 29.9 74 43.3 196 30.2 7 9.7 14 8.6 33 30.8 54 15.8

I don't know

3 1.1 1 0.5 0 0.0 4 0.6 3 4.2 15 9.3 0 0.0 18 5.3

No answer 1 0.4 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

3.1.2.5 Knowledge

Table 20 shows that more than two thirds of respondents in El Fasher urban (73.5 percent) have limited

awareness of the benefits of piped water to house, compared to 76.3 percent in peri-urban and 76 percent in

IDPs camps. Only 7.8 percent, 7.2 percent, and 4.7 percent have good knowledge in urban, peri-urban and

IDPs camps, respectively.

In Zalingei, although the findings showed a significant weakness of awareness, the percentages in peri-urban

(57.4 percent) were better than urban (72.2 percent) and IDPs camps (88.8 percent).

Table 20: Knowledge towards benefits of piped water inside house

El Fasher Zalingei



No knowledge

0 0.0 0 0.0 0 0.0 0 0.0 2 2.8 6 3.7 0 0.0 8 2.3

Weak knowledge

208 73.5 148 76.3 130 76.0 486 75.0 52 72.2 93 57.4 95 88.8 240 70.4

Moderate knowledge

50 17.7 27 13.9 31 18.1 108 16.7 5 6.9 27 16.7 9 8.4 41 12.0

Good knowledge

22 7.8 14 7.2 8 4.7 44 6.8 13 18.1 35 21.6 2 1.9 50 14.7

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

No answer 3 1.1 5 2.6 2 1.2 10 1.5 0 0.0 1 0.6 1 0.9 2 0.6

Total 283 100 194 100 171 100 648 10 72 100 162 100 107 100 341 100

36

3.1.2.6 Attitude

Figure 8: Appearance of water in El Fasher and Zalingei

Ground water was the main water source in El Fasher, and it has low levels of turbidity, hence its appearance

as clear. Figure 8 shows that the majority of respondents in El Fasher urban, peri-urban and IDPs camps (75

percent, 80 percent and 95.3 percent, respectively) believe the water was clear. On the other hand, only 50

percent, 41.6 percent and 48.1 percent of people in Zalingei urban, peri-urban and IDPs camps found their

water clear , since more people use unprotected wells, valleys, and other surface water sources. The

household survey, indicates that the majority of people believe clean water means “safe” water, and

therefore no household water treatment is needed. These results may explain the findings highlighted in

Figure 7, where the majority of respondents in both towns do not treat water at home.

Table 21 shows that in El Fasher, 89.8 percent of urban, 88.7 percent of peri-urban and 95.9 percent of IDPs

camps respondents believe the water is free from odours and smells, compared to 83.3 percent, 77.8 percent

and 72.9 percent in Zalingei, respectively.

95.3

80

75

4.7

19.5

24.6

0.5

0.4

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

El Fasher

Always clear Sometimes turbid Always turbid

48.1

41.6

50

50

55.9

48.6

1.9

1.9

1.4

0.6

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

Zalingei

Always clear Sometimes turbid Always turbid I don't know

37

Table 21: Perception of drinking water smell

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Always no odour

254 89.8 172 88.7 164 95.9 590 91.0 60 83.3 126 77.8 78 72.9 264 77.4

Sometimes has odour

26 9.2 21 10.8 5 2.9 52 8.0 12 16.7 32 19.8 28 26.2 72 21.1

Always has odour

0 0.0 1 0.5 0 0.0 1 0.2 0 0.0 1 0.6 0 0.0 1 0.3

I don't know

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 0 0.0 2 0.6

No Answer 3 1.1 0 0.0 2 1.2 5 0.8 0.0 1 0.6 1 0.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 22: Reaction to the statement "the major benefit of piped water supply is to provide sufficient quantity of water for household"

El Fasher Zalingei

Urban Peri-urban

IDPs Total Urban Peri-urban IDPs Total


Completely agree

251 88.7 171 88.1 129 75.4 551 85.0 44 61.1 127 78.4 69 64.5 240 70.4

May agree 28 9.9 21 10.8 34 19.9 83 12.8 12 16.7 18 11.1 18 16.8 48 14.1

Do not agree

3 1.1 2 1.0 8 4.7 13 2.0 16 22.2 16 9.9 19 17.8 51 15.0

I don't know

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

No answer 1 0.4 0.0 0.0 1 0.2 0.0 1 0.6 1 0.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

38

Table 23: Response to the statement "There is no relationship between water supply and spread of diseases"

El Fasher Zalingei



Completely agree

40 14.1 74 38.1 60 35.1 174 26.9 3 4.2 16 9.9 15 14.0 34 10.0

May agree 15 5.3 19 9.8 14 8.2 48 7.4 9 12.5 21 13.0 11 10.3 41 12.0

Do not agree 227 80.2 98 50.5 97 56.7 422 65.1 60 83.3 123 75.9 80 74.8 263 77.1

I don't know 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

No answer 1 0.4 3 1.5 0.0 4 0.6 0 0.0 2 1.2 1 0.9 3 0.9

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Although all respondents in both towns reported that they believe drinking water supply is important (as

illustrated in Table 24), Table 22 reveals that in El Fasher (88.7 percent urban, 88.1 percent peri-urban and

75.4 percent IDPs camps), respondents believe the major benefits of water piped into the house is to ensure

sufficient quantity of water. This is in comparison to Zalingei, where the figures are 61.1 percent urban, 78.4

percent peri-urban and 64.5 percent IDPs camp respondents.

Table 23 highlights the number of respondents in El Fasher, who believe there is no relationship between

water supply and the spread of diseases (14.1 percent in urban, 38.1 percent peri-urban and 35.1 percent

IDPs camps), compared to (4.2 percent, 9.9 percent and 14 percent) in Zalingei’s urban, peri-urban

population and IDPs camps, respectively. It appears that the connection between clean water and improved

health status is understood better in Zalingei. Meanwhile, 83.1 percent in Zalingei and 90.6 in El Fasher

believe that people with water connection seem to get sick less often than people without regular access to

water source, as shown in the Table 25.

Table 24: Importance of safe drinking water supply in El Fasher and Zalingei

El Fasher Zalingei



Yes 282 99.6 192 99.0 167 97.7 641 98.9 70 97.2 156 96.3 104 97.2 330 96.8

No 0 0.0 0 0.0 2 1.2 2 0.3 0 0.0 0 0.0 1 0.9 1 0.3

I don't know

0 0.0 1 0.5 2 1.2 3 0.5 2 2.8 1 0.6 1 0.9 4 1.2

No answer

1 0.4 1 0.5 0 0.0 2 0.3 0 0.0 5 3.1 1 0.9 6 1.8

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

39

Table 25: Whether people with access to safe drinking water suffer less from disease than those who do not have access or not

El Fasher Zalingei



Yes 261 92.2 178 91.8 148 86.5 587 90.6 59 81.9 135 84.4 87 82.1 281 83.1

No 11 3.9 7 3.6 5 2.9 23 3.5 8 11.1 14 8.8 8 7.5 30 8.9

I don't know

10 3.5 8 4.1 18 10.5 36 5.6 5 6.9 11 6.9 11 10.4 27 8.0

No answer

1 0.4 1 0.5 0 0.0 2 0.3 0.0 0.0 0.0 0 0.0

Total 283 100 194 100 171 100 648 100 72 100 160 100 106 100 338 100

3.1.3 Household Sanitation

3.1.3.1. Knowledge

Table 26 reveals the majority of respondents in El Fasher’s urban (93.3 percent), peri-urban (83 percent) and

IDPs camps (39.2 percent) have a weak level of awareness regarding problems of latrines. In comparison, the

percentages in Zalingei are 83.3 percent in urban, 79.6 percent in peri-urban and 77.6 percent in IDPs camps.

Table 26: Knowledge regarding latrine problems in El Fasher and Zalingei

El Fasher Zalingei



No knowledge 4 1.4 7 3.6 1 0.6 12 1.9 4 5.6 4 2.5 8 7.5 16 4.7

Weak knowledge

264 93.3 161 83.0 67 39.2 492 75.9 60 83.3 129 79.6 83 77.6 272 79.8

Moderate knowledge

12 4.2 1 0.5 18 10.5 31 4.8 4 5.6 12 7.4 3 2.8 19 5.6

Good knowledge

0 0.0 1 0.5 3 1.8 4 0.6 2 2.8 4 2.5 1 0.9 7 2.1

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Not applicable (no HH latrine)

2 0.7 22 11.3 82 48.0 106 16.4 2 2.8 13 8.0 11 10.3 26 7.6

No answer 1 0.4 2 1.0 0 0.0 3 0.5 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

40

Despite the fact that most respondents in both towns believe the availability of a household latrine is an

important issue, Table 27 and Table 28 reveal that the knowledge of respondents as to why latrine is

important and the problems of open defecation, were almost weak.

Table 27: Knowledge regarding importance of latrine

El Fasher Zalingei



No knowledge

0 0.0 2 1.0 3 1.8 5 0.8 0 0.0 11 6.8 0 0.0 11 3.2

Weak knowledge

209 73.9 158 81.4 147 86.0

514 79.3 58 80.6 101 62.3 99 92.5 258 75.7

Moderate knowledge

50 17.7 19 9.8 16 9.4 85 13.1 5 6.9 23 14.2 6 5.6 34 10.0

Good knowledge

21 7.4 12 6.2 2 1.2 35 5.4 8 11.1 25 15.4 0 0.0 33 9.7

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Not applicable

0 0.0 2 1.0 3 1.8 5 0.8 1 1.4 2 1.2 0 0.0 3 0.9

No answer 3 1.1 1 0.5 0 0.0 4 0.6 0 0.0 0 0.0 2 1.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 28: Knowledge regarding open defecation (OD)

El Fasher Zalingei



No knowledge

0 0.0 5 2.6 3 1.8 8 1.2 5 6.9 17 10.5 4 3.7 26 7.6

Weak knowledge

281 99.3 183 94.3 168 98.2 632 97.5 67 93.1 145 89.5 99 92.5 311 91.2

Moderate knowledge

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Good knowledge

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

No answer 2 0.7 6 3.1 0 0.0 8 1.2 0.0 0.0 4 3.7 4 1.2

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

41

3.1.3.2 Practices

Availability of latrines for most households was high in both towns as shown in Table 21. However, Figure 9

exposed that 12.3 percent of these latrines in El Fasher urban, 32.8 percent in peri-urban and 62.5 percent in

IDPs camps, were classified unimproved sanitation according to the WHO criteria. For a facility to be labelled

‘improved sanitation’ it would have to hygienically separate human excreta from human contact, such as flush/

pour flush toilet using septic tank, pit latrine with slab or ventilated pit latrine. Everything else is considered

“unimproved”, including shared toilets.

In Zalingei, despite the availability of household sanitation facilities which were 97.2 percent in urban, 92

percent in peri-urban and 89.6 percent in IDPs camps, only 55.7 percent of these facilities in urban, 55.4

percent in peri-urban, and 32.6 percent in IDPs camps were classified improved sanitation facilities according

to the WHO criteria.

Table 30 highlights that the variations of availability of household latrine were statistically significant between

El Fasher urban, peri-urban and IDPs camps (P value 0.001). However, it is not significant in Zalingei urban,

peri-urban and IDPs camps )P value 0.17).

Table 29: Availability of household latrine in El Fasher and Zalingei

El Fasher Zalingei

Urban Peri urban IDPs Total Urban Peri urban IDPs Total


Yes 280 98.9 172 88.7 89 52.0 541 83.5 70 97.2 149 92.0 95 88.8 314 92.1

No 2 0.7 22 11.3 82 48.0 106 16.4 2 2.8 13 8.0 11 10.3 26 7.6

Missing data

1 0.4 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 30: Association between availability of household latrine and context

Chi-Square Tests












42

Table 31: Association between use of improved sanitation facilities and context

Chi-Square Tests





97.485 1 .000





9.894 1 .002




Table 31 reveals that the variations observed in Figure 9, were statistically significant between urban, peri-

urban and IDPs camps in both towns.

Figure 9: Availability of improved sanitation facilities in El Fasher and Zalingei

87.7

67.2

37.5

12.3

32.8

62.5

0

20

40

60

80

100

120


El Fasher

unimproved

Improved

43

Table 32: Frequency of cleaning household latrine

El Fasher Zalingei

Urban Peri-urban



More than once a day

60 21.2 38 19.6 14 8.2 112 17.3 12 16.7 38 23.5 14 13.1 64 18.8

Daily 144 50.9 63 32.5 30 17.5 237 36.6 15 20.8 63 38.9 23 21.5 101 29.6

Once every 2 - 3 days

56 19.8 38 19.6 32 18.7 126 19.4 27 37.5 28 17.3 32 29.9 87 25.5

Once a week 19 6.7 19 9.8 11 6.4 49 7.6 7 9.7 13 8.0 16 15.0 36 10.6

Did not clean 1 0.4 3 1.5 0 0.0 4 0.6 7 9.7 6 3.7 10 9.3 23 6.7

I don't know 0 0.0 0 0.0 0 0.0 0 0.0 1 1.4 0 0.0 0 0.0 1 0.3

Not applicable 2 0.7 22 11.3 82 48.0 106 16.4 2 2.8 13 8.0 11 10.3 26 7.6

Missing data 1 0.4 11 5.7 2 1.2 14 2.2 1 1.4 1 0.6 1 0.9 3 0.9

Total 283 100 194 100 171 100 648 100 72 100.0 162 100 107 100 341 100

55.7 55.4

32.6

44.3 44.6

67.4

0

20

40

60

80

100

120


Zalingei

unimproved

Improved

Figure 9 Cont.

44

Table 33: Responsibility of cleaning household latrine

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Adult female 175 61.8 119 61.3 83 48.5 377 58.2 51 70.8 120 74.1 67 62.6 238 69.8

Adult male 4 1.4 11 5.7 1 0.6 16 2.5 2 2.8 1 0.6 1 0.9 4 1.2

Female children 2 0.7 7 3.6 0 0.0 9 1.4 1 1.4 0 0.0 2 1.9 3 0.9

Male children 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 1 0.3

Household worker

13 4.6 2 1.0 0 0.0 15 2.3 0 0.0 0 0.0 0 0.0 0 0.0

Anyone of family members

86 30.4 21 10.8 5 2.9 112 17.3 7 9.7 20 12.3 13 12.1 40 11.7

I don’t know 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.9 2 0.6

Not applicable 3 1.1 25 12.9 82 48.0 110 17.0 10 13.9 19 11.7 21 19.6 50 14.7

Missing data 0 0.0 9 4.6 0 0.0 9 1.4 1 1.4 1 0.6 1 0.9 3 0.9

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 34: Alternative sanitation facility when there are difficulties in using household latrine

El Fasher Zalingei

Urban Peri-urban



Latrine in neighbour’s house

197 69.6 86 44.3 10 5.8 293 45.2 64 88.9 60 37.0 72 67.3 196 57.5

Public latrine 10 3.5 7 3.6 26 15.2 43 6.6 0 0.0 1 0.6 0 0.0 1 0.3

Open defecation 2 0.7 16 8.2 14 8.2 32 4.9 4 5.6 1 0.6 6 5.6 11 3.2

Others 35 12.4 22 11.3 20 11.7 77 11.9 2 2.8 22 13.6 1 0.9 25 7.3

More than one 4 1.4 14 7.2 0 0.0 18 2.8 0 0.0 2 1.2 11 10.3 13 3.8

Not applicable 2 0.7 22 11.3 82 48.0 106 16.4 2 2.8 13 8.0 11 10.3 26 7.6

Missing data 33 11.7 27 13.9 19 11.1 79 12.2 0 0.0 63 38.9 6 5.6 69 20.2

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

45

Table 35: Alternative sanitation facility for people who do not have household latrine

El Fasher Zalingei

Urban Peri-urban IDPs Total Urban Peri-urban

IDPs Total


Latrine in neighbour’s house

1 0.4 8 4.1 19 11.1 28 4.3 2 2.8 3 1.9 0 0.0 5 1.5

Public latrine 1 0.4 3 1.5 60 35.1 64 9.9 0 0.0 0 0.0 0 0.0 0 0.0

Open defecation 0 0.0 5 2.6 2 1.2 7 1.1 0 0.0 4 2.5 8 7.5 12 3.5

More than one 0 0.0 5 2.6 1 0.6 6 0.9

0.0 6 3.7 3 2.8 9 2.6

I don’t know 0 0.0 0 0.0 7 4.1 7 1.1 0.0 0.0 0 0.0 0 0.0

Not applicable (have latrine)

280 98.9 172 88.7 82 48.0 534 82.4 70 97.2 149 92.0 95 88.8 314 92.1

Missing data 1 0.4 1 0.5 0 0.0 2 0.3 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 36: Children under 5 use of household sanitation facility

El Fasher Zalingei



Yes 139 49.1 107 55.2 99 57.9 345 53.2 55 76.4 109 67.3 78 72.9 242 71.0

No 70 24.7 62 32.0 49 28.7 181 27.9 12 16.7 32 19.8 17 15.9 61 17.9

Not applicable 68 24.0 22 11.3 22 12.9 112 17.3 5 6.9 21 13.0 11 10.3 37 10.9

No answer 6 2.1 3 1.5 1 0.6 10 1.5 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

46

Table 37: Places where children under 5 defecate routinely

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Family latrine 23 8.1 18 9.3 21 12.3 62 9.6 6 8.3 22 13.6 4 3.7 32 9.4

Special stool seat

95 33.6 59 30.4 23 13.5 177 27.3 13 18.1 12 7.4 1 0.9 26 7.6

Public latrine 1 0.4 3 1.5 7 4.1 11 1.7 0 0.0 0 0.0 1 0.9 1 0.3

Open space inside house

9 3.2 33 17.0 33 19.3 75 11.6 27 37.5 34 21.0 43 40.2 104 30.5

Open defecation

1 0.4 4 2.1 17 9.9 22 3.4 1 1.4 8 4.9 11 10.3 20 5.9

Others 3 1.1 3 1.5 18 10.5 24 3.7 0 0.0 0 0.0 2 1.9 2 0.6

More than one 28 9.9 8 4.1 10 5.8 46 7.1 6 8.3 23 14.2 1 0.9 30 8.8

Not applicable 105 37.1 44 22.7 39 22.8 188 29.0 19 26.4 49 30.2 39 36.4 107 31.4

No answer 18 6.4 22 11.3 3 1.8 43 6.6 0 0.0 14 8.6 5 4.7 19 5.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 38: Disposal methods of grey water

El Fasher Zalingei

Urban Peri-urban


IDPs Total

No.

% No.

% No. % No. % No. % No. % No. % No. %

In open space around house

216 76.3 128 66.0 130 76.0 474 73.1 50 69.4 38 23.5 85 79.4 173 50.7

A place away from house

40 14.1 56 28.9 29 17.0 125 19.3 18 25.0 102 63.0 13 12.1 133 39.0

In latrine 3 1.1 4 2.1 0 0.0 7 1.1 0 0.0 0 0.0 1 0.9 1 0.3

Septic tank 3 1.1 0 0.0 0 0.0 3 0.5 0 0.0 1 0.6 0 0.0 1 0.3

Others 21 7.4 6 3.1 12 7.0 39 6.0 4 5.6 21 13.0 5 4.7 30 8.8

I don't know 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.9 2 0.6

No answer 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

47

Table 39: Disposal methods of household solid waste

El Fasher Zalingei



In open space around the house

10 3.5 26 13.4

60 35.1 96 14.8 0 0.0 7 4.3 9 8.4 16 4.7

In open space in other place

4 1.4 37 19.1

23 13.5 64 9.9 32 44.4 90 55.6 37 34.6 159 46.6

Bury inside the house

19 6.7 46 23.7

13 7.6 78 12.0 0 0.0 5 3.1 6 5.6 11 3.2

Bury in other place

31 11.0

30 15.5

32 18.7 93 14.4 29 40.3 11 6.8 33 30.8 73 21.4

Burn near the house

3 1.1 26 13.4

9 5.3 38 5.9 3 4.2 9 5.6 5 4.7 17 5.0

Burn in other place

3 1.1 14 7.2 21 12.3 38 5.9 2 2.8 4 2.5 5 4.7 11 3.2

Used as compost

0 0.0 1 0.5 2 1.2 3 0.5 0 0.0 0 0.0 0 0.0 0 0.0

Others 201 71.0

13 6.7 11 6.4 225 34.7 6 8.3 33 20.4 11 10.3 50 14.7

I don't know

11 3.9 1 0.5 0 0.0 12 1.9 0 0.0 3 1.9 0 0.0 3 0.9

No answer

1 0.4 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162

100 107

100 341 100

3.1.3.3 Attitudes

It is notable to say that 8.8 percent of respondents without household latrine in El Fasher IDPs camp,

consider that a major barrier for constructing latrine is the possibility of the spread of disease in the house

(Table 40). This answer could be due to unhygienic living conditions inside IDPs camp in general. Importance

of household latrine is recognised by almost all respondents (Table 41).

Table 42 shows different pictures of latrine construction processes in the two towns. In El Fasher, nearly half

of households in IDPs camps still do not have household latrine. But nearly 70 percent of households with

48

latrine in urban and peri-urban El Fasher constructed latrines by themselves. This could be an indicator that

CLTS activity is effective in El Fasher, and similar activities need to be strengthened in IDPs camps. In Zalingei,

however, household latrine availability is higher in IDPs camps, and nearly 80 percent of IDPs camp

households constructed latrines by themselves. This indicates that CLTS activities in Central Darfur IDPs

camps may have been more effective than in North Darfur camps.

Table 40: Barriers for constructing household latrine

El Fasher Zalingei

Urban Peri-urban IDPs Total Urban Peri-urban

IDPs Total


High cost 0 0.0 9 4.6 33 19.3 42 6.5 0 0.0 3 1.9 4 3.7 7 2.1

Latrine may spread disease in the house

2 0.7 0 0.0 15 8.8 17 2.6 0 0.0 0 0.0 0 0.0 0 0.0

No space to construct latrine

0 0.0 1 0.5 28 16.4 29 4.5 0 0.0 1 0.6 1 0.9 2 0.6

Others 1 0.4 9 4.6 0 0.0 10 1.5 2 2.8 8 4.9 6 5.6 16 4.7

I don't know 0 0.0 1 0.5 6 3.5 7 1.1 0 0.0

0.0

0.0 0 0.0

Not applicable (have latrine already)

280 98.9 172 88.7 89 52.0 541 83.5 70 97.2 149 92.0 95 88.8 314 92.1

Missing data 0 0.0 2 1.0 0 0.0 2 0.3 0 0.0 1 0.6 1 0.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 0 162 100 107 100 341 100

Table 41: Importance of household latrine recognition by respondents

El Fasher Zalingei



Yes 281 99.3 191 98.5 168 98.2 640 98.8 71 98.6 162 100.0 106 99.1 339 99.4

No 0 0.0 1 0.5 3 1.8 4 0.6 1 1.4 0 0.0 0 0.0 1 0.3

I don’t know 0 0.0 1 0.5 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0

No answer 2 0.7 1 0.5 0 0.0 3 0.5 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

49

Table 42: Main constructor of household latrine

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Family members 199 70.3 133 68.6 43 25.1 375 57.9 32 44.4 68 42.0 85 79.4 185 54.3

Professional workers

66 23.3 30 15.5 5 2.9 101 15.6 17 23.6 61 37.7 3 2.8 81 23.8

Government agency

1 0.4 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0

CBOs 0 0.0 2 1.0 17 9.9 19 2.9 0 0.0 0 0.0 0 0.0 0 0.0

NGOs 0 0.0 5 2.6 22 12.9 27 4.2 0 0.0 0 0.0 2 1.9 2 0.6

Others 13 4.6 0 0.0 0 0.0 13 2.0 0 0.0 12 7.4 2 1.9 14 4.1

More than one 1 0.4

0.0 0 0.0 1 0.2 21 29.2 8 4.9 3 2.8 32 9.4

Not applicable (do not have latrine)

2 0.7 22 11.3 82 48.0 106 16.4 2 2.8 13 8.0 11 10.3 26 7.6

No answer 1 0.4 2 1.0 2 1.2 5 0.8 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

3.1.4 Health and personal hygiene

3.1.4.1 Knowledge

Table 43: Knowledge regarding concept of hygiene in El Fasher and Zalingei 2016

El Fasher Zalingei



No knowledge 11 3.9 12 6.2 17 9.9 40 6.2 2 2.8 16 9.9 8 7.5 26 7.6

Weak knowledge 187 66.1 144 74.2 105 61.4 436 67.3 59 81.9 113 69.8 95 88.8 267 78.3

Moderate knowledge

74 26.1 38 19.6 49 28.7 161 24.8 11 15.3 32 19.8 3 2.8 46 13.5

Good knowledge 11 3.9 0 0.0 0 0.0 11 1.7 0 0.0 1 0.6 0 0.0 1 0.3

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

No answer 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 99.1 341 100

50

Table 44: Knowledge towards importance of personal hygiene

El Fasher Zalingei



No knowledge 0 0.0 5 2.6 2 1.2 7 1.1 1 1.4 4 2.5 1 0.9 6 1.8

Weak knowledge 206 72.8 145 74.7 166 97.1 517 79.8 58 80.6 104 64.2 74 69.2 236 69.2

Moderate knowledge

67 23.7 24 12.4 2 1.2 93 14.4 12 16.7 46 28.4 27 25.2 85 24.9

Good knowledge 8 2.8 8 4.1 0 0.0 16 2.5 1 1.4 8 4.9 2 1.9 11 3.2

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Not applicable 0 0.0 9 4.6 0 0.0 9 1.4 0 0.0 0 0.0 1 0.9 1 0.3

No answer 2 0.7 3 1.5 1 0.6 6 0.9 0 0.0 0 0.0 2 1.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 45: Knowledge towards how to get infected by diarrheal disease

El Fasher Zalingei



No knowledge 2 0.7 5 2.6 7 4.1 14 2.2 6 8.3 10 6.2 9 8.4 25 7.3

Weak knowledge

231 81.6 167 86.1 145 84.8 543 83.8 55 76.4 105 64.8 96 89.7 256 75.1

Moderate knowledge

50 17.7 21 10.8 19 11.1 90 13.9 11 15.3 47 29.0 1 0.9 59 17.3

Good knowledge

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Not applicable 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

No answer 0 0.0 1 0.5 0 0.0 1 0.2 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

51

Table 46: Knowledge towards prevention of diarrheal disease

El Fasher Zalingei



No knowledge

1 0.4 13 6.7 19 11.1 33 5.1 6 8.3 21 13.0 12 11.2 39 11.4

weak knowledge

217 76.7 163 84.0 137 80.1 517 79.8 51 70.8 105 64.8 88 82.2 244 71.6

moderate knowledge

65 23.0 18 9.3 13 7.6 96 14.8 15 20.8 36 22.2 6 5.6 57 16.7

Good knowledge

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Excellent 0

0

0

0

No answer 0 0.0 0 0.0 2 1.2 2 0.3 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 47: Knowledge regarding anal cleansing materials

El Fasher Zalingei



No knowledge

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 1 0.3

Weak knowledge

0 0.0 0 0.0 1 0.6 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0

Moderate knowledge

21 7.4 9 4.6 5 2.9 35 5.4 15 20.8 40 24.7 9 8.4 64 18.8

Good knowledge

259 91.5 185 95.4 164 95.9 608 93.8 57 79.2 120 74.1 97 90.7 274 80.4

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

No answer 3 1.1 0 0.0 1 0.6 4 0.6 0 0.0 1 0.6 1 0.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

52

Table 48: Knowledge regarding critical points of hand washing

El Fasher Zalingei



No knowledge

0 0.0 1 0.5 0 0.0 1 0.2 3 4.2 16 9.9 0 0.0 19 5.6

Weak knowledge

236 83.4 177 91.2 163 95.3 576 88.9 64 88.9 124 76.5 104 97.2 292 85.6

Moderate knowledge

47 16.6 16 8.2 8 4.7 71 11.0 5 6.9 22 13.6 2 1.9 29 8.5

Good knowledge

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

No answer 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 49: Knowledge towards healthy food

El Fasher Zalingei



No knowledge

0 0.0 12 6.2 8 4.7 20 3.1 5 6.9 9 5.6 12 11.2 26 7.6

Weak knowledge

203 71.7 161 83.0 157 91.8 521 80.4 55 76.4 115 71.0 86 80.4 256 75.1

Moderate knowledge

53 18.7 18 9.3 4 2.3 75 11.6 7 9.7 28 17.3 7 6.5 42 12.3

Good knowledge

26 9.2 2 1.0 0 0.0 28 4.3 5 6.9 10 6.2 1 0.9 16 4.7

Excellent 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

No answer 1 0.4 1 0.5 2 1.2 4 0.6 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

53

Table 50: Detailed answers: critical moments of hand washing

El Fasher Zalingei

Urban Peri-urban


IDPs Total


After using latrine

9 3.2 11 5.7 11 6.4 31 4.8 3 4.2 19 11.7 8 7.5 30 8.8

Before eating 9 3.2 25 12.9 10 5.8 44 6.8 2 2.8 6 3.7 6 5.6 14 4.1

After cleaning child anal

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 1.9 0 0.0 3 0.9

Before preparing meals

1 0.4 1 0.5 0 0.0 2 0.3 0 0.0 1 0.6 4 3.7 5 1.5

After disposed child faeces

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

After cleaning latrine

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

After touching animals

0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

After disposed animals faeces

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Before feeding children

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Before feeding others

1 0.4 1 0.5 0 0.0 2 0.3 0 0.0 0 0.0 0 0.0 0 0.0

After care about patients

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

When returning back home

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Two of these options

129 45.6 78 40.2 71 41.5 278 42.9 40 55.6 55 34.0 46 43.0 141 41.3

Three of these options

83 29.3 57 29.4 62 36.3 202 31.2 16 22.2 44 27.2 35 32.7 95 27.9

More than three options

42 14.8 15 7.7 16 9.4 73 11.3 8 11.1 27 16.7 6 5.6 41 12.0

Others 0 0.0 4 2.1 1 0.6 5 0.8 2 2.8 6 3.7 0 0.0 8 2.3

I don't know 8 2.8 0 0.0 0 0.0 8 1.2 0 0.0 0 0.0 1 0.9 1 0.3

Not applicable 0 0.0 2 1.0 0 0.0 2 0.3 1 1.4 1 0.6 0 0.0 2 0.6

No answer 1 0.4 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

54

3.1.4.2 Attitudes

Table 51: Importance of personal hygiene

El Fasher Zalingei

Urban Peri-urban


No.

% No.

% No. % No. % No. % No. % No. % No. %

Yes 283 100.0 185 95.4 171 100.0 639 98.6 72 100.0 162 100.0 105 98.1 339 99.4

No 0 0.0 3 1.5 0 0.0 3 0.5 0 0.0 0 0.0 0 0.0 0 0.0

I don’t know

0 0.0 6 3.1 0 0.0 6 0.9 0 0.0 0 0.0 1 0.9 1 0.3

No answer

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 52: Benefits of keeping food hygienic (clean)

El Fasher Zalingei

Urban Peri-urban


IDPs Total


No real benefits

4 1.4 10 5.2 3 1.8 17 2.6 1 1.4 2 1.2 4 3.7 7 2.1

More health 240 84.8 142 73.2 153 89.5 535 82.6 56 77.8 108 66.7 67 62.6 231 67.7

Best taste 14 4.9 16 8.2 9 5.3 39 6.0 3 4.2 13 8.0 18 16.8 34 10.0

Others 3 1.1 5 2.6 1 0.6 9 1.4 3 4.2 2 1.2 2 1.9 7 2.1

2 & 3 19 6.7 15 7.7 4 2.3 38 5.9 3 4.2 27 16.7 7 6.5 37 10.9

I don't know 1 0.4 5 2.6 0 0.0 6 0.9 6 8.3 8 4.9 8 7.5 22 6.5

No answer 2 0.7 1 0.5 1 0.6 4 0.6 0 0.0 2 1.2 1 0.9 3 0.9

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

55

Table 53: Importance of covering food vessels

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Very important

281 99.3 190 97.9 170 99.4 641 98.9 72 100.0 154 95.1 104 97.2 330 96.8

Sometimes important

2 0.7 1 0.5 1 0.6 4 0.6 0 0.0 5 3.1 2 1.9 7 2.1

Not important

0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 1 0.3

I don't know

0 0.0 1 0.5 0 0.0 1 0.2 0 0.0 1 0.6 0 0.0 1 0.3

No answer 0 0.0 2 1.0 0 0.0 2 0.3 0 0.0 1 0.6 1 0.9 2 0.6

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

3.1.4.3 Practices

Table 51 reveals that all respondents believe personal hygiene is important for their life. However, Table 43

and Table 44, show that most people have weak knowledge towards personal hygiene and preventable

measures of diarrhoea. The outcome of this lowest knowledge appear clearly in Table 54, which also

highlights that more than a fifth of the population in El Fasher and two thirds of the Zalingei population were

suffering from diarrhoea-related diseases.

Table 54: One or more family members suffering from diarrhoea (within past 2 weeks at the time of survey)

El Fasher Zalingei



Yes 59 20.8 69 35.6 45 26.3 173 26.7 29 40.3 58 35.8 47 43.9 134 39.3

No 224 79.2 122 62.9 124 72.5 470 72.5 42 58.3 100 61.7 58 54.2 200 58.7

I don't know 0 0.0 0 0.0 1 0.6 1 0.2 1 1.4 4 2.5 1 0.9 6 1.8

No answer 0 0.0 3 1.5 1 0.6 4 0.6 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

56

Table 55: Association between use of improved sanitation facilities and suffering from diarrhoea diseases

Chi-Square Tests




sided)






3.905 1 .048







.031 1 .860





57

Table 56: Association between use of improved water sources and suffering from diarrhoea diseases

Chi-Square Tests




sided)

North Darfur Pearson Chi-Square .256a 1 .613





.256 1 .613


Central Darfur Pearson Chi-Square 1.094c 1 .296





1.091 1 .296





Table 57, Table 79 and Table 80, show that the majority of respondents and FGD participants in both towns’

urban, peri-urban and IDPs camps population, practice hand washing as a habit. However, Table 60 reveals

lower percentages of respondents were using water and soap to wash their hands. When we asked about

the critical time for hand washing, a few respondents mentioned the correct answer (see Table 50).

Table 61 shows that only 24.8 percent and 3.2 percent of households in El Fasher and Zalingei respectively,

had a hand washing facility inside household. These results were not concise with the results of Table 57,

Table 79, and Table 80, since nearly 100 percent of respondents in El Fasher said that they wash their hands

as a habit, and nearly 80 percent in Zalingei, according to Table 57. The gap between self-reported hand

washing habit and observed availability of hand washing facility is significant. The enumerators have judged

that a household has hand washing facility if they have observed water container facility (including abrieg,

water vessel) near latrine or kitchen. Therefore, the data in Table 61 and Table 62 are subject to bias.

Considering that low availability of soap indicated in Table 62, and a high number of people reporting

frequent hand washing practice per day (In Table 59, 70.7 percent in El Fasher and 88.6 percent in Zalingei

report that they wash hands more than 5 times a day), it is highly likely that many people consider that

washing hands with water only (especially before prayer) keeps their hands hygienic, even without a soap.

Table 58 reveals that there was no association between use of improved sanitation facilities and availability

of hand washing facilities (P value 0.17 and 0.76) in El Fasher and Zalingei.

58

Table 57: Hand washing practiced as a habit (self-reporting)

El Fasher Zalingei



Yes 274 96.8 186 95.9 167 97.7 627 96.8 55 76.4 152 93.8 63 58.9 270 79.2

Sometimes 7 2.5 4 2.1 1 0.6 12 1.9 16 22.2 9 5.6 43 40.2 68 19.9

No 0 0.0 2 1.0 0 0.0 2 0.3 1 1.4 1 0.6 0 0.0 2 0.6

No answer 2 0.7 2 1.0 3 1.8 7 1.1 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 58: Association between use of improved sanitation facility and availability of hand washing facility

Chi-Square Tests




sided)






2.185 1 .139







.171 1 .679





59

Table 59: Number of hand washing actions taken during a day (self-reporting)

El Fasher Zalingei



1 -2 times 18 6.4 10 5.2 3 1.8 31 4.8 0 0.0 3 1.9 1 0.9 4 1.2

3 - 4 times 51 18.0 73 37.6 30 17.5 154 23.8 9 12.5 15 9.3 8 7.5 32 9.4

5 times or more 212 74.9 109 56.2 137 80.1 458 70.7 62 86.1 143 88.3 97 90.7 302 88.6

Not applicable 0 0.0 2 1.0 0 0.0 2 0.3 1 1.4 1 0.6 0 0.0 2 0.6

No answer 2 0.7 0 0.0 1 0.6 3 0.5 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 60: Material used in hand washing

El Fasher Zalingei



Water and soap

220 77.7 147 75.8 131 76.6 498 76.9 50 69.4 110 67.9 54 50.5 214 62.8

Water and earth

1 0.4 7 3.6 6 3.5 14 2.2 1 1.4 1 0.6 4 3.7 6 1.8

Water only 7 2.5 14 7.2 6 3.5 27 4.2 12 16.7 14 8.6 15 14.0 41 12.0

More than one

42 14.8 19 9.8 25 14.6 86 13.3 8 11.1 35 21.6 32 29.9 75.0 22.0

Not applicable

0 0.0 2 1.0 0 0.0 2 0.3 1 1.4 1 0.6 0 0.0 2 0.6

No answer 13 4.6 5 2.6 3 1.8 21 3.2 0 0.0 1 0.6 2 1.9 3 0.9

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

60

Table 61: Availability of hand washing facility at household (observation by enumerators)

El Fasher Zalingei



Yes 99 35.0 51 26.3 8 4.7 158 24.4 4 5.6 4 2.5 3 2.8 11 3.2

No 179 63.3 143 73.7 159 93.0 481 74.2 68 94.4 158 97.5 103 96.3 329 96.5

No answer 5 1.8 0 0.0 4 2.3 9 1.4 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 62: Availability of soap at household hand washing facility (observation by enumerators)

El Fasher Zalingei



Yes 80 28.3 36 18.6 6 3.5 122 18.8 1 1.4 3 1.9 2 1.9 6 1.8

No 19 6.7 13 6.7 2 1.2 34 5.2 3 4.2 1 0.6 1 0.9 5 1.5

Not applicable 184 65.0 143 73.7 163 95.3 490 75.6 68 94.4 158 97.5 104 97.2 330 96.8

No answer 0 0.0 2 1.0 0 0.0 2 0.3 0 0.0 0 0.0 0 0.0 0 0.0

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 63: Frequency of bathing in summer (March – October)

El Fasher Zalingei




221 78.1 116 59.8 119 69.6 456 70.4 60 83.3 133 82.1 89 83.2 282 82.7

Once a day 26 9.2 42 21.6 28 16.4 96 14.8 4 5.6 12 7.4 14 13.1 30 8.8

2 - 3 times a week

35 12.4 28 14.4 24 14.0 87 13.4 0 0.0 0 0.0 3 2.8 3 0.9

Once a week 0 0.0 1 0.5 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0

I don't know 0 0.0 7 3.6 0 0.0 7 1.1 8 11.1 17 10.5 0 0.0 25 7.3

No answer 1 0.4 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

61

Table 64: Frequency of bathing in winter (November - February)

El Fasher Zalingei




92 32.5 56 28.9 42 24.6 190 29.3 19 26.4 47 29.0 31 29.0 97 28.4

Once a day

160 56.5 91 46.9 99 57.9 350 54.0 37 51.4 78 48.1 55 51.4 170 49.9

2 - 3 times a week

30 10.6 28 14.4 22 12.9 80 12.3 12 16.7 26 16.0 19 17.8 57 16.7

Once a week

1 0.4 9 4.6 7 4.1 17 2.6 0 0.0 2 1.2 0 0.0 2 0.6

I don't know

0 0.0 10 5.2 0 0.0 10 1.5 4 5.6 9 5.6 1 0.9 14 4.1

No answer

0 0.0 0 0.0 1 0.6 1 0.2 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 65: Place of food preparation

El Fasher Zalingei



Separate kitchen inside

271 95.8 171 88.1 160 93.6 602 92.9 67 93.1 138 85.2 83 77.6 288 84.5

Separate kitchen outside

0 0.0 2 1.0 0 0.0 2 0.3 0 0.0 0 0.0 0 0.0 0 0.0

No separate kitchen inside

5 1.8 13 6.7 2 1.2 20 3.1 2 2.8 11 6.8 14 13.1 27 7.9

Kitchen in open space

4 1.4 3 1.5 8 4.7 15 2.3 2 2.8 7 4.3 7 6.5 16 4.7

Others 1 0.4 5 2.6 0 0.0 6 0.9 1 1.4 6 3.7 2 1.9 9 2.6

No answer 2 0.7 0 0.0 1 0.6 3 0.5 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

62

Table 66: Practice of covering food vessels

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Yes always 266 94.0 183 94.3 163 95.3 612 94.4 67 93.1 146 90.1 94 87.9 307 90.0

In specific cases

9 3.2 6 3.1 4 2.3 19 2.9 4 5.6 12 7.4 0 0.0 16 4.7

No 1 0.4 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 7 6.5 7 2.1

I don't know 0 0.0 2 1.0 0 0.0 2 0.3 1 1.4 3 1.9 2 1.9 6 1.8

No answer 7 2.5 3 1.5 4 2.3 14 2.2 0 0.0 1 0.6 4 3.7 5 1.5

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

3.1.5 Awareness

Table 67: Importance of safe drinking water in the house

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Very important 281 99.3 189 97.4 169 98.8 639 98.6 70 97.2 153 94.4 103 96.3 326 95.6

Important to some extent

2 0.7 5 2.6 2 1.2 9 1.4 1 1.4 5 3.1 3 2.8 9 2.6

Not important 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

I don't know 0 0.0 0 0.0 0 0.0 0 0.0 1 1.4 4 2.5 0 0.0 5 1.5

No answer 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

63

Table 68: Importance of sanitary disposal for wastewater

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Very important 272 96.1 182 93.8 162 94.7 616 95.1 64 88.9 119 73.5 84 78.5 267 78.3


9 3.2 9 4.6 5 2.9 23 3.5 4 5.6 19 11.7 4 3.7 27 7.9

Not important 0 0.0 0 0.0 0 0.0 0 0.0 3 4.2 13 8.0 5 4.7 21 6.2

I don't know 2 0.7 3 1.5 4 2.3 9 1.4 1 1.4 7 4.3 12 11.2 20 5.9

No answer 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 4 2.5 2 1.9 6 1.8

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 69: Importance of hygienic place for cooking

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Very important 280 98.9 187 96.4 166 97.1 633 97.7 70 97.2 152 93.8 105 98.1 327 95.9


3 1.1 7 3.6 3 1.8 13 2.0 1 1.4 7 4.3 1 0.9 9 2.6

Not important 0 0.0 0 0.0 1 0.6 1 0.2 1 1.4 2 1.2 0 0.0 3 0.9

I don't know 0 0.0 0 0.0 1 0.6 1 0.2 0 0.0 1 0.6 0 0.0 1 0.3

No answer 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

64

Table 70: Harmfulness of insects

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Very harmful 275 97.2 185 95.4 169 98.8 629 97.1 67 93.1 135 83.3 96 89.7 298 87.4

Harmful to some extent

5 1.8 9 4.6 2 1.2 16 2.5 5 6.9 20 12.3 8 7.5 33 9.7

Not harmful 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 1 0.9 3 0.9

I don't know 2 0.7 0 0.0 0 0.0 2 0.3 0 0.0 5 3.1 1 0.9 6 1.8

No answer 1 0.4 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 71, shows that few respondents attend health education in health facilities, and Table 72 reveals that

the variations in attendance of health education sessions between urban, peri-urban and IDPs camps in the

two towns were statistically significant (P value 0.001). The percentages in IDPs camps were almost higher

than urban and peri-urban. This may be due to health education campaigns conducted by NGOs as mentioned

by FGD participants and stakeholders interviewed.

Table 71: Ever attended health education sessions in health facilities

El Fasher Zalingei



Yes 34 12.0 10 5.2 36 21.1 80 12.3 2 2.8 20 12.3 17 15.9 39 11.4

No 96 33.9 55 28.4 64 37.4 215 33.2 15 20.8 79 48.8 49 45.8 143 41.9

Not applicable 151 53.4 129 66.5 69 40.4 349 53.9 55 76.4 61 37.7 40 37.4 156 45.7

No answer 2 0.7 0 0.0 2 1.2 4 0.6 0 0.0 2 1.2 1 0.9 3 0.9

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

65

Table 72: Association between attendance of health education session and context

Chi-Square Tests





2.128 1 .145





34.200 1 .000




Table 73: Contents discussed during health education session at health facility

El Fasher Zalingei



Yes discussion regarding water

11 3.9 3 1.5 3 1.8 17 2.6 0 0.0 1 0.6 3 2.8 4 1.2

Yes discussion regarding latrines

6 2.1 1 0.5 2 1.2 9 1.4 0 0.0 1 0.6 1 0.9 2 0.6

Yes discussion regarding hygiene

7 2.5 3 1.5 10 5.8 20 3.1 1 1.4 10 6.2 1 0.9 12 3.5

1&2 or 1&3 0 0.0 5 2.6 17 9.9 22 3.4 0 0.0 0 0.0 1 0.9 1 0.3

No 2 0.7 1 0.5 2 1.2 5 0.8 0 0.0 5 3.1 5 4.7 10 2.9

I don't know 2 0.7 1 0.5 1 0.6 4 0.6 1 1.4 0 0.0 0 0.0 1 0.3

Not applicable 253 89.4 180 92.8 132 77.2 565 87.2 70 97.2 141 87.0 90 84.1 301 88.3

No answer 2 0.7 0 0.0 4 2.3 6 0.9 0 0.0 4 2.5 6 5.6 10 2.9

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

66

Table 74: Experience of having health educational discussion with community health workers

El Fasher Zalingei



Yes 86 30.4 35 18.0 40 23.4 161 24.8 11 15.3 13 8.0 6 5.6 30 8.8

No 185 65.4 158 81.4 125 73.1 468 72.2 61 84.7 148 91.4 99 92.5 308 90.3

No answer

12 4.2 1 0.5 6 3.5 19 2.9 0 0.0 1 0.6 2 1.9 3 0.9

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 75: Preferred channel to receive health messages

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Direct communication

53 18.7 79 40.7 81 47.4 213 32.9 34 47.2 73 45.1 61 57.0 168 49.3

Mass media 57 20.1 28 14.4 11 6.4 96 14.8 6 8.3 6 3.7 4 3.7 16 4.7

Both 166 58.7 81 41.8 67 39.2 314 48.5 27 37.5 57 35.2 26 24.3 110 32.3

Others 2 0.7 1 0.5 2 1.2 5 0.8 0 0.0 5 3.1 13 12.1 18 5.3

I don’t know 2 0.7 1 0.5 3 1.8 6 0.9 3 4.2 17 10.5 2 1.9 22 6.5

Not applicable 2 0.7 3 1.5 7 4.1 12 1.9 2 2.8 4 2.5 0 0.0 6 1.8

No answer 1 0.4 1 0.5 0 0.0 2 0.3 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

67

3.1.6 Institutional WASH situation

3.1.6.1 School WASH

Figure 10: Availability of latrine in school in El Fasher and Zalingei towns

Figure 10 revealed that 93.1 percent of households in El Fasher urban have children with a latrine in school,

compared to 88.4 percent in peri-urban and 89 percent in IDPs camps. In Zalingei, 86.2 percent of urban

households have children who have a latrine in school, compared to 82.3 percent in peri-urban and 88.9

percent in IDPs camps. These results matched with qualitative findings (Table 79 and Table 80) which show

that 100 percent, 75 percent and 100 percent of pupils’ FGD in El Fasher mixed group, Zalingei male pupils,

and Zalingei female pupils, respectively, mentioned that a latrine was available in the households.

The majority of teachers in FGDs mentioned that latrine facilities are available at schools. One of the

important challenges mentioned by teachers regarding sanitation and use of latrine was scarceness of water

in the schools. This particular concern is in accordance with quantitative results obtained in Figure 11. The

situation has forced some pupils to return back to their houses or to other houses near the school to use

latrine. A number of female teachers have emphasized that consequently, some pupils do not return to

complete their school day after having to go back home or to a neighbour’s house to use a latrine –

89

88.4

93.1

5.9

5.5

2.3

1.7

4.9

2.3

3.4

1.2

2.3

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

El Fasher

Yes No I don't know They don't go to school

88.9

82.3

86.2

4.9

2.4

6.9

3.7

12.9

5.2

2.5

2.4

1.7

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

Zalingei


68

particularly the female students. While male students tend to use latrines near their school or even open

defecate, female students seek for cleaner, more private latrine that are sometimes far from their school.

Another important issue is the ratio of latrine to pupils. During FGDs, teachers stated that the number of

latrines in some schools were very few compared to the number of pupils.

Figure 11: Availability of water source in school in El Fasher and Zalingei

Figure 11, shows that a significant proportion of households in Zalingei urban (24.6 percent) have children

with no water source in their schools, which is far greater than El Fasher urban area. Water is unavailable

roughly 20 to 30 percent of peri-urban and IDPs camp areas in both towns.

69.2

73.8

89.1

27.5

20

4.6

5.6

4

3.3

0.6

2.3

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

El Fasher


67.1

51.2

63.1

25.6

28.5

24.6

7.3

20.3

12.3

0% 20% 40% 60% 80% 100%

IDP camp

Peri-urban

Urban

Zalingei


69

3.1.6.2 Health Facility

Table 76: Availability of health facilities in the community

El Fasher Zalingei



Yes 131 46.3 65 33.5 100 58.5 296 45.7 17 23.6 101 62.3 66 61.7 184 54.0

No 147 51.9 128 66.0 67 39.2 342 52.8 54 75.0 60 37.0 38 35.5 152 44.6

I don't know

4 1.4 1 0.5 2 1.2 7 1.1 1 1.4 1 0.6 2 1.9 4 1.2

No answer

1 0.4 0 0.0 2 1.2 3 0.5 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

Table 77: Availability of water supply in health facilities

El Fasher Zalingei

Urban Peri-urban


IDPs Total


Yes 117 41.3 44 22.7 88 51.5 249 38.4 14 19.4 54 33.3 43 40.2 111 32.6

No 2 0.7 19 9.8 10 5.8 31 4.8 0 0.0 33 20.4 18 16.8 51 15.0

I don't know

7 2.5 1 0.5 2 1.2 10 1.5 3 4.2 14 8.6 5 4.7 22 6.5

Not applicable (no facilities around)

151 53.4 129 66.5 69 40.4 349 53.9 55 76.4 61 37.7 40 37.4 156 45.7

No answer

6 2.1 1 0.5 2 1.2 9 1.4 0 0.0 0 0.0 1 0.9 1 0.3

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

70

Table 78: Availability of sanitation facility in health facilities

El Fasher Zalingei



Yes 120 42.4 64 33.0 96 56.1 280 43.2 16 22.2 89 54.9 45 42.1 150 44.0

No 0 0.0 0 0.0 2 1.2 2 0.3 0 0.0 3 1.9 16 15.0 19 5.6

I don't know 6 2.1 1 0.5 1 0.6 8 1.2 1 1.4 8 4.9 4 3.7 13 3.8

Not applicable 151 53.4 129 66.5 69 40.4 349 53.9 55 76.4 61 37.7 40 37.4 156 45.7

No answer 6 2.1 0 0.0 3 1.8 9 1.4 0 0.0 1 0.6 2 1.9 3 0.9

Total 283 100 194 100 171 100 648 100 72 100 162 100 107 100 341 100

3.2 Qualitative findings

Table 79, reveals that all pupils and 36 percent of teachers’ Focus Group Discussions in El Fasher urban area,

said they have piped water into the house. However, only 18 percent of teachers believe that water was

sufficient, compared to 77 percent of pupils. This difference may be due to better awareness of how much

water is needed in everyday life, and the fact that teachers (especially female teachers) tend to have greater

responsibilities to ensure water availability both at their home and at school. The pupils may have

considered availability of water for drinking only, and not for all household chores.

In El Fasher’s peri-urban area, 43 percent of teachers said there was piped water into the house but available

water was not sufficient. Fifty percent of community leaders in El Fasher IDPs camps mentioned that they

have piped water into the house, and one participant believes that the water is sufficient.

All pupils and 73 percent of teachers in El Fasher urban areas, said they have a household latrine, however,

some of them were traditional pit latrines. In El Fasher’s peri-urban area, 71 percent of teachers stated they

have a household latrine, compared to 75 percent of community leaders in El Fasher’s IDPs camps. Most of

the available latrines in El Fasher’s peri-urban and IDPs camps, were traditional pit latrine - as mentioned by

participants.

Although only 54 percent pf pupils and 9 percent of teachers in El Fasher urban mentioned that there were

available hand washing facilities at household level, all teachers, pupils and 75 percent of community leaders

stated that people wash their hands with water and soap frequently after defecation and before eating.

These findings were similar to the quantitative results obtained in Table 57 and Table 60. However, Table 43

and Table 44, may support the assumption that due to a weak level of awareness, people believe that

washing their hands anywhere (regardless of the presence of soap) means hand washing. On the other hand,

due to Sudanese behaviour regarding the use of Abrieg (water vessel used for prayer water), people may

practice hand washing by assisting themselves. Abrieg can be considered as a hand washing facility as long as

soap is available nearby.

71

Table 79: Qualitative findings regarding WASH practices mentioned during FGDs in El Fasher

Urban Peri-urban IDPs

Teachers (total 11)

Pupils (total 13)

Teachers (total 7)

Com. Leaders (total 4)

No. % No. % No. % No. %

Piped water is available at home 4 36 13 100 3 43 2 50

Water is sufficiently available 2 18 10 77 0 0 1 25

Availability of latrine at home 8 73 13 100 5 71 3 75

Practice hand washing regularly 11 100 13 100 0 0 3 75

Availability of hand washing facility at home 1 9 7 54 0 0 0 0

Table 80 revealed that community leaders, water suppliers, public health workers, and adult female Focus

Group Discussions in Zalingei urban (75 percent, 60 percent, 50 percent, and 25 percent, respectively), stated

that they have piped water into the house. However, only in the female FGD, did the majority of participants

believe that water supply is sufficient.

In Zalingei peri-urban, teachers and community leaders said there was no piped water into the house and

available water was not sufficient, while 25 percent of male pupils mentioned having piped water into the

house, and 50 percent of them believe the water was sufficient. All FGDs in Zalingei’s IDPs camps mentioned

that they have no piped water into the house. Some 75 percent of female pupils believe the water was

sufficient, in comparison to 25 percent of adult males and 0 percent of community leaders.

All health workers and adult female groups and all but one of the community leaders and of water suppliers

groups in Zalingei urban, stated that they have household latrine. However, most of these latrines were

traditional pit latrine. In Zalingei peri-urban, 75 percent of male pupils, 83 percent of teachers and 85 percent

of the community leaders groups, mentioned having household latrine. They also stated that more than 90

percent of these latrines were traditional pit latrine. All female pupils, 85 percent of the community leaders

and 50 percent of the adult male group said they have traditional pit latrine as a household sanitation facility

in Zalingei’s IDPs camps.

Despite nearly all of the participants stating that hand washing facilities were not available at household

level, all community leaders, 75 percent of health workers, and 50 percent of adult females in Zalingei urban

said people wash their hand with water and soap frequently after defecation and before eating. More than

half of the participants have reported that they wash hands frequently in FGDs of peri-urban and IDPs

camps. The only FGDs where less than half of the participants reported hand washing regularly is water

providers in the urban area, and teachers in the peri-urban area.

72

Table 80: Qualitative findings regarding WASH practices mentioned during FGDs in Zalingei

Urban Peri-urban IDPs

Com. leaders

(total 16)

Serv. Water

(total 5)

Serv. Health

(total 8)

Adult female (total 8)

Male pupils

(total 12)

Teachers (total 6)

Com. Leaders

(total 20)

Adult male

(total 12)

Female pupils

(total 12)

Com. Leaders

(total 20)

No. % No. % No. % No. % No. % No. % No. % No. % No. % No. %

Piped water is available at home

12 75 3 60 4 50 2 25 3 25 0 0 0 0 0 0 0 0 0 0

Water is sufficiently available

4 25 1 20 4 50 6 75 6 50 0 0 0 0 3 25 9 75 0 0

Availability of latrine at home

15 94 4 80 8 100 8 100 9 75 5 83 17 85 6 50 12 100 17 85

Practice hand washing regularly

16 100 1 20 6 75 4 50 12 100 2 33 10 50 9 75 12 100 10 50

Availability of hand washing facility at home

0 0 0 0 0 0 2 25 0 0 0 0 0 0 0 0 0 0 0 0

Table 81 and Table 82 summarize factors that are mentioned in FGDs as bottlenecks to realise better WASH

services in two towns.

Table 81 shows that high cost, and breakage of water pipes were the main reasons causing people to believe

that water was not sufficient in El Fasher urban, compared to other reasons such as incomplete water pipe

network, high cost of water, and long distance of water sources from residential areas in El Fasher peri-

urban and IDPs camps.

High cost of construction and cost of maintenance were the main challenges of constructing latrine in El

Fasher’s urban and peri urban areas, while in the IDPs camps, lack of space for latrine was mentioned as an

additional constraint.

Furthermore, lack of awareness, lack of soap, and lack of hand washing facility were common constraints in

El Fasher’s urban and peri-urban areas and IDPs camps.

73

Table 81: Factors perceived as bottlenecks of insufficient WASH services in FGDs in El Fasher

Urban Peri-urban

IDPs

Why water is not sufficient High cost Break and damages of water pipes

Incomplete network of water pipes High cost Far distance to water sources

High cost Far distance to water sources

Why people did not construct latrine

High cost of construction Cost of maintenance

High cost of construction Cost of maintenance

High cost of construction No space to build latrine

Why people did not practice hand washing

Lack of awareness Lack of soap Lack of hand washing facility



Photo 9: Orientation of WASH partners and stakeholders in El Fasher, 2016

Table 82 shows that unsafe water sources, high cost, frequent power outages, and topography of town,

were main reasons that people believe water was not sufficient in Zalingei urban area. The concern over

unsafe water source was shared by participants in peri-urban and IDPs camp FGD participants, along with

the general high cost of water. In peri-urban and IDPs camps, participants noted that water is a scarce

resource. Incomplete water pipeline is mentioned in peri-urban area FGDs, indicating that water supply

service is patchy and inconsistent within peri-urban area.

74

High cost of construction and cost of maintenance are common factors mentioned in Zalingei FGDs like El

Fasher. Zalingei urban FGDs also noted unplanned areas (slum dwellings) make it difficult to plan where to

build a latrine. Some participants in urban and IDPs camp FGDs showed their concern that latrines may

breed insects in their household. Participants generally have low confidence to build latrines by themselves,

as urban and peri-urban FGDs noted.

The reasons for not practicing hand washing were similar in Zalingei FGDs as in El Fasher. Lack of awareness,

lack of soap, and lack of hand washing facility were common constraints in Zalingei urban, peri-urban and

IDPs camps.

Table 82: Factors perceived as bottlenecks of insufficient WASH services in FGDs in Zalingei

Urban Peri-urban

IDPs

Why water is not sufficient

Unsafe sources High cost Electric power down Topography of town

Incomplete network of water pipes Unsafe sources High cost Scarceness of water

Unsafe sources High cost Scarceness of water

Why people did not construct latrine

High cost of construction Cost of maintenance Unplanned areas Lack of awareness No confidence in construction of a robust facility Fear of breeding insects in the house

High cost of construction Cost of maintenance Collapse

High cost of construction No space to build latrine Breading of insects

Why people did not practice hand washing

Lack of awareness Lack of water Lack of soap Lack of hand washing facility


Lack of awareness Not a common habit Lack of soap Lack of hand washing facility

75

4. Conclusion

4.1 Current condition and Practice

Water

Access to improved water sources is a major challenge for people living in urban, peri-urban and

IDPs camps of El Fasher and Zalingei. However, people living in the peri-urban areas of both towns

are the most vulnerable.

An incomplete network of water pipes, unsafe sources, high cost, and scarcity of water, were main

reasons causing a lack of water sufficiency in both towns.

There was statistical evidence pointing towards a strong association between use of improved water

sources and water consumption; this means that improvement of water sources will increase water

consumption. This could then potentially lead to hygienic practices and positive behaviour changes.

A significant number of schools lack water sources.

People living in IDPs camps, did not have a sufficient quantity of water, particularly in Zalingei.

Sanitation

Half of El Fasher’s IDPs camps lack household latrine, therefore, vulnerability to excreta-related

diseases increases, particularly diarrhoea. Zalingei IDPs camps also lack access to improved

sanitation facilities.

Differences in availability of household latrine between contexts were significant in El Fasher and not

significant in Zalingei.

The high cost of latrine construction, cost of maintenance, space to build latrine, lack of confidence

in a robust construction and breeding insects, were the major latrine construction barriers.

Open defecation is still practiced, even in urban areas in both towns.

A high percentage of diarrheal diseases were reported, particularly in Zalingei.

A significant number of schools do not have sufficient latrines. Consequently, the pupils are unable

to complete their school day. Due to this rather complicated situation, some pupils (particularly

girls), may become frequently absent in school.

76

Hygiene

Although hand washing is reported as a common practice, most households lack a hand washing

facility.

Lack of awareness, lack of water, lack of soap, and lack of hand washing facility were the main

barriers of hand washing. Lack of water was seen as a major reason why difficulties in hygienic

practices are experienced in Zalingei IDPs camps.

4.2 Knowledge

Weak knowledge regarding benefits of piped water, importance of improved water source,

importance of improved household latrine, preventable measures of diarrheal diseases, and

personal hygiene was reported.

The majority of respondents believe that hygienic practices are very important for their livelihood.

A significant number of those among the peri-urban and IDPs camps population believe there is no

association between water supply and diarrheal diseases.

4.3 Attitude

Despite the challenges, people have a positive attitude regarding the importance of water,

importance of household sanitation facility, importance of hygienic practice and personal hygiene.

Direct communication tools were the preferred methods to receive health education messages.

77

5. Recommendations

The provision of safe and sufficient water for the population of both El Fasher and Zalingei towns,

with a focus on peri-urban and IDPs camps, is the responsibility of the State Water Corporation,

WES, UNICEF, and Other WASH partners. This is to ensure people have access to an abundant

quantity of water, are protected from water-related diseases, and encouraged to participate

effectively in their community development.

State Ministries of Health, WHO and their partners, must ensure that the water provided is free from

diseases, pathogens and meets chemical and physical drinking water standards. This task should be

completed via periodical monitoring, follow-ups and an active surveillance system.

Coordination mechanisms at all levels (especially at locality and administrative unit level) should be

established to ensure that all WASH partners work effectively in a collaborative manner.

A participatory approach should be applied by effective Coordination Mechanism and WASH sectors

in all WASH agencies, to ensure community involvement and community ownership towards WASH

facilities and programmes.

A community’s capability to pay its water and sanitation cost should be encouraged by a

Coordination Mechanism and WASH partners, to reduce the cost of service and to ensure an

ownership approach.

Hand pumps, boreholes, and water stand points are a suitable choice for IDPs camps, whereas piped

water network could be a better option for urban and peri-urban areas. The construction of these

water sources is the responsibility of States Water Corporations and their partners. However,

community-based organisations and other community mechanisms should be involved in the

decision making process and in cost recovery (user fee collection).

State Ministries of Health, WASH sectors in NGOs and UN agencies, must encourage local

communities to improve their sanitation technologies and facilities, particularly pit latrine which

should be improved to Ventilated Improved Pit Latrine (VIP Latrine). This promotes an increase in

sanitation coverage and gradual improvement along the sanitation ladder.

The Ministry of Education, Ministry of Health, UNICEF, and local community, should dedicate special

attention towards school health, in particular school WASH, with a focus on female students.

Health promoters in all WASH agencies must use awareness campaigns and CLTS approach in El

Fasher’s IDPs camps to increase the availability of household latrine.

Qualified Health Educators, Health Promoters, and Social Mobilisers should be selected according to

specific criteria and well trained by WASH agencies. A follow-up programme must be set up

78

regarding their qualifications, professionalism, competence and achievement, and should be

implemented by the Federal Ministry of Health, State Ministries of Health, WHO, and UNICEF.

ODF communities should be adopted by the Federal Ministry of Health, State Ministries of Health,

NGOs, CBOs and UN agencies sub-offices, to be one of the WASH programme’s main targets.

The high percentage of diarrheal diseases should be reduced through a strengthened and active

surveillance system, awareness campaigns, regular garbage collection, flies control and training for

health workers.

Direct communication methods such as home visits, counselling, and Focus Group Discussions

should be used effectively by health promoters during health education campaigns to promote

knowledge of WASH, which is currently too low. Advocacy campaigns regarding hand washing and

personal hygiene is more effective in Schools.

Mass media such as posters, pamphlets, and radio should be used by professional health

programmers and designers to use in health education campaigns, particularly in urban areas.

Household heads, school headmasters and community leaders should be encouraged by health

promoters to set hand washing facilities as a priority. This is to ensure the continuation of a positive

practice towards hand washing facilities in households, schools and other institutions.

79

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state, South Sudan.

Action Against Hunger l ACF International, 2014. IYCF Knowledge, Attitude and Practice Survey Kohat

District, KP Province, Pakistan.

Ali, M., 2009. KAP surveys in the context of WASH projects DEW Point Enquiry No. A0292, Development

Resource Centre for Environment, Water and Sanitation, Northampton, UK.

Department of Rural Health Care Ministry of Rural Development, 2010. National Sanitation and Hygiene

Knowledge, Attitudes, and Practices (KAP) Survey Final Report, Cambodia.

Federal Democratic Republic of Ethiopia Ministry of Health (FDREMH) Hygiene and Environmental Health,

Part 1 Blended Learning Module for the Health Extension Programme,

Graphic design: Polysemique.fr / Translated from French to English, corrections: Michael Hariton /

Guillaume Fauvel, Simona Zompi, Axelle Ronsse, Amélie Courcaud, Magali Bouchon, Coralie Trehin,

Gumucio, S2AP with the contribution of Melody Merica, Niklas Luhmann,

Institute for Integrated Development Studies (IIDS, 2006). Knowledge, Attitude and Practice (KAP) Survey

under the Community-based Alternative Schooling Project (CASP) in Kathmandu District, Nepal.

Kaliyaperumal, K., 2004. Guideline for Conducting a Knowledge, Attitude and Practice (KAP) Study, Journal of

Community Ophthalmology, Vo: IV, No. (1) PP7-9

Oxfam in Liberia, 2013. A 2013 study on current community access to and practices on Water, Sanitation

and Hygiene in select rural and urban settlements in Liberia, final report.

Oxfam in Liberia, 2013. 2013 WASH baseline study a study on current community access to and practices on

Water, Sanitation and Hygiene in select rural and urban settlements in Liberia.

Photographies: Benoit Guénot (pp. 1-2), Lâm Duc Hiên (pp. 9-33), Julie Béis (p. 55) / Printing: IGC

Communigraphie, Data Collection Quantitative Methods the KAP Survey Model

Sophie Schapman, Olivier Cheminat, Helena Ranchal, Sandrine Simon, Médecins du Monde, January 2011. /

Vandamme, E., 2009. Concepts and challenges in the use of Knowledge-Attitude-Practice surveys: Literature

review, Department of Animal Health, Institute of Tropical Medicine, Antwerp, Belgium

WHO, 2008. A guide to developing Knowledge Attitude and Practice Survey, Advocacy, communication and

social mobilization for TB control.

80

Appendices

Annex 1: WASH Knowledge, Attitudes and Practices (KAP) Survey

Household (HH) Questionnaire

Organizational and Quality Control Related Data

Name of enumerator

Date of interview

Time of starting the interview

Time of finalizing the interview

Enumerator self-check Yes No

Enumerator signature

Date of signature

Name of Field Supervisor

Field Supervisor check Yes No

Date of check

Missing/incorrect values found Yes No

Questionnaire returned to enumerator Yes No

Field Supervisor 2nd check Yes No

Questionnaire final status Completed Not Completed

Field Supervisor signature

Date of signature

Questionnaire entry by

Questionnaire entry Complete Yes No

81

Location Data

State (code from list)

Area Type Urban 1

Rural 2

Damra (pastoralists’ camp) 3

IDPs 4

Locality (code from list)

Administrative unit (code from list)

Local community

Town/Quarter/Village/Camp/Damra

(code from list)

Household Number

Questionnaire Number

General Instruction for Enumerators:

Very important: The household refers to number of persons who live in the same house and share food and daily life regardless the number of persons and the number of small families, the questionnaire refers to the household as a family or house. On the other side the questionnaire refers to the family composed of parents and children only as a small family.

Female enumerators should conduct the interviews with the female interviewees and male enumerators should conduct the interviews with the male interviewees.

In general, interviews can be conducted with any adult household member.

As much as possible, represent genders equally. This means that if in the first HH the respondent is a male, a female respondent is to be selected for the next interview. If not available, move to the next randomly selected HH.

“Don’t know” also stands for “cannot say”, “cannot judge”, “do not want to answer”, etc.

Multiple answers are not allowed unless the instruction “multiple answers are allowed” is mentioned (for recognition: the questions which have multiple answers allowed, their answers are numbered in A, B, C.. but the other questions which have only one answer are numbered in 1, 2, 3,..

Helping /reminding of options are allowed unless the instruction “do not read the options” is mentioned.

82

If the option “other” is included, always ask to specify.

Instructions for enumerators are italicized.

Module 1 : Basic Household and Respondent Information

Q-

No.

Questions and Enumerator Instructions

Responses Code GO

TO

101 Is the selected respondent the head of the household? Yes 1 103

No 2

102 Who is the head of the household (Sex of head)? Male 1

Female 2

103 What is the age of the respondent?

104 What is the educational level of the respondent? Illiterate 1

Khalwa 2

Adult education 3

Primary 4

Secondary or Vocational equivalent 5

University or equivalent/ Post

graduate

6

105 What is the number of household members? Total

Male

Female

106 What is the number of families living in the HH?

107 What is the number of u-5 children in the HH?

108 What is the number of schooled children (5-15 years)

living in the HH?

109 If applicable:

Are there latrines in the schools of your children?

Yes 1

No 2 111

None of them goes to school 111

Do not know 3 111

83

110 Is there a safe water source in the schools of your

children?

Yes 1

No 2

Do not know 3

111 What is the approximate total income from all workers

in the HH in Sudanese Pound?

(for the enumerator: transfer any daily or weekly

income into monthly income)

112 Does anyone in your HH receive transfers from the

government or a private organization?

Yes 1

No 2 201

113 If yes,

What is the total transfer received by all HH members?

114 Do you have animals in the house? Yes

No

115 If yes,

What types of animals?

Module 2 : Water Facilities and Use

Q.

No. Questions and Enumerator Instructions Responses Code

GO

TO

201 What is the main source of water that your HH depends

on?

Private water connection 1

Hand pump 2

In-house connection of others 3

Donkey (small or big water pant or

taps linked to the donkey)

4

84

Protected Hafir/ dam/ rain water

tank/

5

Protected spring 6

Tanker truck 7

Carts with water tanks 8

Seasonal streams/ small and big

rivers/ irrigation channels/ drainage

9

Unprotected Hafir/ dam/ rain water

tank/

10

Surface well 11

Other (specify): 12

202 What is the other source when the main source is not available?

Hand pump 1

In-house connection of others 2

Donkey (small or big water pant or

taps linked to the donkey)

3

Protected Hafir/ dam/ rain water

tank/

4

Protected spring 5

Tanker truck 6

Carts with water tanks 7

Seasonal streams/ small and big

rivers/ irrigation channels/ drainage

8

Unprotected Hafir/ dam/ rain water

tank/

9

Surface well 10

Other (specify): 11

203 Do you or any of the HH members sometimes or always collect water from a water source into HH in containers?

Yes 1

No 2 213

204 What kind of water containers are used for collecting

water form water source to your HH?

(multiple answers are allowed)

Drums A

Jerry cans B

Buckets C

Clay water containers D

Leather bags (girba) E

Other (specify): F

85

Don’t know G

205 Who are the HH-members mainly responsible for

fetching water?

(multiple answers are allowed)

(If the interviewee is the one who brings the water

choose one of the two first answers)

Adult man (15 and above) A

Adult woman (15 and above) B

Male child under 15 C

Female child under 15 D

Any one (no one specific) E

206 What is the distance between the HH and the main

water source?

(for the enumerator: help the interviewee to calculate

the distance in meters)

<50 meter 1

50 –99 2

100 – 199 3

200 - 299 4

300 – 399 5

400 – 499 6

500 – 599 7

600 – 699 8

700 – 799 9

800 - 899 10

900 - 999 11

More than 1000 12

207 Does the person fetching water have to stay in line to get water?

Yes, always 1

Sometimes 2

Only in shortages seasons 3

No 4 209

Don’t know 5 209

208 How much time is usually spent standing in line? < 10 minutes 1

30 minutes 2

Up to one hour 3

More than one hour 4

Don’t know 5

209 Do the water containers used to transport water have lids?

All water containers have lids 1

Some water containers have lids 2

86

(If only one container is used, the response can only be all or none)

No vessel has lids 3

Don’t know 4

210 Would you say that fingers/hands are put into the water during fetching and transportation?

Yes, always 1

Sometimes 2

No, never 3

Don’t know 4

211 How often are water containers used to collect water cleaned?

Each time they are used 1

Daily 2

Several times per week 3

weekly 4

Several times per month 5

Longer than a month 6

Never 7

Don’t know 8

212 Do you store water inside your house? yes 1

No 2 217

213 How often are water containers used to store water cleaned?

Each time they are used 1

Daily 2

Several times per week 3

weekly 4

Several times per month 5

Longer than a month 6

Never 7

Don’t know 8

214 Do the containers used to store water inside the home have lids?

(If only one container is used, the response can only be all or none)

All containers have lids 1

Some containers have lids 2

No container has lids 3

Don’t know 4

87

215 For enumerators

Is the place where the containers are stored exposed to

contaminants?

Yes 1

No 2 217

Cannot judge 3 217

216 For enumerators

What kind of contaminants?

(Multiple answers are allowed)

Human faeces A

Human urine B

dust C

Manure D

Flies E

Animals F

Other (specify):

Cannot judge G

217 Do you apply any treatment before using water? Yes always 1

Sometimes /for some uses 2

No 3 219

Don’t know 4 219

218 What kind of water treatments do you apply?


Boiling A

Filtering B

Sedimentation (allowing water to

stand and settle)

C

Solar disinfection D

Adding chlorine E

Others: F

Don’t know G

219 Do you consider the water amount available for your HH

sufficient?

Sufficient 1

Relatively sufficient 2

Insufficient 3

Don’t know 4

220 What colour is the water you use? Always clear (no colour) 1

Sometimes turbid (not clear) 2

Always turbid 3

Don’t know 4

88

221 How is the smell of the water you use? Always normal (no smell) 1

Sometimes bad smell 2

Always bad smell 3

Do not know 4

222 What do you consider the major water related problems

you suffer from?

(Do not read the options)


No problems A

Scarcity B

Distant water source C

Irregularity of supply D

Foul odour E

Salty F

High cost G

Turbidity/ Murkiness H

Frequently damaged facilities I

Other (specify) : J

223 The main benefit of having an improved water supply

system is that we can use more water. Do you agree?

Strongly agree 1

Somewhat agree 2

Strongly disagree 3

224 Improved water sources have few or no positive health

impacts because the causes of illnesses are not related

to water. Do you agree?

Strongly agree 1

Somewhat agree 2

Strongly disagree 3

225 What do you consider the most important advantage of

having an own water connection in home?



Improved hygiene/ cleanness A

Improved safety B

Improved health C

Improved status/prestige D

More privacy E

More comfort F

Time efficiency G

Cost effective H

Other: I

Don’t know J

226 Yes 1

89

In general, do you believe that have water from a safe

source is important?

No 2 228

Do not know 3 228

227 What is the most important reason that makes clean

water important?


No taste/Better taste 1

No smell 2

Good for health 3

Prevents illnesses 4

Religious reasons (wadoa) 5

Other 6

Don’t know 7

228 Do you believe that people who have safe water sources

suffer less from illnesses?

Yes 1

No 2

Don’t know 3

229 What is the average water consumption of your HH?

(help the interviewee in the assessment)

Less than 50 litres 1

50 – 99 2

100 – 149 3

150 - 199 4

200 - 249 5

250 – 300 6

More than 300 7

Do not know 8

230 How much does the HH pay for water monthly SDG

(approximately)?

We don’t pay for water 1

Less than 10 2

10 – 19 3

20 – 49 4

50 - 99 5

100 – 200 6

More than 200 7

231 Are you ready to pay (more) money for better water

quality?

Yes 1

No 2 301

Do not know 3 301

232 Less than 25 1

25 – 49 2

90

If yes, what is the maximum amount that you would be

willing to pay for your household (SDG per month) on

monthly basis?

50 – 79 3

80 – 99 4

100 – 199 5

More than 200 6

Module 3 : Sanitation Facilities and Use

Q-

No.


Responses Code GO

TO

301 Do you have your own latrine for your HH?

Yes 1

No

2 315

302 Is the latrine inside or outside the house?

(If there are two latrines inside and outside choose both answers)

Inside 1

Outside 2

Both 3

303 Is the latrine equipped with a water supply system? Yes 1

No 2 305

304 What kind of water source?


Pipe connected to water network A

Pipe or hose connected to water

vessel outside the latrine

B

Ibrig C

Water vessel inside the latrine D

Other: E

305 What kind of latrine do you have?


Flush or pour-flush latrine to sewerage A

Flush or pour- flush latrine to septic tank or pit

B

Flush or pour-flush elsewhere C

Improved pit latrine (with slab) D

91

Traditional Pit latrine (without slab) E

Other (specify): F

306 Who constructed your latrine?


Yourself/ one of the HH members A

Local artisan B

NGO C

Government D

Other (specify): E

307 Is the latrine functioning/usable now? Yes 1 309

No 2

308 If not,

Why?



Dirty A

Full B

No water to flush C

The slab is broken D

Damaged in the autumn season E

Brings flies F

The superstructure is broken/ missing G

Construction is not finished H

Foul odour I

Other (specify): J

309 How often is the latrine cleaned?

(it refers to cleaning the external parts of the toilet)

More than once a day 1

Once a day 2

Once every 2 – 3 days 3

once a week 4

Almost never 5

Other (specify): 6

310 Who among the HH members usually cleans the latrine?

(if the interviewee is the one who brings the water choose one of the two first answers)


Female 15 and above A

Male 15 and above B

Female under 15 C

Male under 15 D

Daily paid labour E

Don’t know F

92

311 What happens to the human waste when it is removed?


Dumped in the forest/bush A

Dumped in open space B

Dumped in the river/ pond/ canal C

Pit contents emptied in a hole D

Other (specify): E

Not applicable F

312 What is the alternative the HH members usually use when the latrine is unusable?


Latrines or pit latrine of another HH (improved or not improved)

A

Public latrines B

Open areas C

Other (specify): D

313 What do you consider the main problems related to having latrines?



Construction costs A

Operation, maintenance and empting

costs

B

Cleaning C

Flooding D

Emptying Process E

Insects (Flies/ Ants/ termites) F

Odours G

Nature of the soil H

Privacy I

Convenience/ Comfort J

Lack of water K

Collapse/ frequent repairs L

Other (specify): M

Don’t know N

314 Was your latrine flooded in the past year? Yes 1 321

No 2 321

Don’t know 3 321

Please note that the following questions from 315 to 320 will be only asked to the interviewees whom answer is “No” in

301

315 Where do the HH-members usually defecate? Shared latrine with neighbours or other HH (improved or not improved)

A

93


Public latrine B

Open areas C

Other (specify): D

316

Why do you not have a latrine?



Too costly A

Not important/not a priority B

No external support/ assistance C

Did not think about it D

No one to build it E

No space in or near house F

It smells badly G

It brings diseases close to the house H

It attracts flies to the house I

We do not own the house/land J

We do not have enough water for flushing and cleaning

K

Cleaning of latrine is too much work L

The land is not suitable (rocky or sandy)

M

Not suitable for children N

Not suitable for elderly people O

Other (specify): P

Don’t know Q

317 What would most thing encourage you to build a latrine?


Full subsidy 1

Financial contribution 2

Provision of latrine materials 3

Microfinance/ loan sources 4

Government law/ regulation 5

Labour assistance 6

If I have money 7

Other (specify): 8

318 Has your household ever thought about or discussed building a latrine?

Yes 1

No 2

Don’t know 3

94

319 Do you currently have any money saved towards having a latrine?

Yes 1

No 2

320 What is the highest amount that you would spend to have an acceptable latrine for your family?

250 SDG or less 1

250 – 499 2

500 - 749 3

750-999

1000 and more

Note: starting from here questions are directed to all interviewees (who have and who do not have toilets)

321 Do the children in your HH use the same system the

adults use for defecation?

Yes 1 323

No 2

Not applicable 3 323

Don’t know 4 323

322 How do children usually defecate?


Own latrine A

Specific tools for children B

Public latrines C

Open areas (inside the yard) D

Open areas (outside the house) E

Other (specify): F

323 For children who are using diapers or something similar, how do you normally get rid of the waste?


In the main human waste disposal

system

A

Rinsed away down a drain B

Thrown on garbage pile C

Thrown elsewhere on property/left

open

D

Thrown off property E

Buried in yard F

Other (specify): G

Not applicable H

Do not know I

324 In general, do you believe that having the toilet is

important?

Yes 1

No 2 326

Do not know 3 326

95

325 What do you consider the most important reason to have

a latrine?


Prestige 1

Comfort (in using) 2

Convenience 3

Safety 4

Hygiene 5

Better health 6

Fewer diseases 7

Privacy 8

Better environment 9

Other (specify): 10

Don’t know 11

326 What do you think is the most important problem of open defecation?


Not hygienic/ Spread disease 1

Lack of safety 2

Not prestigious 3

Lack of privacy 4

Not comfortable 5

Inconvenient 6

Time-consuming 7

Other (specify): 8

Don’t know 9

Module 4 : Health and Hygiene

Q-

No.


Responses Code GO

TO

401 What is your understanding of good hygiene?



Hand washing A

Hand washing with soap B

Bathing C

Personal hygiene D

Food safety /cleanliness (proper cooking, storing, preventing cross

E

96

contamination, washing vegetables)

Improved sanitation system F

General cleanliness (laundry, surfaces, toilets, baths, sinks)

G

Clean/safe water H

Safe disposal of human faeces I

Safe disposal of animal faeces J

Safe disposal of solid waste K

Clean environment L

Other (Specify): M

Don’t know N

402 Do you believe that maintaining good hygiene is important? Yes 1

No 2 404

Do not know

3 404

403 Why do you think you need to maintain good hygiene?



Be healthy/free from sicknesses A

Be/feel clean B

Feel well C

Religious reasons D

Enjoy social acceptance / look nice E

Other (specify): F

Don’t know G

404 How does a person get diarrhoea?



No/ lack of hand-washing before eating

A

No/ lack of hand-washing after defecation

B

No/ lack of hand-washing after cleaning children’s/ disposal of faeces

C

Drinking unsafe water D

Improper cleaning of food E

Improper storage of food F

Improper cooking of food G

97

Using dirty vases and kitchen utilizations

H

Flies (other insects) I

Infection through others J

Other (specify): K

Don’t know L

405 What are the 3 most effective ways to prevent diarrhoea?


(Choose only 3 answers)

Hand washing A

Hand washing with soap B

Bathing C

Personal hygiene D

Food safety /cleanliness E

Improved sanitation system F

General cleanliness G

Clean/safe water H

Safe disposal of human faeces I

Safe disposal of animal faeces J

Safe disposal of solid waste K

Clean environment L

Other (specify): M

Don’t know N

406 In the last two weeks, has any of the HH members had diarrhoea?

Yes 1

No 2

Don’t know 3

407 How do you clean yourself after defecation?


With water only A

With soap and water B

With old rag /cloth C

With paper, grass or stones D

Other (specify): E

Don’t know F

408 When do you think are the critical times for hand washing?



After defecation A

Before eating B

After cleaning children’s bottom C

98

Before preparing meal D

After handling children’s faeces E

After cleaning latrines F

After touching animals G

After handling animal faeces H

Before breast feeding I

Before feeding others J

After getting in touch with sick persons

K

Other (specify): L

Don’t know M

409 Do you personally have the habit of hand washing?


Yes 1 411

Sometimes 2 411

No 3

410 Why not?



It is a waste of water A

No sufficient water B

It is not important C

Other (specify): D

Don’t know E

411 How often do you usually wash your hands (per day)?

1-2 times 1

3-4 times 2

5 times and more 3

412 How do you usually wash your hands?


Soap and water A

Ash and water B

Water C

413 When do you usually wash your hands?



After defecation A

Before eating B

After cleaning children’s bottom C

Before preparing meals D

After handling children’s faeces E

After cleaning latrines F

After touching animals G

99

After handling animal faeces H

Before breastfeeding I

Before feeding others J

After getting in touch with sick persons

K

After coming back to home L

Other (specify): M

414 How often do you take a bath in summer? More than once per day 1

Daily 2

2-3 times a week 3

Once a week 4

Twice a month 5

Once a month 6

Less than once a month 7

Don’t know 8

415 How often do you take a bath in winter? More than once per day 1

Daily 2

2-3 times a week 3

Once a week 4

Twice a month 5

Once a month 6

Less than once a month 7

Don’t know 8

416 Do the children in your HH have the habit of hand washing? Yes 1

Sometimes 2

No 3 419

Not applicable 4 419

Don’t know 5 419

417 How do children usually wash their hands?


With water only A

With soap and water B

With water and dust C

Don’t know D

100

418 When do children usually wash their hands?


After defecation A

Before eating B

After eating C

After touching animals D

After handling animal faeces E

After coming back home from outside

F

Other (specify): G

419 Where is your cooking place?

Separate kitchen in the house 1

Separate Kitchen outside the house 2

In the house but not separate 3

In an open yard 4

Other (specify):

5

420 Does your cooking place have a water connection?

Yes 1

No 2

421 What is your understanding of food safety?



Natural (bio) food/No chemicals A

Clean (washed thoroughly before eating or cooking)

b

Well cooked C

Covered (in all phases) D

Prepared with clean hands E

Other (specify): F

Don’t know G

422 What are the benefits of food hygiene?



No real benefits A

Prevents diseases B

Better health C

Better taste D

Other: E

Don’t know F

423 Do you think covering food is important? Very important 1

In some cases 2

101

(cooked food/clean food for children)

Not important 3 425

Don’t know 4 425

424

Why is covering food important?



Keeps food clean A

Makes food safe B

Protects food from animals C

Protects food from flies /other insects

D

Other: E

425 Is food usually covered in your HH? Yes, always 1

In some cases (cooked food/ clean food for children)

2

No 3

Don’t know 4

Module 5 : House Environment

Q-

No.


Responses Code GO

TO

501 What do you do with the HH wastewater (from

cooking/washing/bathing/cleaning, etc.)?


Throw it in yard / around the house A

Throw it elsewhere B

Pour it in latrine C

Connected to sewerage system D

Connected to septic tank E

Irrigate kitchen garden with it F

Other: G

Don’t know H

502 What do you do with the HH solid wastes?


Use it as a fertilizer (compost pit) A

Throw in yard/around the house B

Throw it elsewhere C

Burry it in a garbage pit in yard/ around the house

D

102

Burry it in a garbage pit elsewhere E

Burn it in yard/around the house F

Burn it elsewhere G

Other: H

Don’t know I

503 Do the rooms in your HH have windows? Yes, all 1

Partly 2

No 3

Not applicable 4

504 Does your kitchen have a window or a fan? Yes 1

No 2

Not applicable 3

505 Does your latrine/bathroom have a window or a fan? Yes 1

No 2

Not applicable 3

506 Does your kitchen/cooking place have a door? Yes 1

No 2

Not applicable 3

507 Does your latrine/bathroom have a door? Yes 1

No 2

Not applicable 3

508 Do you have a problem with insects in your house?


No A

With mosquitoes B

With ants C

With flies D

With cockroaches E

Other: F

Don’t know G

509 Do you believe that a safe proper wastewater disposal

system is important for good health?

Very important 1

Somewhat important 2

Not important 3

103

Don’t know 4

510 Do you believe that a safe solid waste disposal system is

important for good health?

Very important 1


Not important 3

Don’t know 4

511 Do you believe that a safe and clean cooking place is

important for good health?

Very important 1


Not important 3

Don’t know 4

512 Do you believe that insects may be harmful to good health? Very harmful 1

Somewhat harmful 2

Not harmful 3

Don’t know 4

Module 6 : Exposure to Knowledge and Awareness

Q-

No.


Responses Code GO

TO

601 Is there a Health or a Water Committee in your community? Health Committee 1

Water Committee 2

Both 3

Neither 4 604

Don’t know 5 604

602 Are you or any other person in your HH a member in a committee?

Yes 1

No 2

603 Have you ever participated in any event of the committees activities?

Yes 1

No 2

604 Is there a health facility in your community? Yes 1

No 2 609

Don’t know 3 609

605 Is the health centre provided with a water source? Yes

104

No

Don’t know

606 Is there an improved sanitation facility in the health centre? Yes

No

Don’t know

607 Have you ever attend health education session in the health facility?

Yes 1

No 2 609

608 Was any issues discussed about use of water, use of latrine and hygiene?


Yes, use of water A

Yes, Use of latrine B

Yes, Hygiene C

No D

Don’t know E

609 Have you ever personally had a discussion about hygiene issues with a health worker or another officer/advisor?

Yes 1

No 2

610

Have you ever seen any poster or banner about hygiene messages?

Yes 1

No 2 613

611

How do you evaluate the message(s) received? Very useful 1 613

Somewhat useful 2

Not useful 3

Don’t know 4 613

612

Why (messages somewhat or not useful)?


Not nice/attractive A

Not applicable/realistic B

Not clear C

Other (specify): D

Don’t know E

613 Do you watch television on a regular basis (daily or weekly)? Yes 1

No 2 617

614 Did you receive any messages related to health and hygiene through television?

Yes 1

No 2 617

615 How do you evaluate the message(s) received? Very useful 1 617

Somewhat useful 2

Not useful 3

Don’t know 4 617

105

616 Why (messages somewhat or not useful)?


Not enough /too little A


Not clear C

Boring/not attractive D

Other (specify): E

Don’t know F

617 Who (else) watches television regularly in your HH?


Women A

Men B

Children C

No one D

Don’t know E

618 Do you listen to radio on a regular basis (daily or weekly)? Yes 1

No 2

619 Did you receive any messages related to health and hygiene through radio?

Yes 1

No 2 622


Somewhat useful 2

Not useful 3

Don’t know 4 622





Not clear C


Other (specify): E

Don’t know F

622 Who (else) listens to the radio regularly in your HH?


Women A

Men B

Children C

No one D

Don’t know E

623 Do you read newspapers/magazines on a regular basis (daily or weekly)?

Yes 1

No 2 627

624 Did you receive any messages related to health and hygiene

through newspapers/magazines?

Yes 1

No 2 627

106


Somewhat useful 2

Not useful 3

Don’t know 4 627





Not clear C


Other (specify): E

Don’t know F

627 Who (else) reads newspapers/magazines regularly in your HH?


Women A

Men B

Children C

No one D

Don’t know E

628 Did you receive any messages related to health and hygiene from Imams?

Yes 1

No 2 631


Somewhat useful 2

Not useful 3

Don’t know 4 631





Not clear C


Other: E

Don’t know F

631 Would you like to receive more information about health and hygiene issues?

Yes 1

No 2

107

632 What do you believe are the most suitable ways to receive health and hygiene messages?


Television A

Radio B

Print media (newspapers/magazines/other )

C

Mobile messages D

Community meetings E

House visit F

Imams G

Other: H

Don’t know I END

108

Annex 2: Ranking of multi-optional questions used in Darfur KAP study

questionnaire 2016

No. Item No. of

options

No

KAP

Weak Moderate Good Excelle

nt

1 The most important advantage of having

an own water connection in home

8 0 1 - 2 3 - 4 5 - 7 8

2 The main problems related to having

latrines

12 0 1 - 3 4 - 6 7 - 10 11 - 12

3 The most important reason to have a

latrine

9 0 1 - 2 3 - 4 5 - 7 8 - 9

4 The most important problem of open

defecation

7 0 1 - 2 3 - 4 5 - 6 7

5 Understanding of good hygiene 12 0 1 - 3 4 - 6 7 - 10 11 - 12

6 Needs of maintaining good hygiene 4 0 1 2 3 4

7 Ways of having diarrhoea 10 0 1 - 3 4 - 6 7 - 9 10

8 The most effective ways to prevent

diarrhoea

12 0 1 - 3 4 - 6 7 - 9 11 - 12

9 Ways of self-cleaning after defecation 4 0 1 2 3 4

10 The critical times for hand washing 11 0 1 - 3 4 - 6 7 - 10 11

11 Actual times for hand washing 12 0 1 - 3 4 - 6 7 - 10 11 - 12

12 Ways of children hand washing 3 0 1 2 3 -

13 Times of children hand washing 6 0 1 - 2 3 - 4 5 6

14 Understanding of food safety 6 0 1 - 2 3 - 4 5 6

15 Benefits of food safety 3 0 1 2 3 -

16 Food covering importance reasons 3 0 1 2 3 -

17 The most suitable ways to receive health

and hygiene messages

7 0 1 - 2 3 - 4 5 - 6 7

109

Annex 3: Names of survey team staff

El Fasher 1 Mohammed FadlAllah Elradi Team leaders

2 Miaad Mohammed Adam Sirag

3 Adam Haroun State coordinator

4 Ibrahim Salih Omer

Data collectors

5 Waleed Faroug Adam

6 Osman Abdallah Adam

7 Abdusalam Abdulkareem

8 Ibrahim Osman

9 Neamat Ali Adam

10 Alawia Adam Ali

11 Ibrahim Norain Mohamed

Zalingei 12 Dr. Ahmed Abdelgadir Elzaki Team leaders

13 Dr. Khatir Mohamed Khatir

14 Ahmed Mohamed Tamar State coordinator

15 Jamal Adam Hamid

Data collectors 16 Walid Ibrahim

17 Magbola Musa

18 Rehab Arabi Mohamed

Data encoding, entry and analysis 19 Mohamed Ahmed Alsair

Data encoders

20 Abdelrahmen Sulaiman

21 Sana Adam Alradi

22 Ashraf Abdo Gabbad

23 Isra Said Basheir

24 Raian Mohamed Adam

25 Khalid Alagib

26 Ibtihal Alamin Ismail

27 Hatim Mohamed Alawad Research assistants

28 Sana Abdelrahman

110

Annex 4: Focus Group Discussions Guideline

Greetings! My name is _________________ and I am working for the Survey Team of _______________

Focus Group Discussions (FGDs) are held in selected areas to find out about the knowledge, attitudes and

practices of communities in relation to Sanitation and Hygiene. The information you provide will help your

government and international organisations design and monitor projects that will improve the existing

sanitation conditions in your area.

Because time is limited, not all households in this area will be included in the meeting. We would like to request

that ordinary community members (men and women) join the discussion.

1. FGD Guidelines:

Please rest assured that any information you provide us will remain confidential and will not be used for any

reason other than the study.

Should you choose to participate, please remember that there are no correct or wrong answers. There are no

disadvantages if you decide not to participate or not to answer certain questions. However, we would greatly

appreciate your cooperation. We would only like you to give us your honest opinion. The discussion will

probably take us about 3 hours. Thank you.

a. Ten (10) FGDs will be conducted in targeted areas

b. Four of the survey staff will facilitate the discussions

c. The maximum number of FGD participants will be 10 persons

d. Participants:

i. Women FGD: Elderly women and young/ middle-aged women

ii. Men FGD: Elderly men and young/ middle-aged men

e. At least 3 among 10 participants have latrine

f. FGDs will last for at least 2 hours (refreshments will be provided)

g. Venue: Inside survey areas – at the village meeting area, the area chief’s house

2. Materials needed:

Markers, paper tape, paper, flipchart paper, Information Sheets, recorders (if necessary), and cameras (if

pictures are allowed by participants)

3. Methods:

a. Self-introduction of survey Staff and of participants

b. Introduction of purpose of group discussion by Facilitators and group discussions of main topics

prompted by the guide questions.

c. Allow group to discuss main topics among themselves, generating consensus but also allow

differences of ideas

d. Only one survey Staff will facilitate the FGDs to ensure consistency of process, in framing of questions,

and in probing of knowledge, attitudes and practices on sanitation and hygiene.

e. The lead facilitator should encourage active participation from all participants.

111

f. One survey Staff will act as note taker, documenting attendance, process, and discussions results –

points of agreement and individual views/ beliefs in flipcharts so that participants can see what is

noted.

This survey staff should be fully knowledgeable of the area-level activities on sanitation and hygiene

implemented.

Guide Questions:

There are 3 main topics for discussion (use of latrines, hand-washing with soap, and drinking safe water).

Pocket Vote:

The Pocket vote should start before the discussion, the election should follow the guideline by focusing on use

of latrine, hand-washing with soap and drinking safe water. The result of the election will be written in the

flipchart and presented to the group.

Urban Water for Darfur Project - UNICEF

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