Sanitation and Hygiene Education to Prevent Waterborne Diseases in Remote Atoll Settlements of Kiribati
Keywords:
sanitation and hygiene, waterborne diseases, Kiribati, atoll communities, WASH education, Pacific small island developing statesAbstract
Remote atoll settlements in Kiribati face disproportionate burdens of waterborne disease attributable to inadequate sanitation infrastructure, contaminated freshwater lenses, and deeply entrenched hygiene practices that elevate community health risks. This community service initiative delivered a structured sanitation and hygiene education program across four remote atoll villages in the Gilbert Islands group of Kiribati, targeting 214 adult and adolescent participants over a sixteen-week implementation period. Employing a participatory health education methodology, the program integrated community hygiene mapping, demonstration-based handwashing training, latrine promotion campaigns, and safe water storage workshops contextualized within I-Kiribati cultural norms. Pre- and post-program behavioral assessments demonstrated a mean improvement of 36.6% across five key hygiene indicators, with statistically significant gains across all measured domains at p < 0.001. Qualitative evidence confirmed deepened community ownership of sanitation infrastructure and sustained behavioral change beyond the program period. The findings provide actionable evidence for scaling culturally adapted Water, Sanitation, and Hygiene (WASH) programming across Pacific atoll nations facing compounding threats from climate change, freshwater scarcity, and limited public health capacity.
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References
Aiello, A. E., & Larson, E. L. (2002). What is the evidence for a causal link between hygiene and infections? The Lancet Infectious Diseases, 2(2), 103-110. https://doi.org/10.1016/S1473-3099(02)00184-6
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T
Barnett, J., & Campbell, J. (2010). Climate change and small island states: Power, knowledge and the South Pacific. Earthscan.
Biran, A., Schmidt, W. P., Varadharajan, K. S., Rajaraman, D., Kumar, R., Greenland, K., Gopalan, B., Aunger, R., & Curtis, V. (2014). Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): A cluster-randomised trial. The Lancet Global Health, 2(3), e145-e154. https://doi.org/10.1016/S2214-109X(13)70160-8
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa
Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C. H., & Schmidt, W. P. (2010). Water, sanitation and hygiene for the prevention of diarrhoea. International Journal of Epidemiology, 39(Suppl. 1), i193-i205. https://doi.org/10.1093/ije/dyq035
Chambers, R. (2012). Provocations for development. Practical Action Publishing.
Curtis, V., & Cairncross, S. (2003). Effect of washing hands with soap on diarrhoea risk in the community: A systematic review. The Lancet Infectious Diseases, 3(5), 275-281. https://doi.org/10.1016/S1473-3099(03)00606-6
Devine, J., & Kullmann, C. (2011). Introductory guide to CLTS. Plan International and IDS.
Freeman, M. C., Stocks, M. E., Cumming, O., Jeandron, A., Higgins, J. P. T., Wolf, J., Pruss-Ustun, A., Bonjour, S., Hunter, P. R., Fewtrell, L., & Curtis, V. (2014). Systematic review: Hygiene and health—Systematic review of handwashing practices worldwide and update of health effects. Tropical Medicine & International Health, 19(8), 906-916. https://doi.org/10.1111/tmi.12339
Hutton, G., & Chase, C. (2016). The knowledge base for achieving the sustainable development goal targets on water supply, sanitation and hygiene. International Journal of Environmental Research and Public Health, 13(6), 536. https://doi.org/10.3390/ijerph13060536
Intergovernmental Panel on Climate Change. (2022). Climate change 2022: Impacts, adaptation and vulnerability. Cambridge University Press. https://doi.org/10.1017/9781009325844
IRC WASH. (2018). Sustainable WASH in Pacific island countries: Program evaluation and cost analysis. IRC International Water and Sanitation Centre.
Kar, K., & Chambers, R. (2008). Handbook on community-led total sanitation. Plan International and IDS.
Kiedrzynski, T., Souares, Y., & Stewart, T. (2011). Communicable diseases in the Pacific islands: An epidemiological snapshot. Pacific Health Surveillance and Response, 6(1), 1-9.
Kiribati National Statistics Office. (2020). Kiribati 2020 population and housing census. Ministry of Finance and Economic Development, Government of Kiribati.
Kuruppu, N., & Liverman, D. (2011). Mental preparation for climate adaptation: The role of cognition and culture in enhancing adaptive capacity of water management in Kiribati. Global Environmental Change, 21(2), 657-669. https://doi.org/10.1016/j.gloenvcha.2010.11.002
Mehta, M., Mehta, D., & Movik, S. (2014). Shit matters: The potential of community-led total sanitation. Practical Action Publishing.
Mimura, N., Nurse, L., McLean, R. F., Agard, J., Briguglio, L., Lefale, P., Payet, R., & Sem, G. (1999). Small islands. In M. L. Parry, O. F. Canziani, J. P. Palutikof, P. J. van der Linden, & C. E. Hanson (Eds.), Climate change 2007: Impacts, adaptation and vulnerability (pp. 687-716). Cambridge University Press.
Muhsyanur and Mustapha, B. (2023). Challenges and Strategies in Teaching Indonesian to Indonesian Occupied Students in Malaysia. TRICKS: Journal Ff Education And Learning Practices, 1(1), 32–39. https://journal.echaprogres.or.id/index.php/tricks/article/view/6
Mulyana, Y., Akbar, Z., Zainal, H., Jiwantara, F. A., Muhsyanur, Yusriadi, Y., & Bin-Tahir, S. Z. (2021). High domestic violence during the pandemic COVID-19. Proceedings of the International Conference on Industrial Engineering and Operations Management, 6283–6290. https://doi.org/10.46254/an11.20211059
Pattanayak, S. K., Yang, J. C., Dickinson, K. L., Poulos, C., Patil, S. R., Mallick, R. K., Blitstein, J. L., & Praharaj, P. (2009). Shame or subsidy revisited: Social mobilization for sanitation in Orissa, India. Bulletin of the World Health Organization, 87(8), 580-587. https://doi.org/10.2471/BLT.08.057422
Pruss-Ustun, A., Bartram, J., Clasen, T., Colford, J. M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A. D., De France, J., Fewtrell, L., Freeman, M. C., Gordon, B., Hunter, P. R., Johnston, R. B., Mathers, C., Mausezahl, D., Medlicott, K., Neira, M., Stocks, M., & Cairncross, S. (2014). Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: A retrospective analysis of data from 145 countries. Tropical Medicine & International Health, 19(8), 894-905. https://doi.org/10.1111/tmi.12329
Rosenstock, I. M. (1974). Historical origins of the Health Belief Model. Health Education Monographs, 2(4), 328-335. https://doi.org/10.1177/109019817400200403
Snel, M., & Mukherjee, N. (2005). Community water and sanitation committees: From construction to management. World Bank Water and Sanitation Program.
Storey, D., & Hunter, S. (2010). Kiribati: An environmental perfect storm. Australian Geographer, 41(2), 167-181. https://doi.org/10.1080/00049181003668914
White, I., Falkland, T., Metutera, T., Metai, E., Overmars, M., Perez, P., & Dray, A. (2007). Climatic and human influences on groundwater in low atolls. Vadose Zone Journal, 6(3), 581-590. https://doi.org/10.2136/vzj2006.0092
World Health Organization. (2019). Progress on household drinking water, sanitation and hygiene 2000-2017: Special focus on inequalities. WHO and UNICEF.
Wright, J., Gundry, S., & Conroy, R. (2004). Household drinking water in developing countries: A systematic review of microbiological contamination between source and point-of-use. Tropical Medicine & International Health, 9(1), 106-117. https://doi.org/10.1046/j.1365-3156.2003.01160.x
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