ACKNOWLEDGEMENTS

The study was conducted under the technical and statistical guidance of:

With valuable comments provided by:

The core research team from MSR consisted of:1. Mr. Kyaw Hlaing, President and Research Director, Myanmar Survey Research2. Dr. San Tun Aung, Research Director, Myanmar Survey Research3. Mr. Alexander Drummond, Research Executive, Myanmar Survey Research4. Ms. Thet Thet Naing, Database Analyst, Myanmar Survey Research5. Mr. Nay Lin Soe, CSPro and SPSS Specialist, Myanmar Survey Research

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Table of Contents

1. EXECUTIVE SUMMARY....................................................................................................4

2. INTRODUCTION..................................................................................................................6

2.1 Background........................................................................................................................6

2.2 Objectives of the study....................................................................................................7

2.3 Study locations................................................................................................................83. WATER.............................................................................................................................13

3.1. Water source.................................................................................................................13

3.2 Difficulty in getting water...............................................................................................19

Table 3.2.1. Difficulty in getting water by townships covered in the survey...........................19

3.3. Water treatment..............................................................................................................20

3.4 Water quality....................................................................................................................24

3.5 Water storage...................................................................................................................28

3.6 Water source contamination............................................................................................304. SANITATION.....................................................................................................................35

4.1 Latrine Availability............................................................................................................35

4.2 Defecation Practices.....................................................................................................41

4.3 Defecation practices of children under 8..........................................................................46

4.4 Latrine Construction.........................................................................................................47

4.5 Latrine Maintenance.........................................................................................................485. HYGIENE..........................................................................................................................49

6. WASTE DISPOSAL..........................................................................................................547. LINKAGES: WATER, SANITATION AND HYGIENE ON DIARRHOEA...........................55

8. PAUKKHAUNG TOWNSHIP ANALYSIS BETWEEN 2011 AND 2013 STUDIES.............609. CONCLUSION AND RECOMMENDATIONS....................................................................65

10. ANNEX.............................................................................................................................68

Research Design...............................................................................................................68

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1. EXECUTIVE SUMMARY

BackgroundIn January 2014, a study was conducted by UNICEF on the availability of water of communities and their knowledge, attitudes and practices in regards to sanitation and hygiene in more than 4,000 households in 16 townships of nine states and regions across Myanmar. A similar study was conducted in the year 2011 which covered more than 6,000 households from nine states and regions. The main objectives of the study are to combine the baseline data collected from 24 townships in 2011 with those from the 16 townships planned under the current study, through a KAP study and to conduct a cross-sectional analysis of data and information in order to be able to draw relevant conclusions for an improved strategy to sustain the momentum for universal sanitation coverage to meet the millennium development goals in 2015.

The study applied both quantitative and qualitative methods. In the quantitative method, there were four components: a household questionnaire, an observation checklist and two individual questionnaires—one for aged 8-14 years and another for aged 15-64 years. In the qualitative method, focus group discussions were held. Participants of the focus group discussions were community members and mothers and caretakers of children under 5 years of age in each community.

FindingsDuring the dry months, almost two-thirds of households (62.3%) have access to improved water sources while its proportion increased to more than three-fourths (76.2%) in the rainy season. One in two households (48.6%) reported that they get their drinking water from two main sources, namely, protected well and rainwater—in the rainy season. More than one-fourth of the total households (26.9%) said that they face annual shortage of water. Among those households, a higher percentage of rural households (28.7%) face such shortage compared to their urban counterparts (19.6%). More than 80 percent of the respondents reported that they face water shortage in the dry months of March and April while almost 40 percent (39.7%) stated that they face the problem in the month of May, about a month before the onset of the rains. As in the case of many other developing countries, about two-thirds (65.3%) of the water watchers are women. Most households (81.9%) treat water meant for drinking by straining it through a piece of cloth. More than two-fifths of the households (61.5%) said that they boil water meant for drinking. The former method is not considered an adequate method to improve the quality of water to make it safe while the latter is assumed adequate. Less than 10 percent (8.6%) households stated they use water filter (ceramic, sand, composite etc.) and 4.0% said they add bleach/chlorine. In total, 74.1% households reported treating their drinking water in an adequate manner to make it safe to drink.

More than four-fifths of the households are aware that unclean and unsafe water can bring negative impacts on health.

A great majority of households (77.6%) have access to improved latrines at home and most among them do share their latrine with other households. More than one third of urban households (39.4%) and almost a quarter of the rural households (24.5%) reported that their latrine was generally clean. More than a quarter of the rural households (26.6%) and only about

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7.5% of the urban households reported the absence of a latrine at home. The findings show that only a small percentage (14.7%) of the households reported practicing open defecation. Less than half of the households—39.4% urban and 24.5% rural—stated that their latrine was generally clean. The survey results show that many of the children aged between two and five began to defecate at the latrine (44.4%). However, almost the same percentage of the children (44.2%) in the age group still practiced bad sanitation habits by defecating in their shorts, directly on to the ground or without the help of their mother. According to the current study, the percentage of adults cleaning the child's bottom was recorded at 93.4% resulting in children cleaning their bottom by themselves to the figure of 6.6%. The 2011 findings show that percentage as 85. The survey found that less than a quarter of children aged between 8 and 14 years (22%) defecated improperly. The 2011 survey findings show at 6%. The percentage of households who reported that they built their latrine was recorded at 59.3% in the current study and the 2011 study findings show the figure at 70.0%In defining the word personal hygiene, almost 90 percent (89.1%) of the household members aged 15-64 understand it as taking a bath, washing the face (73.9%) and brushing the teeth (75.9%) from multiple answers. Almost two-fifths (58.1%) take a bath once a day, and 90.4% of them wash their hands after defecating but only 76.6% reported to wash their hands with soap after defecating.

Less than half of the household members (46.9%) wash their hands with soap before eating while the 2011 survey findings show the figure at 40.1%.

As Paukkhaung Township has repeated in this survey to ascertain the difference of before and after the introduction of CLTS, findings from the two surveys are included for comparison purpose.

The two findings show that the township has more access to improved water source in all the three seasons, rainy, winter and summer, within the two year period. The percentages are 99.1%, 97.7% and 97.2% in 2013 against 88.6%, 88.1% and 88.1% in 2011. Percentage of the households who have their latrine built over 50 feet rose to 85% in 2013 from 70% in 2011. However, having improved latrines in urban areas slightly declined to 80.0% in 2013 from 82.6% in 2011. For the rural households, the percentages significantly increased within two years, from 61.8% in 2011 to 74.6% in 2013.

The use of a latrine by households increased slightly from 89.6% in 2011 to 92.1% in 2013. The main reason for not having a latrine is still the households’ inability to build one. Among the households who did not have a latrine or use it, 56.5% from the 2011 study and 76.5% of the 2013 study made the statement.

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2. INTRODUCTION

2.1 BackgroundWASH Activities in MyanmarSupported by the Ministry of Health, WASH section of UNICEF in collaboration with its partners has been implementing programmes to improve water, sanitation and hygiene quality in primary schools, households and community across the country throughout the last country programmes.

UNICEF in Myanmar works to ensure access to clean and safe water by installing safe drinking water supply systems in schools, health centres and communities; and ensuring better water quality by testing for arsenic and other contaminants in groundwater, and introducing mitigation activities as needed. UNICEF ensures access to adequate sanitation facilities by providing support for the construction of sanitary latrines in schools and communities; and encouraging national and community support of latrine construction through its support of National Sanitation Weeks. In addition to these activities, UNICEF also promotes hygiene education by supporting the teaching of personal hygiene in schools through the provision of activity-based teaching manuals, learning/game materials and demonstration models; and supporting National Sanitation Weeks, which involve the promotion of hand washing and other basic hygienic measures in the national media and in communities.

KAP Surveys

In order to collect township level baseline data for the 2011-2015 country programme, A KAP study in 40 townships was agreed. The first phase of study was conducted in 24 townships1 in 2011. The study findings were approved by the Ministry of Health and published in 2012. In addition the MoH approved a study of 16 Townships and these were selected during the WASH mid-year Review Meeting 2012 together with Government counterparts and partners considering the townships where UNICEFs Education section, Health section, the Division of Occupational Health and Environmental Sanitation of the Ministry of Health, the Department of Rural Development and The Department of Education Planning and Training are planning to work in 2013 and 2015 using UNICEF fund.

This study will be used to compare findings with the 2011 KAP study, as well as expand the baseline to areas that could not be studied in 2011. This study will support in development of a local WASH planning process which WASH section is developing together with its government partners. The methodology of survey, sampling method and questionnaires are the same as the previous study so that the findings can be compared. Paukkhaung Township is repeated in this survey to ascertain the difference of before and after the introduction of CLTS.

1Originally it was planned to conduct a KAP survey in 25 townships in 2011. However, two townships in Kayah state, namely Demoso and Hpruhso, had to be excluded due to access constraints. Demawso Township was substituted by Pekhon Township in Shan State.

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2.2Objectives of the study

The main objectives of the study are to:

1. Combine the baseline data collected from 24 townships in 2011 with those from the 16 townships planned under the current study, through a KAP study

2. Conduct a cross-sectional analysis of data and information in order to be able to draw relevant conclusions for an improved strategy to sustain the momentum for universal sanitation coverage to meet the MDG in 2015.

Information from the study will be used to support the main goals of UNICEF’s WASH activities which are: Reduce polluted water-borne and excreta related diseases through improved hygiene and behavior in children under 5, ensure access to safe, sustainable and healthy, hygienic water supply to communities to better protect children under 5 against contaminated water.

To be able to achieve the above goals, the current study will focus on knowledge, attitude and practice of the households with regards to water, sanitation and hygiene.

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2.3 Study locations

Location of 16 townships selected for the study

8

Sample TownshipsThe current KAP 2013 study covers sixteen townships, which are potential areas for UNICEF to implement programs or integrated WASH activities and are presented in the table below.

No. Township State / Division Strata

1 Myebon Rakhine Coastal

2 Taunggup Rakhine Coastal

3 Kyaikmayaw Mon Coastal

4 Paung Mon Coastal

5 Kawthoung Tanintharyi Coastal

6 Dawei Tanintharyi Coastal

7 Demawso Kayah Hilly

8 HlaingBwe Kayin Hilly

9 Taunggyi Shan South Hilly

10 Mong Phyat Shan Hilly

11 Wetlet Sagaing Plain

12 Waw Bago Plain

13 Paukkhuang Bago Plain

14 Mahlaing Mandalay Plain

15 Pauk Magway Dry

16 Thabaung Ayeyarwaddy Delta

The present survey has covered both urban and rural areas of the selected townships. A similar study was conducted in the year 2011 that covered 24 townships in 9 states and regions where UNICEF has a plan to implement projects in the country programme 2011-2015. The 24 townships listed below were selected by UNICEF. The survey was also conducted in both urban and rural areas of the townships.

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No. Township Name State/Region Name Strata

1 Launglone Tanintharyi coastal

2 Ponnagyun Rakhine coastal

3 Rathedaung Rakhine coastal

4 Bogalay Ayerwaddy delta

5 Pyapon Ayeyarwady delta

6 Kyaunggone Ayeyarwady delta

7 Hinthada Ayeyarwady delta

8 Pantanaw Ayeyarwady delta

9 Mogaung Kachin hilly

10 Bamaw Kachin hilly

11 Pekhon Shan South hilly

12 Taunggyi Shan South hilly

13 Pinlaung Shan South hilly

14 Kutkai Shan North hilly

15 Mindat Chin hilly

16 Kanpetlet Chin hilly

17 Kawkareik Kayin hilly

18 Homalin Sagaing hilly

19 ChaungOo Sagaing plain

20 Paukkhaung Bago West plain

21 Paungde Bago West plain

22 Nyaunglaybin Bago East plain

23 Oktwin Bago East plain

24 Htantabin Bago East plain

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Location of sample townships in the 2011 survey

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3. WATER

3.1. Water sourceMyanmar has a tropical climate with three seasons: namely, the monsoon or rainy season, which extends from June to October, the cool season, that lasts from November to February and the hot season, that goes on from March to May. In general, it rains only in the rainy reason. Because Myanmar is endowed with rivers, ponds, mountains, hills, thick forest areas and a long stretch of coastal areas, the climate is mild. Nevertheless that are certain areas which get less rain others. They are located in the central part of the country. Rainfalls during the monsoon record more than 100 inches in hilly and mountainous areas in eastern and northern parts of Myanmar, 100-120 inches in the Delta area, 180-200 inches in coastal areas and less than 40 inches in central Myanmar. That part is called the dry zone and Mandalay, Sagaing and Magwe Regions are included in the zone.

Table 3.1.1 percentage of HHs using improved drinking water in all seasons (without and with considering whether original water sources are improved)

Rainy Winter Summer

Count Percent Count Percent Count Percent

Piped water into dwelling 113 2.8% 124 3.1% 118 2.9%

Piped water to yard/plot 109 2.7% 132 3.3% 121 3.0%

Public tap/standpipe 143 3.5% 158 3.9% 161 4.0%

Tube well/borehole 592 14.6% 625 15.4% 646 15.9%

Protected dug well (Brick-lined well) 1033 25.5% 1122 27.7% 1115 27.5%

Protected spring 29 0.7% 43 1.1% 52 1.3%

Rainwater collection 815 20.1% 63 1.6% 38 0.9%

Bottled purified water (Purchased) 256 6.3% 268 6.6% 277 6.8%

Improved water source 3090 76.2% 2536 62.5% 2529 62.3%

Cart with small tank/drum 6 0.1% 10 0.2% 11 0.3%

Tanker/truck 17 0.4% 22 0.5% 23 0.6%

Unprotected dug well 484 11.9% 525 12.9% 519 12.8%

Unprotected spring 52 1.3% 61 1.5% 64 1.6%

Surface water (river, dam, lake, pond, stream, canal, irrigation channels) 407 10.0% 904 22.3% 912 22.5%

Unimproved water source 967 23.8% 1521 37.5% 1528 37.7%

Total 4057 100.0% 4057 100.0% 4057 100.0%

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The findings show the seasonal patterns of availability of water for drinking purpose. The results show that more than three-fourths of the total households (76.2%) have access to improved water sources during the rainy season. The findings from 2011 show 82.5%. Access to such resources from the two surveys during the dry seasons of winter was 71% (2011) and 62.5% (2013) and summer 70.3% (2011) and 62.3% (2013).

Table 3.1.2 Original water sourceRainy Winter Summer

Count Percent Count Percent Count PercentTube well/borehole 736 18.1% 785 19.4% 812 20.0%Protected dug well (Brick-lined well) 1073 26.4% 1171 28.9% 1168 28.8%Protected spring 116 2.9% 143 3.5% 145 3.6%Rainwater collection 900 22.2% 157 3.9% 127 3.1%Bottled purified water (Purchased) 256 6.3% 268 6.6% 277 6.8%Improved water source 3081 76.0% 2523 62.2% 2528 62.3%Unprotected dug well 499 12.3% 540 13.3% 534 13.2%Unprotected spring 69 1.7% 90 2.2% 83 2.1%Surface water (river, dam, lake, pond, stream, canal, irrigation channels) 407 10.0% 904 22.3% 912 22.5%

Unimproved water source 976 24.0% 1534 37.8% 1529 37.7%Total 4057 100.0% 4057 100.0% 4057 100.0%

Almost half of the households (48.6%) reported that they get their drinking water from two main sources—protected well and rainwater—in the rainy season, while in 2011 this was reported as 37.3%. The two resources constitute the main drinking waters in the remaining two seasons with 32.8% in the winter and 31.9% in the summer. In 2011, however, the survey recorded 24.6% and 24.2% get drinking water from these two sources in winter and summer respectively. Almost 20 percent (18.1%) of the households reported to get drinking water from tube wells/boreholes, whereas in the earlier study this was recorded as nearly 30%.

A higher percentage of households covered by the current study use bottled water. Altogether 6.3% of the households reported to use bottled water for their drinking water against 2.1% in the 2011 study..

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Table 3.1.3 Original drinking water source (Rainy season) by urban/rural

Rainy Urban Rural TotalCount Percent Count Percent Count Percent

Tube well/borehole 268 33.7% 468 14.3% 736 18.1%

Protected dug well (Brick-lined well) 117 14.7% 956 29.3% 1073 26.4%

Protected spring 4 0.5% 112 3.4% 116 2.9%

Rainwater collection 91 11.4% 809 24.8% 900 22.2%

Bottled purified water (Purchased) 217 27.3% 39 1.2% 256 6.3%

Improved water source 697 87.7% 2384 73.1% 3081 76.0%Unprotected dug well 51 6.4% 448 13.7% 499 12.3%

Unprotected spring 5 0.6% 64 2.0% 69 1.7%Surface water (river, dam, lake, pond, stream, canal, irrigation channels)

41 5.2% 366 11.2% 407 10.0%

Unimproved water source 97 12.3% 878 26.9% 976 24.0%

Total 794 100.0% 3263 100.0% 4057 100.0%

According to the current findings, a total of 87.7% of the urban households have access to improved water sources against 73.1% of the rural households in the rainy season. The 2011 findings reported 81.9% for urban households and 71.1% for rural households. The current survey also shows that a much higher percentage of urban households (33.7%) reported to get drinking water from tube wells/bore holes sources during the rainy season while only 14.3% of their rural counterparts have access to those sources in the same season. In the earlier study, 43.4% urban households and 31.2% rural households expressed having had access to tube wells/boreholes.

Table 3.1.4 Water source for drinking water in all seasons by type and by urban/rural

All seasons Urban Rural TotalCount Percent Count Percent Count Percent

All seasons use improved water source 428 53.9% 1783 54.6% 2211 54.5%All seasons use unimproved water source 310 39.1% 889 27.3% 1199 29.6%Rainy and winter seasons use improved water source and summer unimproved 10 1.2% 25 0.8% 35 0.9%

Rainy and summer seasons use improved water source and winter unimproved 9 0.3% 9 0.2%

Only rainy season use improved water source 42 5.3% 529 16.2% 571 14.1%

Winter and summer seasons use improved water source and rainy unimproved

2 0.3% 7 0.2% 9 0.2%

Only winter season use improved water source 1 0.1% 1 0.0%

Only summer season use improved water source 1 0.2% 21 0.6% 22 0.5%

Total 794 100.0% 3263 100.0% 4057 100.0%

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The present study shows that urban respondents have more access to improved water sources compared to their rural counterparts. Altogether 53.9% of the urban households and 54.6% of the rural households have access to improved water sources. The 2011 study findings showed 86.4% for urban households and 66.2% for rural households in having access to improved water sources.

Table 3.1.5 Most common water emergency months N=1093Count Percent

January 97 8.9%

February 208 19.0%

March 884 80.9%

April 943 86.3%

May 433 39.7%

June 94 8.6%

July 69 6.4%

August 60 5.5%

September 19 1.8%

October 25 2.2%

November 20 1.8%

December 44 4.0%

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Chart 3.1.6 Most common water emergency months

Janua

ry

Febru

ary

March

April

MayJu

neJu

ly

Augus

t

Septembe

r

October

November

December

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Altogether 1093 households or more than one-fourth (26.9%) of the households said that they face water shortage. Among those households, 19.6% are from urban areas and 28.7% from rural areas. As can be expected, a more serious period is in the dry months of March through May, just before the onset of the monsoon. Monsoon enters in the month of May for certain areas and June for some other areas.

Table 3.1.7 Main household members who fetch water (male/female)

Count Percent

Male 904 34.7%

Female 1698 65.3%

Total 2602 100.0%

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Table 3.1.8. Positions in the households of main water fetchers

Count Percent

Household head 577 22.2%

Spouse of household head 748 28.7%

Son/ daughter; son in law / daughter in law 1090 41.9%

Parent / Parent in law 14 0.5%

Relative 173 6.7%

Total 2602 100.0%

Among those who fetch water in the households almost two-thirds of them (65.3%) are females in the current study and it was 67.0% in the 2011 study. Main water fetchers in the households are sons/daughters or sons-in-law or daughters in law as they make up more two-fifths (41.9%) according to current study and they were also the main water fetchers in the earlier survey. Almost a quarter (22.2%) and more than a quarter (28.7%) of the main water fetchers are household heads or spouses of household heads respectively in the present study.

Table 3.1.9. Persons who fetch water disaggregated by age group

Count Percent

Under 10 years 9 0.3%

11-20 years 586 22.5%

21-30 years 639 24.6%

31-40 years 542 20.8%

41-50 years 402 15.5%

51 and above 423 16.3%

Total 2602 100.0%

Only nine households or 0.3% have children younger than 10 years of age and have to fetch water under the current study and the figure is 1.2% in the earlier survey. Therefore, less percentage of young children have to fetch water according to the current study. Almost a quarter (22.5%) of the water fetchers in the households falls into the aged group of 11-20 years and its percentage was 26.2% in the earlier study.

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Table 3.1.10 Percentage of HHs having to fetch water

Count PercentYes 2602 64.1%

No 1455 35.9%

Total 4057 100.0%

The current study shows that 2602 households (64.1%) have to fetch water. Among them only more than one third of the urban households (33.6%) have to fetch water while more than two-thirds of their rural counterparts (71.6%) had to do the same. Water sources are not that far in general and in the hottest months of the year, 86.3% of the households reported that it takes them less than 30 minutes to fetch water. Only 13.3% of the total households spent more than 30 minutes to fetch water and among those who fetch water, children younger than10 years of age make up only 106 of them or 2.6%. In 2011, however, 7.4% of households spent over half an hour fetching water during the dry months and of those just 1.2% were children younger than 10 years old.

3.2 Difficulty in getting water

Table 3.2.1. Difficulty in getting water by townships covered in the survey

All seasons use unimproved water

source

All seasons use

unimproved water source

Improved water all seasons

Unimproved water all seasons

All seasons use

unimproved water source

All seasons use unimproved water source

All seasons use

unimproved water source

Kawthoung 125 54.9% 43.6% 1.5%Myebon 157 54.9% 21.4% 17.5% 4.9% 0.5%Dawei 272 52.3% 44.1% 3.1% 0.4%Taunggyi 436 49.7% 49.1% 0.9% 0.3%Pauk 273 36.3% 62.1% 1.2% 0.4%Hlaingbwe 319 33.8% 65.5% 0.4% 0.4%Toungup 190 33.8% 56.6% 4.1% 1.4% 3.2%Thabaung 241 33.2% 44.4% 19.1% 0.4%Kyaikmaraw 376 31.6% 55.0% 9.9% 1.3% 1.9%Monghpyak 53 31.3% 64.8% 3.9%Paung 447 22.0% 46.0% 29.1% 0.6% 1.1%Demoso 93 15.1% 64.0% 11.8% 8.1% 1.1%Wetlet 276 13.1% 70.7% 15.8%Mahlaing 319 9.6% 90.4%Waw 301 5.9% 10.7% 82.0% 1.1%Paukkhaung 179 0.9% 97.2% 1.4% 0.5%

The table shows the townships which have difficulty in accessing water. Different townships have different degrees of having access to improved water sources. The townships in coastal areas such as Kawthoung, Myebon and Dawei have greater access to improved water in all

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seasons while those in Central Myanmar or the dry zone such as Wetlet, Mahlaing, Waw and Pakkhaung have least access to improved water in all seasons.

3.3. Water treatment

3.3.1. Household’s treatment of drinking water Count Percent

Yes 3693 91.0%

No 364 9.0%

Total 4057 100.0%

More than 90 percent of the households reported that they treat water in one way or another before they drink it. Almost the same percentage (89.2%) responded in the same way in the 2013 study.

3.3.2. Methods used for treating drinking waterUrban Rural Total

Count % Count % Count N %

Boil 421 65.2% 1852 60.8% 2273 61.5%

Add bleach/chlorine 28 4.3% 119 3.9% 147 4.0%

Strain it through a cloth 485 75.2% 2538 83.3% 3023 81.9%

Use a water filter (ceramic, sand, composite, etc.) 40 6.1% 278 9.1% 318 8.6%

Solar disinfection 0 0.0% 3 .1% 3 .1%

Let it stand and settle 43 6.7% 372 12.2% 415 11.2%

Other 27 4.2% 63 2.1% 91 2.5%

Don't know/No response 0 0.0% 0 0.0% 0 0.0%

Total 646 100.0% 3048 100.0% 3693 100.0%

The most common method the households use in treating water meant for drinking is straining it through a piece of cloth. More than 80% (81.9%) of the households reported using the method. It is not considered an adequate method to improve the quality of water to make it safe. It is followed by boiling in which almost two-thirds of the total households (61.5%) said that they treat their drinking water in that way. It is considered an adequate method. Altogether 4.0%, 8.6% and 0.1% of the households reported that they treat water by adding bleach/chlorine, using a water filter (ceramic, sand, composite, etc.) and through solar disinfection, which come up to almost three-fourths (74.2%) where the households use an adequate method to make the drinking water safe.

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The 2011 findings show similar figures. Altogether 61.1% of the households reported boiling water, 3.6% adding bleach or chlorine, 7.9% using a water filter, and 0.1% through solar disinfection adding up to 72.7% of the households who treatment drinking water adequately.

3.3.3. Households’ use of other purpose water treatment – correct method N=619

Count PercentBoil 38 6.2%

Add bleach/chlorine 89 14.3%

Strain it through a cloth 226 36.6%

Use a water filter (ceramic, sand, composite, etc.) 40 6.4%

Solar disinfection 5 0.7%

Let it stand and settle 283 45.7%

Other 48 7.8%

In responding to a question about whether the households treat the water they use for other purposes, altogether 619 households or 16% of the total households said that they do treat water meant for other purposes rather than drinking. Among them 27.6% use an adequate method by boiling the water (6.2%), adding bleaching/chlorine (14.3%), using a water filter (ceramic, sand, composite etc.) (6.4%), or through solar disinfection (0.7%).

3.3.4. Awareness on correct treatment method

Multiple answers

Count Percent

Boil 2997 73.9%

Add bleach/chlorine 304 7.5%

Use a water filter (ceramic, sand, composite, etc.) 347 8.6%

Solar disinfection 11 .3%

Strain it through a cloth 2859 70.5%

Let it stand and settle 638 15.7%

Others 89 2.2%

Don't' know/No response 55 1.4%

An important factor for the households to use safe drinking water is how to improve the quality of the water from its sources. More than 90 percent (90.3%) of the respondents are aware about correct treatment methods which includes boiling, adding bleach/chlorine, using a filter (ceramic, sand, composite etc.) or solar disinfection resulting in clean and safe water. In the 2011 study, the findings were similar. Altogether 83.1% of the then respondents mentioned boiling. It was

20

followed by adding bleach/chlorine (10.3%), using a water filter (9.7%) and solar disinfection (0.6%) among adequate drinking water treatment methods.

Janu

ary

Febru

ary

March Apr

ilMay

June Ju

ly

Augus

t

Septem

ber

Octobe

r

Novem

ber

Decem

ber

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

3.3.4. Households in which more than 30 minutes is needed in any season to fetch water

Rainy Winter Summer

Count Percent Count Percent Count Percent

More than 30 minute 108 4.1% 168 6.4% 346 13.3%

Less than 30 min 1912 73.5% 2340 89.9% 2246 86.3%

Not relevant 582 22.4% 94 3.6% 10 0.4%

Between 30 min and 1 hour 92 3.5% 126 4.9% 246 9.4%

Between 1 hour and 2 hours 15 0.6% 33 1.3% 57 2.2%

Between 2 hours and 3 hours 1 0.0% 7 0.3% 17 0.6%

More than 3 hours 1 0.0% 27 1.0%

Total 2602 100.0% 2602 100.0% 2602 100.0%

The distance to sources of water for households covered in the survey is not a serious issue. More than 80 percent of the households (83.2%) on average said that they need less than 30 minutes to fetch water in any season.

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3.4 Water quality3.4.1. Household’ perceptions on the quality of water they use after treatment of water

Drinking Water Domestic WaterCount Percent Count Percent

Absolutely clean 706 17.4% 484 11.9%Clean 3079 75.9% 3145 77.5%Normal 223 5.5% 350 8.6%Not clean 4 0.1% 6 0.2%Don't Know/ No response 45 1.1% 72 1.8%Total 4057 100.0% 4057 100.0%

Households believe that water becomes clean after it has been treated in one way or another or if it comes from an improved water source. Among the methods households commonly use, but is not recommended by public health officials, is the straining of water through a piece of cloth. More than three-fourths of the households (75.9%) believe that their drinking water is clean, while nearly one-fifth (17.4%) stated that their drinking water is absolutely clean. Therefore, 93.3% of the households believe their drinking water is at least clean. In the 2011 study, more than 90 percent of the households (95%) believed the quality of the drinking water as at least clean.

Chart 3.4.2. Household’ perceptions on the quality of the water they use

Absolutely clean

Clean Normal Not clean Don't Know/ No response

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Drinking waterDomestic use

Table 3.4.3. How people determine water cleanliness 22

First Answer Combine Answer

Count Percent Count Percent

Colourless, transparent 853 21.0% 1625 40.0%

Cool 88 2.2% 269 6.6%

Acceptable taste; Odourless 23 .6% 155 3.8%

Being water from tube well / hand pump 723 17.8% 1064 26.2%

No sediments 236 5.8% 952 23.5%

Free from harmful chemicals (e.g. calcium, iron) 32 .8% 69 1.7%

Free from germs (e.g. chlorinated, not causing sickness or diarrhoea) 163 4.0% 399 9.8%

Filtered water 690 17.0% 1684 41.5%

Because the water has been kept overnight 26 .6% 185 4.5%

Because the water weigh at least 3.6 lbs 4 .1% 14 .3%

Not salty 21 .5% 51 1.3%

Flavoured 16 .4% 56 1.4%

Boiled water 955 23.5% 1863 45.9%

Others 162 4.0% 329 8.1%

Don't know/ No response 65 1.6% 65 1.6%

Total 4057 100.0%

In discussing matters relating to how the households determine the cleanliness of water, households mentioned it being colourless/transparent (21.0%), it coming from improved water source such as a tube well /hand pump (17.8%) or it has been filtered (17.1%).

The 2011 findings show that household members believed that the water becomes clean after it has been treated or if the water is obtained from an improved water source. The households said that water became clean after boiling (22%), filtering (17.6%), or coming from a tube well/hand pump. Other criteria on cleanliness of the water and cited by the households included the water is colourless and transparent (19.4%) and it is free from germs (4.3%).

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Table 3.4.4. Awareness on water-borne diseases

First Answer Multiple AnswerCount Percent Count Percent

Diarrhoea 2905 71.6% 3434 84.6%

Dysentery 50 1.2% 484 11.9%

Cholera 308 7.6% 536 13.2%

Stomach pain 282 6.9% 1259 31.0%

Catch fever 52 1.3% 231 5.7%

Typhoid 2 0.0% 40 1.0%

Hepatitis 43 1.0% 346 8.5%

Polio 3 0.1%

Malaria 123 3.0% 512 12.6%

Round worm 19 0.5% 175 4.3%

Ringworm, scabies, itchy skin 13 0.3% 200 4.9%

Influenza 13 0.3% 86 2.1%

Dengue Hemorrhagic fever 8 0.2% 152 3.7%

Goitre 11 0.3% 58 1.4%

Others 11 0.3% 67 1.6%

Don't know/No response 216 5.3% 216 5.3%

Total 4057 100.0%

Households are quite knowledgeable about the importance of clean and safe water. A great majority of the households know the impact of drinking unclean water on health. Table 3.4.4. shows negative effects that unclean and unsafe water could bring according to the respondents. The first column describes the percentages of the first answers while the second column shows the percentages taken from multiple answers. Nearly three-fourths of the households (71.6%) said that unclean water can cause water-borne diseases such as diarrhoea

The percentage came up to 79.5% in the 2011 study. However, while current findings show 7.6% of the households stated that it can be the cause of cholera in their first answers; in the earlier study, they were only 1.4% of households.

3.5 Water storage 24

Table 3.5.1. Common drinking water storage containers from observation check list

Count Percent

Earthen pot 3208 79.1%

Plastic container 727 17.9%

Tin/metal container 85 2.1%

Others 36 0.9%

None 1 0.0%

Total 4057 100.0%

According to observation check lists, almost 80 percent (79.1%) of the households were recorded to have earthen ports as water storage containers while 17.9% of the households as that they keep plastic containers - the report from 2011 also expressed similar percentages. The number of households who have other types of water storage containers is negligible. Most households have water containers that can hold 2 to 6 gallons. Findings from the observation check list show that almost three-fifths (59.5%) of the households have containers that have the capacity between 2-4 gallons while 23.5% have containers whose capacities range from 4 to 6 gallons. Nearly three-fourths of the households (71.9%) keep their water storage containers inside the house and were elevated.

The findings from 2011show that almost one third (32%) of the households reported to have containers that store less than two gallons while more than two thirds (68%) of the households have containers that hold two or more gallons. A total of 77 per cent of households kept their water containers inside the household and elevated while a little over 10 percent (12%) kept their water containers on the ground.

Table 3.5.2. Households’ reported clean frequency of drinking water container

Count Percent

Daily 1194 29.4%

Three or four times a week 1568 38.7%

Two times a week 702 17.3%

Once a week 304 7.5%

Less than once a week 82 2.0%

Do not wash at all 57 1.4%

Not applicable 151 3.7%

Total 4057 100.0%

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Chart 3.5.3. Household clean drinking water containers

29.40%

38.70%

17.30%

7.50%

2.00% 1.40% 3.70%

DailyThree or four times a weekTwo times a weekOnce a weekLess than once a weekDo not wash at allNot applicable

More than a quarter (29.4%) of the households reported that they cleaned drinking water containers on a daily basis. Findings from 2011, however, found this percentage to be slightly higher (34.9%).

Nearly two-fifths (38.70%) and nearly 20 percent (17.30%) said that they cleaned their drinking water containers three or four times a week and twice a week respectively, while in 2011 those who cleaned their drinking water containers three of four times a week was reported as 36.3%.

Field interviewers observed that a little over one-third (34.1%) of the households had good drinking water cups while nearly two-thirds (61.7%) had somewhat good types of drinking water cups. In total, 95.8% of the households had either good or somewhat good types of drinking water cups, only a slight difference from 97% as report in 2011. The survey teams also observed that 92.4% of the households had drinking water cups with handles, compared to 89% of the earlier study.

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3.6 Water source contamination

Table 3.6.1. Knowledge on water source contamination

First Answer Multiple Answer

Count Percent Count Percent

Bathing / washing clothes at water source 758 18.7% 1470 36.2%

Water does not flow 80 2.0% 190 4.7%

Urinate / Defecate at the water source 309 7.6% 924 22.8%

Latrine close to the water source 251 6.2% 515 12.7%

Dispose trash near the water source 667 16.4% 1394 34.4%

Trash fallen into the water source 827 20.4% 1764 43.5%

Washing raw meat and raw fish near the water source 28 .7% 116 2.9%

Pouring contaminated water into the water pump to siphon off water 48 1.2% 119 2.9%

Not properly plugging in the holes of the water pipe 41 1.0% 74 1.8%

Do not have separate bucket or rope at the well/Using dirty bucket 63 1.5% 149 3.7%

The well has no roof 210 5.2% 490 12.1%

Then well has no walling 122 3.0% 449 11.1%

The animals can go into the water source. No fence / broken fence around the pond 400 9.9% 841 20.7%

Others 36 .9% 60 1.5%

Don't know/ No response 219 5.4% 219 5.4%

Total 4057 100.0%

Having a latrine and trash disposal, washing or bathing near a water source often leads to contamination of water. The respondents were asked if they have knowledge about matters that cause the contamination of water. Multiple answers were allowed.

The three most common reasons given by the respondents as their multiple answers were bathing/washing clothes at the water source, disposing trash near the water source and trash falling into the water source. A total of 36.2%, 34.4% and 43.5% of the respondents gave those answers respectively. Less common answers given were animals going into the water source (no fence around the water source/broken fence) (20.7%), urinating/defecating near the water source (22.8%) and building a latrine close to the water source (12.7%).

The 2011 findings showed similar results. A total of 47.1%, 33.1% and 34.5% of the respondents said that bathing/washing clothes at the water source, disposing trash near the water source and trash falling into the water source can contaminate water respectively. Other reasons given that can contaminate water were animals going into the water source (no fence around the water source/broken fence) (24.7%), urinating/defecating near the water source (30.2%) and building a latrine close to the water source (25.5%).

Table 3.6.2. Knowledge on water contamination during fetching

27

First Answer Multiple AnswerCount Percent Count Percent

Using contaminated pot / bucket / barrel 891 22.0% 1569 38.7%

Handling the container with dirty hands 145 3.6% 431 10.6%

Putting a hand or fingers while fetching it 323 8.0% 696 17.2%

With Hand 469 11.5%No cover while fetching drinking water 695 17.1% 1184 29.2%

Dirt and mud getting into water while carrying 1012 25.0% 1664 41.0%

No Cover / Dirt getting into water 1708 42.1%Don't have one pot kept specially for this purpose 68 1.7% 225 5.6%

Fetching water without cleaning the container 247 6.1% 530 13.1%

Putting cloth or small branch on top of water 54 1.3% 116 2.9%

Because of the animals 165 4.1% 444 11.0%

Fetching water while wearing wet clothes 50 1.2% 221 5.5%

Stepping into the pond /river /stream to fetch water 156 3.8% 352 8.7%

Others

Don't know/ No response 251 6.2% 251 6.2%Other Knowledge on water contamination during

fetching 990 24.4%

Total 4057 100.0%

In responding to the question about the reasons that can cause contamination of water during transportation, most common answers among the multiple ones are: dirt or mud getting into water (41.0%), using contaminated containers (38.7%), and having no cover while fetching drinking water (29.2%).

These results are consistent with those from 2011 where 45.9% of respondents stated that dirt of mud getting into water can cause contamination. Those who said that contamination can be caused from using contaminated containers and having no cover while fetching drinking water were recorded as 43.8% and 23.6% respectively.

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Table 3.6.3. Knowledge on water contamination during storage First Answer Multiple Answer

Count Percent Count Percent

Using dirty container / do not wash at all 639 15.7% 1205 29.7%

Stored water not covered properly 1849 45.6% 2632 64.9%

Larvae found in water 863 21.3% 1629 40.2%

Water fetched using unclean bucket / cup 179 4.4% 410 10.1%

Water fetched using dirty hands 182 4.5% 502 12.4%

Water fetched using unclean bucket / cup & Water fetched using dirty hands 361 8.9%

Pouring back the leftover water 152 3.8% 478 11.8%

Others 14 .4% 33 .8%

Don't know/ No response 179 4.4% 179 4.4%

Total 4057 100.0%

The respondents were also asked if they have knowledge about how to store water properly and what could cause the contamination of water during storage. In taking out answers from multiple responses, almost two-thirds of the respondents (64.9%) said that water can become contaminated if it is not covered properly during storage, similar with 70.3% as recorded in 2011. Other causes mentioned were: larvae found in water (40.2%), using dirty containers/not cleaning them (29.7%) and fetching water with dirty hands (12.4%), while in the earlier study, these were recorded as larvae found in water as 38.5% and using dirty containers/not cleaning them as 44.3%.

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Table 3.6.3. Bathing location n=4057Count Percent

Bathroom inside the house 324 8.0%

Inside compound (water fetched from outside) 1575 38.8%

Rain water storage point 109 2.7%

Inside compound (water source inside) 1257 31.0%

Outside compound (Motorized / hand pump tube well) 66 1.6%

Outside compound (Water tap) 91 2.2%

Outside compound (Near the well) 738 18.2%

Outside compound (Near the pond) 119 2.9%

Outside compound (In the pond) 55 1.4%

Outside compound (river / stream) 589 14.5%

Outside compound (Inside the dam) 21 .5%

Altogether 30.7% of the households and 31.0% of the households reported that they have bathing location inside their compound (water fetched from outside) and (water source inside) respectively. The percentages are comparable to the 2011 survey with 30.7% (water fetched from outside) and 33.9% (water source inside) respectively.

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4. SANITATION

4.1 Latrine Availability The majority of households (77.6%) have access to improved latrines at home. Of those households 94.3% do not share their latrine with other households. According to observations from field teams, there were 3.9% non-functional latrines and 23.6% partially functional latrines.

The figures of improved latrines were 89.7% in 2011. According to observations from field teams, findings from the study were 5.7% non-functional latrines and 29.8% partially functional latrines.Just over half (59.4%) expressed that at least one member of the household worked in the field and 89.2% of those said that no latrine was available in the field. Findings from the earlier showed the figure was 85.2%.

Alarmingly only 39.4% and 24.5% of urban and rural households respectively said that their latrine was generally clean. Table 4.1.1 expresses that varying types of latrines by percentage.

Table 4.1.1 Latrine Type

Count Percent

Piped sewer system 22 0.7%

Septic tank 527 16.7%

Pit latrine 1816 57.7%

Ventilated improved pit latrine (VIP) 28 0.9%

Pit latrine with slab 485 15.4%

Composting toilet 7 0.2%

Improved latrine 2885 91.6%

Elsewhere 18 0.6%

Unknown place/not sure 1 0.0%

Pit latrine without slab/open pit 183 5.8%

Bucket 1 0.0%

Hanging toilet/hanging latrine 60 1.9%

Unimproved latrine 264 8.4%

Total 3149 100.0%

In rural areas, the proportion of households without any latrine was much higher (26.6%) compared with urban areas (7.5%). Results from the 2011 study were (rural 19.1%, urban 5.1%).

The proportion of households with unimproved latrines was also higher in rural areas (6.8%) compared with urban areas (5.1%). Findings from the 2011 report were (rural 9.3%, urban

31

5.2%).Table 4.1.2 shows estimates disaggregated for urban and rural households.

Table 4.1.2 Latrines (Improved/Not Improved)CountUrban

PercentUrban

CountRural

PercentRural

CountTotal

PercentTotal

Improved latrine 695 87.5% 2190 67.1% 2885 71.1%

Unimproved latrine 40 5.1% 223 6.8% 264 6.5%

No latrine 59 7.5% 849 26.0% 908 22.4%

Total 794 100.0% 3263 100.0% 4057 100.0%

Table 4.1.2 shows the proportion of different types of latrines for the group of households with latrines in both urban and rural areas. Among households with latrines, the use of septic tanks was more common in urban areas and the use of flush to pit latrine less common compared with rural areas. The use of flush/pour to pit latrines and septic tanks by rural households were 59.2% and 12.7% respectively.

Similar results were expressed in the 2011 report. The use of flush/pour latrines and septic tanks by the rural households were 72.1% and 5.4% respectively.

Table 4.1.3 Latrines by different types

Urban Rural Total

Count Percent Count Percent Count Percent

Flush/pour flush to Piped sewer system 19 2.7% 2 0.1% 22 0.7%

Flush/pour flush to Septic tank 220 30.0% 307 12.7% 527 16.7%

Flush/pour flush to Pit latrine 387 52.6% 1429 59.2% 1816 57.7%

Ventilated improved pit latrine (VIP) 3 0.3% 25 1.0% 28 0.9%

Pit latrine with slab 64 8.7% 421 17.5% 485 15.4%

Composting toilet 1 0.2% 5 0.2% 7 0.2%

Flush/pour flush to Elsewhere 3 0.4% 15 0.6% 18 0.6%

Flush/pour flush to Unknown place/not sure 1 0.0% 1 0.0%

Pit latrine without slab/open pit 24 3.2% 160 6.6% 183 5.8%

Bucket 1 0.2% 1 0.0%

Hanging toilet/hanging latrine 12 1.7% 47 2.0% 60 1.9%

Total 735 100.0% 2413 100.0% 3149 100.0%

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Table 4.1.3 shows the proportion of households with improved, unimproved and no latrines across the sampled townships. The Townships are arranged in ascending order of improved latrines. As expected, the Township (Myebon) with the lowest percentage of improved latrines (28.6%) also has the highest percentage of no latrine at all (66%). Waw Township is also notable for having the highest percentage of unimproved latrines, accounting for nearly a third of households (29%).

Table 4.1.4 Proportion of households with improved, unimproved and no latrines across sampled Townships

Township Total number of respondents Improved Latrines Unimproved

Latrines No Latrine

Myebon 157 28.60% 5.30% 66.00%

Thabaung 241 47.70% 7.10% 45.20%

Hlaingbwe 319 54.40% 0.70% 44.80%

Waw 301 57.40% 29.00% 13.60%

Toungup 190 58.00% 7.80% 34.20%

Pauk 273 61.70% 2.70% 35.50%

Monghpyak 53 67.60% 0.00% 32.40%

Paung 447 71.20% 7.10% 21.80%

Paukkhaung 179 75.70% 1.90% 22.40%

Wetlet 276 77.20% 1.20% 21.60%

Kawthoung 125 79.50% 10.80% 9.70%

Mahlaing 319 81.10% 1.80% 17.10%

Dawei 272 82.40% 7.80% 9.80%

Kyaikmaraw 376 88.50% 2.90% 8.60%

Taunggyi 436 90.50% 7.80% 1.70%

Demoso 93 94.60% 3.20% 2.20%

Tables 4.1.5, 4.1.6 and 4.1.7 indicate the different types of materials used for latrine construction. The quality of the latrine construction materials was modest. The use of bamboo mat & thatch for walling material was 24.8% and the use of bricks/concrete was 23.6%.Findings from 2011 survey were the use of bamboo mat & thatch for walling material 38.9% and that of bricks/concrete 15.2%.

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Table 4.1.5 Construction materials for the latrine (Walling)Count Percent

Bricks/Concrete 744 23.6%

Wood 618 19.6%

Wood & bamboo 407 12.9%

Wood & corrugated sheet 146 4.6%

Betel/Coconut tree and thatch 187 5.9%

Bamboo mat & thatch 782 24.8%

Polyester/plastic/tarpaulin & Related materials 226 7.2%

Other 38 1.2%

Total 3149 100.0%

Regarding flooring materials, the use of wood and bamboo, wood and plastic (sitting) and bricks/concrete & ceramic pan (squatting) were 19.9%, 45.6%, and 21.0% respectively.

According to the 2011 survey report, the use of wood and bamboo, wood and plastic (sitting) and bricks/concrete & ceramic pan (squatting) were 43.2%, 27.8% and 13.2% respectively.

Table 4.1.6 Construction materials for the latrine (Flooring)

Count Percent

Bricks/Concrete & ceramic pan (Sitting) 72 2.3%

Bricks/Concrete & ceramic pan (Squatting) 662 21.0%

Bricks & plastic pan (Sitting) 135 4.3%

Wood & plastic pan (Sitting) 1436 45.6%

Betel/Coconut tree 37 1.2%

Wood & bamboo 627 19.9%

Bamboo 180 5.7%

Total 3149 100.0%

According to the current study, the use of thatch and that of tin/corrugated sheet for roofing were 42.2% and 41.5% respectively as indicated in 4.1.7. In the earlier 2011 study, the use of thatch and that of tin/corrugated sheet for roofing were 53.1% and 29.2% respectively.

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Table 4.1.7 Materials the latrine is mainly built of (Roofing)

Count Percent

No Roof 188 6.0%

Tin/corrugated sheet 1307 41.5%

Thatch 1330 42.2%

Tarpaulin 39 1.2%

Bamboo 75 2.4%

Other (Specify) 209 6.6%

Total 3149 100.0%

Table 4.1.8 Construction materials for the latrines (Door)Count Percent

Wood 1201 38.1%

Tarpaulin 745 23.7%

Bamboo 661 21.0%

Other (Specify) 542 17.2%

Total 3149 100.0%

Table 4.1.9 shows the types of communal and other household latrines as reported by household respondents. The percentages of households using pit latrines with slabs and flush/pour flush to pit latrines were 24.2 and 44.0 respectively. The corresponding figures in the 2011 study were 6.9 and 72.9 respectively. The percentage of unimproved latrines according to the study was 22.8%. Table 4.1.9 Households with access to improved communal of other household’s latrines

Count Percent

Flush/ pour flush to Piped sewer system

Flush/ pour flush to Septic tank 27 8.1%

Flush/ pour flush to Pit latrine 147 44.0%

Ventilated improved pit latrine (VIP) 3 0.9%

Pit latrine with slab 81 24.2%

Improved latrine 258 77.2%

Flush/ pour flush to Elsewhere 1 0.4%

Pit latrine without slab/open pit 52 15.6%

Hanging toilet/hanging latrine 23 6.8%

Unimproved latrine 76 22.8%

Total 335 100.0%

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When asked about whether they perceived their latrine to be sanitary, 77% of household respondents deemed them to be so. The majority of individuals (48.4%) expressed the main advantage of a sanitary toilet as being beneficial to one’s health; 11.6% said it contributes to a clean environment and 9.0% mentioned it prevents flies. Only a combined 8.2% per cent acknowledged the existence of a sanitary latrine in preventing diseases or fever.

Altogether 67% of the households covered in the 2011 study stated that their latrine is sanitary.

4.2 Defecation Practices

The majority of individuals were able to identify various hazardous defecation practices, such as defecating behind the bush (59.4%) using latrines without lids (26.7%) and pits (25.7%) and defecating directly into the water (18.7%). Survey results revealed that a majority 77.1% of respondents use their own home latrine, while the use of communal or other people's latrines is exceedingly low in comparison, 1.8% and 6.4% respectively. The results show those openly defecating in fields as 13.9%.

Table 4.2.1 Defecation practices of household member when at home

Count Percent

Defecate openly it in the field 563 13.9

Defecate openly in the compound 30 .8

Use latrine at home 3129 77.1

Use communal latrine 74 1.8

Use other people’s latrine 261 6.4

Total 4057 100.0

Table 4.2.2 expresses defecations practices, when at home, of individual household members disaggregated by township. The data is sorted by the percentage of those reported to openly defecate in ascending order. In half of the townships surveyed over 10% of individuals stated that they defecated openly, in either the field or the compound. In 2011, only one quarter of townships had a percentage over 10% of individuals who open defecated.

‘

36

Table 4.2.2 Defecation practices by township and by type

TownshipTotal

sample township

Openly defecate

Not open defecate

Defecate openly it in the

field

Defecate openly in

the compound

Use latrine

at home

Use communal

latrine

Use other people’s latrine

Myebon 157 55.8% 44.2% 54.9% 1.0% 33.5% 3.4% 7.3%

Hlaingbwe 319 37.7% 62.3% 35.2% 2.5% 55.2% 0.4% 6.8%

Monghpyak 53 30.7% 69.3% 30.2% 0.6% 67.6% 0.6% 1.1%

Pauk 273 29.7% 70.3% 29.3% 0.4% 63.3% 1.6% 5.5%

Toungup 190 26.5% 73.5% 25.1% 1.4% 65.3% 3.2% 5.0%

Thabaung 241 25.7% 74.3% 25.3% 0.4% 53.9% 11.6% 8.7%

Wetlet 276 17.0% 83.0% 16.6% 0.4% 78.4% 0.0% 4.6%

Paung 447 11.9% 88.1% 9.9% 2.0% 77.4% 1.7% 9.0%

Paukkhaung 179 7.9% 92.1% 7.9% 0.0% 77.6% 1.9% 12.6%

Mahlaing 319 6.8% 93.2% 6.4% 0.4% 82.5% 0.0% 10.7%

Kyaikmaraw 376 5.1% 94.9% 5.1% 0.0% 90.4% 1.0% 3.5%

Dawei 272 3.9% 96.1% 3.1% 0.8% 89.8% 1.2% 5.1%

Waw 301 2.6% 97.4% 1.8% 0.7% 86.4% 0.4% 10.7%

Kawthoung 125 1.5% 98.5% 1.0% 0.5% 87.7% 3.1% 7.7%

Demoso 93 0.5% 99.5% 0.5% 0.0% 97.8% 0.0% 1.6%

Taunggyi 436 0.0% 100.0% 0.0% 0.0% 98.3% 1.4% 0.3%

The majority of adults (76.5% of males, 80.6% of females) never defecated openly when at home during the last year. 15.1% of men said they defecated openly at least ‘2’ times in the last year, whereas only 0.8% said at least ‘3’ times. The amount of men who said they always defecate openly, however, is 13.7%.

Table 4.2.3 The practice of open defecation by household members during last yearMale adults Female adults Children (8-15)

Count Column N % Count Column N % Count Column N %

Never 3102 76.5% 3271 80.6% 106 2.6%

>1 712 17.5% 721 17.8% 389 9.6%

>2 612 15.1% 636 15.7% 318 7.8%

2 99 2.5% 85 2.1% 71 1.8%

3 33 0.8% 27 0.7% 12 0.3%

4 21 0.5% 21 0.5% 12 0.3%

Always 558 13.7% 588 14.5% 294 7.2%

DK/NR 18 0.4% 16 0.4% 7 0.2%

Not applicable 226 5.6% 49 1.2% 3555 87.6%

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Table 4.2.3 shows the frequency of individuals who openly defecated in the last year disaggregated by township. The townships are tallied in ascending order according to those who ‘Never’ openly defecate. In Myebon over 50% of people in the township always openly defecate and 58.7% had defecated at least twice in the last year.

Table 4.2.4 Proportions of open defecation disaggregated by townships

TownshipTotal

sample Township

>1 >2 Never 2 3 4 Always

Myebon 157 61.2% 58.7% 38.8% 2.4% 1.9% 2.9% 53.9%

Hlaingbwe 319 41.6% 38.8% 58.4% 2.8% 1.4% 3.9% 33.5%

Monghpyak 53 35.2% 31.8% 64.8% 3.4% 0.6% 0.0% 31.3%

Thabaung 241 34.0% 31.1% 65.6% 2.9% 2.1% 1.2% 27.8%

Toungup 190 33.8% 29.2% 66.2% 4.6% 0.5% 0.5% 28.3%

Pauk 273 31.6% 31.3% 68.4% 0.4% 0.8% 0.4% 30.1%

Wetlet 276 18.1% 17.8% 81.9% 0.4% 0.0% 0.0% 17.8%

Paung 447 17.8% 14.4% 82.2% 3.4% 1.1% 1.1% 12.1%

Paukkhaung 179 15.4% 8.4% 84.6% 7.0% 0.5% 0.0% 7.9%

Waw 301 7.7% 2.9% 92.3% 4.8% 0.0% 0.0% 2.9%

Mahlaing 319 7.5% 7.5% 91.8% 0.0% 0.4% 0.0% 7.1%

Kawthoung 125 7.2% 4.6% 92.8% 2.6% 0.0% 0.0% 4.6%

Kyaikmaraw 376 6.4% 6.1% 93.6% 0.3% 0.3% 0.3% 5.4%

Dawei 272 4.3% 4.3% 95.7% 0.0% 0.0% 0.0% 4.3%

Demoso 93 1.1% 0.5% 98.9% 0.5% 0.0% 0.5% 0.0%

Taunggyi 436 0.0% 0.0% 98.3% 0.0% 0.0% 0.0% 0.0%

Table 4.2.5 reveals the amount of households with any member working in the field. The majority of households (59.4%) have at least one member working in the field and among this percentage only 10.7% expressed that a latrine was present. The overwhelming majority (89.2%) said a latrine in the field was not available.

Table 4.2.5 Household members working in the fieldUrban Rural Total

Count Percentage Count Percentage Count PercentageYes 201 25.2% 2207 67.7% 2408 59.4%No 594 74.8% 1055 32.3% 1649 40.6%Don't Know/ No responseTotal 794 100.0% 3263 100.0% 4057 100.0%

Table 4.2.6 expresses the frequency of open defecation by various groups of household members working in the field during the last year. Over 70% of respondents reported their male adult members practicing open defection at least more than twice in the past year. Female respondents who reported to openly defecate more than '2' was recorded as 56.2%.

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The results from 2011 showed less frequency of men, women and children openly defecating. Over 50% of male respondents reported to defecate openly more than '2'. Female respondents who reported to openly defecate more than '2' was 25.6% in the last study.

Table 4.2.6 Practice of open defecation by household members working in the field Male adults Female adults Children (8-15)

Count Column N % Count Column N % Count Column N %Never 220 10.0% 464 21.1% 481 21.9%

>1 1911 87.1% 1593 72.6% 477 21.7%

>2 1545 70.4% 1233 56.2% 372 16.9%

DK/NR 5 0.2% 6 0.3% 7 0.3%

Not applicable 59 2.7% 131 6.0% 1229 56.0%

Never 220 10.0% 464 21.1% 481 21.9%

Table 4.2.6 expresses defecations practices, when at home, of individual household members disaggregated by township. The data is sorted by the percentage of those reported to openly defecate in ascending order. In half of the townships surveyed over 10% of individuals stated that they defecated openly, in either the field or the compound. In 2011, one quarter of townships had a percentage over 10% of individuals who open defecated.

Table 4.2.7 Defecation practices by township and by type

TownshipTotal

sample township

Openly defecate

Not open defecate

Defecate openly it in the

field

Defecate openly in

the compound

Use latrine

at home

Use communal

latrine

Use other people’s latrine

Myebon 157 55.8% 44.2% 54.9% 1.0% 33.5% 3.4% 7.3%

Hlaingbwe 319 37.7% 62.3% 35.2% 2.5% 55.2% 0.4% 6.8%

Monghpyak 53 30.7% 69.3% 30.2% 0.6% 67.6% 0.6% 1.1%

Pauk 273 29.7% 70.3% 29.3% 0.4% 63.3% 1.6% 5.5%

Toungup 190 26.5% 73.5% 25.1% 1.4% 65.3% 3.2% 5.0%

Thabaung 241 25.7% 74.3% 25.3% 0.4% 53.9% 11.6% 8.7%

Wetlet 276 17.0% 83.0% 16.6% 0.4% 78.4% 0.0% 4.6%

Paung 447 11.9% 88.1% 9.9% 2.0% 77.4% 1.7% 9.0%

Paukkhaung 179 7.9% 92.1% 7.9% 0.0% 77.6% 1.9% 12.6%

Mahlaing 319 6.8% 93.2% 6.4% 0.4% 82.5% 0.0% 10.7%

Kyaikmaraw 376 5.1% 94.9% 5.1% 0.0% 90.4% 1.0% 3.5%

Dawei 272 3.9% 96.1% 3.1% 0.8% 89.8% 1.2% 5.1%

Waw 301 2.6% 97.4% 1.8% 0.7% 86.4% 0.4% 10.7%

Kawthoung 125 1.5% 98.5% 1.0% 0.5% 87.7% 3.1% 7.7%

Demoso 93 0.5% 99.5% 0.5% 0.0% 97.8% 0.0% 1.6%

Taunggyi 436 0.0% 100.0% 0.0% 0.0% 98.3% 1.4% 0.3%

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Table 4.2.8 shows the frequency of individuals who openly defecated in the last year disaggregated by township. The townships are tallied in ascending order according to those who ‘Never’ openly defecate. In Myebon over 50% of people in the township always openly defecate and 58.7% had defecated at least twice in the last year.

Table 4.2.8 Proportions of open defecation disaggregated by townships

TownshipTotal

sample Township

>1 >2 Never 2 3 4 Always

Myebon 157 61.2% 58.7% 38.8% 2.4% 1.9% 2.9% 53.9%

Hlaingbwe 319 41.6% 38.8% 58.4% 2.8% 1.4% 3.9% 33.5%

Monghpyak 53 35.2% 31.8% 64.8% 3.4% 0.6% 0.0% 31.3%

Thabaung 241 34.0% 31.1% 65.6% 2.9% 2.1% 1.2% 27.8%

Toungup 190 33.8% 29.2% 66.2% 4.6% 0.5% 0.5% 28.3%

Pauk 273 31.6% 31.3% 68.4% 0.4% 0.8% 0.4% 30.1%

Wetlet 276 18.1% 17.8% 81.9% 0.4% 0.0% 0.0% 17.8%

Paung 447 17.8% 14.4% 82.2% 3.4% 1.1% 1.1% 12.1%

Paukkhaung 179 15.4% 8.4% 84.6% 7.0% 0.5% 0.0% 7.9%

Waw 301 7.7% 2.9% 92.3% 4.8% 0.0% 0.0% 2.9%

Mahlaing 319 7.5% 7.5% 91.8% 0.0% 0.4% 0.0% 7.1%

Kawthoung 125 7.2% 4.6% 92.8% 2.6% 0.0% 0.0% 4.6%

Kyaikmaraw 376 6.4% 6.1% 93.6% 0.3% 0.3% 0.3% 5.4%

Dawei 272 4.3% 4.3% 95.7% 0.0% 0.0% 0.0% 4.3%

Demoso 93 1.1% 0.5% 98.9% 0.5% 0.0% 0.5% 0.0%

Taunggyi 436 0.0% 0.0% 98.3% 0.0% 0.0% 0.0% 0.0%

Findings of qualitative study on open defecation are quite consistent with quantitative results. In Mon villages most people do not defecate openly, in part due to latrine bowl donations by NGOs. However, poor villages where people cannot afford to build latrines, such as villages in Toungup and Thabaung townships, have higher numbers of people who openly defecate. Those villagers who work outside of the village occasionally defecate in the field mostly in the early morning or evening. Generally, women openly defecate less than men and children because they are shy and embarrassed about the practice.Everyone understood the potential health risks caused as a result of open defecation and felt repelled whenever they witnessed it. Only a few people said they would actually inform the person defecating of their wrong doing, most would ignore the situation and continue on their way. Everyone said action of some kind should be taken to improve the situation. “People should be educated about good practices on defecating, personal hygiene and building fly proof latrines. Latrines should be built to make the surroundings clean. Most important point is to build latrines” – a villager from Wetlet township. However, most people cited financial constraints when asked what barriers would prevent improvement.

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4.3 Defecation practices of children under 8

Children less than twelve months oldThe survey found that the majority of children under 12 months defecated improperly, either in the napkin, their shorts or in the bed (80.6%), while those who defecated directly onto the ground whilst sitting on their mother's feet (7.5%) was much less but still practised. Only 6.4% practised the good defecation method of defecating into a pot, assisted by their mother. Of those caretakers assisting their infant with defecating 53.1% used water only. The percentage of caretakers using a water-soaked gauze was recorded at just 4.6%. The percentage using cloth, water soaked paper or tissue was put at 24.3%.

After cleaning the infant 94.5% stated they washed their hands and 80.5% of those said they used soap.

Regarding the disposal of the infant's faeces, only 15.2% said they disposed of them into a latrine. Data from this survey reveals the practice of washing the napkin/shorts with soap at 35%. Those caretakers using only water to wash their infant’s napkin/shorts were recorded at 26.5%. Just 5.1% of the respondents reported the unsanitary practice of disposing of faeces into surface water such pond, river or stream.

Children between one and two years oldThe survey found that over two thirds (70%) of children between one and two years old defecate improperly. A total of 35.9% households reported about children defecating directly onto the ground whilst standing on their mother's feet. The percentage of children practising the unsanitary practice of defecating into their shorts or in the bed was recorded as 24.6. A total of 15.5% respondents stated of the good practice of defecating into a pot and the percentage of children using the latrine is only 6.6%.

The use of survey indicated good practises to clean the child's bottom is reported as 92.9%, the majority of this figure using only water (63.4%). 4.8% respondents talked about using the bad practise of sticks and twigs to clean the child's bottom.Regarding the disposal of the child's faeces, 32.4% stated disposing of the faeces into a latrine. The bad practice of disposing of faeces inside the yard has been recorded as 17.6%; those disposing of faeces outside of the yard as 14% and those disposing of faeces in surface water as 7.1%. The overwhelming majority of households said they washed their hands after cleaning the child (93.4%), while 73.4% of those used both water and soap.

Children between two and five years oldThe survey found that many of the children had switched to defecating at the latrine (44.4%) by the time they reached between two and five years old. However, a large amount (44.2%) still practised bad sanitation habits by defecating in their shorts, directly on the ground with or without the aid of their mother. The percentage of adults cleaning the child's bottom has been recorded as 93.4% resulting in children cleaning their bottom by themselves to the figure of 6.6%.

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The survey found significant contrast in sanitation levels between adults cleaning their children after defecting and children cleaning themselves. An alarming 32.4% of children said their used sticks or twigs to clean their bottom after defecating while 50.1% used water only 10.8% used both water and soap. The results show caretakers who clean the child's bottom through the use of sticks or twigs at 10.7%. As with children cleaning by themselves, the majority of adults (61.5%) used only water and only 19.6% used both water and soap. Of caretakers, 92% washed their hands after cleaning the child's bottom and 75.8% of those used both water and soap.

Children between five and eight years oldAccording to the respondents, bad defecation practises for the group of five to eight year old is limited to 22%. The survey found that the majority of these children practised good defecation by using a latrine (76.6%).

Children from this age group cleaning their own bottoms after defecation are put at 68.4%. Of this figure the majority (57.9%) stated that they used water to clean their bottom while 30.1% still practiced bad habits of using paper, sticks or twigs.75.5% of children expressed washing their hands after defecating while 65.7% of them used both water and soap. For this groups where caretakers or mothers clean the child's bottom after defecating, the survey found that over 85% were cleaned properly and such as with water (60.7%) or water and soap (22.1%), while 93.7% washed their hands afterwards and 79% of them reported to use both water and soap.FGD regarding child faeces revealed that mothers take responsibility for disposing of their child’s faeces and dispose of them mostly into latrines. However, numerous people mentioned disposing of the faeces into bushes, pits and even streams highlighting a lack of access to latrines. Everyone acknowledged that child faeces can harm people’s health but most expressed that adult faeces are dirtier and more harmful because of the variety of foods that adults eat.

4.4 Latrine ConstructionRegarding latrine construction, the percentage of those reported to self build their latrine has been recorded at 59.3%. Just 0.6% of the latrines were donated by organizations. Meanwhile, the percentage of hired hands to build latrines has been recorded at 40.1%.

When asked who urged them to build their latrines 26.7% said health staff/employees and 23.4% said Ward/Village officials.

87.2% of households stated that increased knowledge in health was the reason for building their latrine. 11.5% stated that no reason for having built their latrine as it had existed in the household for some time. About 12.5% of households expressed the reason for building their latrine came from knowledge shared through television, radio and newspaper media. From those households without latrines, 53.0% stated financial constraints for reasoning and 18.4% expressed that it was due to a lack of space.

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4.5 Latrine MaintenanceThe percentage of people reporting of an entity checking latrine conditions has been put at just 36.4. Of this figure the overwhelming majority entity is reported to be the health department (66%) followed by Community Health Worker (11.1%) and Ward PDC (8.9%). The percentage of INGOs checking latrines is 7.1.When the latrine pit gets full, 79.4% of households seal off the current pit and dig a new one. Only 0.8% of households let out the faeces during a flood to ensure the septic never fills up completely. The number of men reported to maintain the latrine is 71.7%. The number of women performing latrine maintenance work is 10.3%. 10.4% of households said there were times when their latrines were out of service. The majority exclaimed this to be due to flooding (60.3%), while only 50.4% of households said that decay of the latrine structure was the reason for its dysfunctional status.

When the latrine becomes out of service most households defecate at other people's latrine (40.5%). The number of households defecating in the field (outside the compound) is 33.1% and those defecating inside the compound, 24.1%.

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5. HYGIENE

Adults aged 15- 64 were asked what hygiene activities came to mind when thinking about ways of ensuring personal hygiene. Table 5.1.1 expresses the results of different methods of ensuring personal hygiene. Looking at multiple (combined) answers, bathing, brushing teeth and washing one’s face were expressed as the most common with 89.1%, 75.9% and 73.9% respectively.

Table 5.1.1 Known hygiene activities (Household members aged 15 – 64)

First Answer Multiple Answer

Count Percent Count Percent

Bathing 1965 48.4% 3615 89.1%

Shampoo hair 104 2.6% 974 24.0%

Keep the hair clean 39 0.9% 595 14.7%

Wash the face 935 23.0% 2997 73.9%

Brush the teeth 431 10.6% 3080 75.9%

Apply Thanakha 86 2.1% 1394 34.4%

Wearing clean clothes 86 2.1% 923 22.8%

Clip hand nails / toe nails 223 5.5% 1379 34.0%

Wash hands after coming out of the latrine 31 0.8% 484 11.9%

Wash hands 113 2.8% 1280 31.6%

Wash feet 32 0.8% 1030 25.4%

Don't know/ No response 14 0.3% 14 0.3%

Total 4057 100.0%

Table 5.1.2 shows how often adults take a bath. The percentage of adults bathing more than once a day is recorded as 29.1% and those adults who bath once a day have become the majority with 58.1%.

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Table.5.1.2 Taking a bathCount Percent

more than once a day 1179 29.1%

once a day 2358 58.1%

4-5 times a week 191 4.7%

2-3 times a week 241 5.9%

once a week 73 1.8%

less than once a week 16 0.4%

Total 4057 100.0%

Table 5.1.3 expresses frequency of adult bathing disaggregated by townships. Townships are arranged in ascending order of those who bath at least once a day. Only in two townships, Demoso (22.%) and Taunggyi (44.5%), do the majority bath less than once a day. While in Pauk Township 2% practice the unhygienic habit of bathing less than once a week.

Table.5.1.3 Bathing frequencies for adults disaggregated by townshipsTotal

sampled individuals

At least once a

day

Less than once a day

4-5 times a week

2-3 times a week

once a week

less than once a week

Demoso 93 22.0% 78.0% 9.1% 44.1% 23.7% 1.1%Taunggyi 436 44.5% 55.5% 17.6% 28.9% 7.8% 1.2%Monghpyak 53 65.9% 34.1% 12.3% 17.3% 4.5% 0.0%Wetlet 276 75.7% 24.3% 13.1% 10.0% 1.2% 0.0%Pauk 273 81.3% 18.8% 8.6% 5.9% 2.3% 2.0%Mahlaing 319 92.9% 7.1% 3.9% 2.9% .4% 0.0%Hlaingbwe 319 95.4% 4.6% 2.1% 1.8% .4% .4%Waw 301 96.7% 3.3% 2.6% .7% 0.0% 0.0%Thabaung 241 97.1% 2.9% .8% .8% .4% .8%Myebon 157 97.6% 2.4% 1.5% 0.0% 0.0% 1.0%Dawei 272 98.0% 2.0% 1.2% .4% .4% 0.0%Paukkhaung 179 98.6% 1.4% .9% 0.0% .5% 0.0%Kawthoung 125 99.0% 1.0% .5% .5% 0.0% 0.0%Toungup 190 99.5% .5% .5% 0.0% 0.0% 0.0%Kyaikmaraw 376 99.7% .3% .3% 0.0% 0.0% 0.0%Paung 447 100.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Table 5.1.4 indicates the amount of times per day adults brush their teeth. It also shows the type of technique these use. Of adults reported to brush their teeth a minimum of once a day and 85% did so using a toothbrush and toothpaste. Those who use salt and their finger were much lower at just 12.2% and only 1.2% stated to use charcoal or ash using their finger.

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Table.5.1.4 Tooth brushing and tools

Count Percent

Once a day 1974 49.8%

More than once a day 1991 50.2%

Total 3966 100.0%

Count Percent

Toothbrush using tooth paste 3371 85.0%

Toothbrush using salt 46 1.2%

Salt using finger 483 12.2%

Charcoal using finger 23 0.6%

Ash using finger 26 0.6%

Others 17 0.4%

Total 3966 100.0%

When water is available in toilets 98.6% of individuals reported that soap was also available. Only 16.6% expressed that neither soap nor water were available. The percentage of the availability of was found to be just 18.4% in the 2011 study.

Table.5.1.4 Availability of water in the toilets by availability of soapSoap is available Soap is not available

Count Percent Count Percent

Water is available 554 98.6% 2157 83.4%

Water is not available 8 1.4% 429 16.6%

Total 562 100.0% 2586 100.0%

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Table.5.1.5 Individuals washing hands with soap after defecating (Urban and Rural)The majority of Myanmar people (88.3%), eat with their fingers. After defecating, 90.4% reported to wash their hands. 76.6% (Urban 89.4%, Rural 73.1%) of them expressed that they washed their hands with both soap and water. The findings from 2011 were 69.3% (Urban 86.7%, Rural 64.7%).

Urban Rural Total

Count Percentage Count Percentage Count PercentageYes 777 97.8% 2891 88.6% 3668 90.4%No 18 2.2% 372 11.4% 389 9.6%Don't Know/ No

responseTotal 794 100.0% 3263 100.0% 4057 100.0%

Table.5.1.6 Individuals washing hands with soap after defecating by Urban and RuralUrban Rural Total

Count Percentage Count Percentage Count Percentage

Only with water 82 10.6% 764 26.4% 846 23.1%

Burned paddy husk/ash 2 0.1% 2 0.1%

Rubbing matter (dried sponge gourd/brush) 4 0.1% 4 0.1%

With sand soap 8 0.3% 8 0.2%

With soap 695 89.4% 2113 73.1% 2808 76.6%

Table.5.1.7 Individuals eating with fingers after defecating by Urban and RuralUrban Rural Total

Count Percentage Count Percentage Count Percentage

Hand 579 72.9% 3003 92.0% 3582 88.3%

Spoon/Fox/Chopstick 215 27.1% 260 8.0% 475 11.7%

Total 794 100.0% 3263 100.0% 4057 100.0%

Table.5.1.8 Hand washing of individuals before eating by Urban and Rural

Urban Rural TotalCount Percentage Count Percentage Count Percentage

Yes 578 99.8% 2990 99.6% 3569 99.6% No 1 0.2% 12 0.4% 13 0.4% Total 579 100.0% 3003 100.0% 3582 100.0%

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Of those households who eat with their fingers, Table 5.1.9 expresses their usual methods of washing their hands before eating. 52.9% stated that they washed their hands only with water where as 46.7% mentioned they used soap when washing their hands. In the 2011 study, most household (82%) had water available for washing in their compounds, only 81.6% of those with water had soaps as well.

Table.5.1.9 Household members eating with fingers by methods of washing their hands before eating

Count Percent

Only with water 1890 52.9%

Burned paddy husk/ash 1 0.0%

Rubbing matter (dried sponge gourd/brush) 3 0.1%

Without soap 1894 53%

With sand soap 8 0.2%

With soap 1667 46.7%

With soap 1675 46.9%

Total 3569 100.0%

Focus group discussions about personal hygiene revealed that people are aware of general routine hygiene practices such as bathing, washing hands, face and feet with soap; brushing teeth, cutting nails, combing hair, washing clothes and using Thanakha.When asked what other practices could be applied which are currently not, a majority expressed an increase in using soap when bathing or washing. “Women should keep themselves clean and hygienic during menstruation period”, was also highlighted by a female villager from Demoso township.

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6. WASTE DISPOSAL

The data collected in 2014 shows that 42.5% respondents talked about burning up their waste and they were in the majority. They were followed by 17.7% respondents who claimed that they dispose their garbage in the field, and by 14.1% respondents who reported they dispose their garbage into the river, stream or pond. In terms of cleanliness, only 19.1% of housing compounds from both urban and rural areas were deemed to be clean, and of those, clean urban housing compounds were over double the percentage of those found in rural areas.

Our survey identified a significant positive trend of households disposing of their waste properly. Urban and rural households disposing of waste in a pit inside the compound has been recorded at 9.0%.In the 2011 study, more than a third of households (34% of urban households, 37% of rural households) burned up their garbage. Just 25.1% of urban households had their waste collected by municipal garbage collection in the study. In rural areas, however, development of municipal and private waste collection and specified areas has been nearly non-existent with just 0.03% overall.

Table.6.1.1 Where households mostly dispose wastes from the kitchenUrban Rural Total

Count Percentage Count Percentage Count PercentagePlace specified by municipal 69 8.7% 7 0.2% 76 1.9%Garbage collector (Municipal) 200 25.1% 1 0.0% 201 4.9%Garbage collector (Private) 11 1.4% 2 0.1% 14 0.3%In a garbage disposing hole inside the compound 35 4.5% 331 10.2% 367 9.0%

Burn them 251 31.6% 1474 45.2% 1725 42.5%Where everybody dispose garbage (illegal) 40 5.0% 104 3.2% 144 3.6%

Into the ditch 40 5.0% 103 3.2% 143 3.5%On the bank of the river, stream, pond 27 3.4% 57 1.7% 83 2.1%

Into the river, stream, pond 87 11.0% 485 14.9% 572 14.1%In the field 33 4.2% 685 21.0% 719 17.7%Other 1 0.1% 12 0.4% 14 0.3%Total 794 100.0% 3263 100.0% 4057 100.0%

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7. LINKAGES: WATER, SANITATION AND HYGIENE ON DIARRHOEA

As table 7.1.1 expresses, 5.4% of households with children under 5 said that their child had experienced diarrhoea at least once in the two weeks prior to the survey and 94.6% said they had not.

These figures are consistent with findings from the earlier study which recorded 7.9% and 92.1% respectively.

Table 7.1.1 Incidences of children under 5 with diarrhoeaIncidents in the past 2 weeks Households Percentage

Yes 78 5.4%

No 1359 94.6%

Total 1437 100.0%

More in depth analysis highlights 11.1% of children in households who practice open defecation had diarrhoea in the two weeks preceding the survey, while for those using other communal or other people’s latrines it was 8.7% and just 3.6% for households using their own latrine.

According to the 2011 study, these results were recorded as 17.3%, 9.3% and 6.5% respectively.

Table 7.1.2 HH defecation practices with children under 5 years of age

Under 5 ChildOpen defecation Use latrine at home Use communal or

other people's latrine Total

Count Percent Count Percent Count Percent Count Percent

Under 5 diarrhoea child 28 11.1% 37 3.60% 13 8.7% 78 5.4%

Under 5 no diarrhoea child 224 88.9% 999 96.40% 136 91.3% 1359 94.6%

Total 252 100.0% 1036 100.00% 149 100.0% 1437 100.0%

The survey found that those households with unimproved latrines (6.8%) were twice as likely to have a child suffer from diarrhoea in the past two weeks prior to the survey as those with improved latrines (3.3%), while those with no latrine at all (10.2%) were nearly three times as likely to experience diarrhoea in their child. In the 2011 study, the percentage of unimproved latrines was noticeably higher (16.3%) than those with improved latrines (5.3%) and no latrine at all (12.5%).

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Table 7.1.3 Crosstabs between Under-5 Child and HH defecation practice (OCL)

Under 5 ChildImproved Latrine Unimproved Latrine No Latrine Total

Count Percent Count Percent Count Percent Count Percent

Under 5 diarrhoea Child 31 3.3% 7 6.8% 40 10.2% 78 5.4%

Under 5 no diarrhoea child 911 96.7% 99 93.2% 349 89.8% 1359 94.6%

Total 942 100.0% 106 100.0% 389 100.0% 1437 100.0%

Of households without hand-washing facilities, 6.4% suffered from diarrhoea in their child in the two weeks prior to the survey, whereas only 4.9% of those with hand-washing facilities experienced the same defecation of their under 5 year old child.

Table 7.1.3 Crosstabs between Under-5 Child and HH having hand-washing facilities

Under 5 ChildYes No Total

Count Percent Count Percent Count Percent

Under 5 diarrhoea child 47 4.9% 31 6.4% 78 5.4%

Under 5 no diarrhoea child 903 95.1% 456 93.6% 1359 94.6%

Total 949 100.0% 487 100.0% 1437 100.0%

Further analysis shows that of those households with hand-washing facilities those without soap were three times as likely to have a child under 5 years old suffer from diarrhoea in the two weeks preceding the survey (10.2%) than those households where soap was available (3.2%), highlighting the effectiveness of soap in killing harmful bacteria that can cause diarrhoea.

Table 7.1.4 Crosstabs between Under 5 Child and households having hand-washing facilities with soap

Under 5 Child

Yes, HH have hand-washing facilities No, HH have not hand-washing facilities

Soap is available Soap is not available Soap is available Soap is not available

Count Percent Count Percent Count Percent Count Percent

Under 5 diarrhoea child 23 3.2% 24 10.2% 0 0.0% 0 0.0%

Under 5 no diarrhoea child 694 96.8% 208 89.8% 0 0.0% 0 0.0%

Total 717 100.0% 232 100.0% 0 0.0% 0 0.0%

In regards to methods of water treatment for drinking water, those households with an improved water source and who used the correct method experienced fewer cases of diarrhoea in their child two weeks prior to the survey (4.6%) than those who used no method at all (5.6%). This trend is similar to findings from 2011 which reported 4.5% and 6.1% respectively.

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Table 7.1.4 Crosstabs between Under 5 child and having improved water sources during summer

Under 5 Child

Improved water source Unimproved water source

Correct method No method Correct method No method

Count Percent Count Percent Count Percent Count Percent

Under 5 diarrhoea child 21 4.6% 14 5.6% 19 5.0% 12 5.3%

Under 5 diarrhoea child 431 95.4% 245 94.4% 351 95.0% 214 94.7%

Total under 5 child 451 100.0% 259 100.0% 369 100.0% 226 100.0%

Hygiene and Sanitation Promotion Regarding hygiene and sanitation promotion, when household members where asked whether they had ever heard about the Four Cleanliness Program (Thant Lay Thant), only 19.4% said they had. The majority (80.6%) said they had not. Of those individuals who had heard for the program, 37.4% heard about it through the television and 32.5% through healthcare staff. INGOs, healthcare volunteers and radio accounted for 20.4%, 12.3% and 12.2% respectively. Only 4.9% said they had heard it from village authorities. When compared with findings from 2011, a similar trend is noticeable. Only 23.7% had heard of the Four Cleanliness program. Information about the program was primarily received through INGOs (34%), basic healthcare staff (34%), television (29%) and radio (14%).

Upon further analysis of current findings, differences in percentages between urban and rural channels of notification become apparent. As reported by urban households, the major channels of dissemination were through television (58.9%) and basic health care staff (23.9%). However, the opposite trend is apparent regarding rural households where notification through basic health care staffs accounted for 35.5% and television just 29.8%. INGOs, however, account for a much larger percentage in rural areas (25.3%) than in urban areas (6.3%). We can assume a lack of infrastructure (especially electricity), less access to electrical consumer goods, poorer households with less disposable income than urban households and a high presence of INGO staff in rural areas as the reasoning behind these results.Both, current findings and those from 2011, show that only 5% of individuals were aware of National Sanitation Week. In the qualitative study, if more males or females wash their hands were discussed. Many participants were of the opinion that females are more likely to wash their hands. “Females wash their hands more frequently than males do because females have more house work to do.—Female respondents, Toungup & Thabaung Townships.“Women wash their hands more often because they have to do more household work such as daily chores and cooking.”—Male respondent, Paukkhaung Township. Many participants were knowledgeable about the importance of keeping their hands clean. They knew that dirty hands can cause diseases. “Bacteria from hands can be detrimental to one’s health, if people feed food without washing hands. If hands are dirty, it can cause diarrhoea.” –Female respondent, Paukkhaung.“Not washing hands can affect the health of people. If we eat something with dirty hands, or we use dirty hands to feed others, it isn’t good for health. It isn’t hygienic for many people to use the

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same bowl wash their hands in it. We should wash our hands with soap.” –Male respondent, Wetlet TownshipOne of the topics discussed was how to disseminate health knowledge. “Many health talks should be held to educate the public about health.” Male respondent, Wetlet“There should be more health talks.”—Male respondent, Dawei.“There should be social workers who reach out to the communities to raise awareness about hygiene practices. Health talks could also be held in the communities. Public toilets should be built in market places, and health awareness messages could be depicted on billboards.”—Female respondent, Taunggyi Township Table 7.1.5 Individuals awareness about 4-cleanliness through social mobilization

Urban Rural Total

Count Percentage Count Percentage Count Percentage

Yes 205 25.8% 582 17.8% 787 19.4%

No 590 74.2% 2681 82.2% 3270 80.6%

Total 794 100.0% 3263 100.0% 4057 100.0%

In qualitative study the topic ‘children as agents of change for hygienic practices’ was discussed. The majority of people expressed that adults knew more about personal hygiene than children except for in poorer townships, such as Myebon and Kyaikmaraw, where respondents said that children knew more than adults as a result of primary school education. All participants said that the children learned about personal hygiene from school and/or their parents. When asked about the main personal hygiene practices the children have learned about, respondents gave a variety of answers: washing hands (after defecation and before eating), washing face, taking a shower, cutting nails and hair, combing hair, brushing teeth and wearing clean clothes; using soap when washing hands was also mentioned by a few respondents, but notably not all.It was also found that most children applied what they had learned at school. Only a few did not apply. Parents of those children who did not apply said they had to help implement good hygiene practices to ensure their child did not forget to implement such practices by themselves in the future. Some parents, however, did not follow such a routine: “Children do not practice the good personal hygiene habits because parents go to work early in the morning and cannot pay attention to the children. Poor families cannot practice good personal hygiene habits because of financial difficulties.” – Female respondent, Hlaingbwe Township. “The school children wash their hands more often because they know more about personal hygiene. The teachers teach them to wash the hands with soap.”—Female respondent, Wet Township.Another respondent (Demoso Township) said that children are unable to practice what they have learned because they are too busy helping their parents. Such examples express the existing barriers children face in applying what they have learned at school about hygiene practices.The overwhelming majority expressed that the hygiene practices children learned at school can be useful for adults too. As a result, most adults mentioned that children influence other household members on better hygiene practices: “The adults have also begun to cut their nails

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regularly, take a bath regularly and brush their teeth regularly.” – Female respondent from Taunggyi Township. As with findings from 2011, the main concern of the majority of participants for the village/community continual ‘open defecation’. The lack of water (particularly in Paukkhaung Township), improper disposing of waste and bad hygiene habits when it comes to washing hands (especially with soap) were also highlighted as areas of concern. The community perceived that in order to improve the situation, educational talks regarding health should be conducted to raise awareness about good hygiene practices. The need for latrines to discourage open defecation and the digging of wells for improved water supply were also highlighted. However, a lack of financial capital to implement these changes was expressed.

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8. PAUKKHAUNG TOWNSHIP ANALYSIS BETWEEN 2011 AND 2013 STUDIES

A base line data survey was conducted in Paukkhaung Township in both 2011 and 2013 to enable accurate comparative analysis to be drawn from the data collected.The percentage of households using improved drinking water sources across all three seasons – rainy, winter and summer, has increased significant in three years. In 2011 88% of households used improved water sources in all three seasons. In 2013 these figures are up by as much as over 10% to 97.2% + of households. In 2011, half of households consistently used tube well/boreholes as a water source, followed by a protected spring 20% and protected dug well (brick-lined well) 15%. Data collected in 2013, however, expresses a decrease in the usage of protected spring, with just 7%, corresponding with a rise in the use of tube well/boreholes to 64% of households. The percentage of households using protected dug wells (brick-lined wells) also increased but differed depending on the season – 21% during rainy season and 26% during winter and summer. As a result, the number of households using the main unimproved water source - unprotected dug well - fell from 11% in 2011 to 0.5% in 2013 across three seasons. However, statistics indicate a slight rise of 1% in the use of unprotected springs during the dry seasons.

Households using improved drinking water sources in all seasons

Rainy Winter Summer

2011 2013 2011 2013 2011 2013

Tube well/borehole 51.1% 63.6% 52.1% 64.0% 52.1% 64.0%

Protected dug well (Brick-lined well) 15.1% 21.0% 15.5% 26.6% 15.5% 26.2%

Protected spring 19.6% 6.1% 20.5% 7.0% 20.5% 7.0%

Rainwater collection 2.7% 8.4%

Improved water source 88.6% 99.1% 88.1% 97.7% 88.1% 97.2%

Unprotected dug well 11.0% 0.5% 11.0% 0.5% 11.0% 0.5%

Unprotected spring 0.5% 0.9% 1.9% 0.9% 1.9%Surface water (river, dam, lake, pond, stream, canal, irrigation channels) 0.5% 0.5%

Unimproved water source 11.4% 0.9% 11.9% 2.3% 11.9% 2.8%

Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

There has been a decline in the percentage of households who perceive the quality of their drinking water to be ‘absolutely clean’ from 20% to 8%, corresponding with an increase in the perception of ‘clean’ water from 77% to 83% and ‘normal’ from 3% to 8%. A similar trend is apparent regarding data on the perception of water used in the kitchen – a decline of 15% and 1.5% of those who believed it to be ‘absolutely clean’ and ‘clean’ respectively, and an increase from 2.7% to 19.6% of those who perceived water quality as just ‘normal’.

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Absolutely clean

Clean Normal Not clean Don't Know/ No response

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%20

%

77%

3% 0% 1%

8%

83%

9%

0% 0%

Household perception on the quality of Drinking water

20112013

The distance of latrines from a water source in Paukkhaung Township has generally increased in the three year period between base line surveys. In 2011, those latrines 10-29 feet away from a water source amounted to 9.7% whereas in 2013 this was recorded as 5.4%. Similarly those 30-49 feet away reduced in percentage from 19.5% in 2011 to just 9% in 2013, corresponding with an increase from 70.1% to 84.9% of latrines that were over 50 feet away from a water source.

Over 50 feet 30-49 feet 10-29 feet < 10 feet0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

70%

20%

10%

1%

85%

9% 5%

1%

Distance of latrine from water source

20112013

Rural households in Paukkhaung Township experienced a significant development in latrines between 2011 and 2013. The percentage of unimproved latrines fell by 3.4% and improved latrines rose from 61.8% to 74.6%. The amount of households with no latrine also fell from 32.9% to 23.7%. Data concerning urban households, however, did not express such changes. In fact, urban households experienced an increase of unimproved latrines from 0.0% to 2.2%.

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Latrine Type2011 2013

Urban Rural Urban RuralCount Column N % Count Column N % Count Column N % Count Column N %

Improved latrine 34 82.6% 96 61.8% 30 80.0% 105 74.6%Unimproved latrine 0 0.0% 8 5.2% 1 2.2% 3 1.8%No latrine 7 17.4% 51 32.9% 7 17.8% 33 23.7%Total 41 100.0% 155 100.0% 38 100.0% 141 100.0%

The increase in defecation and hygiene awareness of increased numbers of latrines could account for the increase in percentage of those from Paukkhaing Township using a latrine at home from 70.8% to 77.6% corresponding with a decline in those defecating openly in the field from 10% to 7.9%. However, data expressing an increase in the common practice of open defecation while at home, from 11.4% to 18.7%, indicates that while the trend of using latrines at home in increasing, further knowledge and awareness of good sanitation practices are still needed.

Defecation practice when at home

2011 2013

Count Column N % Count Column N %

Defecate openly in the field 20 10.0% 14 7.9%Defecate openly in the compound 1 0.5%Use latrine at home 139 70.8% 139 77.6%Use communal latrine 1 0.5% 3 1.9%Use other people’s latrine 36 18.3% 23 12.6%Total 196 100.0% 179 100.0%

Common practice of defecation while at home

2011 2013

Count Column N % Count Column N %Open defecate 22 11.4% 33 18.7%Not Open defecate 173 88.6% 146 81.3%Total 196 100.0% 179 100.0%

A general increase in the frequency of male adults, female adults and children (8-14) openly defecating at least once in the year before the basic line survey, from 11% to 17.3% for male adults and 11% to 16.8% for female adults supports the need for further education on correct defecation practices.

Regarding the individual or entity that urged participants of the base line survey to build their latrine, 31% in 2011 expressed health staff/employees, whereas 33.1% expressed so in 2013. The largest increase has come from ward/village officials with 21.9% in 2011 and accounting for 39.6% in 2013.

In terms of reasons behind why Paukkhaung residents did not manage to build and utilize their latrine, from both studies a lack of space to build or finances to fund a build were cited as the main reasons. However, the study from 2013 saw a distinct decrease those who expressed a lack of space from 34.8% to just 5.9% correlating with an increase in unaffordability from 56.5% to 76.5%.

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Main reason for not building and utilizing the latrine

2011 2013

Count Column N % Count Column N %No space to build it 7 34.8% 1 5.9%Can't dig the pit (hardness of earth) 1 5.9%Neighbours don't approve of 1 5.9%Can't afford to build one 12 56.5% 11 76.5%Not customary 1 4.3% 1 5.9%Don't know/No response 1 4.3%Total 21 100.0% 14 100.0%

Of those individuals who local residents have experienced checking and inspecting their latrines, there has been a decline in community health workers from 26.7% in 2011 to just 11% and an increase in a representative from the health department from 62.7% to 79.3%.

Individual who plays primary role checking the latrine

2011 2013

Count Column N % Count Column N %Community Health Worker 18 26.7% 8 11.0%Health dept 42 62.7% 54 79.3%Ward PDC 4 5.3% 6 8.5%Ward volunteer association (Maternal & Child Care etc) 4 5.3% 1 1.2%

Total 67 100.0% 69 100.0%

Regarding facilitating good hand washing practice after using a latrine, data from both base line surveys does not indicate any real change in the three years between data collections. In spite of this, there has been an increase in individuals from rural areas washing with soap after using the latrine from 72.3% to 80.4% and in particular, among those individuals who eat with their fingers from 46.3% to 51.7%, indicating an increase in awareness among people from rural area of Paukkhaung Township of the benefits of soap in preventing diseases.

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Availability of water and soap in toilets2011 2013

Count Column N % Count Column N %C.2.11 Is water available in toilet(s) during time of observation?

Yes, water is available 122 88.3% 122 88.0%No, water is not available 16 11.7% 17 12.0%Don’t know/No responseTotal 138 100.0% 139 100.0%

C.2.12 Is soap available in toilet(s) during time of observation?

Yes, soap is available 11 7.8% 13 9.6%No, soap is not available 127 92.2% 125 90.4%Don’t know/No responseTotal 138 100.0% 139 100.0%

The comparative study has indicated general improvements in the knowledge, attitudes and practices of residents from Paukkhaung Township, particularly in regards to using improved water sources, moving or erecting latrines away from water sources and defecation practices. In spite of this however, residents of Paukkhaung Township are held back from furthering personal and communal sanitation and hygiene levels due, in part, to financial constraints.

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9. CONCLUSION AND RECOMMENDATIONS

More than three-fourths of the current households reported about having access to improved water sources in the rainy reason and the proportion decreased to almost two-thirds in the dry season. More than a quarter of the households (26.9%) of the households said that they faced water shortage while only about one-fifth (19.4%) in the earlier survey reported a similar situation. Households covered in the 2011 survey had more access to improved water sources with 82.5% in the rainy season and 70.3% in the dry season. The two surveys did not find much difference in the households’ treatment of water. A total of 90% of the current survey and 89.2% of the earlier survey reported to treat their water meant for drinking in one way or another. However, majority of the households covered in both surveys passed water through a cloth filter, which is not considered adequate to significantly improve the quality of water meant for drinking. However, more than 60 percent of the households covered in both current and earlier surveys reported boiling water meant for drinking. The percentage of households who perceived the quality of their drinking water ‘at least clean’ was almost the same between the cohorts of households who participated in the two surveys. The percentages were 93.3% for the current survey and 95.0% for the earlier survey.

Knowledge about things that cause contamination of water at different sources does not differ much between respondents who took part in the two surveys. The three most common reasons cited in multiple answers were taking a bath/washing at the water sources, disposing trash near them and trash falling into them. More than 70 percent of the households were able to identify each of them. The proportion of current households who have access to improved latrines was higher compared to that of households who were involved in the earlier survey. About 90 percent—91.6% of the current households and 89.7% of the earlier households—reported having improved latrines. Findings from the current study show higher percentage of households without any latrine compared with the earlier survey. Both surveys showed a higher proportion of households without any latrine in rural areas compared to urban areas. They were 26.6% and 7.5% respectively in the current survey and 19.1% and 5.1% respectively in the earlier survey. The proportion of present households who were able to identify unhygienic or unsanitary defecation practices was 11% higher compared to those who took part in the 2011 study. However, the percentage of household members who reported defecating openly in the field also was recorded as 13.9% in the current study against 6.8% of the earlier one. The survey findings show that a great majority of children under 12 months old defected improperly and they were 80% from the current study and 75% from the earlier study. The proportions of children who defecated improperly dropped as they get older.

Findings from the two surveys did not show much difference between the two groups of household members aged 15-64 years in their perceptions about personal hygiene. Taking a bath, brushing teeth and washing one’s face were mentioned as the most common and the figures from the two surveys correspond very closely with one another.

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The percentage of households with incidents of a child suffering diarrhoea two weeks prior to the survey is very similar to findings from the earlier study at around 5%. Those households where soap was not available at their hand-washing facility were three times as likely to have a child under 5 years of age suffer from diarrhoea during this time period than those households where soap was readily available.

Level of knowledge about hygiene and sanitation practices did not differ much between respondents who had take part in the two surveys. However, focus group discussion revealed that children’s knowledge of basic hygiene practices is widespread but barriers, such as economic pressures on households, prevent some children from being able to practice what they have learnt.A lower percentage of the households covered by the present study have access to improved water sources compared with those who took part in the earlier study. It may be that the households or areas covered by the present study are more economically vulnerable or are less developed compared to those in the 2011 study. According to health officials, most households’ treatment of drinking water does not improve the quality of water for drinking purpose as they only pass water through a piece of cloth. UNICEF, or other stakeholders, who have a mandate to increase people’s access to safe and clean water shall take more measures for their target groups to have more access to water treatment systems such as ceramic filters or distribution of chlorine/bleach in order to significantly improve the quality of water. They may also engage in providing health education in which emphasis is given on treating water that could significantly enhance its quality such as boiling it.

The surveys asked households’ perception of the quality of their drinking water and about 90 percent of them said that it was clean. The questionnaire did not cover anything related to objective quality of the water. Such kind of question may be included in the future surveys so as to be able to gauge the quality of water, especially drinking water, scientifically.

Through the analysis of the responses on matters that could cause the contamination of water at the sources, during transportation and at the time of storage, the dissemination of health knowledge seems to have been effective. The percentage of current households who have improved latrines is higher compared with the earlier study. Relative to the proportion of households which have improved latrines across the country, those covered by both surveys are more likely to have these latrines. It could be that the areas have been covered by WASH programmes of UNICEF and that they have been benefited from the interventions through hardware or software support or both. Health education on the subject from other sources may also have reached areas covered by the surveys. The practice of open defecation still exists and a high percentage of children who do not defecate properly can still be found. These findings suggest that there is still a gap for the people, both adults and children, to practice sanitary defecation.

Focus group discussions reveal that men are less likely to wash their hands, children can be used as agents of behavior change and health messages can be disseminated through different forms of mass media or through people, who can be health staff or volunteers or outreach workers.

The two studies show there has been an increase in the percentages of households using improved drinking water sources across all three seasons – rainy, winter and summer between the two studies. Awareness about hygiene and sanitation has increased among the two cohorts. The distance of latrines from a water source in Paukkhaung Township has increased in principle, the percentage of households with no latrine fell, more people from urban areas are

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washing their hand with soap after defecation and there has been general improvements on health matters in the three year period.All these call for greater coordination and cooperation between civil society, non-governmental organizations and the government agencies to ensure that each and every household have access to improved water sources, have adequate knowledge about water, sanitation and personal hygiene, have access to improved latrine and practice sanitary defecation.

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Quantitative MethodologyHH interview

KAP with HH member 15-64 yrsKAP with child aged 8-14 yrs

Observation checklist

Qualitative MethodologyFocus group discussions with

general population

KAP SURVEY ON WASH IN 16 TOWNSHIPS IN MYANMAR

10. ANNEX

Research Design

The KAP study has used both quantitative and qualitative methodologies.

The quantitative methods include household interviews, individual interviews from household member (15 -64 years, selected using Kish Grid), Interview with child (8-14 years), and an observation checklist.The qualitative method includes focus group discussions with care givers and general population.

The combination of research methods provide a comprehensive assessment of the information on KAP on WASH from the 16 selected townships. Detailed methodologies for quantitative and qualitative components are presented below:

Quantitative ComponentIn order to be comparable, the same questionnaires and FGD guideline of 2011 KAP survey has been used with appropriate modification. There are four modules of questionnaire for quantitative survey namely—

1. Questionnaire for household2. Questionnaire for KAP with HH member 15-64 yrs3. Questionnaire for KAP with child aged 8-14 yrs and4. Observation checklist.

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Wards and villages covered

The number of sample households selected for the study is 4057 in total.

Sr Township Name S/D Name Region Total Sample HH

Urban Cluster

Rural cluster

1 Myebon Rakhine Coastal 206 206 206

2 Taunggup Rakhine Coastal 219 219 219

3 Kyaikmaraw Mon Coastal 313 313 313

4 Paung Mon Coastal 354 354 354

5 Kawthoung Tanintharyi Coastal 195 195 195

6 Dawei Tanintharyi Coastal 256 256 256

7 Deemawsoe Kayah Hilly 186 186 186

8 HlaingBwe Mon Coastal 281 281 281

9 Taunggyi Shan Hilly 346 346 346

10 Mongphyak Shan Hilly 179 179 179

11 Wetlet Sagaing Dry 259 259 259

12 Waw Sagaing Dry 272 272 272

13 Paukkhaung Magway Dry 214 214 214

14 Mahlaing Mandalay Dry 280 280 280

15 Pauk Magway Dry 256 256 256

16 Thabaung Ayeyarwaddy Delta 241 241 241TOTAL 4,057 4,057 4,057

Selection of Sample Wards and Villages

Urban (ward) and rural (village) clusters are allocated proportional size in each township.

Sample wards and sample village tracts has been selected by simple random sampling method. From each village tract, one village is selected by simple random sampling method. The selection procedure has been as follows:

Step 1: The list of urban wards and the list of rural village-tracts for each township is prepared.VT-Pcode and name of the village tract will be included in the list.

Step 2: By using random numbers, generated from computer, wards and village tracts are selected.Next, a village is selected from each village-tract by using a random number generated from computer.

The list of selected wards and villages will be submitted to UNICEF for approval. The locations of the villages and wards for each township will be provided together with GIS map so that UNICEF can see the locations of the sample villages and wards in the respective townships.

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Households covered

Sample Size- Wards, Villages, and Households in 16 Townships

Sr Township Name Region

# of Urban sample # of Rural sample # of total sample

Wards Household Villages Household Village & Wards Household

1 Myebon Coastal 1 27 7 179 8 206

2 Taunggup Coastal 2 46 7 173 9 219

3 Kyaikmaraw Coastal 1 25 12 288 13 313

4 Paung Coastal 1 35 13 319 14 354

5 Kawthoung Coastal 4 111 3 84 7 195

6 Dawei Coastal 6 146 4 110 10 256

7 Deemawsoe Hilly 1 28 6 158 7 186

8 HlaingBwe Coastal 1 20 10 261 11 281

9 Taunggyi Hilly 6 148 8 198 14 346

10 Mongphyak Hilly 2 43 5 136 7 179

11 Wetlet Dry 1 16 10 243 11 259

12 Waw Dry 1 33 10 239 11 272

13 Paukkhaung Dry 2 45 7 169 9 214

14 Mahlaing Dry 3 67 9 213 12 280

15 Pauk Dry 1 15 10 241 11 256

16 Thabaung Delta 1 14 9 227 10 241TOTAL 33 819 130 3,238 163 4,057

Selection of Households

Households has been selected by systematic random sampling method.Step 1: Total number of households in the selected ward/village is counted in the field. Step 2: The total number of households is divided by sample size to get an interval.Step 3: A starting point at the ward/village has been determined. (Before sampling, the

survey team looks around the village, and chooses the starting point as appropriate, mostly at the entrance to the village or from a significant building such as a school. In urban areas, residential wards are in blocks, and the starting point is fixed from a street corner.)

Step 4: A random number between 1 and the interval has been generated.Step 5: Suppose the random number is three, the third household from the starting

point is selected for the first interview. The next household is identified by adding the interval. In the case of multi-apartment buildings, the interviewer does the sampling clock-wise. He starts from the apartment on his left side on the ground floor, goes up the staircase, sticking to the left side while counting the interval, and from the top floor, he switches to the other half of the apartments.

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NOTE: If a selected ward/village is too big to count the households, the ward/village is divided into equal parts (for example, northern part, southern part, western part, and eastern part) and a part is selected at random. Households are selected from the selected part.

Selection of RespondentsFor the household questionnaire, household head or main care giver or a household member who can answer questions about the household will be interviewed. In each township, the field team has made sure that respondents to the questionnaires are gender-balanced. Household InterviewFor the HH interview, respondents will be selected based on their knowledge of different issues relating to WASH. Normally, the household head or the main care giver / mother will has been interviewed for this section.Individual interviews

A respondent aged 15 to 64 is selected from each sample household by Kish Grid method. This Kish Grid method will ensure that the selection of respondent is unbiased which is imperative in a KAP survey.

Interview with ChildA short interview with children aged between 8 and 14 years has been conducted to understand the knowledge, attitudes and practice towards various aspects of the WASH study.

Qualitative component

The study proposes to conduct three focus group discussions per township, one FGD in the urban area, and two in the village. Urban area focus group discussions have been a gender mix, while the rural FGD will be conducted with one male group and one female group, respectively.In total 48 focus group discussions has been conducted.

Each FGD will comprise of 8 participants. Participants for the FGD has been selected from households other than those selected for the HH quantitative survey.

The frame work for FGD is presented below:

No. State / Division Township Strata Urban Rural Total

1.Rakhine

Myebon Coastal 1 2 32 Taunggup Coastal 1 2 33

MonKyaikmayaw Coastal 1 2 3

4 Paung Coastal 1 2 35

TanintharyiKawthoung Coastal 1 2 3

6 Dawei Coastal 1 2 37 Kayah Demawso Hilly 1 2 38 Kayin HlaingBwe Hilly 1 2 3

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9Shan

Taunggyi Hilly 1 2 310 Mong Phyat Hilly 1 2 311 Sagaing Wetlet Plain 1 2 312

BagoWaw Plain 1 2 3

13 Paukkhuang Plain 1 2 314 Mandalay Mahlaing Dry 1 2 315 Magway Pauk Dry 1 2 316 Ayeyarwaddy Thabaung Delta 1 2 3

Total FGD 16 32 48

Deployment of Field StaffThe following calculations are based on one interviewer being able to conduct 4 households’ interviews per day.

No. Township State / Division Number of staff

Number of

sample HH

Number of FGD

Working Days

1Rakhine

Myebon4

206 335

2 Taunggup 219 3

3Mon

Kyaikmayaw6

313 340

4 Paung 354 3

5Tanintharyi

Kawthoung4

195 330

6 Dawei 256 3

7 Kayah Demawso 4 186 3 20

8 Kayin HlaingBwe 5 281 3 30

9Shan

Taunggyi6

346 340

10 Mong Phyat 179 3

11 Sagaing Wetlet 4 259 3 24

12Bago

Waw5

272 330

13 Paukkhuang 214 314 Mandalay Mahlaing 4 280 3 25

15 Magway Pauk 4 256 3 25

16 Ayeyarwaddy Thabaung 4 241 3 25

Total 50 4057 48 40

MSR will assign 50 field staff for the quantitative survey. Each team will comprise of five members (4 enumerators and one supervisor). There has been 11 teams deployed for the study. One-third of field staff has been full-time employees of MSR who have experiences in social surveys. The rest of interviewers has been part-time interviewers, who are on a roster of Myanmar Survey Research and who have been trained to do similar surveys and have had

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related experiences. The number of days for field work has been in the range of 24-40 days. Teams will enjoy a day off in a week. In addition, MSR will assign 6 people for FGD. Each FGD team will comprise of three members, one facilitator, one moderator and one note-taker.

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