Toward Sustainable Community Health Through Participatory Water and Public Health Education Programs in Southeastern Uganda

Achieving access to safely managed water resources, sanitation and health requires multifaceted approaches in public health education programs through public-private partnerships. This study assessed the impact of public health education programs of the Center for Sustainable Rural Livelihoods and Iowa State University Uganda Program on household water access, WASH facilities, sanitation, and morbidity in Kamuli district, Uganda. We surveyed 454 households, among whom 55.1% attended public health training. Among the four public health education modules trained, 99.2, 86.8, 84.4, and 80.4 percent of households trained on WASH, sexually transmitted diseases, pregnancy health, and jigger (sand flea) and rat control, respectively. Most households (86.8%) participated in all four modules, and 74.8% attended between 9-12 rounds of training. All trainees scored at least four of six points in knowledge comprehension assessments, which has positive implications for implementation and behavioral change. In water access, overall, 87.2% had access to water from boreholes, 95.8% accessed it within two kilometers, and 62.6% spent ≤30 minutes on the round trip. In implementation, trained households (65.6%) were statistically associated with possession of at least four WASH facilities than 57.4% of non-trained. WASH facilities included latrines, bathrooms, kitchens, rubbish pits, tippy taps, and plate stands. Similarly, 57.2% of trained households were associated with possession of clean WASH facilities than 53.4% of non-trained. On morbidity, 30 days before the survey, 95.4% households reported having experienced WASH-related diseases. Overall, the poor structural and unhygienic state of WASH facilities were statistically associated with occurrences of malaria, diarrhea, and dysentery, affecting mostly non-trained households. Community education on water resources and WASH facilities should be prioritized to reduce household predisposition to related illnesses and fostering participatory monitoring of the implementation of WASH programs.