Submitted to Oxfam GB Nepal by Deepak Timsina (Project Officer)

1. Baseline KAP Survey
(Knowledge, Attitudes and Practice)
Conducted in the frame of an ECHO funded project
“Water and Sanitation Support Program to Vulnerable Communities of Dailekh
and Surkhet Districts of Nepal”
Prepared by:
Deepak Timsina (Project Officer), and
Edited by Er. Pankaj Kumar Singh (Project Manager)
For
Oxfam GB, Dailekh Office, Nepal
February, 2010

2. 1
Table of Contents
Table of Contents ___________________________________________________________1
Table of Figures ____________________________________________________________1
INTRODUCTION ____________________________________________________________2
INTRODUCTION ____________________________________________________________2
Objectives of KAP Survey__________________________________________________________________2
Methodology and Sampling Technique________________________________________________________2
Calculation of sample size and sampling ratio (K):_______________________________________________2
Data Collection Tools _____________________________________________________________________3
Ethical Consideration _____________________________________________________________________3
SUMMARY OF FINDINGS _____________________________________________________4
1. GENERAL INFORMATION________________________________________________________4
1.1 Age group ___________________________________________________________________________4
1.2 Ethnicity_____________________________________________________________________________4
1.3 Sex ________________________________________________________________________________4
2. WATER AND FOOD RELATED INFORMATION_______________________________________4
2.1 Drinking water source in communities _____________________________________________________4
2.2 Fetching Time ________________________________________________________________________5
2.3 Cleaning of water collection container _____________________________________________________5
2.4 Water Collection and Storage ____________________________________________________________6
2.6 Knowledge on Water Treatment __________________________________________________________7
2.8 Food Handling________________________________________________________________________8
3. SANITATION RELATED INFORMATION ____________________________________________8
3.1 Latrine at household level, type of latrines and use ___________________________________________8
3.2 Observation of latrine __________________________________________________________________9
4. HAND WASHING KNOWLEDGE AND PRACTICE _____________________________________9
4.1 Knowledge of hand washing _____________________________________________________________9
4.2 Hand washing practice before eating ______________________________________________________9
4.3 Hand washing practice after defecation ____________________________________________________9
4.4 Hand washing material _________________________________________________________________9
4.5 Information on hand washing ___________________________________________________________10
5. Personal Hygiene______________________________________________________________10
5.1 Bathing Habit________________________________________________________________________10
5.2 Nail and Dress Observation: ____________________________________________________________10
6. Environmental Sanitation _______________________________________________________11
7. Diarrhoea Management_________________________________________________________11
CONCLUSION _____________________________________________________________12
Table of Figures
Fig. 1Drinking water source in communities.................................................................................................................4
Fig. 2 Container cleaning practice ................................................................................................................................5
Fig. 3 Container cleaning materials ..............................................................................................................................6
Fig. 4 Water collection and storage ..............................................................................................................................7
Fig. 5 Practice of water treatment at household level...................................................................................................7
Fig. 6 Latrine use ..........................................................................................................................................................8
Fig. 7 Hand washing materials used...........................................................................................................................10

3. 2
INTRODUCTION
With financial support from European Commission Humanitarian Aid Office (ECHO) Nepal
Oxfam GB has been implementing “Water and Sanitation Support Program to Vulnerable
Communities of Dailekh and Surkhet districts” through three different partners namely-
Environment Development Society (EDS) Surkhet, Sustainable Development and Environment
Conservation Centre (SuDECC), Dailekh and Rural Reconstruction Nepal (RRN). This project
covers a total of 15 communities, 10 in Dailekh and 5 in Surkhet district. The project
implementation period is from 01 July 2009 to 31 July 2010.
Objectives of KAP Survey
1 To identify gaps in knowledge regarding health, hygiene and sanitation and existing
practices leading to negative impact on health.
2 To describe the socio-demographic, cultural information of respondents and the
communities.
3 To create database for comparing the effectiveness of the project for project monitoring.
Methodology and Sampling Technique
Systematic random sampling method was applied for data collection. Total number of
beneficiary household is 1655. The sample size was 331 (20% of the total households of the
target communities). The methodologies used for KAP survey were direct observation and
interview using standard questionnaire developed based on LFA indicators.
To ensure homogeneity, the enumerators (Public Health and Social Mobilizers of this project)
received a day-long orientation on sampling, data collection, editing and coding. For sampling,
enumerators prepared the list of households and identified sampling ratio (K).
Calculation of sample size and sampling ratio (K):
Generally a sample size between 10% and 20% is acceptable for KAP survey. The Public
Health Team, OXFAM GB Nepal and its implementing partners (IPs), decided to consider 20%
of the beneficiary household as sample size. For a total of 1655 beneficiary households, the
sample size comes to 331 (20% of 1655).
‘K’ value can be calculated using
K=1553/331= 5 (K= N/n, where, N= Population size and n= sample size)

4. 3
In the beginning, the enumerators numbered all beneficiary households separately for each
community and then selected a number between 1 and 5 (sampling ratio). This number referred
the first sample household and other sample households were those whose serial number is the
number of first sample household plus 5 and so on.
Data Collection Tools
Data was collected by using the standard questionnaire developed for this survey using LFA
indicators. In addition, direct observation was also used for the survey. Questionnaire was pre-
tested in the field and necessary modifications were made.
Ethical Consideration
Verbal consent was taken from the respondents prior to data collection after explaining the
purpose of the study. Respondents were informed that they could request the interviewer to skip
the questions or reject interview at any time when felt necessary.

5. 4
SUMMARY OF FINDINGS
1. GENERAL INFORMATION
1.1 Age group
The respondents were aged between 16 to 50 years.
1.2 Ethnicity
47.6% of respondents were Dalit and ethnic minorities whereas 52.4% of respondents were
from higher caste (Brahman/Chhetri).
1.3 Sex
Among the total respondents, 53% were women and remaining 47% were male.
2. WATER AND FOOD RELATED INFORMATION
2.1 Drinking water source in communities
79% households collect water from unprotected springs, 12% households collect water from
unprotected piped water schemes (pipe provided by village development committee/district
development committee and laid without proper design) and remaining 9% households collect
water from other water sources such as shallow well (kuwa) and stream.
79
12
9
0
10
20
30
40
50
60
70
80
Respondents(%)
Unprotected
springs
Unprotected
piped water
schemes
Kuwa and Stream
Drinking water source
Fig. 1Drinking water source in communities

6. 5
2.2 Fetching Time
Travel time to source: The median time spend on travelling to the water source is 10 minutes
(Range: 1 minute to 60 minutes) with standard deviation of 8.6, which means there is huge
variation in the duration of travel time.
Waiting Time: The median time spend on waiting at source is 10 minutes (Range: 1 minute to
240 minutes) with standard deviation of 32.8, which means there is huge variation in the
duration of waiting time.
Return Time: The median time spend on return from source is 10 minutes (Range: 1 minute to
180 minutes) with standard deviation of 17, which means there is huge variation in the duration
of return time.
2.3 Cleaning of water collection container
Most of the households practise cleaning of container before collecting water from source;
however most of them use unhygienic material for cleaning. 85% households responded to
cleaning their container before collecting water, 14% households responded to not cleaning it
before collection and 1% household did not reply. However, based on observation it was found
that only 59% of the households cleaned their water collection container before collecting water
from source.
Container cleaning practice
Yes
85%
No
14%
Did not respond
1%
Fig. 2 Container cleaning practice

7. 6
To clean the container (n=280), 49% of respondents use ash, 22% use mud, 19% use soap, 1%
use detergent, 5% use hay, straw or leaves and 5% used sand.
Container cleaning materials
49
20 19
6 6
0
10
20
30
40
50
60
Ash Mud Soap Sand Hay, straw or
leaves
Response(%)
Fig. 3 Container cleaning materials
2.4 Water Collection and Storage
Beneficiary households use a variety of container for collecting water from sources ranging from
pitcher to utensils. 3% household use pitcher and bucket, 12% households use pitcher and
jerrycan, 65% households use pitcher only, 7% households use bucket only, 2% households
use jerrican only and remaining 11% households use other containers such as drum and
utensils.
In two-third households, water storage container was found covered whereas in remaining one-
third households, water storage containers were without lid.

8. 7
3
12
65
7
2
11
0
10
20
30
40
50
60
70
Response(%)
Pitcher
and
bucket
Pitcher
and jerry
can
Pitcher Bucket Jerry can Utensils
Water collection and Storage
Fig. 4 Water collection and storage
2.6 Knowledge and Practice on Water Treatment
45% respondents are not aware of household water treatment and 60% households do not
practise household water treatment. Out of 40% those practise household water treatment, 48%
households use boiling, 19% households use filter, 31% households use chlorine solution such
as Water Guard and Piyush and remaining 2% practise SODIS (solar disinfection).
48
19
31
2
0
10
20
30
40
50
Response (%)
Boiling Filter Chlorine SODIS
Practice of water treatment at household level
Fig. 5 Practice of water treatment at household level

9. 8
2.8 Food Handling
Even though most of the household keep cooked food covered, often they consume stale food.
79% of the households keep food covered, however, the consumption habit of stale food was
not satisfactory. Only 47% respondents mentioned that they washed fruit thoroughly before
eating.
3. SANITATION RELATED INFORMATION
3.1 Latrine at household level, type of latrines and use
Baseline KAP survey data shows that only 32% of the households have latrine. However, only
10% households have sanitary latrine. Other existing latrines are temporary in nature and
unsanitary. Majority of the respondents defecate in jungle (42%), 11% of them defecate in
river/stream and remaining 15% defecate in field and along roadside. However, of all the
children 28% defecate in toilet, 22% defecate in jungle, 22% defecate in the premises of the
house and remaining 28% defecate in field, river/streams and along roadside.
22
28 28
22
0
5
10
15
20
25
30
Response(%)
Jungle
Field,R
iver/Stream
and
Road
Toilet
Prem
ises
of house
Latrine Use
Fig. 6 Latrine use

10. 9
3.2 Observation of latrine
Existing latrines were visited to check the cleanliness and during visit, it was found that only
22% of existing latrines were clean while only 15% of them were equipped with brush and water
bucket for cleaning. The reasons of not having cleaning brush and water bucket were lack of
water, cleaning chemicals, money and lack of knowledge and attitude.
4. HAND WASHING KNOWLEDGE AND PRACTICE
4.1 Knowledge of hand washing
Most of the respondents (84%) know the importance of hand washing especially after
defecation and before eating. However, only few respondents are aware of (13%) importance of
hand washing after cleaning baby’s bottom. The reason behind the good knowledge (especially
hand washing after defecation and before eating) can be easily predicted. During last year
diarrhoea outbreak, mass campaign including mass communication through radio and TV was
launched and hand washing before eating and after defecation was very much highlighted.
4.2 Hand washing practice before eating
Hand washing practice among the adult respondents was good (92%). However, it among the
children was not satisfactory (only 71% of all the child respondents practise hand washing
before eating and 4% of them do not wash hand at all).
4.3 Hand washing practice after defecation
Hand washing practice among the adult respondents was good (90%). However, it among the
children was not satisfactory (only 68% of all child respondents wash hand after defecation).
4.4 Hand washing material
Hand washing materials used were soap (66%), followed by water only (20%) and ash (14%).

11. 10
66
14
20
0
10
20
30
40
50
60
70
Response(%)
soap ash water
Hand washing materials used
Fig. 7 Hand washing materials used
4.5 Information on hand washing
Radio was the main source of information (73%) on hand washing followed by health personnel
(50%) and ECHO-WatSan staffs (43%). Some of the other sources of information were
teachers, seniors and parents.
5. Personal Hygiene
5.1 Bathing Habit
The baseline data shows communities were aware on personal hygiene like bathing, nail cutting
and washing clothes. But more than a half (56%) of the respondents were found bathing only
once a week and 15% of the respondents had poor bathing habit (responded to the option- ‘do
not know, sometimes after many days’). Two-third (66%) of the respondents bathe at spring,
20% respondents go to river/stream for bathing and remaining 14% bathe at home with water
collected from spring.
5.2 Nail and Dress Observation:
More than half (60%) of the respondents had their nails well trimmed. This is a good result in
itself but the remaining 40% had too long and dirty nails. Regarding the dress, 14% of the
respondents wore very dirty clothes and almost three-fourth (73%) of the respondents wore dirty
clothes. The remaining 13% respondents wore clean clothes.

12. 11
6. Environmental Sanitation
Only 22% of the households use wastewater (grey water from kitchen, bathing and washing) for
kitchen gardening and the same percentage of households have solid waste disposal pit.
Enumerators observed that only 35% of the household use pits for animal dung disposal. Only
39% households have separate house for living and animal shed.
7. Diarrhoea Management
Most of the households visit local health centres to seek treatment for diarrhoeal diseases. 94%
households visit local health facilities to receive treatment for diarrhoeal diseases. Remaining
6% still believe in traditional healers. Ninety-one percent of all the respondents had heard of
Oral Re-hydration Solution and 56% of them responded that they could prepare ORS by
themselves.

13. 12
CONCLUSION
During the implementation of ECHO-WATSAN project, construction and maintenance of latrine,
hand washing among children and hand washing after cleaning baby’s bottom, use of soap for
hand washing, use of hygienic material for water collection container, covering of water storage
and collection container and proper management of solid and liquid waste should be
emphasised.