Sanitation in Riverine Areas: the Anomaly of Access and Health Outcomes in the Niger Delta

Globally, efforts are renewed towards achieving universal access to sanitation by 2030 through the Sustainable Development Goals Six. Previous efforts focused mainly on increasing access but evidence is mixed on the impact of increased access to sanitation on health outcomes like diarrhoea. This study explores sanitation in riverine communities of Nigeria. Riverine communities in the Niger Delta region of the country have one of the worst sanitation access rates in the country yet the best reported health outcomes for diarrhoea.
To understand this anomaly, a mixed methods study was carried out in two riverine communities of Bayelsa State, Nigeria. The study assessed access to water and sanitation infrastructure in the study communities and perceptions, behaviors and attitude to water and sanitation using seven focus group discussions, twenty six semi-structured interviews, four school surveys and 723 households’ surveys. To examine resultant faecal contamination levels in stored household drinking water and how this differs between households with access to a toilet and those without, microbiological examination was carried out on water samples from a randomly selected subset of households 50% with access to a toilet at home and 50% with no access. The water samples collected were from stored household drinking water, source water and hand rinse samples and were analysed for E.coli as an indicator of faecal contamination. Following from the results of the aforementioned, plausible faecal contamination transmission pathways resulting from current sanitation practices were explored.
Findings show direct defecation into the river and the use of flush toilets were the most common sanitation in use.
Boreholes and the river were the main sources of drinking water and these were with mean concentrations of E.coli at 4.44 x 102 and 1.29 x 103 CFU/ml respectively. Treating drinking water was uncommon except for the use of alum to treat river water and camphor balls in stored drinking water. Three main defecation behaviours were identified. Direct defecation into the river, use of poorly constructed toilets and open defecation in nearby bushes. Poorly constructed septic tanks resulted in backflow of sewerage into households in the rainy season. Septic tanks were leaking sewage into the environment. Perceptions showed that both communities were happy with their current behavior of defecating in the river and improved water sources were preferred especially for ease of access. Existing water and sanitation facilities in these communities are inadequate. The microbiological analysis of water samples showed faecal contamination concentrations were higher in households with access to a toilet than those without access.
Examination of plausible faecal contamination transmission pathways in these communities highlights poorly constructed toilets pose the biggest risk of exposure to faecal contamination. This study concludes that in riverine areas where the behaviour, environment and health outcomes are similar to the study communities, increasing access will only be valuable if it contains faeces adequately at source and does not in itself introduce faecal contamination closer to home and people. Though, this study does not undermine the importance of toilet access.
This study makes significant contribution in providing strong evidence in support of the more ambitious nature of Sustainable Development Goals six towards ‘safely managed’ sanitation ‘for all’ and access to water of adequate quality beyond the Millennium development goals target of access to sanitation and an improved water source.