Exploring the contribution of basic water hygiene practices, income and education level in the variance of diarrhea incidence among households in the health zone of Mpokolo in Eastern Kasai Province (Democratic Republic of the Congo)

Strategies for enhancement of water hygiene practices, incomes and education have been increasingly considered to achieve millennium development goals. However, no known study has yet explored the specific and combined contribution of water hygiene, income and education in the reduction of the burden of endemic diseases such as diarrhea in Eastern Kasai. Moreover, although water hygiene, income and education conditions have been anecdotally described as deficient, no empirically established community based measures exist to enable policy-makers to formulate sound development objectives for Eastern Kasai communities. This study describes the situation in one of the fifty health zones of the province and explores the extent to which the incidence of diarrhea could be explained by income, education, treatment of water before consumption, hand washing with soap after wiping a child that has just finished toileting and daily bathing. A survey of adult members in 588 households was conducted in 2007, providing, among other things, data on the aforementioned variables. Descriptive and stepwise regression analyses were performed. About 61% of households have had at least one case of diarrhea in the 6 months prior to the survey; 42.5% usually take a daily bath; 32.1% wash hands with soap after wiping a child; and 13.9% treat their drinking water before consumption. The per capita average monthly income is US$ 1.08 (n = 526 and S.D. = 0.806). About 47% of household heads have 6 years of elementary education or less, 42.7% have the equivalent of four or six years of high school education; and 10.3% have a college degree. Variance in diarrhea incidence is explained respectively by income, education and water treatment habit, but not by the other two water hygiene variables (R Square Change = .227, F-Change = 0.052; p = .046). Acute poverty, lower school attainment and widespread lack of basic water hygiene contribute to higher incidence of diarrhea. In the context of health promotion and diarrhea reduction in Eastern Kasai, the enhancement of income, access to higher education and adoption of safer water hygiene practices should be pursued with higher priority and based on adequate understanding of the underlying causes of the current low performance in each of these dimensions.