Assessment of Knowledge, Attitudes, and Practices of Community Health Workers on Household Sanitation and Hygiene in Rural Tanzania

Background: Access to improved sanitation, adherence to good hygienic practices, and adequate supply of safe water are very crucial factors for the health and well-being of people within the household and the entire community. Household sanitation and hygiene promotion has largely been done by community health workers in most places in Tanzania and worldwide, especially in rural and marginalized areas. Despite the presence of community health workers in Tanzania as primary health providers, WASH-sensitive indicators such as diarrhea, stunted growth, and typhoid are still high. However, little has been done to assess their knowledge, attitude, and practices regarding household sanitation and hygiene. Aim: This study aimed to assess knowledge, attitude and practices among community health workers on household sanitation and hygiene at Mbarali and Mbeya rural districts in Mbeya region, south-west highlands of Tanzania. Methods: The study used a descriptive cross-sectional design. The sample size was estimated by using Yamane formula for calculating sample size. Data for the study were collected for one month, questionnaire guide and observation checklist were used as data collection methods. Data were entered in STATA version 15 databases by two research assistants, and then data were cleaned, validated and analyzed. Descriptive analyses included frequencies and percentages of socio-demographic characteristics such as age, sex, education, knowledge, attitude, and practice of hygiene and sanitation. To determine the association between socio-demographic characteristics and respondents 'KAP, a bivariate chi-square test was conducted. A threshold of 0.05 p-values was used for statistical significance. Results: A total of 391CHWs were recruited. Out of 391CHWs, 184 (47.1%) had adequate knowledge regarding household sanitation and hygiene, while 207(52.9%) CHWs had inadequate knowledge. 74.4% of the CHWs had a positive attitude towards, whilst 25.6% of the participants had a negative attitude regarding household sanitation and hygiene. A total of 128 (33.0%) had good practices, while (67.1%) of the participants had poor practices regarding household sanitation and hygiene. High education level and the short period from the last training on sanitation and hygiene were found to be associated with adequate knowledge (p=0012) and (p=0.008) respectively. Female participants were found to have good practices (p=0.015) than their counterparts. The observation checklist revealed that, of the total 391CHWs, 206(52.7%) CHWs didn’t receive the needed cooperation from the community members, though they had all the necessary equipment for home visits. On house-to-house visits, only 28 CHWs had all the necessary equipment. None of the CHWs had allowance at the end of the visit. Conclusion: The findings of this study underscore the need to check CHW programs to match their needs as per their roles to strengthen the knowledge, attitude, and practices hence ensuring efficiency in their provision of primary health services and promotion of improvement in household sanitation and hygiene particularly in household sanitation and hygiene.