The Trilemma of Globalisation: Free Trade, Fair Trade or Fear Trade

Ken Costa Chairman: Europe, Middle East and Africa UBS Investment Banking Department 2 Finsbury Avenue London EC2M 2PP Cass Business School 2 March 2006 EMBARGO UNTIL 19:30pm 2 March 2006 The Trilemma of Globalisation: Free Trade, Fair Trade or Fear Trade In discussing the challenges presented by today’s diverse global environment few topics can be as important as the issue of globalisation. It is at the heart of the structural change that has taken place in our generation as borders have shrunk, technology changed and communications enhanced.Economists believe – almost universally, which says something(! ) that globalisation is a net benefit. But, if recent examples are to go by, there seems to be a growing doubt gnawing at its foundation. Globalisation faces a trilemma. Which is to be master? Free Trade, Fair Trade or Fear Trade. Free Trade For globalisation to succeed there needs to be a common acceptance of the frictionless flow of capital across borders and the det ermination to eliminate 2 impediments to the free movement of resources and products. Free trade is the pillar on which the argument for globalisation is founded.For the last decade we have lived with the prevailing sense that the globalised environment is here to stay. There has of course been a vigorous debate about how the benefits should be shared, the implications of the growing technology divide and the sustainability of regional development. But by and large the foundations have been in place. What has become disquieting recently has been the realisation that some of the most basic premises of globalisation are far from secure. The case for globalisation still has to be made. Globalisation still needs to be nurtured as a beneficial system and hown to be demonstrably favourable to all participants in the global market place. This is an argument that needs to be advanced and argued for and can not merely be assumed. Fear Trade But free trade seems to have been supplanted by fea r trade. The recent actions in the United States to prevent the completion of the acquisition by the Dubai Ports World of the US ports previously owned by P&O underlines the serious challenge to the argument. Here we have the US, the major exemplar of modern capitalism, wishing to restrict the take-over by one foreign company of another foreign company with operations in the United States.This action is unfortunately not an isolated example, it comes sharply on the heels of the decision to prevent CNOC, a Chinese company, from acquiring Unocal in the US. The ports case has become a testing place for the future direction of globalization. At issue is ownership. There are after all in any market regulations that govern ways in which corporations 3 act. In any event these ports will overwhelmingly be run by and managed, as they have been in the previous foreign owners’ hands, by US citizens. Of course there are arguments for national security.That would be true in any country. B ut it is of deep concern when these concerns are deployed selectively discriminating between one foreign owner and another. Friends of the United States, and I count myself as one, will do the country the highest favour by lobbying actively against these barriers. Not only on their merits but also because of the sign that is given. Free trade flourishes in a climate of reciprocal openness and mutual advantage, fear trade now seems to be an underlying assumption lurking not only in this decision in the United States but in other countries as well.Security, national interest, cultural preservation and other nationalist reactions can easily stoke these fears. Italy have complained about protectionist activities within the European Union, but recently, albeit unsuccessfully, Italy attempted to prevent nonItalian acquisitions of domestic banks. In France, the Prime Minister has attacked â€Å"fragmented share capital† as being a risk to independence and is looking to bolster the b arriers to takeover activity in France. These trends will grow if the strongest and freest markets continue to act in a protectionist way.Those committed to developing sustainable and responsible flows of capital worldwide have a full task to remain vigilant to promote vigorously the need to have a competitive and sustainable global economic order. 4 All participants in the global economy, Government, business, consumers, will need to find a common language to prevent misunderstanding and actions that could easily lead to disastrous protectionist decisions similar to those in 1914 or the 1930’s. Protection can grow rapidly fuelled by job losses, eroding cultural influence, security concerns and ultimately the visceral reaction against foreigners.The openness of markets to trade and to the acquisition of assets lies at the centre of the future prosperity for all. There are risks if this protectionism grows unchecked. Inflation will creep back because the benefits of globalisat ion will not be felt, interest rates will therefore inevitably hedge higher with a sell-off in the bond markets, pressure on the equity markets and the inevitable liquidity problems could lead to capital controls. A dark scenario and one which I believe is avoidable.But it does require a concerted effort to win both the economic argument but also the ethical ones. Fair Trade Fair trade has therefore emerged in the debate. Unfortunately the concept seems to have been colonised by particular single interest lobby groups seeking to address for example levels of sub-economic activity in Africa and arguing for an increase in the price structure of consumer goods in the developed world. In the end the fairest trade will still be the freest provided the benefits are seen to be shared equitably.Globalised markets have to, and above all be seen to, benefit all: the strongest and the weakest. When the strong economies wish to exclude access to them by emerging economies the very base of the a rgument is eroded. For this reason, and in a different 5 sphere it remains a moral affront to those who are committed to future global prosperity that the WTO is unable to reach agreement to allow access, without the burden of duties, by the developing world to the markets of the economically prosperous world.The diverse global environment raises questions of standards and sustainability of economic activity. These are moral issues. They should be tackled as such. But that does not mean that they are not economic ones too. Take for example one of the questions that is posed by globalisation. Is the move away from regulated markets to unregulated ones simply a means of avoiding the high hurdles of regulation in the developed world? Take the tobacco industry for instance.Do the global tobacco companies seeking entrance into new markets do so in order to evade the onerous restrictions of the major OECD markets? Similarly polluting factories in third world countries where the desire for employment places pressure on local governments to allow activities which would be frowned on in the home countries of multi-national corporations. Low labour costs have brought huge advantages to consumers in the Western world but at what cost to the emerging markets in which they operate?But the moral debate is not a one way street. The clash of civilisations was a debate in ancient Rome and Greece long before Huntingdon raised the topic, but globalisation now means that people find out much more about each others’ cultures much more rapidly. It is true that many international corporations have seen their numerators expand as the top line has grown through sales to emerging markets. Similarly, the 6 denominators of the P & L have benefitted as costs have shrunk through outsourcing and manufacturing at lower costs.But on the other hand many emerging markets have also benefitted as their standards of living have increased and transparency has grown. If we wish to make povert y history and I profoundly hope that this objective remains at the forefront of every global citizen then it will come about by working with the grain of capital flows, by recognizing the reward for risk and through supportive actions by Government creating the climate for enterprise to flourish. We work on the natural assumption that it is a good thing to understand each other’s cultures, aspirations and diversity.However we do have to work on one unfortunate fact of human life. It is not good news but bad news that travels fastest. The Danish cartoon incidents and the activities of radical minorities are flashed across our screens and soon become representative of the cultures being depicted. Every global business will need to develop the necessary training programmes not only to enable the free flow of information to work effectively but to determine how globalising information could bring together incompatible elements of culture.Essentially this is a political question à ¢â‚¬â€œ how can free speech and cultural sensitivities be reconciled? But ultimately it will be on the ground an important issue for businesses who try to create core values for global workforces. Will education of itself lead to greater tolerance? This is a topic too large for this address. But suffice it to say that education and prosperity will not of themselves eliminate global tensions though they are essential pre-requisites. 7 8 Diversity Diversity is important to this process.Diversity enhances competitiveness enabling the most innovative, creative solutions to be advanced as perspectives, eclectically drawn across cultures, countries, products, markets are pooled to provide answers to the issues of the day. For example, UBS needs talented people who can efficiently and effectively work across multiple cultures and time zones. Diversity is therefore not an issue merely of gender or ethnicity but it reflects an open and flexible culture which tries to understand the motivatio ns and aspirations of different people and their points of view.These dialogues above all are integrated into the day to day operations of the firm. To respond to the pressures and to come up with innovative solutions requires close co-operation and the working together of a very disparate group of people with a very common set of values and a common desire to understand and appreciate the ways in which common goals can be achieved whilst recognising diverse and local aspirations. There is I believe an even more fundamental issue that will require addressing. There is strong evidence that in a young and mobile workforce material satisfaction is not sufficient to retain their commitment and motivation.There is a deep hunger, almost spiritual, that is diffused and not traditionally expressed but which needs addressing. There is a desire among young people across the globe that there is more to life than the pursuit of material prosperity. Concern for the environment, for just practice s in the workplace and for a balanced working life are key themes in this emerging generation. Traditionally this has been a â€Å"no go† area. After all religion and work do not mix. But any desire for a values-based organisation will require 9 careful attention to be given to a much deeper understanding and respect for he religious beliefs, cultural and spiritual aspirations of this new global workforce. A new dialogue of understanding faith in business space is rapidly becoming a global imperative for business. Securities Industry Having made these general remarks it is worth looking at trends in the financial industry. ?Expansion of the Business: Financial sector activities are likely to experience substantial growth over the next decade. Two reasons can be singled out: Deregulation and liberalization mainly in emerging markets, and wealth accumulation and retirement provisioning all over the world. Over the past few decades, the trend towards deregulation and liberalizat ion in financial services has contributed significantly to the industry’s expansion. This process is well advanced in many countries, mainly in the mature markets, but further liberalization is, however, likely in emerging market countries where domestic markets are still highly protected. In general, further liberalization of financial markets is expected to benefit investment banking and securities firms which are positioned to 10 ake advantage of any further opening of individual domestic capital markets. Global asset managers could benefit from the facilitation of cross-border mutual fund business, and possibly from a trend towards harmonized pension fund regulation. †¢ Especially in mature markets, but basically to a global extent, financial sector activities are also likely to gain further importance, mainly due to two trends: On the one hand, wealth accumulation is likely to increase as a result of the shift from labour-intensive production to more capital-intensi ve activities.We see a clear secular trend towards wealth accumulation that is likely to continue over the next decade. On the other hand, the fact that in the coming decades, most developed countries will be confronted with significant demographic shifts leads to a trend that pension reform is on the agenda of many governments around the world. Although each country will follow its own regulatory agenda, we believe a gradual shift from public unfunded to private funded pension schemes is likely to take place. Institutional asset management will be the sector most impacted by this trend. ?Increasing Diversity of the Business: Financial market products are getting increasingly diverse and sophisticated with the main characteristics being securitisation, equitisation, and corporate restructuring. 11 †¢ The transformation of financial services over the last years has been driven primarily by the increasing de-emphasis of traditional lending activities combined with the increasing importance of securities trading and financial markets. Corporations are frequently in a position to directly finance their funding needs by accessing the capital markets, expanding corporate bond markets.At the same time, an increase in bank assets has fueled growth in the securitisation of these assets. We expect these trends to continue, as increasing transparency will further facility financing by way of the securities market. †¢ Despite the bursting of the new economy bubble, the underlying trend towards an increasing role of equity finance and equity investments remains intact. Institutional and individual market participants will tend to invest a greater share of their assets into equity products and the corporate sector will increasingly rely on equity financing. We see long-term secular trends pointing towards an ongoing demand for advice on corporate restructuring, as trade liberalization and technological progress will increase global competition for corporations, pr essuring them in turn to restructure and consolidate their business.At the same time, cross-border consolidation in some industries has just begun. ? Further internationalization of business and new markets: It is crucial for financial sector firms to have at the same time both a strong 12 footprint in mature markets and expand actively into emerging markets. Economic growth is a key indicator of the potential for financial services in different regional markets. We expect the largest absolute GDP increase over the next 10 years to occur in North America, followed by Asia and Western Europe. Even though North America is set to grow at a slower rate than Asia, the absolute GDP increase will be higher. This demonstrates the importance of having a significant presence in the US and other mature markets. †¢ At the same time, emerging markets, especially emerging Asia, have a huge potential.GDP growth in China averaged more than 9% since 1979, and India is on track to achieve a high sustainable growth path in the foreseeable future. Other markets in the region are benefiting from the increased demand in the region and globally, increasing the attractiveness for global financial firms. Another important emerging area is the Gulf region, driven by sky-high oil prices and some first steps towards a further diversification of the countries’ economic structure. Based on remarkable macroeconomic stablisation efforts in recent years, Latin America finally seems to have overcome its historical volatility, providing interesting nvestment opportunities. 13 ? Alternative Asset Managers: Hedge funds and buyout groups are raising ever increasing sums of money to be deployed principally cross border. The current size of the hedge fund market is estimated at US$ 1. 2 trillion and will expand significantly in the years ahead. Highly liquid and mobile capital should not be seen as restless capital. Opportunities for long term foreign direct investments in the emerging m arkets continue to grow as infrastructure projects absorb capital and new investment opportunities allow for petro dollars and other pools of investment funds to help grow these economies. ChallengesAn international presence in diverse global environment creates substantial challenges. Global firms have to integrate diverse cultures, strike the balance between global reach and local presence, match the structure and characteristics of its international workforce with functional and regional business needs, and establish infrastructure and processes to provide global communication and co-operation means. ? Integrating cultural diversity: A global firm’s clients and employees are generally, at least to a significant extent, not global in their nature and characteristics, but are based and anchored in their respective home countries.This determines a broad variability of cultural and religious habits, business styles and customs, and consumptions models and needs a global firm i s confronted with on a day by day 14 basis. In order to achieve long-term profitability and growth, this variability has to be managed and integrated into the firm. ? Striking the balance between global reach and local presence: In order to be perceived as a global player, global firms have to establish a global strategy and business model.At the same time, due to the cultural diversity mentioned above, specific market and customer orientation has to be focused along country-specific needs. This is true for the products offered to the customers, the communication employed to establish and strengthen links with clients and stakeholders, and for every other interaction between the firm and the outside (local) world. ? Finding and strengthening a diversified workforce: Especially in the area of service providers, well-skilled staff is crucial for the long-term success of the company. International mobility and intercultural skills have to be ade core value of every corporate culture. T herefore, human capital management and attracting best people is crucial, especially as the international competition for skilled workforce becomes harder and more intense. Especially in the financial sector, specialist knowledge is required and decides on success in a specific region or business area. Hence, if companies wants to achieve continuous success, it has to establish internal talent development and management processes to ensure that employees are promoted in their personal and professional development.To distinguish itself from its competitors, firms have to offer their staff unique development opportunities, thereby attracting current and future leaders. 15 ? Managing critical resources: Internal processes, corporate communication and IT face considerable challenges in a diverse global environment. As such, it is challenging to guarantee a consistent appearance in terms of brand, strategy and communication. In addition, doing business all over the world is especially ch allenging for the IT infrastructure and for know-how sharing on a global level. Yet, this offers economies of scale and synergies at the same time, e. g. y streamlining the brand and the public appearance, by having one integrated IT and know-how sharing platform and by reviewing internal processes re duplications, potential for improvements inefficiency and for streamlining and simplifying processes. UBS manages these challenges and makes them opportunities ? One Firm: We firmly believe our integrated business model creates more value than our businesses would as stand-alone units. Our clients all over the globe should effortlessly be able to access all the services our firm can provide, where and when they are required, and regardless of what combinations of teams lie behind the solutions.This â€Å"one firm† approach facilitates cross-selling through client referrals and the exchange of produces and distribution services between businesses and thus contributes significantl y to our revenue flows. The integrated business model and our â€Å"one firm† approach enable us to combine global reach with local sensitivity. 16 ? Innovative products: As one of the leading global financial services groups, UBS actively shapes the future development of financial markets.As such, challenges emerging from today’s diverse global environment are converted into opportunities by meeting emerging cultural and business needs with innovative products tailored to specific cultural requirements. Another example is the growing importance of hedge funds on international financial markets, where UBS offers products and services specifically targeted at these clients. ? Managing and promoting diversity: †¢ To UBS, diversity means recognizing and appreciating multiple backgrounds, cultures, and perspectives within its organisation.UBS builds on these differences to produce cross-cultural teams that generate new ideas and creative solutions for our increasingly diverse clients. †¢ Diversity consists of a broad range of aspects that vary in their degree of visibility going from gender over ethnicity, age, disability, sexual orientation, religion, nationality to though. †¢ In addition, senior management takes the topic seriously and is often participating in meetings and employee forums on the topic. ? Corporate Social Responsibility: UBS makes responsible behavior an important part of its culture, identity and business practice. As a 7 leading global financial services firm, UBS wants to provide our clients with value-added products and services, promote a corporate culture that adheres to the highest ethical standards, and generate superior but sustainable returns for our shareholders. In order to retain the trust society gives to UBS, UBS conducts its business responsibly and at the same time engages in the communities that it is part of. Socially Responsible Investments In additional to financial considerations, UBS provides e xpertise in incorporating environmental and social aspects into our research and environmental activities.Advice on social investments not only have to take into account financial considerations but also environment, social and ethical criteria. Human Resources To remain at the cutting edge of the rapid changes in the diverse global economy requires an enormous investment in leadership training talent management and attention to cultivating an environment within which entrepreneurial spirit can flourish. The handling of outsourcing, one of the most dynamic developments in the global economy, has become an important part of the HR process. It emains a challenge when developing outsourcing plans to minimize the impact on existing employees, to plan the transition with meticulous 18 execution and to ensure that the benefits are understood and communicated well before the plans inevitably leak out. Managing declining morale and performance of remaining employees is vital as they often s uffer anxiety, envy and a last gasp of invigorated competitiveness. Any outsourcing activity is a time of upheaval and it is important therefore to underline not only what is changing but also what is not.Conclusion Let me conclude by saying that global organizations face an unprecedented opportunity to grow their worldwide businesses. With this comes increased prosperity and therefore the need to ensure the attractions of globalisation are well understood by all participants; that the benefits of increased profitability are seen to be in the interests of all stakeholders not only the shareholders; and that the barriers to the flows of capital are removed as often as they are erected. Fear trade has no place in a fair and free globalised world.

A company, interested in the design Essay

Gabriel Oak’s character has developed a lot in ‘Far from the Madding Crowd’. He started off as ‘clumsy and foolish’ and he ended up as ‘heroic’. A hero is a man admired for achievements and noble qualities; In this case this word does not refer to someone with superhuman powers! The first description of Gabriel Oak: ‘on working days, he was a man of sound judgement, easy motions, proper dress and general good character’. Hardy’s description implies that there is nothing special about Farmer Oak; that he is just an average man. Hardy also states, that on a Sunday, a non-working day; Oak is a kind of pepper and salt mixture. This means that he is normal; he is a man with ‘balanced’ morals. Another thing that Hardy uses to bring across Oak’s personality is the way he dresses. This gives people more idea about Oak’s character and personality. His clothes were very practical but they made him look ‘clumsy and foolish’. Hardy also states that Gabriel was a source of some amusement; his watch was very difficult to get out, apart from being amusing, this also demonstrates that Oak doesn’t need to use modern conventions to tell the time. He can use the position of the sun and stars to tell the time. This is an example of how close he is to nature. This is also hinted in his name: Gabriel ‘oak’, the word oak is used to describe him as ‘natural and sturdy’ like the oak tree. In the 1st chapter, Bathsheba is in a carriage laden with goods, she is stopped at a toll gate and she refuses to pay the toll. When Farmer Oak sees this he steps in and pays the man at the gate the money needed to let Bathsheba pass. This shows that Oak is a generous and bold man. Generosity is one of Oaks many ‘noble qualities’. In chapter 5, Hardy demonstrates one of Gabriel’s first changes in character: one of Farmer Oak’s dogs rounded up and chased all of his flock over the cliff. This lost him a lot of money as the sheep were not insured and ruined his livelihood. His first thought was of pity, he felt pity for the sheep, after this Gabriel muttered: â€Å"Thank God I am not married: what would she have done in the poverty now coming upon me! † This proves Oak to be a very humble and kind man, he did not think of himself or the debts he now had. This demonstrates another noble quality that Farmer Oak has: selflessness. It also shows Oak’s true feelings about Bathsheba. In chapter 6, Hardy also demonstrates Oak’s heroism: there was a fire at the farm in weatherbury, a rick of straw had caught fire in a barn. There was a crowd of spectators all panicking, none of them new what to do. Gabriel immediately and calmly took charge of the panicking crowd. He called for a ladder and began putting out the fire himself with no concern of his own personal safety. This was a very heroic act by Gabriel. He was described as ‘bold’ by one of the bystanders. In chapter 21, there is another disaster at Bathsheba’s farm, one of her flocks of sheep managed to get into a clover field and they are all going to die. Bathsheba sends for Farmer Oak; he is the one who knows how to cure them, as Oak has just been sacked from the farm, he is reluctant to come back and help. Although, Gabriel swallows his pride and goes to the farm and began to cure the sheep very calmly and precisely: â€Å"Gabriel began to use it with a dexterity that would have graced a hospital surgeon. † This is a very heroic act, he swallows his own pride and helps someone else, he didn’t even think about receiving a reward, he did it out of his own kindness and his own concern for the animals. In chapter 36, Gabriel realises that there is lots of Bathsheba’s produce exposed to rain. He goes back inside to fetch help but everybody has passed out because they were drunk. Gabriel, rather than leaving it and hoping it would not rain, begins work atop the rick with no concern for his own safety. This is a very helpful and heroic thing to do. In chapter 37, Gabriel Oak is working on top of one of the ricks of straw in a powerful lightning storm. Bathsheba comes up to help Oak; they then begin to engage in an intimate conversation in which Bathsheba turns to Gabriel for guidance. Once again, Farmer Oak puts his own feelings aside and guides Bathsheba. Thomas Hardy made Gabriel Oak the hero in this novel, at the end of the novel, Gabriel’s noble qualities finally paid off and he managed to marry Bathsheba Everdene; he was always the one standing by her side, supporting and helping her in whatever she did. Hardy implied this by his name- he was a ‘rooted’ form of support. This shows Farmer Oak as a true hero, putting his feelings aside to help others.

What is meant by effective career management and planning and who is Essay - 2

What is meant by effective career management and planning and who is responsible for this Illustrate your answer by referring to relevant literature, theory and experience - Essay Example In building up a career several important aspects have to considered. In other words the career has to be effectively managed by an individual himself. He has to look for opportunities which would lead him to the top position. In business terms it is also the organization for which the individual is working for. Nowadays as the businesses have reached their top position it can analyzed that careers revolve around the work related activities. In order to manage a career it is important that several aspects are considered (Rosemary 2005; Arnold 1997). Effective career management is when the person handles his career well to reach the top position. The realms of career management revolve around the work that they are into. Previously the employees looked for opportunities where they could progress their career and secure their job. However in the recent years it is seen that this concept has shifted towards a new category of expectance. The transactional contract has taken up the position of the old view as the employees now look forward to a better quality of life from their employer along with progression to better positions. In other words the new concept has begin to move more towards career management. Individuals nowadays are striving to achieve top positions and not making themselves loyal to a single organization. Herriot & Pemberton (1995) give an excellent review of this current situation by terming it an economic exchange between the employer and the employee. Both the employer and employee are working for their persona l benefits and the integration has now become horizontal along with the previous approach of vertical. It depends on both the employees and employers to achieve a sustainable contract so that the individual can achieve success in his career. In order to manage career effectively the employees nowadays are looking forwards to the concept of Herriot & Pemberton (1995). They are moving towards a revolutionary era of ‘careerism’. By

Postmodern Work Essay Example | Topics and Well Written Essays - 1500 words

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GLOBAL FINANCIAL CRISIS - Essay Example It started when the US sub-prime mortgage market collapsed due to the default on payments. A sub-Prime mortgage is a loan made for homes to borrowers who are not eligible for prime home loans because they either do not have sound credit history or have non at all. For example, people with low incomes, low bank transactions, history of defaults or unemployment, can use these mortgage loans to purchase homes. These loans are generally given out by lenders on higher interest rates, additional fees, penalties for early satisfaction of the loan and other additional costs such as adjustable interest rates (ARM). With such instruments where the borrowers do not have a credit history for the borrowers to base heir decisions on, there is a high risk of default. What was once known as the leader and a strong entity of the economy in 2007, the real estate business took a complete nosedive, which was not expected as the values of houses had not declined since World War 2 and were on a continuous rise after the great depression, and thus, lead to the liquidity crunch in the US market. The mortgage taken by investors had real estate as collateral which eventually lost all its value and hence defaults on payments occurred. The demand for houses increased also during 2001 because the federal government reduced the interest rates, it was the lowest in 2001. This allowed people to invest in more houses and people started buying vacation houses and second homes. The builders continued building more and more houses even after the demand for property started to decrease after a while. The property market became so overvalued that finally the market collapsed, resulting in a rapid decrease in the rates properties and property demands. (University of Iowa, 2008) Many Credit Rating agencies also played a major role in the event. The Mortgage backed securities which were in great demand in the early 2002, continued with the increasing demand and although

Paradoxically, although modernity appeared to be a threat to Essay

Paradoxically, although modernity appeared to be a threat to Christianity, it had been nurtured, in significant part, by Christ - Essay Example Modernity mainly believes in what it sees and in the current living style only. It is for this reason that modernity is greatly affected by factors such as fashion trends, money, and status. On the other hand, Christianity believes that there is something more to staying alive and surviving in the world (Asad, 2003, 18). Therefore, clearly it appears modernity may be a threat to Christianity (Augustine, Pusey & William, 2011, 32). However, despite these threats caused by modernity, it has been found that it is actually Christianity that has fuelled modernity into place. Through a large number of factors, Christianity has significantly nurtured modernity and caused it to develop in the society. Although modernity has brought about poor moral values that were not there in the traditional world, most of these traits mainly arise from Christianity in a broad sense. In addition, the way in which Christian beliefs are changing with time, they may give rise to modernity (Augustine, Pusey & William, 2011, 33). This is because; modernity is not an original lifestyle. It a living style that has grown from what was originally in the world. Since Christianity has been in place for a longer period than modernity, then it can be argued that modernity picked its traits from Christian ways of life. Modernity tries to ape what was original and thus, the human beings themselves shape it. The fuelling of modernity by Christianity can be clearly observed from the politics practiced in the world today (Berglund, Bruce & Brian, 2010, 11). For a number of years, Christianity had no part to play in politics. Politics have been referred to as a ‘dirty game’ and thus, Christianity believes that leadership only comes from God. This way, Christians would believe that God would choose His own rightful leaders and thus, they would not actively participate in the politics. This subject has been thought as bringing modernity into the world. This is because; with Christianity not participating in the political arena, politics were left in the hands of non-Christians. Consequently, politics were practiced without considering or taking into account, the Christian values written in the Bible or initially practised by the people (Brown, John & Kim, 2008, 15). There being no opposition, modernity took its course and directed the political field. Leaders would come up with modern ways of meeting their objectives and solving any challenges that they faced. In addition, conflict resolution was no longer conducted using the religious laws in the Bible. Instead, modern arms used to fight the enemy were built up and murder was no longer considered a sin. Indeed Christianity can be said to have fuelled modernity into place. This is because; had Christians taken part in the political environment, politics could have been conducted in the right manner without using modern ways of gaining power. In addition, failure of Christian involvement, also led to increased corruptio n among the people (Carter, 2000, 84). Political leaders were now eager to find ways of doing things in a fast and easy way. It is in this way that modernity found its way into the world economy since; major inventions were being made to ease the way of life. Christianity was also not effective in teaching the people the right way of life (Kung, 1980, 74). While people know that they should

The Berlin Conference of 1884 and Africa Research Paper

The Berlin Conference of 1884 and Africa - Research Paper Example The continent was relatively isolated from the rest of the world especially the western countries but historians have recorded early trade in Africa. Trans-Saharan trade is one of the earliest recorded commerce, carried out in Africa between eighth and 16th century (Wright, 2007). According to Wright (2007), Trans -Saharan trade was concentrated in the northern Africa and it involved countries around the Mediterranean Sea and West Africa. The trade route crossed the Saharan desert and the caravans travelled for long distances to obtain goods in various regions covered in the larger frontier. The Arabs dominated the trade and it mainly involved precious metals such as gold that was mined in West African region, ivory, salt and agricultural products. In addition, slave trade was an important component of Trans- Saharan trade, and African servants were transported to the north to work as soldiers and domestic workers (Wright, 2007 pp76-81). Conditions Leading to the Berlin Conference Th e rich gold deposits and success of the Trans-Saharan trade attracted the attention of Europeans and in the 15th century, Portuguese traders opened new trade routes along the West African coast that had rich gold deposits (Wright, 2007 p 137). ... In the mid 1870, Henry Morton successfully completed the Congo River basin expedition that had remained the last unchartered frontier in Africa (Emerson, 1979). Henry Morton was later appointed by King Leopold II of Belgium as an envoy to Congo that eventually became Congo Free State, a Belgian colony (Emerson, 1979 p69). In central Africa, France moved to the western part of the Congo basin and established Brazzaville in 1881. Great Britain conquered and occupied the Ottoman Empire in Egypt that ruled Sudan and the Somaliland. Germany declared territorial ownership of Namibia, Cameroon, and Togo while Italy claimed Eritrea in the horn of Africa in 1882 (Koponen, 1993 p124). The scramble for more African colonies generated intense competition among the European powers leading to violent conflicts and the need to have a more organized criterion for partitioning Africa became apparent. Germany had become an influential European power and other countries, including France and Britain we re aggressively seeking new colonies to assert their power in Europe. In view of the emerging power changes in Europe, Germany was determined to maintain its leading influence in Europe. Therefore, it was important to formulate a reasonable formula of partitioning African continent among the competing European powers to avoid the risk of conflict that would threaten Germany influence in Europe and the globe (Koponen, 1993, pp 129-133). The Berlin Conference At the request of Portugal, the German chancellor Otto von Bismarck invited leaders of fourteen European countries with territorial interests in Africa, and the United States for a conference in Berlin in 1884 (Collins,

Politics essay Example | Topics and Well Written Essays - 1500 words - 1

Politics - Essay Example The Marxist theory, laid down by Karl Marx, is an ardent follower of a class structure within the state. Marx said that there remained a vast demarcation between the capitalist and the socialist structures of society and in order for the weaker sections to rise; there normatively should be a revolution on part of the working class. The capitalist society exploited the working classes with respect to power and wealth and used the labour in order to gain more and more resources and climb the social ladder. They were not concerned about the plight of the working class at all. Thus, all the political power rested within the hands of the capitalists. The questions however remained, could the working class not rise and abolish the suffering that it was subjected to by the capitalists, overnight? â€Å"Certainly, on paper, the working class could do away with the state However, this would be only a formal, juridical act to the extent that the workers had not seized power in a society already so rich and with such an abundance of material goods and services that social conflicts as such, that is, centring on the distribution of these products, could disappear; and that the necessity for arbiters, watchdogs, police, to control all that chaos disappeared at the same time as did the relative scarcity of goods. This has never happened in the past and it is hardly likely that it ever will.† (Mendel, Ernest) The main reason for Marx’s theory was to establish how power was divided between the ‘haves’ and the ‘have-nots’ of society; how there was a competition for the scarce resources that existed and how the politically powerful capitalists were the ones that had gained access to everything. The working class could only hope to gain some important by abolishing the existing state in order to themselves regulate the conflicts that existed among the

Active Voluntary and Nonvoluntary Euthanasia Essay Example for Free

Active Voluntary and Nonvoluntary Euthanasia Essay The term euthanasia originated from the Greek word for good death. It is the act or practice of ending the life of a person either by lethal injection or the deferment of medical treatment (Munson, 2012, p. 578). Many view euthanasia as simply bringing relief by alleviating pain and suffering. Euthanasia has been a long-standing ethical debate for decades in the United States. Active euthanasia is only legal in the Netherlands, Belgium and Luxembourg. Assisted suicide is legal in Switzerland and in the United States in the states of Washington, Oregon and Montana (Angell). Several surveys indicate that roughly two thirds of the American public now support physician-assisted suicide, and more than half the doctors in the United States do too (Angell). Active voluntary and nonvoluntary euthanasia matter because they allow the patient or family to relieve them of pain and suffering, and to die with dignity and respect. In this paper I will argue that it is immoral and unethical to deny a patient the right to die and that active voluntary and nonvoluntary euthanasia should be a legal practice in the United States. When denied the right to die one can endure a tremendous amount of physiological and emotional pain. The 1973 case of Dax Cowart is a great example of this. Dax went through fourteen months of grueling, barbaric treatments of skin debriding, tank soakings, and dressing changes. He compared the debridements to being skinned alive and the solutions poured over his skin were like having alcohol poured over raw flesh except it burns more and longer (Asher). Dax requested on several different occasions to just leave him alone and let him die but all of his physicians’ refused his requests and kept going with their treatment plan. The physicians were going against the principle of non-maleficence, which states, â€Å" Physicians have an obligation to do no harm to the patient† (Munson, 2012, p. 892). Dax suffered through painful debridements for months without proper pain control because his physicians were too worried about him becoming addicted to the pain medications. They knew how painful these debridements were for their patient and they continued to maintain the same treatment plan with no modifications. They deliberately violated the principle of non-maleficence. If active voluntary euthanasia were an acceptable practice in society, Dax ould have been able to refuse the treatments and die by way of infection, or a physician could have given him a lethal injection. Either of these options would have helped Dax to die keeping his wishes of dignity and respect intact. In this case, death is less harmful than the barbaric treatments that Dax had to endure for countless months. Today, many Americans are so concerned about the possibility of a lingering, high technology death that they are responsive to the idea of doctors being allowed to help them die (Angell). This is why we need to legalize active voluntary and nonvoluntary euthanasia in the United States. In an article from The New England Journal of Medicine, Marcia Angell states, â€Å"The most important ethical principle in medicine is respect for each patients autonomy, and that when this principle conflicts with others, it should almost always take precedence† (Angell). To deny someone his or her autonomy is to treat that individual as something less than a person (Munson, 2012, p. 900). It is wrong to take control of someone else’s life and to dictate their actions. Each person has a right to act autonomously; in doing this they must have the ability to choose among different options. A forced option is no option at all (Munson, 2012, p. 901). Dax Cowart was denied his autonomy when the doctors would not listen to his wishes of wanting to die; instead they did what they wanted. Munson states that, â€Å"Making decisions for the good of others, without consulting their wishes, deprives them of their status as autonomous agents† (Munson, 2012, p. 902). Dax was not given options to choose from, nor was his voice heard at all in the process, which violated the entire principle of autonomy. It should have been his choice because it was his life. In a completely different case, Terri Schiavo was denied her autonomy when she was kept alive on a feeding tube, when she had previously stated this was not what she wanted if it ever came down to it. With our autonomy, we should have the right to say how and when we die. It should not be based solely on societies morals, values, and beliefs. No one else should have the right to decide how one ends their life, except for that person. We value our autonomy because we are more willing to live with our own choices then to have somebody else decide for us. Active voluntary and nonvoluntary euthanasia give patients their autonomy and right to die with dignity. Active voluntary and non-voluntary euthanasia should be an approved practice because it allows patients who are in a persistent vegetative state the chance to die with dignity, while allowing their loved ones to keep their morals and values in place. Patients that end up in such unfortunate circumstances are unable to use their autonomy and make decisions regarding their treatment and potential end of life care. Maintaining one’s autonomy is part of a dignified death. If these were approved practices, it would allow family members the chance to put an end to their loved one’s suffering the way they would have wanted. It is unethical to force someone to do something against their will, as it is also immoral to make someone live if it’s against their wants or beliefs. On February 26, 1990, Terri Schiavo collapsed and unexpectedly went into a persistent vegetative state, where she remained for fifteen years by sustaining artificial hydration and nutrition through a feeding tube. Terri lost all dignity and autonomy when her terminal illness came, requiring care around the clock. Michael Schiavo believed that his wife would not want to be kept alive in her condition, which ultimately lead to his decision of discontinuing her feeding tube. After a long, tortuous thirteen days, Terri starved to death. The way Terri died was very inhumane and unethical; however it is an approved practice in the United States that continues to be used even today. If active voluntary and non-voluntary euthanasia were an acceptable practice in the United States, patients like Terri would not have to die in such a barbaric way. It is unethical to allow a patient to starve to death, as it is also unethical to deny a patient the right to die (Munson, 2012). Non-voluntary euthanasia would have allowed Terri to die pain free with her dignity and wishes in place. In Timothy Quill’s article, Death and Dignity, A Case of Individualized Decision Making, he talks about his patient Diane, who was diagnosed with leukemia. Diane denied all treatments and eventually agreed upon home hospice care. It was extremely important to Diane to maintain control of herself and her dignity during the time remaining to her. She wanted to remain an autonomous person, and when this was no longer possible, she clearly wanted to die. She asked Dr. Quill for sleeping pills, which he wrote a prescription for knowing she had trouble sleeping, but also knowing it could be a means to an end when the time came for Diane. Diane was able to make an informed decision to take her own life and to die with dignity and her wishes respected in the end. Dr. Quill states, â€Å"I know we have measures to help control pain and lessen suffering, to think that people do not suffer in the process of dying is an illusion† (Quill 2). This is why people in our society should be more open-minded to active voluntary and non-voluntary euthanasia. These two concepts can allow our terminally ill, suffering, loved ones to die with the dignity and respect they deserve, like Diane was able to do. Patients who are diagnosed with a terminal illness such as cancer or progressive neurological disorders eventually become weak and debilitated. These patients end up relying on family, friends, and healthcare workers to help them do their activities of daily living such as batheing and eating. Many of these terminally ill patients lay in bed suffering, with zero quality of life, just waiting to die. These patients have lost their will to live and find no joy or simple pleasures left in life because their pain has become too unbearable. These patients suffer on a daily basis, while family and friends watch, helplessly; as their loved ones decline day by day. It is unethical for society to expect these patients to go on with the quality of life they are maintaining. Terminally ill patients should be allowed to control their demise and end their suffering at their own disposal. Therefore, active voluntary and non-voluntary euthanasia should be a socially acceptable and approved legal practice in the United States. One could oppose the original argument saying that active voluntary and nonvoluntary euthanasia should remain illegal in the United States because it is inhumane and barbaric. Patients do have other options such as hospice programs and pain control. These provide alternative options that can be ethically and morally acceptable in our society. There are a number of options to treat chronic pain such as narcotics. There are an enormous variety of narcotics on the market, all of which can be tried until a specific one is found to be to right for that patient. Palliative care and hospice programs are gaining more attention for the end of life care they provide for terminally ill patients. The goals of these programs are based on comfort care, dignity and respect to the terminally ill patient. These programs allow patients to die with their dignity, respect, morals, and values all in place. Due to the fact that there are other options available for terminally ill patients, other than death, active voluntary and non-voluntary euthanasia should remain an illegal practice in the United States. Another powerful argument made by Marcia Angell is that â€Å"people do not need assistance to commit suicide, with enough determination they can do it themselves† (Angell). People who are too debilitated for physical means can simply just stop eating and drinking and ultimately starve to death, while others given a terminal diagnosis, that have physical means, can end their lives by pills or a gun. This is another reason why active voluntary and non-voluntary euthanasia should remain an illegal practice in the United States. In response to this objection, a rule utilitarian could argue that, the taking of a human life is permissible when suffering is intense and the condition of the person permits no legitimate hope (Munson, 2012, p. 84). Pain cannot always be controlled by narcotics and pain-alleviating techniques, there will always be a small percentage of patients whose suffering simply cannot be adequately controlled. Palliative care and hospice programs are a great idea but are not available to everyone because not everyone has insurance and the means to afford them. They can be very pricy and space is very limited, even with insurance and affordab ility in place. Allowing active voluntary and nonvoluntary euthanasia would give patients more ethical options for death, rather then having to commit the ultimate sin of suicide by starvation or the use of a gun. It is unethical to make a person feel that starvation or the use a gun are their only options. Having the options that active voluntary and nonvoluntary euthanasia can give, would enable a patient to many more ethical options for death, which would ultimately, relieve family members from having to deal with the emotional pain and suffering of finding their loved one’s mutilated body after a self inflicted suicide by use of a gun. Based on the ethical dilemma at hand, my three points have proven that active voluntary and non-voluntary euthanasia should be a legal practice in the United States. One could object this, but I have proven my argument by the physiological and emotional pain one can endure when denied the right to die, by maintaining patients’ autonomy and dignity throughout the process, and by focusing on the quality of life for patients diagnosed with terminal illnesses. The long-standing ethical debate of euthanasia is decades old and will never have a perfect resolution, but one must take into account all sides of each argument to make an informed decision for their self. It is crucial that society remain open-minded regarding this issue. It is unethical to deny a person the right to die. Therefore, active voluntary and non-voluntary euthanasia should be made an approved and acceptable end of life medical practice in the United States.

Factors Influencing Sanitation Conditions

Factors Influencing Sanitation Conditions ABSTRACT This thesis examines the socio-cultural and demographic factors influencing sanitation conditions, identifies the presence of Escherichia coli in household drinking water samples and investigates prevalence of diarrhoea among infants. It is based on questionnaire interviews of 120 household heads and 77 caretakers of young children below the age of 5years, direct observation of clues of household sanitation practice as well as analyses of household water samples in six surrounding communities in Bogoso. Data collected was analysed using SPSS and the Pearson Product Moment Correlation Value(R) technique. The findings revealed that the sanitation condition of households improved with high educational attainment and ageing household heads. On the contrary, sanitation deteriorated with overcrowding in the household. Furthermore, in houses where the religion of the head of household was Traditional, sanitation was superior to those of a Christian head and this household also had better sa nitary conditions than that with a Moslem head of household. Water quality analysis, indicated that 27 samples out of the 30 representing 90% tested negative for E. Coli bacteria whilst 17(56.7%) samples had acceptable levels of total Escherichia coli. Finally, it was found out that diarrhoea among infants were highly prevalent since 47 (61.04%) out of the 77 child minders admitted their wards had a bout with infant diarrhoea. Massive infrastructural development, supported by behavioural change education focussing on proper usage of sanitary facilities is urgently needed in these communities to reduce the incidence of public health diseases. Intensive health education could also prove vital and such programs must target young heads of household, households with large family size and households whose heads are Christians and Moslems. CHAPTER ONE INTRODUCTION BACKGROUND TO THE STUDY Efforts to assuage poverty cannot be complete if access to good water and sanitation systems are not part. In 2000, 189 nations adopted the United Nations Millennium Declaration, and from that, the Millennium Development Goals were made. Goal 4, which aims at reducing child mortality by two thirds for children under five, is the focus of this study. Clean water and sanitation considerably lessen water- linked diseases which kill thousands of children every day (United Nations, 2006). According to the World Health Organization (2004), 1.1 billion people lacked access to an enhanced water supply in 2002, and 2.3 billion people got poorly from diseases caused by unhygienic water. Each year 1.8 million people pass away from diarrhoea diseases, and 90% of these deaths are of children under five years (WHO, 2004). Ghana Water and Sewerage Corporation (GWSC) had traditionally been the major stakeholder in the provision of safe water and sanitation facilities. Since the 1960s the GWSC has focussed chiefly on urban areas at the peril of rural areas and thus, rural communities in the Wassa West District are no exception. According to the Ghana 2003 Core Welfare Indicators Questionnaire (CWIQ II) Survey Report (GSS, 2005), roughly 78% of all households in the Tamale Metropolis, 97 percent in Accra, 86% in Kumasi and 94% in Sekondi-Takoradi own pipe-borne water. Once more, the report show that a few households do not own any toilet facilities and depend on the bush for their toilet needs, that is 2.1%, 7.3%, and 5% for Accra, Kumasi, and Sekondi-Takoradi correspondingly. Access to safe sanitation, improved water and improved waste disposal systems is more of an urban than rural occurrence. In the rural poor households, only 9.2% have safe sanitation, 21.1% use improved waste disposal method and 63.0 % have access to improved water. The major diseases prevalent in Ghana are malaria, yellow fever, schistosomiasis (bilharzias), typhoid and diarrhea. Diarrhea is of precise concern since it has been recognized as the second most universal disease treated at clinics and one of the major contributors to infant mortality (UNICEF, 2004). The infant mortality rate currently stands at about 55 deaths per 1,000 live births (CIA, 2006). The Wassa West District of Ghana has seen an improvement in water and sanitation facilities during the last decade. Most of the development projects in the district are sponsored by the mining companies, individuals and some non-governmental organisations (NGOs). Between 2002 and 2008, Goldfields Tarkwa Mine constructed 118 new hand dug wells (77 of which were fitted with hand pumps) and refurbished 48 wells in poor condition. Also, a total of 44 modern style public water closets, were constructed in their catchment areas. The company also donated 19 large refuse collection containers to the District Assembly and built 6 new nurses quarters. The Tarkwa Mine has so far spent 10.5million US dollars of which 26% went into health, water and sanitation projects, 24% into agricultural development, 31% into formal education and the remaining went into other projects like roads and community centre construction ( GGL, 2008). Golden Star Resources (consist of Bogoso/Prestea Mine and Wassa Min e at Damang) also established the community development department in 2005 and has since invested 800 thousand US dollars. Their projects include 22 Acqua-Privy toilets, 10 hand dug wells (all fitted with hand pumps) and supplied potable water to villages with their tanker trucks (BGL, 2007). Other development partners complimenting the efforts of the central government include NGOs WACAM, Care International and Friends of the Nation (FON). WACAM is an environmentally based NGO which monitors water pollution by large scale mining companies. They have sponsored about 10 hand dug wells for villages in the district. Care International sponsors hygiene and reproductive health programmes in schools and on radio. They have also donated a couple of motor bicycles to public health workers in the district who travel to villages. The aims of all these projects were to improve hygiene and sanitation so as to reduce disease transmission. Despite efforts by the development partners, water supply and sanitation related diseases are highly prevalent in the district. Data obtained from the Public and Environmental Health Department of the Ministry of Health (M.O.H., 2008) showed that the top ten most prevalent diseases in the district include malaria, acute respiratory infections, skin diseases and diarrhoea. The others are acute eye infection, rheumatism, dental carries, hypertension, pregnancy related complications and home/occupational accidents. A lot more illnesses occur but on a lower scale and these include intestinal worms, coughs and typhoid fever. A complete data on the top ten diseases prevalent in the district is attached as Appendix D but below is a selection of the illnesses that directly result from bad water and sanitation practices. The number of malaria cases decreased from 350 in 2006 to 300 cases per 1000 population in 2008. Despite the decrease, the values involved are still quite high. The incidence of diarrhoea among infants and acute respiratory infection remained 30 and 60 cases per 1,000 populations respectively. This can be attributed to several reasons, including population boom, lack of uninterrupted services and inadequate functioning facilities. In fact, according to the World Health Organization (WHO, 2004), an estimated 90% of all incidence of diarrhoea among infants can be blamed on inadequate sanitation and unclean water. For example, in a study of 11 countries in Sub-Saharan Africa, only between 35-80% of water systems were operational in the rural areas (Sutton, 2004). Another survey in South Africa recognized that over 70% of the boreholes in the Eastern Cape were not working (Mackintosh and Colvin, 2003). Further examples of sanitation systems in bad condition have also been acknowledged in rural Ghana, where nearly 40% of latrines put up due to the support of a sanitation program were uncompleted or not used (Rodgers et al., 2007). The author had a personal communication with the District Environmental Officer and he estimated that, approximately there are 224 public toilets, 560 hand dug wells, 1,255 public standpipes and 3 well managed waste disposal sites in the district. According to the 2006 projection, the population of the district is expected to reach 295,753 by the end of the year 2009 (WWDA, 2006). Development partners in the past have concentrated their efforts on facilities provision only. They have not looked well at the possible causes of the persistence of disease transmission despite the effort they are making. Relationships between households socio cultural demographic factors and peoples behaviour with respect to the practice of hygiene could prove an essential lead to the solution of the problem. The fact is, merely providing a water closet does not guarantee that it could be adopted by the people and used well to reduce disease transmission. Epidemiological investigations have revealed that even in dearth supply of latrines, diarrhoeal morbidity can be reduced with the implementation of improved hygiene behaviours (IRC, 2001: Morgan, 1990). Access to waste disposal systems, their regular, consistent and hygienic use and adoption of other hygienic behavioural practices that block the transmission of diseases are the most important factors. In quite a lot of studies fro m different countries, the advancement of personal and domestic hygiene accounted for a decline in diarrhoeal morbidity (Henry and Rahim, 1990). The World Bank, (2003) identifies the demographic characteristics of the household including education of members, occupation, size and composition as influencing the willingness of the household to use an improved water supply and sanitation system. Education, especially for females results in well spaced child birth, greater ability of parents to give better health care which in turn contribute to reduced mortality rates among children under 5years (Grant, 1995). In a study into water resource scarcity in coastal Ghana, Hunter (2004) identified a valid association between household size, the presence of young children and the gender of the household head. It was noted that, female heads were less likely to collect water in larger households. Furthermore, increasing number of young children present increased the odds of female head/spouse being the household water collector. Cultural issues play active part in hygiene and sanitation behaviour especially among members of rural communities. For example, women are hardly seen urinating in public due to a perceived shame in the act but men can be left alone if found doing it. Also, the act of defecation publicly is generally unacceptable except when infants and young children are involved. The reason is that the faeces from young people are allegedly free from pathogens and less offensive (Drangert, 2004). Ismails (1999) work on nutritional assessment in Africa, detected that peoples demographic features, socioeconomic and access to basic social services such as food, water and electricity correlate significantly to their health and nutrition status. Specifically, factors such as age, gender, township status and ethnicity, which are basic to demography, can play a role in the quality of life especially of the elderly. This research assessed peoples practice of personal hygiene in Bogoso and surrounding villages. It also identified the common bacteria present in household stored water sources. Furthermore, the research identified the relationships between some socio-cultural demographic factors of households and the sanitation practice of its members. THE PROBLEM STATEMENT The Wassa West District in the Western Region is home to six large scale mining companies and hundreds of small scale and illegal mining units. Towns and villages in the district have been affected by mining, forestry and agricultural activities for over 120 years (BGL EIS, 2005). Because of this development, the local environment has been subjected to varying degrees of degradation. For example, water quality analysis carried out in 1989 by the former Canadian Bogoso Resources (CBR) showed that water samples had Total coliform bacteria in excess of 16 colonies per 100ml (BGL EIS,2005). Most of the water and sanitation programs executed in the district exerted little positive impact and thus, diarrhoeal diseases are still very high in the towns and villages (See Appendix D on page 80). However, in order to solve any problem it is important to appreciate the issues that contribute to it; after all, identifying the problem in itself is said to be a solution in disguise. Numerous health impact research have evidently recognized that the upgrading of water supply and sanitation alone is generally required but not adequate to attain broad health effects if personal and domestic hygiene are not given equivalent prominence (Scherlenlieb, 2003). The troubles of scarce water and safe sanitation provisions in developing countries have previously been dealt with by researchers for quite some time. However, until recent times they were mostly considered as technical and/or economic problems. Even rural water and sanitation issues are repeatedly dealt with from an entirely engineering point of view, with only a simple reference to social or demographic aspects. Therefore, relatively not much is proven how the socio-cultural demographic influences impinge on hygiene behaviour which in turn influences the transmission of diseases. The relationship between household socio cultural factors and the sanitation conditions of households in the Wassa West District especially the Bogoso Rural Council area has not been systematically documented or there is inadequate research that investigates such relationship. THE RESEARCH QUESTIONS The following research questions were posed to help address the objectives; Why are the several sanitation intervention projects failing to achieve desired results? Why is the prevalence of malaria and diarrhea diseases so high in the district? What types of common bacteria are prevalent in the stored drinking water of households? OBJECTIVES The main aim of this research was to investigate peoples awareness and practice of personal hygiene, access to quality water and sanitation and the possible causes of diarrhoeal diseases and suggest ways to reduce the incidence of diseases in the community. The specific objectives were; To assess the quality of stored household drinking water To establish the extent to which sanitation behaviour is affected by household socio-cultural demographic factors like age and education level of the head. To investigate the occurrence of diarrhoea among young children (0-59 months old) in the households. To identify and recommend good intervention methods to eliminate or reduce the outbreak of diseases and improve sanitation. HYPOTHESIS In addition to the above objectives, the following hypotheses were tested; Occurrence of infant diarrhoea in the household is independent on the educational attainment of child caretakers. There is no relationship between households background factors and the sanitation conditions of the household. CHAPTER TWO LITERATURE REVIEW In this chapter, various literature related to the subject matter of study are reviewed. Areas covered are sanitation, hygiene, water quality and diarrhoeal diseases. Theories and models the study contributed to include USAIDs Sanitation Improvement Framework, the F diagram by Wagner and Lanois and the theory of Social learning. SANITATION Until recently, policies of many countries have focused on access to latrines by households as a principal indicator of sanitation coverage, although of late there has been a change and an expansion in understanding the term sanitation. Sanitation can best be defined as the way of collecting and disposing of excreta and community liquid waste in a germ-free way so as not to risk the health of persons or the community as a whole (WEDC, 1998). Ideally, sanitation should end in the seclusion or destruction of pathogenic material and, hence, a breach in the transmission pathway. The transmission pathways are well known and are potted and simplified in the F diagram (Wagner and Lanois 1958) shown below by figure 3.1. The more paths that can be blocked, the more useful a health and sanitation intervention program will be. It may be mentioned that the health impact indicators of sanitation programmes are not easy to define and measure, particularly in the short run. Therefore, it seems more reasonable to look at sanitation as a package of services and actions which taken together can have some bearing on the health of a person and health status in a community. According to IRC (2001:0), issues that need to be addressed when assessing sanitation would include: How complete the sanitation programme is in addressing major risks for transmitting sanitation-related diseases; Whether the sanitation programme adopted a demand driven approach, through greater peoples participation, or supply driven approach, through heavy subsidy; Whether it allows adjustment to peoples varying needs and payment; If the programme leads to measurably improved practices by the majority of men and women, boys and girls; If it is environmentally friendly. That is; if it does not increase or create new environmental hazards (IRC, 2001) Sanitation is a key determinant of both fairness in society and societys ability to maintain itself. If the sanitation challenges described above cannot be met, we will not be able to provide for the needs of the present generation without hindering that of future generations. Thus, sanitation approaches must be resource minded, not waste minded. HYGIENE Hygiene is the discipline of health and its safeguarding (Dorland, 1997). Health is the capacity to function efficiently within ones surroundings. Our health as individuals depends on the healthfulness of our environment. A healthful environment, devoid of risky substances allows the individual to attain complete physical, emotional and social potential. Hygiene is articulated in the efforts of an individual to safeguard, sustain and enhance health status (Anderson and Langton, 1961). Measures of hygiene are vital in the fight against diarrhoeal diseases, the major fatal disease of the young in developing countries (Hamburg, 1987). The most successful interventions against diarrhoeal diseases are those that break off the transmission of contagious agents at home. Personal and domestic hygiene can be enhanced with such trouble-free actions like ordinary use of water in adequate quantity for hand washing, bathing, laundering and cleaning of cooking and eating utensils; regular washing and change of clothes; eating healthy and clean foods and appropriate disposal of solid and liquid waste. Diarrheal Dise ases Diarrhoea can be defined in absolute or relative terms based on either the rate of recurrence of bowel movements or the constancy (or looseness) of stools (Kendall, 1996). Absolute diarrhoea is having more bowel movements than normal. Relative diarrhoea is defined based on the consistency of stool. Thus, an individual who develops looser stools than usual has diarrhoea even though the stools may be within the range of normal with respect to consistency. According to the United States Centre for Disease Control and Prevention (CDC, 2006), with diarrhoea, stools typically are looser whether or not the frequency of bowel movements is increased. This looseness of stool which can vary all the way from slightly soft to watery is caused by increased water in the stool. Increased amounts of water in stool can occur if the stomach and/or small intestine produce too much fluid, the distal small intestine and colon do not soak up enough water, or the undigested, liquid food passes too quickly through the small intestine and colon for them to take out enough water. Of course, more than one of these anomalous processes may occur at the same time. For example, some viruses, bacteria and parasites cause increased discharge of fluid, either by invading and inflaming the lining of the small intestine (inflammation stimulates the lining to secrete fluid) or by producing toxins (chemicals) that also fire up the lining to secrete fluid but without caus ing inflammation. Swelling of the small intestine and/or colon from bacteria or from ileitis/colitis can increase the haste with which food passes through the intestines, reducing the time that is available for absorbing water. Conditions of the colon such as collagenous colitis can also impede the capacity of the colon to soak up water. Escherichia coli O157:H7 is probably the most dreaded bacteria today among parents of young children. The name of the bacteria refers to the chemical compounds found on the bacteriums surface. Cattle are the main sources of E. coli O157:H7, but these bacteria also can be found in other domestic and wild mammals. E. coli O157:H7 became a household word in 1993 when it was recognized as the cause of four deaths and more than 600 cases of bloody diarrhoea among children under 5years in North-western United States (US EPA, 1996). The Northwest epidemic was traced to undercooked hamburgers served in a fast food restaurant. Other sources of outbreaks have included raw milk, unpasteurized apple juice, raw sprouts, raw spinach, and contaminated water. Most strains of E. coli bacteria are not dangerous however, this particular strain attaches itself to the intestinal wall and then releases a toxin that causes severe abdominal cramps, bloody diarrhoea and vomiting that lasts a week or longer. In small children and the elderly, the disease can advance to kidney failure. The good news is that E. coli O157:H7 is easily destroyed by cooking to 160F throughout. Reducing diarrhoea morbidity with USAIDs Framework To attain noteworthy improvement in reducing the number of deaths attributed to diarrhoea, its fundamental causes must be addressed. It is approximated that 90% of all cases of diarrhoea can be attributed to three major causes: insufficient sanitation, inadequate hygiene, and contaminated water (WHO 1997). According to USAID, for further progress to be made in the fight against diarrhoea, the concentration will need to include prevention, especially in child health programs. The first method, case management of diarrhoea, has been tremendously successful in recent years in reducing child mortality. The primary process of achieving effect has been through the initiation and operation of oral rehydration therapy; i.e. the dispensation of oral rehydration solution and sustained feeding (both solid and fluid, including breast milk). In addition, health experts have emphasized the need for caretakers to become aware of the danger signs early in children under their care and to obtain suitable, appropriate care to avoid severe dehydration and death. The second approach, increasing host resistance to diarrhoea, has also had some victory with the enhancement of a childs nutritional status and vaccination against measles, a familiar cause of diarrhoea. The third element is prevention through hygiene improvement. Although the health care system has dealt comprehensively with the symptoms of diarrhoea, it has done insufficiently to bring down the overall incidence of the disease. Despite a drop in deaths owing to diarrhoea, morbidity or the health burden due to diarrhoea has not decreased, because health experts are treating the symptoms but not addressing the causes. Thus, diarrhoeas drain on the health system, its effects on household finances and education, and its additional burden on mothers has not been mitigated . Programs in several countries have confirmed that interventions can and do reduce diarrhoea morbidity. A critical constituent of successful prevention efforts is an effective monitoring and appraisal strategy. In order to reduce transmission of faecal-oral diseases at the household level, for example, an expert group of epidemiologist and water supply and sanitation specialist concluded that three interventions would be crucial. These are: Safer disposal of human excreta, particularly of babies and people with diarrhoea. Hand washing after defecation and handling babies faeces and before feeding, eating and preparing food, and; Maintaining drinking water free from faecal contamination in the home and at the source (WHO, 1993). Studies on hand washing, as reported in Boot and Cairncross (1993), confirm that it is not only the act of hand washing, but also how well hands are washed that make a difference. To prevent diarrhoea, its causes must first be fully tacit. According to the USAIDs hygiene improvement framework, a thorough approach to diarrhoea at the national level must tackle the three key elements of any triumphant program to fight disease. These are; contact with the necessary hardware or technologies, encouragement of healthy behaviours, and assistance for long-term sustainability. The concept is explained by figure 3.3 below; The first part, water supply systems, addresses mutually the issue of water quality and water quantity, which reduces the risk of contamination of food and drink. Similarly, ensuring access to water supply systems can greatly ease the time women spend collecting water, allowing more time to care for young children and more time for income generating activities. The third element, household technologies and materials, refers to the increased accessibility to such hygiene supplies as soap (or local substitutes), chlorine, filters, water storage containers that have restricted necks and are covered, and potties for small children. The second element of the hardware component, toilet facilities, involves providing facilities to dispose off human excreta in ways that safeguard the environment and public health, characteristically in the form of numerous kinds of latrines, septic tanks, and water-borne toilets. Sanitation reporting is important because faecal contamination can spread from one household to another, especially in closely populated areas. WATER QUALITY STANDARDS AND GUIDELINES Water quality is defined in terms of the chemical, physical, and biological constituents in water. The word standards is used to refer to legally enforceable threshold values for the water parameters analyzed, while guidelines refer to threshold values that are recommended and do not have any regulatory status. This study employs the world health organization (WHO) and the Ghana standards board (GSB) standards and guidelines in determining the quality of water. Water Quality Requirements for Drinking Water – Ghana Standards The Ghana Standards for drinking water (GS 175-Part 1:1998) indicate the required physical, chemical, microbial and radiological properties of drinking water. The standards are adapted from the World Health Organizations Guidelines for Drinking Water Quality, Second Edition, Volume 1, 1993, but also incorporate national standards that are specific to the countrys environment. Physical Requirements The Ghana Standards set the maximum turbidity of drinking water at 5 NTU. Other physical requirements pertain to temperature, odour, taste and colour. Temperature, odour and taste are generally not to be objectionable, while the maximum threshold values for colour are given quantitatively as True Colour Units (TCU) or Hazen units. The Ghana Standards specify 5 TCU or 5 Hazen units for colour after filtration. The requirements for pH values set by the Ghana Standards for drinking water is 6.5 to 8.5 (GS 175-Part1:1998). Microbial Requirements The Ghana Standards specify that E.coli or thermotolerant bacteria and total coliform bacteria should not be detected in a 100ml sample of drinking water (0 CFU/100ml). The Ghana Standards also specify that drinking water should be free of human enteroviruses. WHO Drinking Water Guidelines Physical Requirements Although no health-based guideline is given by WHO (2006) for turbidity in drinking water, it is recommended that the median turbidity should ideally be below 0.1 NTU for effective disinfection. Microbial Requirements Like the Ghana Standards, no E.coli or thermotolerant bacteria should be detected in a 100 ml sample of drinking water. Water Related Diseases Every year, water-related diseases claim the lives of 3.4 million people, the greater part of whom are children (Dufour et. al, 2003). Water-related diseases can be grouped into four categories ( Bradley, 1977) based on the path of transmission: waterborne diseases, water-washed diseases, water-based diseases, insect vector-related diseases. Waterborne diseases are caused by the ingestion of water contaminated by human or animal faeces or urine containing pathogenic bacteria or viruses. These include cholera, typhoid, amoebic and bacillary dysentery and other diarrhoeal diseases. Water washed diseases are caused by poor personal hygiene and skin or eye contact with contaminated water. These include scabies, trachoma and flea, lice and tick-borne diseases. Water-based diseases are caused by parasites found in intermediate organisms living in contaminated water. These include dracunculiasis, schistosomiasis and other helminths. Water related diseases are caused by insect vectors, especially mosquitoes that breed in water. They include dengue, filariasis, malaria, onchocerciasis, trypanosomiasis and yellow fever. The Theory of Social Learning Learning is any relatively permanent change in behaviour that can be attributed to experience (Coon, 1989). According to the social learning theory, behavioural processes are directly acquired by the continually dynamic interplay between the individual and its social environment (Mc Connell, 1982). For example, children learn what to do at home by observing what happens when their siblings talk back to their parents or throw rubbish into the household compound. The learning process occurs through reinforcement and punishment. Reinforcement refers to any event that increases chances that a response will occur again (Coon, 1989). Reinforcement and punishment can be learned through education where the person can read about what happens to people as a result of actions they make. The elementary unit of society is the household and this can be defined as a residential group of persons who live under the same roof and eat out of the same pot (Friedman, 1992). Social learning is necessary for the household in acquiring the skills pertinent to the maintenance of health promoting behaviour. Most of our daily activities are learned in the household. Individuals begin to learn behaviour patterns from childhood by observing especially the parents and later on their siblings. The environment is understood as comprising the whole set of natural or biophysical and man-made or socio-cultural systems, in which man and other organisms live, work or interact (Ocran, 1999). The environment is human lifes supporting system from which food, air and shelter are derived to sustain human life. Humans interact with the physical and man-made environment and this interaction creates a complex, finely balanced set of structures and processes, which evolve over the history of a people. These structures and processes determine the culture of the society, their social behaviour, beliefs and superstition about health and diseases. Social relationships seem to protect individuals against behavioural disorders and they facilitate health promoting behaviour (Barlow and Durand, 1995; Ho Factors Influencing Sanitation Conditions Factors Influencing Sanitation Conditions ABSTRACT This thesis examines the socio-cultural and demographic factors influencing sanitation conditions, identifies the presence of Escherichia coli in household drinking water samples and investigates prevalence of diarrhoea among infants. It is based on questionnaire interviews of 120 household heads and 77 caretakers of young children below the age of 5years, direct observation of clues of household sanitation practice as well as analyses of household water samples in six surrounding communities in Bogoso. Data collected was analysed using SPSS and the Pearson Product Moment Correlation Value(R) technique. The findings revealed that the sanitation condition of households improved with high educational attainment and ageing household heads. On the contrary, sanitation deteriorated with overcrowding in the household. Furthermore, in houses where the religion of the head of household was Traditional, sanitation was superior to those of a Christian head and this household also had better sa nitary conditions than that with a Moslem head of household. Water quality analysis, indicated that 27 samples out of the 30 representing 90% tested negative for E. Coli bacteria whilst 17(56.7%) samples had acceptable levels of total Escherichia coli. Finally, it was found out that diarrhoea among infants were highly prevalent since 47 (61.04%) out of the 77 child minders admitted their wards had a bout with infant diarrhoea. Massive infrastructural development, supported by behavioural change education focussing on proper usage of sanitary facilities is urgently needed in these communities to reduce the incidence of public health diseases. Intensive health education could also prove vital and such programs must target young heads of household, households with large family size and households whose heads are Christians and Moslems. CHAPTER ONE INTRODUCTION BACKGROUND TO THE STUDY Efforts to assuage poverty cannot be complete if access to good water and sanitation systems are not part. In 2000, 189 nations adopted the United Nations Millennium Declaration, and from that, the Millennium Development Goals were made. Goal 4, which aims at reducing child mortality by two thirds for children under five, is the focus of this study. Clean water and sanitation considerably lessen water- linked diseases which kill thousands of children every day (United Nations, 2006). According to the World Health Organization (2004), 1.1 billion people lacked access to an enhanced water supply in 2002, and 2.3 billion people got poorly from diseases caused by unhygienic water. Each year 1.8 million people pass away from diarrhoea diseases, and 90% of these deaths are of children under five years (WHO, 2004). Ghana Water and Sewerage Corporation (GWSC) had traditionally been the major stakeholder in the provision of safe water and sanitation facilities. Since the 1960s the GWSC has focussed chiefly on urban areas at the peril of rural areas and thus, rural communities in the Wassa West District are no exception. According to the Ghana 2003 Core Welfare Indicators Questionnaire (CWIQ II) Survey Report (GSS, 2005), roughly 78% of all households in the Tamale Metropolis, 97 percent in Accra, 86% in Kumasi and 94% in Sekondi-Takoradi own pipe-borne water. Once more, the report show that a few households do not own any toilet facilities and depend on the bush for their toilet needs, that is 2.1%, 7.3%, and 5% for Accra, Kumasi, and Sekondi-Takoradi correspondingly. Access to safe sanitation, improved water and improved waste disposal systems is more of an urban than rural occurrence. In the rural poor households, only 9.2% have safe sanitation, 21.1% use improved waste disposal method and 63.0 % have access to improved water. The major diseases prevalent in Ghana are malaria, yellow fever, schistosomiasis (bilharzias), typhoid and diarrhea. Diarrhea is of precise concern since it has been recognized as the second most universal disease treated at clinics and one of the major contributors to infant mortality (UNICEF, 2004). The infant mortality rate currently stands at about 55 deaths per 1,000 live births (CIA, 2006). The Wassa West District of Ghana has seen an improvement in water and sanitation facilities during the last decade. Most of the development projects in the district are sponsored by the mining companies, individuals and some non-governmental organisations (NGOs). Between 2002 and 2008, Goldfields Tarkwa Mine constructed 118 new hand dug wells (77 of which were fitted with hand pumps) and refurbished 48 wells in poor condition. Also, a total of 44 modern style public water closets, were constructed in their catchment areas. The company also donated 19 large refuse collection containers to the District Assembly and built 6 new nurses quarters. The Tarkwa Mine has so far spent 10.5million US dollars of which 26% went into health, water and sanitation projects, 24% into agricultural development, 31% into formal education and the remaining went into other projects like roads and community centre construction ( GGL, 2008). Golden Star Resources (consist of Bogoso/Prestea Mine and Wassa Min e at Damang) also established the community development department in 2005 and has since invested 800 thousand US dollars. Their projects include 22 Acqua-Privy toilets, 10 hand dug wells (all fitted with hand pumps) and supplied potable water to villages with their tanker trucks (BGL, 2007). Other development partners complimenting the efforts of the central government include NGOs WACAM, Care International and Friends of the Nation (FON). WACAM is an environmentally based NGO which monitors water pollution by large scale mining companies. They have sponsored about 10 hand dug wells for villages in the district. Care International sponsors hygiene and reproductive health programmes in schools and on radio. They have also donated a couple of motor bicycles to public health workers in the district who travel to villages. The aims of all these projects were to improve hygiene and sanitation so as to reduce disease transmission. Despite efforts by the development partners, water supply and sanitation related diseases are highly prevalent in the district. Data obtained from the Public and Environmental Health Department of the Ministry of Health (M.O.H., 2008) showed that the top ten most prevalent diseases in the district include malaria, acute respiratory infections, skin diseases and diarrhoea. The others are acute eye infection, rheumatism, dental carries, hypertension, pregnancy related complications and home/occupational accidents. A lot more illnesses occur but on a lower scale and these include intestinal worms, coughs and typhoid fever. A complete data on the top ten diseases prevalent in the district is attached as Appendix D but below is a selection of the illnesses that directly result from bad water and sanitation practices. The number of malaria cases decreased from 350 in 2006 to 300 cases per 1000 population in 2008. Despite the decrease, the values involved are still quite high. The incidence of diarrhoea among infants and acute respiratory infection remained 30 and 60 cases per 1,000 populations respectively. This can be attributed to several reasons, including population boom, lack of uninterrupted services and inadequate functioning facilities. In fact, according to the World Health Organization (WHO, 2004), an estimated 90% of all incidence of diarrhoea among infants can be blamed on inadequate sanitation and unclean water. For example, in a study of 11 countries in Sub-Saharan Africa, only between 35-80% of water systems were operational in the rural areas (Sutton, 2004). Another survey in South Africa recognized that over 70% of the boreholes in the Eastern Cape were not working (Mackintosh and Colvin, 2003). Further examples of sanitation systems in bad condition have also been acknowledged in rural Ghana, where nearly 40% of latrines put up due to the support of a sanitation program were uncompleted or not used (Rodgers et al., 2007). The author had a personal communication with the District Environmental Officer and he estimated that, approximately there are 224 public toilets, 560 hand dug wells, 1,255 public standpipes and 3 well managed waste disposal sites in the district. According to the 2006 projection, the population of the district is expected to reach 295,753 by the end of the year 2009 (WWDA, 2006). Development partners in the past have concentrated their efforts on facilities provision only. They have not looked well at the possible causes of the persistence of disease transmission despite the effort they are making. Relationships between households socio cultural demographic factors and peoples behaviour with respect to the practice of hygiene could prove an essential lead to the solution of the problem. The fact is, merely providing a water closet does not guarantee that it could be adopted by the people and used well to reduce disease transmission. Epidemiological investigations have revealed that even in dearth supply of latrines, diarrhoeal morbidity can be reduced with the implementation of improved hygiene behaviours (IRC, 2001: Morgan, 1990). Access to waste disposal systems, their regular, consistent and hygienic use and adoption of other hygienic behavioural practices that block the transmission of diseases are the most important factors. In quite a lot of studies fro m different countries, the advancement of personal and domestic hygiene accounted for a decline in diarrhoeal morbidity (Henry and Rahim, 1990). The World Bank, (2003) identifies the demographic characteristics of the household including education of members, occupation, size and composition as influencing the willingness of the household to use an improved water supply and sanitation system. Education, especially for females results in well spaced child birth, greater ability of parents to give better health care which in turn contribute to reduced mortality rates among children under 5years (Grant, 1995). In a study into water resource scarcity in coastal Ghana, Hunter (2004) identified a valid association between household size, the presence of young children and the gender of the household head. It was noted that, female heads were less likely to collect water in larger households. Furthermore, increasing number of young children present increased the odds of female head/spouse being the household water collector. Cultural issues play active part in hygiene and sanitation behaviour especially among members of rural communities. For example, women are hardly seen urinating in public due to a perceived shame in the act but men can be left alone if found doing it. Also, the act of defecation publicly is generally unacceptable except when infants and young children are involved. The reason is that the faeces from young people are allegedly free from pathogens and less offensive (Drangert, 2004). Ismails (1999) work on nutritional assessment in Africa, detected that peoples demographic features, socioeconomic and access to basic social services such as food, water and electricity correlate significantly to their health and nutrition status. Specifically, factors such as age, gender, township status and ethnicity, which are basic to demography, can play a role in the quality of life especially of the elderly. This research assessed peoples practice of personal hygiene in Bogoso and surrounding villages. It also identified the common bacteria present in household stored water sources. Furthermore, the research identified the relationships between some socio-cultural demographic factors of households and the sanitation practice of its members. THE PROBLEM STATEMENT The Wassa West District in the Western Region is home to six large scale mining companies and hundreds of small scale and illegal mining units. Towns and villages in the district have been affected by mining, forestry and agricultural activities for over 120 years (BGL EIS, 2005). Because of this development, the local environment has been subjected to varying degrees of degradation. For example, water quality analysis carried out in 1989 by the former Canadian Bogoso Resources (CBR) showed that water samples had Total coliform bacteria in excess of 16 colonies per 100ml (BGL EIS,2005). Most of the water and sanitation programs executed in the district exerted little positive impact and thus, diarrhoeal diseases are still very high in the towns and villages (See Appendix D on page 80). However, in order to solve any problem it is important to appreciate the issues that contribute to it; after all, identifying the problem in itself is said to be a solution in disguise. Numerous health impact research have evidently recognized that the upgrading of water supply and sanitation alone is generally required but not adequate to attain broad health effects if personal and domestic hygiene are not given equivalent prominence (Scherlenlieb, 2003). The troubles of scarce water and safe sanitation provisions in developing countries have previously been dealt with by researchers for quite some time. However, until recent times they were mostly considered as technical and/or economic problems. Even rural water and sanitation issues are repeatedly dealt with from an entirely engineering point of view, with only a simple reference to social or demographic aspects. Therefore, relatively not much is proven how the socio-cultural demographic influences impinge on hygiene behaviour which in turn influences the transmission of diseases. The relationship between household socio cultural factors and the sanitation conditions of households in the Wassa West District especially the Bogoso Rural Council area has not been systematically documented or there is inadequate research that investigates such relationship. THE RESEARCH QUESTIONS The following research questions were posed to help address the objectives; Why are the several sanitation intervention projects failing to achieve desired results? Why is the prevalence of malaria and diarrhea diseases so high in the district? What types of common bacteria are prevalent in the stored drinking water of households? OBJECTIVES The main aim of this research was to investigate peoples awareness and practice of personal hygiene, access to quality water and sanitation and the possible causes of diarrhoeal diseases and suggest ways to reduce the incidence of diseases in the community. The specific objectives were; To assess the quality of stored household drinking water To establish the extent to which sanitation behaviour is affected by household socio-cultural demographic factors like age and education level of the head. To investigate the occurrence of diarrhoea among young children (0-59 months old) in the households. To identify and recommend good intervention methods to eliminate or reduce the outbreak of diseases and improve sanitation. HYPOTHESIS In addition to the above objectives, the following hypotheses were tested; Occurrence of infant diarrhoea in the household is independent on the educational attainment of child caretakers. There is no relationship between households background factors and the sanitation conditions of the household. CHAPTER TWO LITERATURE REVIEW In this chapter, various literature related to the subject matter of study are reviewed. Areas covered are sanitation, hygiene, water quality and diarrhoeal diseases. Theories and models the study contributed to include USAIDs Sanitation Improvement Framework, the F diagram by Wagner and Lanois and the theory of Social learning. SANITATION Until recently, policies of many countries have focused on access to latrines by households as a principal indicator of sanitation coverage, although of late there has been a change and an expansion in understanding the term sanitation. Sanitation can best be defined as the way of collecting and disposing of excreta and community liquid waste in a germ-free way so as not to risk the health of persons or the community as a whole (WEDC, 1998). Ideally, sanitation should end in the seclusion or destruction of pathogenic material and, hence, a breach in the transmission pathway. The transmission pathways are well known and are potted and simplified in the F diagram (Wagner and Lanois 1958) shown below by figure 3.1. The more paths that can be blocked, the more useful a health and sanitation intervention program will be. It may be mentioned that the health impact indicators of sanitation programmes are not easy to define and measure, particularly in the short run. Therefore, it seems more reasonable to look at sanitation as a package of services and actions which taken together can have some bearing on the health of a person and health status in a community. According to IRC (2001:0), issues that need to be addressed when assessing sanitation would include: How complete the sanitation programme is in addressing major risks for transmitting sanitation-related diseases; Whether the sanitation programme adopted a demand driven approach, through greater peoples participation, or supply driven approach, through heavy subsidy; Whether it allows adjustment to peoples varying needs and payment; If the programme leads to measurably improved practices by the majority of men and women, boys and girls; If it is environmentally friendly. That is; if it does not increase or create new environmental hazards (IRC, 2001) Sanitation is a key determinant of both fairness in society and societys ability to maintain itself. If the sanitation challenges described above cannot be met, we will not be able to provide for the needs of the present generation without hindering that of future generations. Thus, sanitation approaches must be resource minded, not waste minded. HYGIENE Hygiene is the discipline of health and its safeguarding (Dorland, 1997). Health is the capacity to function efficiently within ones surroundings. Our health as individuals depends on the healthfulness of our environment. A healthful environment, devoid of risky substances allows the individual to attain complete physical, emotional and social potential. Hygiene is articulated in the efforts of an individual to safeguard, sustain and enhance health status (Anderson and Langton, 1961). Measures of hygiene are vital in the fight against diarrhoeal diseases, the major fatal disease of the young in developing countries (Hamburg, 1987). The most successful interventions against diarrhoeal diseases are those that break off the transmission of contagious agents at home. Personal and domestic hygiene can be enhanced with such trouble-free actions like ordinary use of water in adequate quantity for hand washing, bathing, laundering and cleaning of cooking and eating utensils; regular washing and change of clothes; eating healthy and clean foods and appropriate disposal of solid and liquid waste. Diarrheal Dise ases Diarrhoea can be defined in absolute or relative terms based on either the rate of recurrence of bowel movements or the constancy (or looseness) of stools (Kendall, 1996). Absolute diarrhoea is having more bowel movements than normal. Relative diarrhoea is defined based on the consistency of stool. Thus, an individual who develops looser stools than usual has diarrhoea even though the stools may be within the range of normal with respect to consistency. According to the United States Centre for Disease Control and Prevention (CDC, 2006), with diarrhoea, stools typically are looser whether or not the frequency of bowel movements is increased. This looseness of stool which can vary all the way from slightly soft to watery is caused by increased water in the stool. Increased amounts of water in stool can occur if the stomach and/or small intestine produce too much fluid, the distal small intestine and colon do not soak up enough water, or the undigested, liquid food passes too quickly through the small intestine and colon for them to take out enough water. Of course, more than one of these anomalous processes may occur at the same time. For example, some viruses, bacteria and parasites cause increased discharge of fluid, either by invading and inflaming the lining of the small intestine (inflammation stimulates the lining to secrete fluid) or by producing toxins (chemicals) that also fire up the lining to secrete fluid but without caus ing inflammation. Swelling of the small intestine and/or colon from bacteria or from ileitis/colitis can increase the haste with which food passes through the intestines, reducing the time that is available for absorbing water. Conditions of the colon such as collagenous colitis can also impede the capacity of the colon to soak up water. Escherichia coli O157:H7 is probably the most dreaded bacteria today among parents of young children. The name of the bacteria refers to the chemical compounds found on the bacteriums surface. Cattle are the main sources of E. coli O157:H7, but these bacteria also can be found in other domestic and wild mammals. E. coli O157:H7 became a household word in 1993 when it was recognized as the cause of four deaths and more than 600 cases of bloody diarrhoea among children under 5years in North-western United States (US EPA, 1996). The Northwest epidemic was traced to undercooked hamburgers served in a fast food restaurant. Other sources of outbreaks have included raw milk, unpasteurized apple juice, raw sprouts, raw spinach, and contaminated water. Most strains of E. coli bacteria are not dangerous however, this particular strain attaches itself to the intestinal wall and then releases a toxin that causes severe abdominal cramps, bloody diarrhoea and vomiting that lasts a week or longer. In small children and the elderly, the disease can advance to kidney failure. The good news is that E. coli O157:H7 is easily destroyed by cooking to 160F throughout. Reducing diarrhoea morbidity with USAIDs Framework To attain noteworthy improvement in reducing the number of deaths attributed to diarrhoea, its fundamental causes must be addressed. It is approximated that 90% of all cases of diarrhoea can be attributed to three major causes: insufficient sanitation, inadequate hygiene, and contaminated water (WHO 1997). According to USAID, for further progress to be made in the fight against diarrhoea, the concentration will need to include prevention, especially in child health programs. The first method, case management of diarrhoea, has been tremendously successful in recent years in reducing child mortality. The primary process of achieving effect has been through the initiation and operation of oral rehydration therapy; i.e. the dispensation of oral rehydration solution and sustained feeding (both solid and fluid, including breast milk). In addition, health experts have emphasized the need for caretakers to become aware of the danger signs early in children under their care and to obtain suitable, appropriate care to avoid severe dehydration and death. The second approach, increasing host resistance to diarrhoea, has also had some victory with the enhancement of a childs nutritional status and vaccination against measles, a familiar cause of diarrhoea. The third element is prevention through hygiene improvement. Although the health care system has dealt comprehensively with the symptoms of diarrhoea, it has done insufficiently to bring down the overall incidence of the disease. Despite a drop in deaths owing to diarrhoea, morbidity or the health burden due to diarrhoea has not decreased, because health experts are treating the symptoms but not addressing the causes. Thus, diarrhoeas drain on the health system, its effects on household finances and education, and its additional burden on mothers has not been mitigated . Programs in several countries have confirmed that interventions can and do reduce diarrhoea morbidity. A critical constituent of successful prevention efforts is an effective monitoring and appraisal strategy. In order to reduce transmission of faecal-oral diseases at the household level, for example, an expert group of epidemiologist and water supply and sanitation specialist concluded that three interventions would be crucial. These are: Safer disposal of human excreta, particularly of babies and people with diarrhoea. Hand washing after defecation and handling babies faeces and before feeding, eating and preparing food, and; Maintaining drinking water free from faecal contamination in the home and at the source (WHO, 1993). Studies on hand washing, as reported in Boot and Cairncross (1993), confirm that it is not only the act of hand washing, but also how well hands are washed that make a difference. To prevent diarrhoea, its causes must first be fully tacit. According to the USAIDs hygiene improvement framework, a thorough approach to diarrhoea at the national level must tackle the three key elements of any triumphant program to fight disease. These are; contact with the necessary hardware or technologies, encouragement of healthy behaviours, and assistance for long-term sustainability. The concept is explained by figure 3.3 below; The first part, water supply systems, addresses mutually the issue of water quality and water quantity, which reduces the risk of contamination of food and drink. Similarly, ensuring access to water supply systems can greatly ease the time women spend collecting water, allowing more time to care for young children and more time for income generating activities. The third element, household technologies and materials, refers to the increased accessibility to such hygiene supplies as soap (or local substitutes), chlorine, filters, water storage containers that have restricted necks and are covered, and potties for small children. The second element of the hardware component, toilet facilities, involves providing facilities to dispose off human excreta in ways that safeguard the environment and public health, characteristically in the form of numerous kinds of latrines, septic tanks, and water-borne toilets. Sanitation reporting is important because faecal contamination can spread from one household to another, especially in closely populated areas. WATER QUALITY STANDARDS AND GUIDELINES Water quality is defined in terms of the chemical, physical, and biological constituents in water. The word standards is used to refer to legally enforceable threshold values for the water parameters analyzed, while guidelines refer to threshold values that are recommended and do not have any regulatory status. This study employs the world health organization (WHO) and the Ghana standards board (GSB) standards and guidelines in determining the quality of water. Water Quality Requirements for Drinking Water – Ghana Standards The Ghana Standards for drinking water (GS 175-Part 1:1998) indicate the required physical, chemical, microbial and radiological properties of drinking water. The standards are adapted from the World Health Organizations Guidelines for Drinking Water Quality, Second Edition, Volume 1, 1993, but also incorporate national standards that are specific to the countrys environment. Physical Requirements The Ghana Standards set the maximum turbidity of drinking water at 5 NTU. Other physical requirements pertain to temperature, odour, taste and colour. Temperature, odour and taste are generally not to be objectionable, while the maximum threshold values for colour are given quantitatively as True Colour Units (TCU) or Hazen units. The Ghana Standards specify 5 TCU or 5 Hazen units for colour after filtration. The requirements for pH values set by the Ghana Standards for drinking water is 6.5 to 8.5 (GS 175-Part1:1998). Microbial Requirements The Ghana Standards specify that E.coli or thermotolerant bacteria and total coliform bacteria should not be detected in a 100ml sample of drinking water (0 CFU/100ml). The Ghana Standards also specify that drinking water should be free of human enteroviruses. WHO Drinking Water Guidelines Physical Requirements Although no health-based guideline is given by WHO (2006) for turbidity in drinking water, it is recommended that the median turbidity should ideally be below 0.1 NTU for effective disinfection. Microbial Requirements Like the Ghana Standards, no E.coli or thermotolerant bacteria should be detected in a 100 ml sample of drinking water. Water Related Diseases Every year, water-related diseases claim the lives of 3.4 million people, the greater part of whom are children (Dufour et. al, 2003). Water-related diseases can be grouped into four categories ( Bradley, 1977) based on the path of transmission: waterborne diseases, water-washed diseases, water-based diseases, insect vector-related diseases. Waterborne diseases are caused by the ingestion of water contaminated by human or animal faeces or urine containing pathogenic bacteria or viruses. These include cholera, typhoid, amoebic and bacillary dysentery and other diarrhoeal diseases. Water washed diseases are caused by poor personal hygiene and skin or eye contact with contaminated water. These include scabies, trachoma and flea, lice and tick-borne diseases. Water-based diseases are caused by parasites found in intermediate organisms living in contaminated water. These include dracunculiasis, schistosomiasis and other helminths. Water related diseases are caused by insect vectors, especially mosquitoes that breed in water. They include dengue, filariasis, malaria, onchocerciasis, trypanosomiasis and yellow fever. The Theory of Social Learning Learning is any relatively permanent change in behaviour that can be attributed to experience (Coon, 1989). According to the social learning theory, behavioural processes are directly acquired by the continually dynamic interplay between the individual and its social environment (Mc Connell, 1982). For example, children learn what to do at home by observing what happens when their siblings talk back to their parents or throw rubbish into the household compound. The learning process occurs through reinforcement and punishment. Reinforcement refers to any event that increases chances that a response will occur again (Coon, 1989). Reinforcement and punishment can be learned through education where the person can read about what happens to people as a result of actions they make. The elementary unit of society is the household and this can be defined as a residential group of persons who live under the same roof and eat out of the same pot (Friedman, 1992). Social learning is necessary for the household in acquiring the skills pertinent to the maintenance of health promoting behaviour. Most of our daily activities are learned in the household. Individuals begin to learn behaviour patterns from childhood by observing especially the parents and later on their siblings. The environment is understood as comprising the whole set of natural or biophysical and man-made or socio-cultural systems, in which man and other organisms live, work or interact (Ocran, 1999). The environment is human lifes supporting system from which food, air and shelter are derived to sustain human life. Humans interact with the physical and man-made environment and this interaction creates a complex, finely balanced set of structures and processes, which evolve over the history of a people. These structures and processes determine the culture of the society, their social behaviour, beliefs and superstition about health and diseases. Social relationships seem to protect individuals against behavioural disorders and they facilitate health promoting behaviour (Barlow and Durand, 1995; Ho