Public health implication of solid waste generated by households in Bekwarra Local Government area

Background This study was conducted in Bekwarra Local Government Area of Cross River State, Nigeria, to determine the public health implication of solid waste generated by households. Methods A cross sectional descriptive design was employed, using a semi-structured questionnaire together with an observation checklist to elicit information from the respondents. Proportionate sampling was used to select 400 respondents of 18 years and above for the study area. Data collected were analysed using the Microsoft Excel 2007 and Statistical Package for Social Sciences (SPSS) software version 20. Results Respondents knowledge concerning solid waste disposal was assessed and the results showed that majority of the respondents 193 (63.7%) had high level of knowledge of solid waste disposal, while 170 (42.5%) had average level of knowledge of solid waste disposal. Wastes produced by households in the study include vegetables (95.5%), ash (94%), clothing/rag (94.2%), wood (95%), and animal waste (86.2%) had the highest abundance. Diseases associated with these wastes produced by households include cholera (18.2%), malaria (47.2%), lassa fever (10.7%) and diarrhea (23.9%) with malaria been the most prevalence infection. Conclusion The result shows solid waste posed a serious health hazard and lead to the spread of infectious diseases. These issues can be addressed through health education and enlightenment of the people on waste disposal.


Introduction
Solid waste comprises all the waste arising from human and animal activities and by-products of processes, which are normally solid, and are discarded as useless or unwanted materials that may be required by law to be disposed off. Solid waste can be classified in a number of ways on the basis of their sources, environmental risks, utility and physical property. Based on origin or source, solid wastes are classified as: Municipal solid waste, Industrial solid waste and Agricultural Solid Waste 1 . The rural communities and urban towns are today struggling to clear heaps of solid waste from their environments. These strategic centers are now being overtaken by overflowing dumps and uncollected heaps of solid waste emanating from household or domestic sources, markets, shopping and business centers 2 . The local government councils are unable to carry out their statutory responsibilities of managing municipal solid in the towns and cities which is a clear violation of the environmental sanitation edicts and regulation. These solid wastes have become threats to the health of the dwellers and it is no longer in doubt that Nigerian cities are overwhelmed with the challenges of uncleared solid waste 3 .
Improper solid waste disposal causes pollution of air, soil, and water while indiscriminate dumping of waste contaminates surface and ground water supplies. In urban areas, solid waste clogs drains, creating stagnant water for insect breeding and floods during the rainy 4 . Uncontrolled burning of solid wastes and improper incineration contributes significantly to urban air pollution. Greenhouse gases are generated from the decomposition of organic wastes in landfills, and untreated leachate pollutes surrounding soil and water bodies. Health and safety issues also arise from improp-er solid waste management. Insect and rodent vectors are attracted to the waste and can spread diseases such as cholera and dengue fever 5 . Using water polluted by municipal solid wastes for bathing, food irrigation and drinking can also expose individuals to disease organisms and other contaminants 6 . The U.S. Public Health Service identified 22 human diseases that are linked to improper solid waste management. Waste worker and pickers in developing countries are seldom protected from direct contact and injury 7 . Exhaust fumes from waste collection vehicles, dust stemming from disposal practices and the open burning of waste also contribute to overall health problems 8 .
Elizabeth et al. 9 reported that indiscriminate waste dumping practice caused the increasing incidence of diarrhea among under age children in Odukpani, Akamkpa and Biase Local Government Area of Cross River State, Nigeria. Despite significant investments in the waste management sector, solid waste management remains one of the major environmental sanitation challenges facing the country today and has continually remained at the lowest level, because industrialization and rapid population growth in many cities and towns have led to wastes being generated faster than they are collected, and disposed. The major issues affecting Bekwarra Local Government Area of Cross River State, Nigeria include the absence of proper solid waste collection services, growing number of uncontrolled heaps of rubbish in the communities constituting hazards to public health. In Cross River State, for instance, studies have shown that the Calabar Urban Development Authority (CUDA) is saddled with the responsibility of refuse collection and evacuation but the situation is different in the rural areas, including Bekwarra Local Governmen 10 . Poor public attitude resulting in indiscriminate waste dumps in street corners, in the drains increase the rate of pest and vector breeding vectors and pollution of the environment, air, water and soil. According to Bassey et al. 11 , the disposal of solid waste in the Ikot Effanga Area of Cross River State has caused the pollution of underground water leading to high mortality rate. Therefore, it is in this context that the present study was carried out to assess the level of environmental pollution and the potential impacts on public health in relation to solid waste management in Bekwarra Local Government Area of Cross River State, Nigeria and proffer solutions to them which would help change the negative attitude of the people and lead to improved waste management practices as well as ensure clean environment.

Study Setting
Bekwarra Local Government Area is located in the Northern Senatorial district of Cross River State of Nigeria and was created out of the former Ogoja Local Government Area on 1 st October 1996. The Local Government is bounded on the north by Vandekya Local Government of Benue State, on the South by Ogoja Local Government, on the east by Obudu and west by Yala. The Local Government has a projected population of 105,822 and Area of 306km2 (118sqmi) with ten political wards 12 . Most inhabitants of the area are traders, rural farmers and fisherman. Majority of the populace are Christians with few Muslims and traditional religious groups

Study Design
The design for this study was a cross sectional descriptive study using a self-developed questionnaires and an observation checklist to gather relevant information on solid waste disposal practices in Bekwarra Local Government Area of Cross River State.

Study Population
The study population included all adult females and males of 18 years and above living in the study area.

Sample Size Determination
The sample size for this study was determined by using Cochran's formular 13 .
Where: t= value of selected alpha level of 0.025 (e.g. 1.96 for 95% confidence level) p = proportion of solid waste disposal= 0.7(70% being the prevalence for Calabar)13 q = (1 -p) = 0.3 d=acceptable margin of error for proportion being estimated = 0.05 no = (1.96)2 x (0.7) (0.3) = 322 (0.05)2 To account for the possible attrition and non-response, the sample size was increased by 25% giving a sample size of 400 which was used as the actual sample size for the study.

Sampling Procedure
Multi-stage sampling technique was adopted in the selection of study participant and are describes below: Stage 1: Selection of Wards: Out of the ten wards in Bekwarra Local Government Area, five wards were selected using simple random technique (balloting). This was done by writing the names of all the council wards in the Local Government in a sheet of paper and folded. From the folded papers only five (5) were picked without replacement representing five wards for the study after mixing and shuffling in a basket. Stage 2: Selection of Houses and Households: In each selected ward, the total number of houses was obtained from the Primary Health Care Department from house numbering used by the Primary Health Care Department for immunization. Conservative recruitment sampling of households starting from the village square, the chief house respectively was then applied to select the required number of houses/households from the wards. Stage 3: Selection of Respondents: In each household, an adult female/male was selected. In households with many adult females and males, simple random technique (balloting) was carried out. Yes and No were written in a piece of paper and folded. Thereafter, these were placed in a basket and shaken to mix thoroughly, then the adult females/males were asked to pick, the one with the yes was selected for the interview.

Data Collection
Data was collected from respondents at the household level using the semi-structured questionnaire. The questionnaire comprised of section A -socio-demographic data while section B comprised types of waste generated, methods of waste collection and disposal and self-reported health problems associated with solid waste disposal by respondents. The questionnaire was pre-tested among 5% of the sample population in Yala Local Government Area having similar characteristics with the study area. This was to ensure that the questions were appropriate for the study. Three research assistants with tertiary education were recruited and trained for one week to assist in data collection by the research coordinator. The questionnaire was administered to each respondent after seeking her verbal consent. Proper explanations were given by the researcher when required, and it took about 8 -15 minutes to administer the questionnaire to each respondent. In all, a period of four (4) weeks was used, from June 2016 to July 2016 to complete the study. The observational check list was also used by the researcher to provide additional information such as services and conveniences, ventilation, waste disposal facility and refuse collection on premises that was not captured in the questionnaire.

Methods of Data Analysis
Data was analysed using the Microsoft Excel 2007 and Statistical Package for Social Sciences (SPSS) software version 20. The association between variables was tested using the Chi-square. Scores were assigned to each response accordingly and later summed up to get the total score for each individual. Score range 0 -3 represented low knowledge of waste disposal, score range 4 -7 represented average knowledge of waste disposal while score range of 8 -10 represented high knowledge of waste disposal. The minimum score was 0 while the maximum score was 10 out of a possible total of 10.

Ethical consideration
A letter of introduction was obtained from the Department of Public Health, University of Calabar, to enable the researcher obtain ethical clearance from the Cross River State Research Ethics Committee, Ministry of Health to facilitate access in the Community. Verbal consent was sought from the community heads in Bekwarra Local Government Area where the research was carried out. Informed verbal consent was also obtained from the study participants. The Participants were informed that participation in the study was voluntary and assured of anonymity of their identity before commencement of the survey. In addition, they were also told that at any point in time they could withdraw from the study without consequences.

Results
A total of 400 participants completed and returned the questionnaires giving a response rate of 100% as presented in Table 1. Respondents between the ages 20 -29 years accounted for majority of the participants 145 (40.6%) while the least respondents were within the age bracket 50 -59 years of age (9%). Majority of the respondents (49.5%) were engaged in small scale businesses with 27.8% been farmers. Most of the respondents (42.2%) were observed to have secondary education, with only 9.3% that had no formal education. Majority of the respondents (73.4%) of the respondents earned below N10,000, as basic monthly income. The interval in which the respondents reportedly earned their income varied as 47.2% of respondents earned their income daily while 22% earned their income monthly.
Majority of the respondents (96.9%) were Christians, married respondents were 62%, while respondents with small family size of less than four children were 43.9%. Among the respondents sampled as shown in Figure  1, majority of the respondents (61.8%) disposed their wastes in containers without cover while only 2.5% of the respondents dump their wastes in sack bags. Results from the observation checklist as presented on Figure 2 showed majority of the storage sites were dirty with no storage containers and inadequate storage facility. Results obtain in Table 2 showed the perceived association between health problems and the method of solid waste disposal.    Moreover, central depots where each household can deposit wastes for collection by garbage trucks and tippers are not evenly located along most streets and, in most cases, located very far away from most available space 8 , a situation that is attributed to the high cost of purchasing the dustbins. This situation is not different in most Nigerian cities including Abuja till date, as reported by Aliyu 19 .

Conclusion
The study focused on the on impact of solid waste on the health conditions of indigenes of Bekwarra Local Government Area of Cross River State, Nigeria due to non-engineering and non-scientific disposal. It is found that with increase in the global population and the rising demand for food and other essentials, there has been a rise in the amount of waste being generated daily by each household. This poses serious health risk and destruction of biodiversity in both terrestrial and aquatic ecosystems of the area. The situation could be aggravated by the poor storage systems in homes and establishments thus constituting good channels for disease transmission by flies, mosquitoes and rats. Further assessments could be needed during the rainy season to have a comparative idea of the level solid waste dumpsite in Bekwarra Local Government Area of Cross River State, Nigeria is of great public health concerns.