Villette Charlotte Brontë;s Lesser-Known Masterpiece

Charlotte Brontà «s 1852 novel Villette  tells the story of Lucy Snowe as she travels from England to France to work at a school for girls. The psychologically penetrating  novel is less well-known than  Jane Eyre, but is frequently considered Charlotte Brontà «s best work.   Summary of Plot Villette follows the story of Lucy Snowe, a young English girl with a tragic past. At the start of the story, Lucy is just fourteen years old and lives in the English countryside with her godmother. Lucy eventually leaves England for Villette and finds work at a boarding school for girls. She falls in love with Dr. John, a young and handsome English doctor who does not return her affections. Lucy is very hurt by this, but deeply values his friendship. Dr. John eventually marries an acquaintance of Lucys. Lucy meets another man at the school named Monsieur Paul Emanuel. M. Paul is a very good teacher, but he is somewhat controlling and critical when it comes to Lucy. However, he does begin to show her kindness and expresses interest in both her mind and her heart. M. Paul arranges for Lucy to become the headmistress of her own school before setting sail to Guadalupe to do missionary work. The two agree to marry upon his return, but it is implied that he dies on the ship ride home before the nuptials can occur. Major Characters Lucy Snowe: The protagonist and narrator of Villette. Lucy is a plain,  hardworking Protestant English girl. She is quiet, reserved and somewhat lonely, yet she longs for independence and a passionate love affair. Mrs. Bretton: Lucys godmother. Mrs. Bretton is a widow who is in good health and good spirits. She dotes on her only son, John Graham Bretton. Lucy stays in Mrs. Brettons home at the start of the story before seeking work in another home. John Graham Bretton: A young physician and the son of Lucys godmother. Also known as Dr. John, John Graham Bretton is a kindhearted man who lives in Villette. Lucy knew him in her youth and then falls in love with him  ten years later when their paths cross once again. Dr. John instead gives his affections first to Ginevra Fanshawe and later to Polly Home, the latter of whom he eventually marries. Madame Beck: The mistress of a boarding school for girls. Madame Beck hires Lucy to teach English at the boarding school. She is rather intrusive. She snoops through Lucys possessions and interferes in Lucys romance with Monsieur Paul Emanuel. Monsieur Paul Emanuel: Madame Becks cousin and Lucys love interest. Monsieur Paul Emanuel teaches at the school where Lucy works. He falls in love with Lucy, and she eventually returns his affections. Ginevra Fanshawe: A student at Madame Becks boarding school. Ginevra Fanshawe is a pretty but shallow girl. She is frequently cruel to Lucy and attracts the attention of Dr. John, who eventually realizes that she may not be worthy of his affections. Polly Home: Lucys friend and Ginevra Fanshawes cousin. Also known as Countess Paulina Mary de Bassompierre, Polly is a smart and beautiful girl who falls in love with and later marries John Graham Bretton. Major Themes Unrequited Love: Lucy, the protagonist, loves and loses more than once during this story. She falls for the handsome Dr. John, who does not love her back. She later falls for Monsieur Paul Emanuel. Although he returns her love, the other characters conspire to keep them apart. At the end of the story, it is implied that Monsieur Paul dies and does not return to her. Independence: The theme of independence is present throughout the story. Lucy is quite passive in the beginning of the novel, but grows into a very independent woman, particularly for the era in which the story is set. She seeks a job and travels  to Villette, despite the fact that she knows very little French. Lucy longs for independence, and when the man she loves leaves to do missionary work in Guadalupe, she lives independently and serves in the role of headmistress of her own day school. Resilience: Near the beginning of the novel, Lucy experiences a devastating family tragedy. Although the details of this tragedy are not specifically outlined for the reader, we do know that Lucy is left without a family, home or money. But Lucy is resilient. She gets a job and finds ways to care for herself. Lucy is somewhat isolated, but she is resilient enough to overcome her tragedy, find satisfaction in her work, and build relationships with other people. Literary Style Villette is a Victorian novel, which means it was published during the Victorian era (1837-1901). The three Brontà «Ã‚  sisters, Charlotte, Emily and Anne each published works during this time. Villette uses the biographical structure commonly seen in traditional Victorian literature, but deviates somewhat due to its autobiographical nature. Many of the events that happen to the protagonist of the story mirror the events in the authors life. Like Lucy, Charlotte Brontà «Ã‚  experienced family tragedy when her mother died. Brontà «Ã‚  also left home in pursuit of a teaching job, suffered from loneliness and experienced unrequited love with Constantin Heger, a married schoolmaster she met in Brussels at the age of 26. Historical Context The ending of Villette is intentionally ambiguous; the reader is left to determine  whether or not  Monsieur  Paul Emanuel makes it back to shore and returns to Lucy. However, in the original ending written by Brontà «, it is made clear to the reader that Monsieur Paul Emanuel perishes in a shipwreck. Brontà «s father did not like the idea of the book ending on such a sad note, so Brontà « altered the final pages to make the events more uncertain. Key Quotes Villette has earned its reputation as one of Charlotte Brontà «s best works because of its beautiful writing. Many of the most familiar quotes from the novel showcase Brontà «s unique and poetic style. â€Å"I believe in some blending of hope and sunshine sweetening the worst lots. I believe that this life is not all; neither the beginning nor the end. I believe while I tremble; I trust while I weep.†Ã¢â‚¬Å"Peril, loneliness, an uncertain future, are not oppressive evils, so long as the frame is healthy and the faculties are employed; so long, especially, as Liberty lends us her wings, and Hope guides us by her star.†Ã¢â‚¬Å"The negation of severe suffering was the nearest approach to happiness I expected to know. Besides, I seemed to hold two lives - the life of thought, and that of reality.†Ã‚  Ã¢â‚¬Å"Tempered by late incidents, my nerves disdained hysteria. Warm from illuminations, and music, and thronging thousands, thoroughly lashed up by a new scourge, I defied spectra.†Ã¢â‚¬Å"Trouble no quiet, kind heart; leave sunny imaginations hope. Let it be theirs to conceive the delight of joy born again fresh out of great terror, the rapture of rescue from peri l, the wondrous reprieve from dread, the fruition of return. Let them picture union and a happy succeeding life.† Villette Fast Facts Title: VilletteAuthor: Charlotte Brontà «Publisher:  Smith, Elder Co.Year Published: 1853Genre: Victorian fictionType of Work: NovelOriginal language: EnglishThemes: Unrequited love, independence, and resilienceCharacters: Lucy Snowe, Mrs. Bretton, Ginevra Fanshawe, Polly Home, John Graham Bretton, Monsieur Paul Emanuel, Madame BeckNotable adaptations: Villette was adapted into a television miniseries in 1970 and into a radio serial in 1999 and 2009.

Critical Examination of Malthusian Theory of Population Essay

Thomas Robert Malthus, very popularly known as Malthus, was a professor of History and Political Economy at Haileybury College of the East Indian Company. He was a philosopher of 19th century. He lived his life from 1766 to 1834 AD. After writing an essay on the Principle of Population in 1805 AD, he became popular in the history of population studies. In his essay which later on became a very famous theory by the name Malthusian Theory. In the theory, he has drawn some assumptions such as: ol li value=1 Human beings have great potentialities to produce children li value=2 In agriculture Law of Diminishing Returns operates li value=3 Human beings will need food to eat li value=4 Passion between sexes is†¦show more content†¦That is how the nature will bring balance in population and in the means of subsistence and will enter into the cycle which again continues to population growth and food growth in different ratios and the so on. Of course he was the first philosopher who applied the inductive method very thoroughly and systematically to social science, but all is assumptions could be true and might work at the ancient period and in a particular society where his study was based on. Now at the present, it is not applicable at all. So many things which have great belongings with human beings, and developments in sciences and technologies and even in cultures that bring a lot of changes in several aspects of life and living are ignored in the theory. In his theory, he claims that the human beings are interested in increasing family size, which might be applicable in an ancient period when the people were illiterate, depend on agriculture, and so on. But in the present context, it is not applicable anywhere because now the people are educated. People know the demerits of large family size. People are not found interested in increasing the size of family because there is no rational of increasing family size. 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NPV method Free Essays

This report focuses on three Important areas of financial management namely Capital structure, Management of Working Capital and Investment appraisal. While the flirt two parts of the report analysis Apple’s activities, the last part of the report is related to the given scenario. The first part of the report evaluates Apple’s capital structure. We will write a custom essay sample on NPV method or any similar topic only for you Order Now After determining the company’s capital structure, the report will evaluate different financing options for the company’s capital investments. The analysis involves the cost of debt and equity. The aim Is to justify the financing decision for a Eng term. The second part of the report evaluates the performance of Apple’s working capital management practices. This part relies on the ratio analysis. Current Ratio, Debtors, Creditors and Inventory days will be calculated over a three years period. The data is gathered from the Yahoo Finance. In order to make the analysis more meaningful there will be a benchmarking with a main competitor. The last part of the report conducts NAP analysis to find out the best investment option for the given scenario. The project with the highest NAP is likely to be most beneficial for the company. Subsequently conclusions will be drawn. Reason for Choosing Apple for this study I have a personal interest in this company as it is seen the most successful company in the world at the moment. I will be able to learn from the best practice. Capital Structure and Financing Decision A firm’s optimal capital structure is the mix of debt and equity that minimizes the weight cost of capital of the firm. When the cost of capital is minimized, the total value of firm’s shares are maximized. As a result the minimum cost capital structure is called as the optimum capital structure. (Moyer et al. 012) According to Moles et al. (201 1) managers decide on the optimum capital structure based on the trade-offs between the benefits and costs of debt. The fact that there are a number of different benefits and costs associated with the use of debt flagging suggests that managers will balance these different options. Moles et al. (2012) explains that debt can be cheaper as debt is less risky than the equity. In addition, there is a tax advantage with debt financing as interest expenses are generally tax deductible. Another world, the company pays less tax if they use debt financing. However, a company can go into liquation If It cannot payback Its debts of Interest obligations. According to Apple’s financial statements on Yahoo Finance (2012) over the last three years period (2009, 2010 and 2011 ) the company did not have any long term debt as well as short term debt. While the company’s retained earnings increased from $23. 4 billion in 2009 to $37 billion in 2010 and this figure reached to $63 billion in 2011, the company financed its projects through retained profits. The company was able to do this because It had large profits. Apple’s net profits were $8. Lion, $14 billion and $25. 9 billion In 2009, 2010 and 201 1 respectively. According to the Apple’s Annual and $1. 3 billion in 2011, 2010 and 2009 respectively. Currently the company is using equity option to finance its capital expenditure. According to BBC (2012) this year the company announced $2. 65 per share quarterly dividends. This is the first dividend payment since 199 5. As the company does not pay regular dividends, it is not meaningful to calculate the company’s cost of equity using the divided valuation model. However, the market prices of Apple shares increased almost 22% in 2011. Therefore, it can be said that Apple’s cost of equity is quite high. In conclusion, currently Apple finances its capital projects through equity financing. With a possible debt financing the company is likely to reduce its cost of capital. This could be a good idea if the company’s profit figures start to decline. According to the financial statements of the company Apple did not have any short term or long term loans between 2009 and 2011. Analysis of working capital management Working capital management concerns with organizing a company’s short term sources to sustain ongoing activities mobiles funds and optimism liquidity. It further dropped to 1. 61 in 2011. The company’s figures can be compared with the Blackberry manufacturer RIM. RIM’s current ratios are higher than Apple’s in 2010 and 2011. RIM 2011 2010 2009 current Ratio 2. 08 2. 06 2. 39 The main reason for the decline in Apple’s current ratio is decline in debtor and from 2010 to 2011. In the same period, the inventor days decline from 9. 3 days to 4. 4 days. This indicates that the efficiency of the company’s working capital management as they were able to receive the money from debtors faster and to keep fewer inventories. The company also was able to keep creditors days high with 135. 5 days. Consequently the company’s current ratio declined dramatically in recent years. However, this decline should be seen as a positive development as the company has been leaner in recent years. Therefore, the figures above indicate the company’s working management practices are successful. Investment Appraisal with NAP method Net present value (NAP) of a project is the sum of the present values of all its cash flows, both outflows and inflows. The rate used to discount the cash flows must be consistent with the project’s risk. Another word, if the project risky then higher discount rates should be used when appraising the investment options. The same company might use different discount rates for its difference projects depending on a rockiness of the project. (Graham and Smart, 2011) According to Graham and Smart (2011) the companies can invest in any projects if the NAP figure is positive as any positive figure will increase the value of the company. The table below demonstrates the NAP calculations for an investment option. Delta Printing is considering buying machinery and there are three different purchase options. The machines can be used for a six-year period. After six year Machine A and B can be sold with a scraped value. Initial cost of each options are as follows; El m for Machine A, CHEEK for machine B and CHEEK for Machine C. According to the initial cost figures the Project C is the best option as it requires less investment. However, there will be no scrapped value for Machine C. With the original figures, it is difficult to make a decision. In this case, NAP method can simplify the investment decisions. The cash inflows are discounted with the company’s cost of capital of 15%. How to cite NPV method, Papers

Communication Skills Training For Oncology -Myassignmenthelp.Com

Question: Discuss About The Communication Skills Training For Oncology? Answer: Introduction Social work consists of many processes, which pay attention to the relationship among individuals and the improvement in the quality of life of people. Individuals have various social roles and how effectively they perform those determine the social relationships. Social work intervenes in this junction of performing the duties and improving lives of people. Helping process is one of the many functioning of the social works. Social functioning comprises of the activities, which are necessary to satisfy the relationships in the experiences of the social living (Fox, 2013). The basic functions of the helping process are restoration of social functioning, provision of resources for development and prevention of social dysfunction. In simple words, helping process in social work is the set of activities to assist the people to identify and cope up with their problems through relationship building, assessment of the problem, setting of the goals, interventions and termination (Miller Rol lnick, 2012). The stages of helping processes will be discussed in the following essay. Discussion Helping process is sometimes defined as the counseling process. Communication skills are extremely important for effective helping process. There are five stages of helping process, namely, Rapport and relationship building, Assessment or problem defining, goal setting, initiating the interventions, and termination of the problem. In each of the stages, Communication plays an important role, as relationships are always determined through effective communication (Egan, 2013). Relationship building Relationships are always based on trust. Thus, laying the foundations for trust by designing a structure and form, voluntary or involuntary, and the roles of articulating is the primary factor for building relationships. Firstly, rapport needs to be developed between the counselor and the client, through introduction, clear description of individuals roles, purpose and active listening to the client. Thus, through effective communication, a relationship is built. Empathy, unconditional positive regard, and congruence are essential in this stage (Shulman, 2012). In this stage, drilling down to the problem is important. The counselor must ask simple and detailed questions to the client to know the exact problem and its source. There should be some basic questions and detailed inquiry on life functions and stress factors. After that, the focus should be on getting more detailed information about the problems through trust (Crowe et al., 2012). Goal Setting In a helping process, once the problems are identified, goals should be specific and clear. Its the duty of the counselor to talk to the client tactfully and find out his or her objective or goal (Brandler Roman, 2015). It has to be mutually agreed upon. In this process, the trust and relationship between the counselor and the client becomes more strong and the client confides into the counselor about his or her perspectives. Thus, effective communication by the counselor is very important not only for conversing with the client, but also to find out the goals for the process (Shulman, 2012). Initiating Intervention Interventions are the perspectives to find out new ways to approach the issue. How to accomplish the goals and solve the problem is addressed through intervention. Communication again plays a crucial role to define the achievable goals and motivate the client to follow the process. The intervention plans are usually positive and action oriented, and can be adapted with time. Termination This is the last stage in the helping process. In this stage, the dependency of the client on the counselor is tactfully reduced, the client is made prepared for the ending of the sessions, and plans are made for possible needs in the future. Termination is also considered earlier if the counselor feels that the process is not helpful for the client. This is done through a systematic process, so that the client can mentally prepare himself or herself. For example, the counselor sets an advance date for the last session, then gradually reviews the progress and makes future plans accordingly. This process empowers the client to think independently (Arnold Boggs, 2015). Thus, it can be said that, communication is extremely powerful tool in helping process. It is a sensitive issue for all the clients and only through supportive attitude, active and attentive listening and comforting words, the helping process can be successful. Barriers to communication Communication is a process of transferring of information through speaking, listening, writing, reading and observing. Thus, during the helping process, communication takes many forms, such as, speaking, listening, observing etc. (Austin Pinkleton, 2015). There can be many barriers to effective communication in the helping process. Those are as follows: Emotional barriers or taboos: Sometimes people feel shy to express their emotions. Again sometimes, due to social taboos, they do not open up. Cultural and language differences: Social norms often determine the way of expression and these vary across different cultures. For example, the definition of personal space varies among different cultures. Along with that, language difference also impede communication. Sometimes, unfamiliar accents create barriers in understanding. Use of jargons: Sometimes the counselor use jargons, which becomes difficult to understand for the client. Prejudices and expectations: Due to cultural differences, people often have preconceived notions and prejudices. They do not make the effort to think beyond that. Hence, they keep the same expectation from the counselor. However, these prejudices seldom meet the expectation and people cannot accept the helping (Kissane et al., 2012). Non-verbal communication and physical barriers: If the counselor cannot understand the body language, facial expressions, gestures, postures and other non-verbal cues, then the communication becomes less effective. Lack of attention: If any one of the counselor or client is not attentive to the sessions, and gets distracted easily, then the helping process would not be effective. Apart from all these, the differences in the view points and perception, physical disabilities, such as speech problems or hearing problems, lack of flexible attitude of the client also create barriers to communication in the helping process (Berge, 2013). Recommendation for overcoming the barriers in communication In the helping process, the barriers to communication, especially interpersonal barriers, are a common issue. It is a challenge for the counselor to build a trusting relationship with the client and find out the precise problems and solve them. Hence, effective communication is extremely important. As there are barriers to communication, there are also ways to overcome those challenges. Those are as follows: Use of simple language: The counselor must not use jargons and use simple language while communicating to make the client comfortable. The client can understand the process if it is communicated in a simple language with easy accent. Even if the perceptions are different, still it has to be conveyed through easy understandable language (Gratis, 2017). Active listening: The counselor must have high level of patience and the practice of active listening. He must listen to everything attentively that the client has to say. Similarly, the client must also listen to what the counselor is instructing respond accordingly. Clarity in the thoughts: It is very important to know about the topic or subject to be discussed with the client and clear thoughts about that. The Counselor must be very clear about the objectives of the helping process and must design his way of dealing accordingly. After the client expresses his thoughts, the counselor must be able to understand that and find out a solution to help the client (Egan, 2013). Staying calm and patient: Both the parties involved in the helping process must be very patient and must control own emotions and frustrations while communicating through the process. If the conversation needs more time, it should be given and must not be hurried. Avoid too much information in one session: People would feel overloaded if they are asked to process too much information in one session. Hence, the counselor must understand the receiving capacity of each client and plan accordingly as per the needs. Providing feedback: Feedbacks should always be given by both the parties to make the process effective. It helps in personal development as well as contributes in effectiveness of the session. Understanding the body language: Counselors must be able to read the gestures, expressions, general body language and non-verbal cues of the client during the helping process. It helps to get many aspects of the clients nature, which he is not being able to say verbally (Ray, 2014). Conclusion Helping process is an integral part of the social work. Many people need help in many ways and counseling is one of the ways to help them. Through counseling people can overcome many challenges and can live a better life. Helping process is heavily dependent on effective communication. In all the five stages of helping process, communication plays the major role, which lays the foundation of trust and relationship. Although there are many barriers to communication in the helping process, there are ways to overcome them also. Both the counselor and the client must put effort for easy communication, understanding, keeping patience and cooperating with each other for making the process successful. With effective communication, helping process can yield the best results. References Arnold, E. C., Boggs, K. U. (2015).Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences. Austin, E. W., Pinkleton, B. E. (2015).Strategic public relations management: Planning and managing effective communication campaigns(Vol. 10). Routledge. Berge, Z. L. (2013). Barriers to Communication in Distance Education.Turkish Online Journal of Distance Education,14(1), 374-388. Brandler, S., Roman, C. P. (2015).Group work: Skills and strategies for effective interventions. Routledge. Crowe, M., Whitehead, L., Carlyle, D., McIntosh, V., Jordan, J., Joyce, P., Carter, J. (2012). The process of change in psychotherapy for depression: helping clients to reformulate the problem.Journal of psychiatric and mental health nursing,19(8), 681-689. Ray, D. (2014). Overcoming cross-cultural barriers to knowledge management using social media.Journal of Enterprise Information Management,27(1), 45-55. Egan, G. (2013).The skilled helper: A problem-management and opportunity-development approach to helping. Cengage Learning. Fox, R. (2013).Elements of the helping process: A guide for clinicians. Routledge. Gratis, B. (2017).Overcoming Interpersonal Barriers to Communication.Nulab. Retrieved 9 October 2017, from https://nulab-inc.com/blog/typetalk/overcoming-interpersonal-barriers-communication/ Kissane, D. W., Bylund, C. L., Banerjee, S. C., Bialer, P. A., Levin, T. T., Maloney, E. K., D'Agostino, T. A. (2012). Communication skills training for oncology professionals.Journal of Clinical Oncology,30(11), 1242-1247. Miller, W. R., Rollnick, S. (2012).Motivational interviewing: Helping people change. Guilford press. Shulman, L. (2012).Brooks/Cole empowerment series: The skills of helping individuals, families, groups, and communities. Cengage Learning.

Singapore Air Essay Example

Singapore Air Essay It is the basic difference between the product and a service. Singapore air has made a strong brand name in the field of aviation, they were formed in 1973 and immediate concerns for them were to provide customers with services that could make the customer experience every level of the entertainment and comfort. Singapore air is understanding and following the way they should treat their customers and make them feel and experience what has been provided to them. The airline does provide its customers with all the benefits and comforts they have asked for, the only difference occurs in the class. The airline is said to have so much in their entertainment package that it is enough to make customer differentiate it on the basis of features. It is claimed that Singapore air has got the highest number of entertainment options in the entire industry which are merely 600.They include the latest stock of at least 100 Movies, 80 TV Shows, Nintendo Games, 200 CDs, Audio Channels, Flight Camera s, Flight Statistics, Destination Info and Traveller Guides, and now Live TV Channels, all on demand (You can Pause, Fast Forward etc.) This system is supported on all of Singapores Aicraft, utilizing the Wisemen 3000 hardware and Dolby Digital Personal Cinmea Headphones for economy class, and Active Noise Cancelling Headphones for Raffles and First Class. (Service and Innovation).This naturally makes the customer experience something different. The quality services are not just limited to the planes but it starts right from the point the customer reaches for check in service. Surprisingly, it further serves customers by using a Singapore tourist bus which distinguishes it from others in service. In short we may say that word of mouth is the key in the marketing of Singapore air and further they do emotional appeal in their advertisements to attract peopleInseparable:Services are indeed inseparable from the provider, we cannot expect a customer to take the entertainment the airline provides to home, but what customer can take home is the experience that the airline provides. There are many ways to make customer realize that he/she has to travel in a particular airline, many of the audits do the job for airlines. Singapore air is a 5 star airline, which naturally portrays it as a top class mode to travel somewhere. Of course customer has got a specific time to enjoy the services offered by the air but for Singapore air, customers do wait for that time to come and if they are not aware of the services provided by the Singapore air, then they sooner know everything about it.The marketing for the service is done in a simple manner as word of mouth has got more meaning in such services, but the company could market itself as not only the provider of service but also the provider of many items that could fascinate the customer later on even when he/she lefts the airport. One of the good ways to do so is to apply a strategy used by Emirates and in the past, by KLM. S ingapore air could give small gifts to the customers or their children (if any), this would answer the inseparability issue as well as the marketing issue.Variable: (Heterogeneous)Another unique quality of services is that, they vary from customer to customer. Singapore air answers to it in a very unique and professional manner. There are three classes in almost every airline, first class, business and economy. The needs and requirements of the customers traveling in each of these classes are different. Singapore air addresses those issues and tries to provide the best possible to customers traveling in various classes. The service response starts differently from the point the customer moves to the counter for check in service. The first class/business class customers are provided different waiting launch with excellent product facilities and staff services, which gives the customer a hint of what is coming to them next. The economy class services are not to bad either, as usually the customers traveling in economy class have no much concern about the service but the destination.In response to marketing, the saving grace of any airline service is that the customers who travel from the business or first class usually group up with the similar people or people with equal caliber, so the word of mouth does support the service in this regard as the customers discuss what they experience with the similar people which transforms those people into potential customers. Customers further have a mindset when it comes to the class system, they know what they could possibly see in the first class or business class so therefore marketing is not an issue. However, Singapore air advertises in a way that in support with emotional appeal delivers a sentence to the customer that makes him/her feel different such as â€Å"Experience Singapore airlines business class†.Perishable:Anything which is not tangible (mostly) is perishable and it is an issue that no body can do a nything about. Services are of course for a limited time as they end once the customer walks out of the place of availing those services. Again the important point to consider here is that services are perishable and not the experiences, so the Singapore air has an intense concern on nurturing the experiences of customer. For the sake of this goal, the company has been doing many improvements in its systems. They not only have enhanced their entertainment within the airplane but also the increase in services can be measured from the point that there are currently 90 destinations they are having their planes at. They have further made a wider collection of aircrafts of almost every kind, making the customer to see Singapore air whenever he/she goes to airport and further there are Customer service centers which are acting themselves as reminders to the customers.;The company has done well in marketing itself, but there are yet few issues that need to be addressed such as the company can maintain a sound database of its first class and business class passengers by taking their contact info and also their office addresses and it can send them reminders about the new services (if exciting one – travel packages, family holiday plans etc.), and that in a way in which customer can give a response, such as by calling over a toll free Singapore air’s office number. This way the important customers would remain informed about the services. Meanwhile, for the purpose of cost reduction, the company can invest less in television advertisement as it would then have lesser meaning due to the use of direct marketing and word of mouth.SourcesService and Innovation, ;;http://www.answers.com/topic/singapore-airlines;;.World Airline Survey, ;;http://www.airlinequality.com/Airlines/SQ.htm;;.;;AppendixService and Innovation (http://www.answers.com/topic/singapore-airlines)Early on, Singapore Airlines became the first airline to offer free headsets and drinks. Its serv ice quality has made it the worlds most awarded airline to date.The KrisWorld Entertainment system that Singapore Airlines currently has offers has the largest range of Entertainment Choices of all Airlines with over 600 Entertainment options. They include the latest stock of at least 100 Movies, 80 TV Shows, Nintendo Games, 200 CDs, Audio Channels, Flight Cameras, Flight Statistics, Destination Info and Traveller Guides, and now Live TV Channels, all on demand (You can Pause, Fast Forward etc.) This system is supported on all of Singapores Aicraft, utilizing the Wisemen 3000 hardware and Dolby Digital Personal Cinmea Headphones for economy class, and Active Noise Cancelling Headphones for Raffles and First Class.In 2005, it was one of the earliest to introduce high-speed, in-flight internet service in March by installing the Connexion by Boeing system, and became the first airline in the world to offer live international television broadcasts using the same system from June [8]. In the same month, one can take up free language lessons using Berlitz Word Travelers interactive language learning programme, with 11 languages offered, and subsequently increased to 22 by November [9]. In December 2005, the airline offered free live news feeds it called Live Text News via its KrisWorld entertainment system [10].

Free Essays on Marriage Interview

The first question one asks is â€Å"what is marriage?† One definition of marriage is a union between two people that feel that they are right for each other, and decide to spend the rest of their lives together as one. But what one perceives of marriage to be at the get go is not always what they see after getting marriage. Some couples fear the worst, which is an unhealthy marriage that can lead to divorce. Others hope for the best, which is to live a long and healthy marriage. But I believe that everyone knows that marriage is harder than it seems but still do not believe it. Marriage has good attributes but also has it bad attributes that it brings with it. A marriage might start off good, but after a few years it might be considered to be going down the drain. Marriage, of course, has its ups and its downs. Problems arise in every marriage. But how one copes with them determines the marriage. The second question one asks is â€Å"what is a good marriage?† Wallerste in and Blakeslee believe that a good marriage is one that follows the nine tasks provided by their book â€Å"The Good Marriage: How and Why Love Lasts.† Using this book as a reference, I interviewed a married couple that believes that they have a good marriage and I will assess if the marriage is a good one. The names of the couple I interviewed were Thomas and Maria Fernandez. I asked them questions that were provided in class and asked them to answer truthfully. Here is a brief history of how they became a couple. They grew up in the same town in Mexico. So they were bound to bump into each other. He worked as a cab driver. She was a grocery clerk. One day, he went in the store she worked in to buy something to drink. She remembers what she felt when she first saw him. She said, â€Å"It was love at first sight.† He said, â€Å"Her beauty caught my eye.† He then went over to her and initiated a conversation. From this point on they began to date. This led to them getting ... Free Essays on Marriage Interview Free Essays on Marriage Interview The first question one asks is â€Å"what is marriage?† One definition of marriage is a union between two people that feel that they are right for each other, and decide to spend the rest of their lives together as one. But what one perceives of marriage to be at the get go is not always what they see after getting marriage. Some couples fear the worst, which is an unhealthy marriage that can lead to divorce. Others hope for the best, which is to live a long and healthy marriage. But I believe that everyone knows that marriage is harder than it seems but still do not believe it. Marriage has good attributes but also has it bad attributes that it brings with it. A marriage might start off good, but after a few years it might be considered to be going down the drain. Marriage, of course, has its ups and its downs. Problems arise in every marriage. But how one copes with them determines the marriage. The second question one asks is â€Å"what is a good marriage?† Wallerste in and Blakeslee believe that a good marriage is one that follows the nine tasks provided by their book â€Å"The Good Marriage: How and Why Love Lasts.† Using this book as a reference, I interviewed a married couple that believes that they have a good marriage and I will assess if the marriage is a good one. The names of the couple I interviewed were Thomas and Maria Fernandez. I asked them questions that were provided in class and asked them to answer truthfully. Here is a brief history of how they became a couple. They grew up in the same town in Mexico. So they were bound to bump into each other. He worked as a cab driver. She was a grocery clerk. One day, he went in the store she worked in to buy something to drink. She remembers what she felt when she first saw him. She said, â€Å"It was love at first sight.† He said, â€Å"Her beauty caught my eye.† He then went over to her and initiated a conversation. From this point on they began to date. This led to them getting ...

Six Feet of the Country Essay Example | Topics and Well Written Essays - 500 words

Six Feet of the Country - Essay Example apartheid system was implemented in South Africa which segregated the people into major racial groups - white; Bantu, or black Africans; Colored, or people of mixed descent; and Asians - and determined the living and employment standards of each group. Public facilities were segregated and nonwhites were not represented in the national government. The policy ended in 1990 when then-President F. W. de Klerk released the anti-apartheid activist and African National Congress leader Nelson Mandela from prison and legalized black African political organizations (â€Å"Apartheid†). Clearly, the story was set at a time when apartheid was at its peak as the narrator tells us about the â€Å"tensions the Johannesburg people speak of† not being the hubbub of the city but of the â€Å"guns under the white men’s pillows and the burglar bars on the white men’s windows..† and the awkward moments when â€Å"a black man won’t stand aside for a white man† (Gordimer 9). The couple chose to live in the farm to change something in them and find peace in their marriage. Although it is clear that they were not able to fulfill the latter goal, at least they were able to change. The histrionic Lerice became engrossed with running the farm and became attached to the servants. The narrator, who was a complainant brat who did not care about his servants as long as they did their work, sees the injustice of the system in the middle of the business of illegal immigrant’s body. Upon knowing of the death, the narrator notified the health authorities and the police to be able to know the cause of death. Apparently, the young man died of pneumonia and was disposed of by the authorities. However, Petrus insisted on burying his brother’s body and repeatedly begged the narrator, his baas or boss, thinking that because the baas is a white man, he can do anything. Petrus, together with the other servants, scraped up twenty pounds just to be able to get the dead body back which annoyed the

The Subiaco Centro project (Transit-oriented develepments) Research Proposal

The Subiaco Centro project (Transit-oriented develepments) - Research Proposal Example The project is aimed to expand the land usage opportunities in the Subiaco area and balance and complement the existing community fabric, while promoting alternative transport usage. Following are some of planning innovations that went into the project: Transit oriented development Community engagement Affordable housing Heritage conservation Reason for the selection of the topic: In the past, developmental design in the city of Perth has largely been oriented towards mobility through cars and other automobiles. However, with the development of the Subiaco-Centro project, this focus has now shifted from car-friendly planning to development that is grounded not only in land usage policies but also on the principle of actively pursuing the opportunities of transit-oriented development. This shift in focus has come with a significant challenges as well as opportunities, and the primary reason that I have selected this subject for my research is the fact that it presents a wide array of topics that need exploration. Since this project is not only focused on the creation of a safe, sustainable and harmonious city, there is also a major emphasize on re-inventing the city’s transportation system and provide easy and equal access to different modes of transportation. In this regard, the concept of transit-oriented has given rise to a lot of issues and I intend to not only study and research the various opportunities that have arisen due to this, but also explore the various obstacles that have been a part of this project. In the course of my research, I intend to study the following: The vision behind this project and the significance of creating development around public transportation. Current transport infrastructure designs. The need and demand for transit-oriented development design in Perth. The Socio-Economic effects of this type of development. The opportunities presented by maintaining a balance between high level of transit accessibility and land usage providing affordable housing. The research paper will take from current existing literature on these topics and compare the trending opinions with what has happened/is happening in Perth, and how it will effect the population, environment and economy of the city. Potential Sources of Information: Journal Articles: Theoretical discussions about the topic, cast studies documenting other instances of TOD in different countries etc. Reports/Other Documents: SRA planning schemes, Subiaco Redevelopment Act 1994, project information, Scheme texts/maps Websites: Subiaco Redevelopment Authority, Western Australian Planning Commission, City of Subiaco Proposed Structure of the Paper: 1. Introduction – A discussion about the fundamentals issues examined in the paper 2. Transit-oriented development in the Subi-centro project - A discussion about the history of TOD, the motivation behind incorporating it into Perth’s developmental designs, the vision behind the plans. - The Key pl ayers (Dept. of planning, private investors, SRA) - The objectives of the Subi-Centro project (in terms of development centred around transit modes in Perth) 3. The Obstacles and Opportunities arising due to TOD - A discussion about the demand for TOD in Perth - The attitudes of the residents of the city about this change of developmental designs. (Through a discussion of stakeholder interviews conducted

Raw Food Diet report Research Paper Example | Topics and Well Written Essays - 500 words

Raw Food Diet report - Research Paper Example The benefits of raw foods can be seen and felt in society today as these dietary changes continue to evolve enabling individuals to escape the fast lifestyle that was and is still developing in many parts of the world. The natural enzymes that are found in these raw foods often combat diseases that make their way into the body, and at the same time, work on improving digestion. Minerals, vitamins, and fiber are the main elements in these foods and are essential in boosting the immune system’s functions. Due to the lack of high sodium, fat, or calorie content in these natural foods, assumptions are made that they assist individuals in reducing weight. Eating fruits and vegetables may assist in keeping blood pressure and cholesterol at bay (Ungar, 2007). This is if this pattern is complimented by low fat and salt consumption. As this diet assists in controlling body weight, it is assumed that it may also assist in controlling or regulating diabetes. There are some limitations to following a diet that simply revolves around raw foods. Protein, an essential element in the development of an individual, may present a challenge for some the raw foods present. Seeds and nuts can provide these protein needs, but they need to be consumed in rather large quantities in order to fulfill the dietary requirements. In order to acquire certain vitamins found only in animals, for example; vitamin B12, individuals on a raw food diet may be required to use supplements to satisfy this dietary requirement. Calories may be seen as a detrimental aspect in countless diets, but it is essential in the human body. Raw food diets and their low calorie content require that individuals consume a lot in order to satisfy this requirement in their diet (Ungar, 2007). Raw food diets may run into the issue of poisoning, especially if there is the issue of being undercooked. Individuals who eat meat may want to pay close attention to this problem as it

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