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Effects of Habitat For Humanity Housing on the Health of Children and their Mothers in the Communities of Khmer Kampuchea

Khrom, Samaki and Sen Sok in Phnom Penh, Cambodia

Carmen Aurora Garcia

World Toilet Summit

Nov 3-6 2008

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Background

According to the UN-Habitat:

“adequate shelter means more than a roof over one’s

head. It also means adequate privacy; adequate

space; physical accessibility; adequate security;

security of tenure; structural stability and durability;

adequate lighting, heating and ventilation; adequate

basic infrastructure, such as water supply, sanitation

and waste-management facilities; suitable

environmental quality and health-related factors…”

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Housing and Health background

In developing countries children diarrhea incidence and acute lower respiratory infections are linked strongly to housing conditions. (Chaudhuri, 2004)

Wolff et al (2001)Children 5 years old and below living in Habitat Houses experienced lower incidence of respiratory infection 21% to 29%; GI,10% to 14%; and malaria, 15% to 20%. than those living in traditional houses

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Problem Statement

•Improving the health of children and women requires addressing many factors, including their housing and sanitation condition.

•Inadequate housing conditions have adverse effect to the health of children and women but there have been few studies in developing countries.

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Purpose of The study

To compare the health of children and their mothers in Habitat for Humanity housing and

non-Habitat housing in the communities of Khmer Kampuchea Khrom, Samaki and Sen

Sok in Phnom Penh, Cambodia.

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Specific Objectives

To assess the impact on children’s and mothers’ health in Habitat housing in Khmer Kampuchea Khrom, Samaki and Sen Sok communities.

To identify the specific aspects of improved housing that are most closely associated with housing-related differences in children's and mothers' health.

To identify children and their mothers’ illnesses and diseases that may be related to poor housing conditions.

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Description of Study Area

In the capital city of Phnom Penh, it is estimated that at least 20% of the city’s population live in squatter settlements where more than half of them live in houses made of temporary materials.

Khmer Kampuchea Khrom, Samaki and Sen Sok Communities are 3 of the more than 19 communities opened by the city government to relocate squatter families living in the downtown area.

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Conceptual Framework

Habitat for Humanity

Addressed: Improved HousingNot addressed: Training (financial management, etc.),Community Participation, Local LeadershipDevelopment, Advocacy

Socio-economic SituationAddressed: Income, Education, OccupationNot addressed: Inequality

EnvironmentalAddressed: Drinking water source, Building materials, Arrangement of rooms, Household size, Exposure to fuel smoke, Mosquito coil, Garbage disposal, Home sanitationNot addressed: Distance to economic center, Terrain

InfrastructureAddressed: Drainage system, Sewer systemNot addressed: Public services (e.g., roads, public transport, public market, health center, electricity, communication system)

BehavioralAddressed: Smoking/drinking, ExerciseNot addressed: Diet and, Hygiene

Health

Addressed in mothers and children:Respiratory

Gastro-intestinalSkin

Not Addressed:Perception of health now vs. a year

agoMental Health

Social IsolationSelf-esteem

Dependent Variables

Independent Variables

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Participants and Methodology

Household-based cross sectional analytical study

Children ages 10 years and younger, and their mothers, who are living in Habitat-built houses and children and mothers living next door or within 100 meters in non-Habitat homes

294 respondents: 147 households living in Habitat-built houses and 147 households adjacent to them

108 in Samaki; 108 in KK and; 78 in Sen Sok

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Data Collection Methodology

A structured, standardized, pre-tested questionnaire in English and Khmer were administered by 10 trained interviewers.

Samples from drinking water source were directly collected from each household and taken to the Resource Development International laboratory for testing.

The respondent were expected to be the mother whenever possible, or another adult female caregiver.

The respondent reported on recalled illness and symptoms during the last 4 weeks, and the last 2 weeks.

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Data Analysis

SPSS software was utilized

Independent T test statistics

Chi-square

Logistic regression

Pearson’s chi-square

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Results General characteristics, including demographics, of

non- Habitat and Habitat households

Non-Habitat households reported staying in the community for an average of 4.37 years compared to 3.9 years for the Habitat households (p=.012).

Habitat for Humanity program in Phnom Penh is relatively new, having started only in 2004

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Housing conditions in non-Habitat and Habitat homes

Non-Habitat households have more occupants than Habitat ones, 5.86 and 5.31 people respectively (p=.060)

Habitat households reported higher satisfaction about the condition and size of their homes compared with the non-Habitat ones (p=<.001)

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Discussion (continued)

Results from questionnaire-derived and interviewer-observed indicate that Habitat houses are in better physical conditions than the non-Habitat ones.

Habitat households are generally more satisfied with their current housing conditions, reporting more adequate conditions during the rainy season and having better quality toilet facilities: Only 12.2% of Habitat households reported having inadequate toilet facilities compared with 35.% in non-Habitat.

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Mothers and children health in non-Habitat and Habitat homes

Results indicate that both the mothers’ and children’s symptom rates generally did not differ. reporting very high rates of both individual and combined symptoms

Results suggest that both groups are subjected to important unidentified health risk factors in the communities surveyed.

The communities lack adequate infrastructure and basic services, such as drainage for waste water.

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When children’s health was associated with potential continuous confounders:

Households that have lived longer in the community the rates of the combined symptoms of diarrhea and vomiting increases.

Family income shows a direct association with all 3 combined symptoms. As the income increases the odds of the following combined illnesses decreases:

Cough and phlegm (p=.020) Cough and cold (p=.004) Diarrhea and vomiting (p=.041)

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Children’s health in relation to continuous potential confounders Characteristic Logistic modeled odds ratio per unit increase P-value Child's age Cough and phlegm .992 .807 Cough and cold .888 .001 Diarrhea and vomiting .824 <.001 Number of children 10 years old in household Cough and phlegm .911 .292 Cough and cold .922 .346 Diarrhea and vomiting 1.060 .574 Hours spent with children each day Cough and phlegm .982 .249 Cough and cold 1.005 .736 Diarrhea and vomiting .997 .853 Mother's educational level Cough and phlegm .972 .777 Cough and cold .915 .371 Diarrhea and vomiting .965 .775 Years in community Cough and phlegm .947 .246 Cough and cold .998 .971 Diarrhea and vomiting 1.2226 .002 Years in this house Cough and phlegm .988 .799 Cough and cold 1.032 .504 Diarrhea and vomiting 1.229 <.001 Monthly Income Cough and phlegm .996 .020 Cough and cold .996 .004 Diarrhea and vomiting .995 .041

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Discussion (continued)

When housing conditions are associated with rate of incidence of certain combined symptoms, the results show:

24% of mothers of households without toilet facilities reported diarrhea and vomiting symptoms as compared to only 8.3% of those with toilets.

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Mothers' and children's health in relation to characteristics associated with Habitat housing

(potential confounders)

Mothers' health in relation to categorical potential confounders Symptoms No Yes X2 (df)

P- Value Has toilet Cough and phlegm 9 (34.6%) 69 (25.9%) .911 (1) P=.340 Cough and cold 12 (46.2%) 88 (33.3%) 1.722 (1) P= .189 Diarrhea and vomiting 6 (24.0%) 22 (8.3%) 6.406 (1) P=.011 House size perceived adequate Cough and phlegm 23 (29.5%) 55 (25.6%) .447 (1) P=.504 Cough and cold 33 (42.9%) 67 (31.3%) 3.348 (1) P=.067 Diarrhea and vomiting 3 (3.9%) 25 (11.7%) 3.847 (1) P=.050 Housing condition perceived adequate Cough and phlegm 21 (20.6%) 57 (30.0%) 3.003 (1) .083 Cough and cold 38 (37.3%) 62 (33.0%) .535 (1) .464 Diarrhea and vomiting 9 (8.9%) 19 (10.1%) .107 (1) .743

The direct association of inadequate toilet facilities and the rate of diarrhea and vomiting incidence, which the study establishes is consistent with the conclusion made in the study by Wolff et al (2001) that reveals that having access to safe water and owning private toilet are significantly associated to lowering the odds of acquiring some illness.

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Limitations of the Study

Habitat program in Cambodia is relatively new: Less than 200 families in 3 community projects in Phnom Penh. This limited number of Habitat for Humanity houses in turn limits the confidence and power of the tests for health-related differences between Habitat and non-Habitat housing.

This study did specifically examine the physiological health-related effects of the Habitat housing, specifically gastrointestinal, respiratory and skin diseases, but did not measure other potential benefits such as increased self-esteem, stronger neighborhood/community cohesion, and increased family economic value.

The time constraint for the research did allow the researcher to undertake a more thorough multivariate study.

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Thank you!