Behavioural and Cultural Factors That Influence Open Defaecation Among First Cycle School Pupils in the Eastern and Volta Regions of Ghana

ABSTRACT

The influence of human behaviour and culture on open defaecation has attracted global concern in recent times. As a way of placing the behavioural and cultural factors influencing open defaecation behaviour in Ghana on the public agenda, a school-basedcross-sectional study was conducted in eight first cycle schools selected from eight communities within the Eastern and Volta regions of the country. The objective of the study was to explore the behavioural and cultural factors influencing open defaecation among the pupils aged between nine and eighteen years. Self-reported data on attitudes, subjective norms, perceived control behaviour, behavioural intentions, culture and situational factors associated with school toilet systems were collected from 400 pupils in the selected schools. The study employed mixed methods—questionnaires, focus group discussions, in-depth interview, and checklist observation. Quantitative data was analyzed using Structural Equation Modelling (SEM) path analysis with the aid of AMOS software version 20 (IBM), and the qualitative data was also analyzed using thematic data analysis procedures.

The results of the study showed high level of open defaecation (64.3%) among the pupils with more female pupils (32.6%) than male pupils (29.4%) recording the higher open defaecation prevalence across the study schools. The overall knowledge level of risks associated with open defaecation behaviour was high (89.8%) among the pupils. Knowledge of health risks of open defaecation behaviour was, however, low among the greater number (53%) of the pupils. Pupils’ knowledge of environmental risks associated with the open defaecation behaviour was found to be fairly high (52%). Attitude was found to have significant direct influence on pupils’ intention to engage in open defaecation behaviour (standardized mean positive effect size = 0.708; p0.05 and PBC iii (standardized mean effect size =-0.11; p< 0.05). The interaction effect size of subjective norms and perceived behavioural control variables was also found to be strong and statistically significant predictor (standardized mean positive effect size = 0.608, p