UNICEF - GuinéeProgramme de Coopération 2013 - 2017

Learning Program on Advances in Social Norms and Social ChangeUNICEF -University of Pennsylvania.

July 1st to 12th, 2013

STUDY CASE ON TRADITIONAL PRACTICIES AND BEHAVIOURS ON DEAD PERSONS AFFECTING CHOLERA SPREAD IN GUINEA

By Almamy I.S. Barry, C4D specialist Unicef Guinea Conakry

University of Pennsylvania, 11July, 2012

PLAN OF PRESENTATION I. Description of challenge

II. Critical Evaluation of the Work done so

III. Change in Practices

1. Description of the challenge

1.1 Introduction

As everywhere in the developing, in Guinea access to drinkable water, sanitation and hygiene cause major public health problems linked to social practices and behaviors;

Guinea, is among those countries facing endemic cholera, known in Guinea, 43 years ago in 2013 ;

From an epidemic disease at the beginning, early 70’s, cholera has become endemic today in Guinea ;

In 2012, it’s spread out when between February 2nd and 31st of December 7,351 cases were notified among them 138 death of cholera with a case fatality rate (CFR) of 1,9%. 

Overview situation in 2012

Guinea

Populations: 11,3 M hbts (estimation)

Poverty : Very poor country

-More than one Guinean on two (55.2%) lives in2012 below the absolute poverty

Rural areas incidence of poverty increased from 63% in 2007 to 64.7% in 2012.

Education: Illiteracy is still high 60% with 84% of women representing more than 53% of the population.

Health : Main diseases are Malaria, acute respiratory infections and diarrhea including cholera.

WASH: Use of traditional wells, rivers and water

- More than 50% of the water brought in the households undergoes a modification of fecal coliforms a consequences of both preferences and empirical expectations for the utilization of one pot by all family and visitors to drink water.

-Only 14.7% of the rural households have hygienic latrines, 43.6% have traditional non hygienic latrines as a social preferences and 41.5% do not have any type of latrines(empiric expectations) (According to the EDSIII – 2005).

-Non-observance of the rules of hygiene in particular hand-washing with water and soap at the crucial moments is not a common practice yet (empiric expectations), even if knowledge on the matter exists.

Map of cholera cases

in Guinea 2012

1. Description of the challenge

1.2 Description of the problemThe relevance of this study is the fact that the cholera has become endemic in Guinea. Since 2002, it is noted each year an epidemic which even tends to reappear in several periods during the same year. It will analyze the bonds between harmful practices and behaviors, the communication for the behavioral changes and adoption of new social norms on treatment of persons dead from cholera , with focus on social practices and behaviors during funerals : ceremonies , treating dead persons from cholera and burial at homelands. This project aim to analyze harmful traditional empiric ad normative expectations to induce new

individual preferences to build a new social norms for cholera eradication.

1.2.1 Justification

The added-value of this project will be to change social norms during funerals related to toileting dead persons, shaking hand, washing hands , drinking, eating together and transportation of dead persons from cholera. Children less than 5 years old represent about half of persons visited following the diseases related to consumption of unhealthy water practiced as it’s an empiric expectations, along with the lack of hygiene and adequate sanitation disposals.

More, unchanged traditional practices and factual believes during funerals ceremonies which are harmful in case of death persons due to cholera. There re both empiric and normative expectations lead community leaders with unanimous acceptance by populations. This conformity means that individual preferences meet the above noted expectations and clearly showed that these practices and factual believes are with no doubt social norms social norms definition and in consequence need to be a conformity submit to these practices and factual believes.

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1. Description of the challenge 1.2.2 Causes

Studies carried out in 2000 and 2002 indicated that the contamination (with a modification of with at

least a parameter between the pump and storage, particularly by fecal coliforms) of the water by more

than 50% of the water brought in the households due non hygienic empiric behaviors on drawing,

carrying, storage and utilization of drinking water in houses.

The containers for collection and storage of water are generally unhealthy. The cans used in more

than 70% households for the drawing, the transportation and storage contain impurities which modify

the properties of water considerably. In 1999, the evaluation of the quality of drinking water in 66 rural

communities showed that in 40 households out of 48, representing approximately 83%, the water

stored for consumption was contaminated with an average of 1376 UCF/100 ml against 304 UCF/100

ml (for 75% of the cases) 2005 DHS 2005.The modification of water quality between the pump and the

use in the households remain significant.

1.2.3 Factors

Several factors contribute to the endemically and the persistence of the cholera in Guinea including the following: The utilization of unhealthy water (traditional wells, rivers and even water from pumps, taps/faucets) by the lack of the public water supply service; Drinking water house contamination

 Food consumption without the observance of hygiene ; Dissemination of the fecal danger by the insufficiency of the cover in hygienic latrines; The persistence of the harmful practices like the open defecation; The low knowledge on adequate measures in cases of diarrhea at house; - Traditional beliefs on reference to traditional healers instead of going to the nearest hospital or health

center in case of diarrhea;

2. Critical evaluation of the work doneCholera a disease related on weak access to clean water, low hand washing at the crucial moments linked to factual behaviors, traditional ceremonies and habits of bodies transportation to native lands guided by conditional preferences/empirical and normative expectations and the lack of hygienic sanitation facilities/disposals rank respectively 3rd, 4th and 5th causes of consultation in hospitals and other health centers with a morbidity rate of 15.21% for helminthiasis, 10.02% for the diarrheal diseases and 2.45% for the dermatological infections.2.1 Strategies

So far Advocacy, Social mobilization / Partnership, Communication for Behavioral Changes and institutional capacity building has been utilized as a 4 major strategies to overcome cholera.

These mentioned 4 strategies meet the leanings as they aim to behavioral changes through promotion of new essential family Practices among individual, primarily the opinions leaders, the most respected, influent persons in the community and power decision makers, means advocacy

Social mobilisation / Partnership involved NGOs, international organisations, national and local youth and women to strengthennew behavioural change among first comers by creating a favorable environnement to maintan the new practice and not return to empiric and/or normative harmfull practices caused by expectations.

 - Communication for Behavioral Changes consisted on huge utilisation of interpersonnal communication like home visits (door to door) by associations, public meetings, meetings, focus groups discussions conducted by agents of the Red Cross and NGOs and partner organisation as well as items distribution ( soap and chlorine solution).

-Institutional Capacity building in communication via the training of 80% of the participants in communication in response to the out break of cholera identified above on communication for development related to cholera with focus on skills needed for interpersonal and mass media communication, (through radio and TV in particular. This strategy inclus also furniture of equipement, material comprising communication tools, megaphones, bicycles …

2. Critical evaluation of the work done

2.2 Strategies utilized analysis

Nevertheless they do not fully use the social norms approach especially the consideration of expectations(empiric and normative) and not at all preferences, schemas and scripts. Advocacy and social mobilization where more closer to what have been learned, despite specific, deep and more effective sociological approaches acquired for inducting social norms changes. These 2 approaches where more individual and group focused than social norms expectations. Although the social mobilization used networking but not so deeply linked to norms, he strategy of communication for behavioral changes.

Diagnostic table between Social norms and the problem/challenge- Practices and behaviors during funerals: ceremonies, toileting dead persons and transportation from cholera and burial at homelands - 

1 CONDITIONAL PREFERENCES   Toileting the bodies before the burial, hands checking, washing hands in the

same and eating together practices and transportation to the native due2 EMPIRICAL EXPECTATIONS   Utilization of traditional wells, rivers for drinking water and washing  1rst reference to traditional healers instead of   Washing hands without soap and eating together in a common bowl  Drinking water with the same jug 3 NORMATIVES EXPECTATIONS  Shaking hands to everybody especially during funerals and other ceremonies   Touching the dead bodies and kissing them whatever causes the death   Toileting bodies in conformity with traditional rules and/or religions believes  Bearing bodies from the place of death to native land/home land 4 ATTITUDES/PERSONAL NORMATIVE BELIEFS  Frequent hands washing will diminish chance in live reduce financial incomes

(False)  Toileting a dead persons is rewarded by God  Giving water or food to a person suffering for diarrhea will worsen the situation5 FACTUAL BELIEFS  A person who washes frequently hands will lose chance in life and will not get

sufficient financial incomes.   God will reward anyone who make the toileting of a death person

3. Change in Practices

- Hence, following the analysis of strategies utilized so far, the major changes in stratregy will emphasis on expectations capture for advocacy and more for social mobilisation and partnership y using typologies of network theory , typologie ( central, high degree) , bridges, edges.

- The 3rd strateggy, communication for behavioral changes will now rather empahsis on both individual ,groups conditional prefrences, expectations, power of norms ( castes norms, bargaining. course advocacy via expectations for norms creation with core groups an the progressively extension to others. Social dilemma will be the entry point.

- This strategy will continue to use fear of death from by disease contracted from a died person but will use alternatives, continue to take in consideration fear of death, while preferably argues based on a analyze of legal, moral and social norms knowing that social norms are reaction to social dilemma.

Together we can progressively bring social changes by proposing alternatives to both empiric and normative

negatives expectations against cholera in Guinea.

Thanks