Yesterday (November 19) was World Toilet Day, a day aimed at inspiring action to tackle global sanitation crises. In Rwanda, the Ministry of Health has embarked on different activities to ensure good sanitation within the population.

According to officials, this being the third time for the Day to be celebrated in the country, more efforts have been invested in creating awareness among people regarding hygiene and sanitation promotion.

The three-month awareness drive which was started last month in all districts across the country is expected to end in December with expectations that at least each and every household should have a toilet in their homes.

Sanitation practices in place

Alphonsine Mukamunana, an environmental health specialist at the Ministry, says there are many diseases that are related to poor hygiene and sanitation. She says when the culture of hand washing, and ensuring personal and environmental hygiene are adopted, it reduces the number of people suffering from communicable disease linked to poor hygiene and sanitation.

Mukamunana says there are strategies that were put in place starting last month to raise awareness on hygiene and behavioural change, among them the Community-based Environmental Health Promotion Programme (CBEHPP).

Within this programme is a strategy called community hygiene club (CHC); where the Ministry targets to build the capacity of the communities to identify the problems they have themselves, related to poor hygiene and sanitation.

They should develop solutions to them, which is one way of creating home-based solutions to sanitation issues.

"Within this strategy, a member of each household is expected to be represented at CHC. They meet once a week for two hours to do a mapping of the village, find out the infrastructure that are located within the village like schools, water sources and market,” she says.

Mukamunana further explains that, they then take on the role of protecting any infrastructure they have within their village. After mapping their village, they also identify the problems they are facing in their community.

For instance, if they find out that children below the age of five are suffering from diarrhoea, they assess why it is so. Through this open identification, they then identify which households do not having latrines in the village.

Mukamunana says together, the members figure out how the problem can be solved. For those people found not to be having latrines, the community again assesses if the individuals are in a position to construct one or not. Those found with the ability to construct them are compelled to do so, whereas the community works together to put up latrines for individuals without the capacity.

"In some cases, you may find that some of the people without the latrine are capable of doing it but lack knowledge of the importance. This is where the community comes in to educate them on the importance of having a latrine,” she says.

Training the community

The Ministry has also been training communities about road marks and visual toolkits among others. The main objective of the strategy is to promote positive behaviour change within the community.

"We believe that what the community does itself is more sustainable compared to when such things are done for them by the government. This is because when involved, they are able to for instance understand the importance of having toilets, different from when they are built for them,” Mukamunana explains.

She urges people in communities to participate in the community health clubs as a way of ensuring good health of the population in general.

Another important aspect that has been carried out by the Ministry over the last two months is the launching of the hygiene and family campaigns in Kirehe District, as well as the sanitation campaign, where the global Hand Washing Day was celebrated.

VIP toilets for each household

The Ministry is putting a lot of efforts on households, where each is expected to have a VIP toilet. VIP stands for ventilated improved pit latrine, which is supposed to be between five and six feet deep, have a slab which is washable and easy to clean, a door and strong walls.

"Apart from that, we are educating people on proper hand washing techniques. We tell them about the five critical times of washing hands; after visiting a latrine, before preparing food, after cleaning children when they have defecated, as well as after touching dirt,” says Mukamunana.

Dangers associated with dirty toilets

Dr Janvier Rusizana, a general practitioner at La Nouvelle Clinic, Kigali, says its not only dirty toilets that can bring about diseases but an unhygienic environment too.

He notes that diseases such as cholera, diarrhoea, typhoid and infectious hepatitis among others, are brought about by drinking dirty and untreated water.

Rusizana says diseases such as parasitic worm infections can blossom in areas with poor sanitation and open defecation, and mostly affect children.

He explains that without proper treatment, this can lead to anaemia, malnourishment, as well as impaired mental and physical development.

Toilet hygiene tips

According to Albert Ndata, a resident surgeon at Rwanda Military Hospital Kanombe, good toilet hygiene reduces the risk of illinesss, infection and diseases like gastrointinal and urinary tract infection.

He points out that to avoid this; hand washing is an essential practice.

"Effective hand washing involves clean water and soap and scrubbing both the front and back of your hands, between your fingers and under your nails for a minimum of 20 seconds,” he explains.

Ndata further notes that people should avoid touching different toilets surfaces like faucets and door handles after a hand wash since these surfaces harbour and spread germs.

He adds that using disposable towels or toilet paper is a good way to avoid touching such surfaces. Flushing and covering toilet seats after using the toilet is important as well.

"Training children on hygiene is also important. For instance, boys should be trained about not urinating on toilets seats and girls about wiping from front to back to avoid spreading germs to their genitals,” he says.

Ndata advises that using liquid soap is a better option than bar soap as the latter could be a source of infection, pointing out that avoiding towels in rest rooms is vital as these are not frequently changed and could be a source of infection. Opt for disposable tissue to dry hands after using the toilet.

"Shaking hands is are also another source of spread of germs, especially after toilet use, so be sure to wash hands frequently after several handshakes or touching surfaces in public areas used by big numbers of people,” he says.

Ndata discourages the habit of placing bags or phones on the toilet floors as these are ridden with germs. Not flushing sanitary pads down the toilet, but rather placing them in the bins provided is as well vital.