KNOWLEDGE, ATTITUDES AND PRACTICES REGARDING WATER, SANITATION AND HYGIENE AMONG MOTHERS OF CHILDREN UNDER 5 YEARS IN KASAI PROVINCE OF THE DEMOCRATIC REPUBLIC OF CONGO

Abstract

ABSRACT Background: Child mortality remains critically high in Sub-Saharan Africa, especially in the Democratic Republic of Congo (DRC), where about one in ten children dies before the age of five, largely due to preventable diseases such as diarrhea and pneumonia. Despite global progress, diarrhea still accounts for a significant proportion of child deaths, with the DRC among the countries with the highest under-five diarrheal morbidity rates. Poor water, sanitation, and hygiene (WASH) practices are closely linked to these outcomes, as nearly 60% of diarrhea-related deaths are attributed to unsafe water and inadequate sanitation. Evidence from national surveys highlights the protective role of improved sanitation and hygiene behaviors, such as handwashing with soap, in reducing infections. However, limited access to infrastructure and education, particularly in conflict-affected and low-income areas, undermines these efforts. Improving community knowledge, attitudes, and practices regarding WASH is therefore crucial to combating child mortality and curbing the spread of waterborne diseases in the DRC and similar settings. Methodology: This study employed a cross-sectional design using quantitative methods to assess the knowledge, attitudes, and practices (KAP) related to water, sanitation, and hygiene (WASH) among mothers of children under five in four health zones of Kasaï province, DRC (Tshikapa, Kanzala, Kamonia, and Kamuesha). The study targeted mothers who had lived in the area for at least one year, due to their key role in child health and WASH practices. A sample of 869 respondents was determined using Cochran’s formula and stratified random sampling was applied to ensure proportional representation from each health zone. Data were collected through structured questionnaires administered in local languages during face-to-face interviews by trained data collectors. Primary data were supplemented by secondary sources, and SPSS version 27.0 was used to conduct descriptive and inferential analyses, including regression, with p < 0.05 considered statistically significant. Validity was ensured through expert review and Content Validity Index, while reliability was verified through a pilot study and Cronbach’s alpha (≥ 0.70). Ethical approval was secured from Kabale university Research Ethics committee in Uganda and the School of Public Health of the University of Kinshasa in DRC, and informed consent was obtained from all participants. Results will be shared with local health authorities, published in academic journals, and presented at conferences to inform policy and intervention strategies in WASH. Results: The study surveyed 869 mothers of children under five across four health zones in Kasaï province, DRC, achieving a 100% response rate. Findings showed that the majority of mothers had low (38.4%) or moderate (32.1%) knowledge of WASH practices, with only 29.5% demonstrating high knowledge. Attitudinal analysis revealed that just 27.5% had a positive outlook toward WASH, while 37.6% had negative attitudes. Regarding practices, 35.2% of mothers exhibited poor WASH behaviors, 35.4% moderate, and only 29.3% good practices. Critical challenges identified included limited access to safe water, inadequate sanitation facilities, poor hygiene behavior, and low utilization of handwashing with soap. Statistically significant relationships were found between WASH practices and education level, knowledge, attitudes, media influence, national policy awareness, and social networks. ANOVA and t-tests confirmed that better education and positive attitudes correlated with improved WASH practices, while higher social capital or policy awareness surprisingly did not. Multiple regression analysis further showed that six predictors (education, social networks, media, national policy, knowledge, and attitude) significantly explained variations in WASH behavior, accounting for about 12.1% of the variance. These findings underline the urgent need for targeted awareness, education, and behavior change interventions to enhance WASH outcomes in the region. Conclusion and Recommendations: The study concludes that while mothers in Kasaï Province, DRC, exhibit moderate knowledge and some positive attitudes toward WASH, their practices remain inadequate, contributing to high rates of preventable diseases such as diarrhea, malaria, and malnutrition in children under five. Key predictors of WASH behavior include education, knowledge, attitudes, media influence, and awareness of national policies, while poor infrastructure, limited resources, and social barriers hinder improvements. Based on these findings, the study recommends enhancing health education through targeted programs and health worker involvement, improving WASH infrastructure with increased funding and partnerships, addressing cultural and social norms that impede behavior change, and leveraging media and community leadership to promote sustained engagement. Strengthening policy enforcement and providing accessible hygiene materials are also crucial. Future research should explore long-term impacts of interventions, the role of local governance, gender roles in WASH decisions, and cultural influences to inform more effective, context-specific strategies. Key words: Water, Sanitation and Hygiene (WASH), Knowledge, Attitudes, Practices, WASH-related diseases.