Potable water supply among the physically challenged in selected homes for the disabled in Ibadan

There is paucity of information on accessibility to potable water in homes for the disabled in Nigeria. This study investigated access to potable water among physically challenged people in three homes for the disabled in Ibadan. Sixty-four physically challenged persons living at the Cheshire Home (CH), Sekinat Adekola (SAC) and Lawal Centre (LC) were surveyed. Quantity of Drinking Water (QDW) received daily was compared to the WHO minimum requirement of 2.5 litres/head/day. Drinking water samples were analysed for total coliform (TCC) and Escherichia coli counts (ECC). Respondents’ ages were 22.4± 5.1 years in CH, 23.6± 7.4 years in SAC and 13.8± 5.6 years in LC. The QDW received was 5.3± 1.5 litres/ head/day in CH, 4.5± 0.5 litres/head/day in SAC and 2.8± 0.8 litres/head/day in LC. Thirty-seven percent in CH, 55.0% in SAC and 22.0% in LC were very satisfied with QDW received. CH water had lower TCC (2.0± 0.6 cfu/100 mL) compared to SAC (378± 169.3 cfu/100 mL) and LC (357.3± 174.3 cfu/100 mL). Only LC water showed an ECC of 1.0± 0.4 cfu/100 mL. Not all individuals experienced adequate access within the homes. Water quality was poor across the homes and treatment was inadequate. Constant potable water is required for the well-being of disabled people in these homes. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/). doi: 10.2166/washdev.2019.170 ://iwaponline.com/washdev/article-pdf/9/2/225/643621/washdev0090225.pdf Ifiok P. Udofia (corresponding author) Elizabeth O. Oloruntoba Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria E-mail: piusifiok@yahoo.com This article has been made Open Access thanks to the generous support of a global network of libraries as part of the Knowledge Unlatched Select initiative.


INTRODUCTION
there is a dearth of information on accessibility to potable water in homes for the disabled in Nigeria. This study was designed to investigate access to potable water supply among the physically challenged in homes for the disabled in Ibadan.

Study area
The study was conducted in Ibadan, the capital city of Oyo State. Ibadan is located in the south-western part of Nigeria, 128 km inland north-east of Lagos (the economic hub of Nigeria) and 530 km southwest of Abuja, the Federal Capital Territory. It is a prominent transit point between the coastal region and the areas of the north. It has a total population of 3.16 million according to the Nigeria Demographic Profile (). It has a density of 2,140/sq mi (828/km 2 ) and a total area of 1,190 sq mi (3,080 km 2 ).
A cross-sectional study with field and laboratory components was conducted. Three homes for the disabled were used for this study (Figure 1 with the online version of this paper). Equal allocation was assumed for all occupants; this value was compared to WHO minimum requirement of 2.5 litres/head/day (Howard & Bartram ). This was checked by gathering information from the participants by using the questionnaire.

Physicochemical and bacteriological parameters analysis
The physicochemical parameters determined were pH, temperature, total dissolved solids (TDS), total suspended solids (TSS), chloride, nitrate, iron, lead, manganese and zinc, as described by APHA (). Also total coliform count (TCC), Escherichia coli count (ECC) and total heterotrophic count (THC) were determined using standard methods.
These parameters were assessed to obtain essential information about the sanitary quality of the water sources.
All results were compared with WHO guidelines.

Sanitary inspection of water sources and storage containers
Sanitary inspection of the water sources was carried out by the use of Sanitary Inspection Forms designed by WHO () (see Appendix V, available online). These were used to evaluate the water sources in the homes as well as storage containers. The forms contained ten questions about the water sources, asked such that if the answer is YES, it indicates a risk of contamination, thus 1 mark. If the answer is NO, there is no risk of contamination, thus no (0) mark. At the end of the exercise, risk scores were added and rated as shown: Figure 2 shows the age distribution of the respondents. In CH, the mean age was 22.4 years, in SAC, mean age was 23.6 years and in LC, mean age was 13.8 years. Table 1 and Figure 3 show other socio-demographic characteristics of the study population.

Access to potable water
The main source of potable water for respondents in CH was a borehole, for those in SAC, a protected well, and for those in LC, water from Oyo State Water Corporation, Ibadan. Observation revealed that the proximity of the water facility to the hostels in the three homes exceeded the recommended range of 5-10 m ( Jones & Reed ). In CH,  'They fetch it for us but sometimes we fetch it ourselves and it takes a long time to get the water to our abode.
Our legs and hands begin to ache when we do this. If the caregiver was consistent, we would not have felt pains' (FGD with males in Lawal Centre).
'The caregivers and our friends (non-physically challenged) fetch it for us. We send students when the school is in session, when they are on holiday and the caregiver is not around, we fetch it ourselves. The caregivers are not constantly available, this means we have to find a way to fetch it ourselves' (FGD with males in SAC).
'The caregivers fetch for us but we don't stay together, thus it is difficult to get water when they are not around. Chest pain results from fetching with wheelchair and we stay upstairs, getting the water up there proves very difficult' (FGD with females in SAC).
'We fetch for them as the need arises. It is difficult at times but we make sure we provide them with the water they need' (KII with female caregiver in CH).
'There are no challenges as I and disabled persons that can walk fetch for those with mobility impairment every now and then as the need arises' (KII with caregiver in LC).
'We fetch for them regularly, we also get the disabled ones that can walk to fetch for them so there is always water for them to use' (KII with male caregiver in SAC).
There were mixed reactions from the physically challenged persons concerning how satisfied they were with the quantity of water received from caregivers. Extracts from the FGDs are shown below: 'Yes we are satisfied with the quantity of water we receive' (FGDs, Cheshire Home, males and females).
'Not all the time; sometimes we are satisfied, sometimes we are not' (FGD Lawal Centre, males).
'Sometimes we are satisfied and sometimes we are not, especially when our day's activities require more water and the caregiver is not available to fetch more water for us. Only one caregiver is officially employed to attend to us but she does not stay here with us and is not available all the time' (FGDs, SAC males and females).  Method of treating drinking water Table 4 shows the treatment methods reported. During the KIIs, across the homes, caregivers said they only treated the water when they felt it was necessary.

Suggestions from participants on how to improve access to water and sanitation facilities
Participants suggested what should be done to improve access to potable water and sanitation. Figure 4 shows that   Physico-chemical and bacteriological quality of source and stored water samples from the homes   FGDs, it was discovered that the mild satisfaction for some was because most of them shared (or used) water from the same storage container for cooking, drinking and washing plates; thus there was enough to drink for most of them but not enough for other activities that required more water.
In SAC, there was one caregiver available for the residents. With more hands (to fetch water), access would improve; also the fact that the caregiver did not live in the compound meant there were times the participants needed more water but could not get it. With more storage containers in the rooms, the caregiver would have more work to do but access would improve.
In LC, the participants cited inconsistency on the part of the caregivers as a factor contributing to their limited access.
Another limiting factor was the capacity of storage containers in the rooms (5 L and 10 L) and the number of occupants that drank from the containers (5 in one room, 6 in another). Here, the physically challenged and intellectually disabled stay together, so when the caregiver is unavailable, the nonphysically challenged friend (NPCF) assists. However, the intellectually disabled may exhibit poor hygiene practices like not rinsing the storage container before fetching water.
On the other hand, caregivers in the respective homes stated the residents always had potable water to drink. In a situation whereby three or more people drink from one storage container, the water in that container will go down faster than if consumed by one person; thus caregivers need to refill the storage containers more often.
A major factor in the accessibility of water is proximity.
This means the water collection point should either be in the house or at most 5 to 10 metres from the house ( Jones & Reed ). Across the homes, the distance of the water sources from the hostels exceeded the recommended range. Thus in the absence of a caregiver, physically challenged people would have to cover beyond 10 metres to fetch water. Also, the sources of water in the respective homes were not disabled-friendly, thus limiting accessibility to water when caregivers are unavailable.

Quantity of drinking water received from caregivers
Across the homes, the mean QDW the participants had access to (based on what the caregivers fetched for them) exceeded WHO minimum requirement. Though they seemed to have enough to drink, FGDs revealed some of them were not satisfied with the efforts of the caregivers. In LC, the small size of the drinking water storage containers, the number of occupants in the rooms and inconsistency on the part of the caregiver could be responsible for this (even though the minimum requirement for a 13-year-old child is not expected to be the same as that of 22-and 23- year-old adultsmean ages in CH and SAC, respectively).
In SAC, the caregivers did not live in the compound (this could be caused by high financial demand), thus getting water when the caregiver and NPCF were not around could reduce the QDW received daily.

Sanitary inspection of water sources and storage containers
On a scale of 1 to 10, the scores were at the midpoint indicating a medium risk of contamination of the water.
In CH (borehole), the risk factors observed could increase the likelihood of contamination of the water from the source, so the management needs to ensure drainage channels are free from sand and weeds. Caregivers Area (Ojelabi et al. ). The drinking water storage container of the males was without a cover at times and that of the females did not look clean; some of the physically challenged people used their hands for support while crawling on the floor, thus increasing the risk of contamination of the water. On observation, they did not make a conscious effort to wash their hands before handling the storage container. In a study conducted by Oloruntoba (), which assessed households' drinking water quality in Ibadan, it was concluded that the unhygienic handling of storage containers could lead to contamination of the water.
Across the homes, sanitary inspection of the storage containers indicated that the water in the boys' storage containers had a higher risk of contamination than that of the girls'. This could be because the boys were more playful and carefree. E. coli is a major indicator of water pollution.
In SAC, there was a significant reduction in TCC in the girls' storage container. This centre had the largest proportion of respondents who said their water was boiled.
Even though the TCC in the girls' storage container was not within WHO recommended values, the counts indicated that the water consumed by the girls was subjected to some treatment. Also the low sanitary risk score could as well reduce the likelihood of contamination of the water.

CONCLUSION
In a home for physically challenged people, access to water depends on the availability of a constant water supply as well as the availability and efficiency of caregivers. Also water facilities should be close to the hostel and accessible to the physically challenged people by means of wheel chair ramps (where necessary), and disabled friendly facilities.
Across the homes, access to potable water was not good enough; even though the quantity of drinking water the residents had access to exceeded WHO minimum requirement, some of the residents were very unsatisfied with the QDW they received from their caregivers daily. More caregivers were needed to respond to the needs of the physically challenged people. Also, some of the indicator organisms assessed exceeded the WHO recommended limit implying that the drinking water was not potable. The management of the homes needed to do more in terms of water treatment.

Recommendation
Government should establish minimum requirements for the opening of a home for physically challenged people: a constant supply of potable water in the compound (preferably a borehole facility which supplies water throughout the year); at least two male and two female caregivers should be employed; the buildings should be bungalows with wheelchair ramps at strategic locations.
Challenges during the study 1. Scarcity of participants: There are not many physically challenged people living in homes for the handicapped who only have mobility impairment. Finding them took time and reduced the study population.
2. Co-operation of participants: Getting the physically challenged people to trust and co-operate with the researcher was not easy as they saw some information they divulged as confidential.