1. Effects of Habitat For Humanity Housing on the Health of Children
and their Mothers in the Communities of Khmer Kampuchea
Khrom, Samaki and Sen Sok in Phnom Penh, Cambodia
Carmen Aurora Garcia
World Toilet Summit
Nov 3-6 2008
1

2. Background
According to the UN-Habitat:
“adequate shelter means more than a roof over one’s
head. It also means adequate privacy; adequate
space; physical accessibility; adequate security;
security of tenure; structural stability and durability;
adequate lighting, heating and ventilation; adequate
basic infrastructure, such as water supply, sanitation
and waste-management facilities; suitable
environmental quality and health-related factors…”
2

3. Housing and Health background
In developing countries children diarrhea
incidence and acute lower respiratory infections
are linked strongly to housing conditions.
(Chaudhuri, 2004)
Wolff et al (2001)
Children 5 years old and below living in Habitat Houses
experienced lower incidence of respiratory infection
21% to 29%; GI,10% to 14%; and malaria, 15% to 20%.
than those living in traditional houses
3

4. Problem Statement
•Improving the health of children and women requires
addressing many factors, including their housing and
sanitation condition.
•Inadequate housing conditions have adverse effect
to the health of children and women but there have
been few studies in developing countries.
4

5. 5

6. Purpose of The study
To compare the health of children and their
mothers in Habitat for Humanity housing and
non-Habitat housing in the communities of
Khmer Kampuchea Khrom, Samaki and Sen
Sok in Phnom Penh, Cambodia.
6

7. Specific Objectives
 To assess the impact on children’s and mothers’
health in Habitat housing in Khmer Kampuchea
Khrom, Samaki and Sen Sok communities.
 To identify the specific aspects of improved
housing that are most closely associated with
housing-related differences in children's and
mothers' health.
 To identify children and their mothers’ illnesses
and diseases that may be related to poor
housing conditions.
7

8. Description of Study Area
 In the capital city of Phnom Penh, it is estimated that
at least 20% of the city’s population live in squatter
settlements where more than half of them live in
houses made of temporary materials.
 Khmer Kampuchea Khrom, Samaki and Sen Sok
Communities are 3 of the more than 19 communities
opened by the city government to relocate squatter
families living in the downtown area.
8

9. 9

10. Conceptual Framework
Independent Variables
Habitat for Humanity Dependent Variables
Addressed: Improved Housing
Not addressed: Training (financial
management, etc.),Community
Participation, Local Leadership
Development, Advocacy
Socio-economic Situation Health
Addressed: Income, Education, Occupation
Not addressed: Inequality
Addressed in mothers and children:
Environmental Respiratory
Addressed: Drinking water source, Building materials, Gastro-intestinal
Arrangement of rooms, Household size, Exposure to fuel Skin
smoke, Mosquito coil, Garbage disposal, Home sanitation
Not addressed: Distance to economic center, Terrain
Not Addressed:
Infrastructure Perception of health now vs. a year
Addressed: Drainage system, Sewer system ago
Not addressed: Public services (e.g., roads, public
transport, public market, health center, electricity, Mental Health
communication system) Social Isolation
Self-esteem
Behavioral
Addressed: Smoking/drinking, Exercise
Not addressed: Diet and, Hygiene
10

11. Participants and Methodology
 Household-based cross sectional analytical study
 Children ages 10 years and younger, and their
mothers, who are living in Habitat-built houses and
children and mothers living next door or within 100
meters in non-Habitat homes
 294 respondents: 147 households living in Habitat-
built houses and 147 households adjacent to them
 108 in Samaki; 108 in KK and; 78 in Sen Sok
11

12. Data Collection Methodology
 A structured, standardized, pre-tested questionnaire in
English and Khmer were administered by 10 trained
interviewers.
 Samples from drinking water source were directly collected
from each household and taken to the Resource
Development International laboratory for testing.
 The respondent were expected to be the mother whenever
possible, or another adult female caregiver.
 The respondent reported on recalled illness and symptoms
during the last 4 weeks, and the last 2 weeks.
12

13. Data Analysis
SPSS software was utilized
Independent T test statistics
Chi-square
Logistic regression
Pearson’s chi-square
13

14. Results
 General characteristics, including demographics, of
non- Habitat and Habitat households
 Non-Habitat households reported staying in the
community for an average of 4.37 years compared
to 3.9 years for the Habitat households (p=.012).
 Habitat for Humanity program in Phnom Penh is
relatively new, having started only in 2004
14

15. Housing conditions in non-Habitat and Habitat homes
 Non-Habitat households have more occupants
than Habitat ones, 5.86 and 5.31 people
respectively (p=.060)
 Habitat households reported higher satisfaction
about the condition and size of their homes
compared with the non-Habitat ones (p=<.001)
15

16. Discussion (continued)
 Results from questionnaire-derived and interviewer-
observed indicate that Habitat houses are in better
physical conditions than the non-Habitat ones.
 Habitat households are generally more satisfied
with their current housing conditions, reporting
more adequate conditions during the rainy season
and having better quality toilet facilities: Only 12.2%
of Habitat households reported having inadequate
toilet facilities compared with 35.% in non-Habitat.
16

17. 17

18. Mothers and children health in non-Habitat and Habitat homes
 Results indicate that both the mothers’ and
children’s symptom rates generally did not differ.
reporting very high rates of both individual and
combined symptoms
 Results suggest that both groups are subjected to
important unidentified health risk factors in the
communities surveyed.
 The communities lack adequate infrastructure and
basic services, such as drainage for waste water.
18

19. When children’s health was associated with potential
continuous confounders:
Households that have lived longer in the community the rates
of the combined symptoms of diarrhea and vomiting
increases.
Familyincome shows a direct association with all 3 combined
symptoms. As the income increases the odds of the following
combined illnesses decreases:
 Cough and phlegm (p=.020)
 Cough and cold (p=.004)
 Diarrhea and vomiting (p=.041)
19

20. Children’s health in relation to continuous potential confounders
Characteristic Logistic modeled odds ratio per unit increase P-value
Child's age
Cough and phlegm .992 .807
Cough and cold .888 .001
Diarrhea and vomiting .824 <.001
Number of children ≤ 10 years old in household
Cough and phlegm .911 .292
Cough and cold .922 .346
Diarrhea and vomiting 1.060 .574
Hours spent with children each day
Cough and phlegm .982 .249
Cough and cold 1.005 .736
Diarrhea and vomiting .997 .853
Mother's educational level
Cough and phlegm .972 .777
Cough and cold .915 .371
Diarrhea and vomiting .965 .775
Years in community
Cough and phlegm .947 .246
Cough and cold .998 .971
Diarrhea and vomiting 1.2226 .002
Years in this house
Cough and phlegm .988 .799
Cough and cold 1.032 .504
Diarrhea and vomiting 1.229 <.001
Monthly Income
Cough and phlegm .996 .020
Cough and cold .996 .004
20
Diarrhea and vomiting .995 .041

21. Discussion (continued)
 When housing conditions are associated with rate
of incidence of certain combined symptoms, the
results show:
 24% of mothers of households without toilet facilities
reported diarrhea and vomiting symptoms as
compared to only 8.3% of those with toilets.
21

22. Mothers' and children's health in relation to
characteristics associated with Habitat housing
(potential confounders)
Mothers' health in relation to categorical potential confounders
Symptoms No Yes X2 (df)
P- Value
Has toilet
Cough and phlegm 9 (34.6%) 69 (25.9%) .911 (1) P=.340
Cough and cold 12 (46.2%) 88 (33.3%) 1.722 (1) P= .189
Diarrhea and vomiting 6 (24.0%) 22 (8.3%) 6.406 (1) P=.011
House size perceived adequate
Cough and phlegm 23 (29.5%) 55 (25.6%) .447 (1) P=.504
Cough and cold 33 (42.9%) 67 (31.3%) 3.348 (1) P=.067
Diarrhea and vomiting 3 (3.9%) 25 (11.7%) 3.847 (1) P=.050
Housing condition perceived adequate
Cough and phlegm 21 (20.6%) 57 (30.0%) 3.003 (1) .083
Cough and cold 38 (37.3%) 62 (33.0%) .535 (1) .464
Diarrhea and vomiting 9 (8.9%) 19 (10.1%) .107 (1) .743
22

23.  The direct association of inadequate toilet
facilities and the rate of diarrhea and
vomiting incidence, which the study
establishes is consistent with the
conclusion made in the study by Wolff et
al (2001) that reveals that having access
to safe water and owning private toilet are
significantly associated to lowering the
odds of acquiring some illness.
23

24. Limitations of the Study
 Habitat program in Cambodia is relatively new: Less
than 200 families in 3 community projects in Phnom
Penh. This limited number of Habitat for Humanity
houses in turn limits the confidence and power of the
tests for health-related differences between Habitat
and non-Habitat housing.
 This study did specifically examine the physiological
health-related effects of the Habitat housing,
specifically gastrointestinal, respiratory and skin
diseases, but did not measure other potential benefits
such as increased self-esteem, stronger neighborhood/
community cohesion, and increased family economic
value.
 The time constraint for the research did allow the
researcher to undertake a more thorough multivariate
study.
24

25. Thank you!
25