Natural Resources, School of



Essays on Health Education and Behavior, and Household Decision-Making

First Advisor

Elizabeth VanWormer

Second Advisor

Christopher R. Gustafson

Date of this Version

Fall 12-3-2019


Ahamad, Mazbahul G. 2019. "Essays on Health Education and Behavior, and Household Decision-Making." Order No. 22622498, The University of Nebraska - Lincoln.


A dissertation presented to the faculty of The Graduate College at the University of Nebraska in partial fulfillment of requirements for the degree of Doctor of Philosophy, Major: Natural Resource Sciences (Human Dimensions), under the supervision of Professors Elizabeth VanWormer and Christopher R. Gustafson. Lincoln, Nebraska: September, 2019.


Unsafe water sources, poor sanitation, and insufficient hygiene practices are risk factors for disease among pastoralists (extensive livestock-keepers) in sub-Saharan Africa. Preventive health behaviors such as treating water, using pit toilets, and handwashing with soap—WASH behaviors—can reduce disease transmission and improve overall household health. This dissertation is a compilation of three empirical studies: one investigating pastoralist households’ water treatment, sanitation, and hygiene-related preventive health decisions; one examining the effect of a short education intervention on WASH behaviors; and one investigating seasonal differences in their primary water sources in the Iringa Rural District of south-central Tanzania. Chapter one investigates the socioeconomic, demographic, and environmental factors related to pastoralists’ WASH behaviors using household survey data of 196 pastoralists from Barabaig, Maasai, and Sukuma ethnic communities among 21 villages. Our results show that the percentage of school-going children in the household was associated with pastoralists’ water treatment behaviors, pit toilet use, and handwashing with soap after toilet use and working with livestock. Chapter two evaluates the impact of a short health educational intervention on pastoralists’ behaviors related to water treatment in the rainy and dry seasons and handwashing with soap at three critical points in time (before eating, after toilet use, and after working with animals). After two baseline surveys, we collected follow-up data from eight to 20 months after the educational intervention. We found no significant impact of the health education intervention on households’ water treatment and handwashing behaviors. Additional investigation of households’ attitudes and levels of knowledge, social norms, and belief-related factors will strengthen our understanding of their preventive health behaviors. The third chapter explores the socioeconomic, demographic, and spatial factors associated with the pastoralists using different primary water sources in the rainy and dry seasons. Using household-level survey data from four rounds (2012, 2013, 2015, and 2016), pastoralists were found to collect all or the majority of their household water from three major sources in both seasons: dug wells, piped water, and rivers, with slight seasonal variation. We also found seasonal differences in pastoralists’ primary household water sources, which were associated with pastoralists’ ethnic and village characteristics. These findings provide a foundation to better understand WASH behaviors, impacts of health education interventions on pastoralists’ WASH decisions, and source- and season based water access and usage behaviors of pastoralist households to facilitate safe drinking water, improved sanitation, and handwashing practices.