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Kebede N, Delie AM, Bogale EK, Anagaw TF, Tiruneh MG, Fenta ET, Endeshaw D, Eshetu HB, Adal O, Tareke AA. Mapping and predicting open defecation in Ethiopia: 2021 PMA-ET study. BMC Public Health 2024; 24:1671. [PMID: 38910246 PMCID: PMC11194908 DOI: 10.1186/s12889-024-19222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/21/2024] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION There has been extensive research conducted on open defecation in Ethiopia, but a notable gap persists in comprehensively understanding the spatial variation and predictors at the household level. This study utilizes data from the 2021 Performance Monitoring for Action Ethiopia (PMA-ET) to address this gap by identifying hotspots and predictors of open defecation. Employing geographically weighted regression analysis, it goes beyond traditional models to account for spatial heterogeneity, offering a nuanced understanding of geographical variations in open defecation prevalence and its determinants. This research pinpoints hotspot areas and significant predictors, aiding policymakers and practitioners in tailoring interventions effectively. It not only fills the knowledge gap in Ethiopia but also informs global sanitation initiatives. METHODS The study comprised a total weighted sample of 24,747 household participants. ArcGIS version 10.7 and SaT Scan version 9.6 were used to handle mapping, hotspots, ordinary least squares, Bernoulli model analysis, and Spatial regression. Bernoulli-based model was used to analyze the purely spatial cluster detection of open defecation at the household level in Ethiopia. Ordinary Least Square (OLS) analysis and geographically weighted regression analysis were employed to assess the association between an open defecation and explanatory variables. RESULTS The spatial distribution of open defecation at the household level exhibited clustering (global Moran's I index value of 4.540385, coupled with a p-value of less than 0.001), with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Spatial analysis using Kuldorff's Scan identified six clusters, with four showing statistical significance (P-value < 0.05) in Amhara, Afar, Harari, Tigray, and southwest Ethiopia. In the geographically weighted regression model, being male [coefficient = 0.87, P-value < 0.05] and having no media exposure (not watching TV or listening to the radio) [coefficient = 0.47, P-value < 0.05] emerged as statistically significant predictors of household-level open defecation in Ethiopia. CONCLUSION The study revealed that open defecation at the household level in Ethiopia varies across the regions, with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Geographically weighted regression analysis highlights male participants lacking media exposure as substantial predictors of open defecation. Targeted interventions in Ethiopia should improve media exposure among males in hotspot regions, tailored sanitation programs, and region-specific awareness campaigns. Collaboration with local communities is crucial.
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Affiliation(s)
- Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Amare Mebrat Delie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabel Anagaw
- Department of Health Promotion and Behavioral Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gonder, Gonder, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Destaw Endeshaw
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habitu Birhanu Eshetu
- Department of Health Promotion and Health Behaviour, Institute of Public Health, College of Medicine and Health Science, University of Gonder, Gonder, Ethiopia
| | - Ousman Adal
- Department of Emergency Nurse, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abiyu Abadi Tareke
- COVID-219 Vaccine/EPI Technical Assistant at West Gondar Zonal Health Department, Amref Health Africa, Gonder, Ethiopia
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Ageed A, Khan M. Eliminating Trachoma in Africa: The Importance of Environmental Interventions. Cureus 2024; 16:e52358. [PMID: 38234389 PMCID: PMC10792353 DOI: 10.7759/cureus.52358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/19/2024] Open
Abstract
Subsequent to the failure of the World Health Organisation (WHO) of achieving their target to eliminate trachoma by the year 2020, the most effective strategy in eliminating trachoma must be re-examined to accomplish the new target of eradication by the year 2030. Whilst antibiotic therapy is a core foundation of this elimination strategy, another important factor is the state of the environmental conditions in trachoma endemic countries. This manuscript aimed to identify the impact of environmental improvement strategies on the prevalence of trachoma and the significance of environmental improvement alongside the use of antibiotic treatment to achieve trachoma elimination. Two independent literature searches were conducted up until the 5th of July 2021. Two main databases were used to carry out these literature searches, namely, Ovid EMBASE and Ovid MEDLINE. All of the relevant references were found using MeSH and free text terms. Key terms used were 'trachoma', 'water', 'sanitation', 'hygiene' and 'environmental Improvement'. The exclusion criteria included non-African-based studies, review papers, protocols and case reports. A total of 17 studies were included for this review. Living within a close range of a water source was significantly associated with reduced risk of trachoma infection. Water obtained from piped water sources was associated with the lowest rates of active trachoma. Studies on facial cleanliness evidenced a strong association with reduced prevalence of trachoma. Whilst the provision of latrine facilities found was significantly associated with reduced prevalence of trachoma, there was no significant difference between the use of private latrine facilities over communal latrine facilities. The use of repeated scheduled antibiotic treatments over single-use antibiotic distribution had a greater impact both short term and long term on the prevalence rates of trachoma. Nonetheless, prevalence rates increased again following the commencement of treatment. Mass antibiotic treatment has been proven to have a greater impact on lowering the prevalence of trachoma initially, but this impact is not sustainable due to the rise in prevalence rates following the completion of treatment. A holistic approach, therefore, must be implemented with evidence showing that an emphasis on longer-term environmental methods should be implemented to compliment antibiotic distribution. Prioritisation of specific interventional measures should be tailored according to local epidemiology; nonetheless, these measures form the backbone of a trachoma elimination strategy to eliminate trachoma by the year 2030.
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Affiliation(s)
- Ahmed Ageed
- Hospital Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Maaz Khan
- Medical Education, Royal Surrey County Hospital, Guildford, GBR
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Gayawan E, Somo-Aina O, Kuti O. Analysis of the space-time trends in open defecation in Nigeria. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:68524-68535. [PMID: 37126172 DOI: 10.1007/s11356-023-26161-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 02/23/2023] [Indexed: 05/27/2023]
Abstract
The practice of open defecation has persistently remained high in Nigeria despite the grave danger it poses to public and environmental health, and the several intervention programs put in place over the years to curtail the ugly practice. This study quantifies the space and time trends in open defecation practice in Nigeria with the aim of highlighting the changes that have taken place at various locations in Nigeria over a 15-year period. A Bayesian spatio-temporal model was applied to cross-section data obtained from the Nigeria Demographic and Health Survey conducted in 2003, 2008, 2013, and 2018, and inference was based on integrated nested Laplace approximation technique. The findings indicate a north-south spatio-temporal patterns that are similar among the rural and urban dwellers. States such as Kwara, Kogi, Oyo, Ondo, Osun, Ekiti, Enugu, and Ebonyi all of which are neighbors to each other are among those with persistent high prevalence of open defecation in the country. Given the diversity of the Nigerian population groups within the states, a more understanding of the socio-cultural standard of the different communities would be required to implement policies that recognize opportunities to explore, while being culturally responsive to community needs in ending open defecation in Nigeria.
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Affiliation(s)
- Ezra Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria.
| | - Omodolapo Somo-Aina
- Department of Educational Research Methodology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Oluwatosin Kuti
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Kouassi HAA, Andrianisa HA, Traoré MB, Sossou SK, Momo Nguematio R, Ymélé SSS, Ahossouhe MS. Review of the slippage factors from open defecation-free (ODF) status towards open defecation (OD) after the Community-Led Total Sanitation (CLTS) approach implementation. Int J Hyg Environ Health 2023; 250:114160. [PMID: 36958189 DOI: 10.1016/j.ijheh.2023.114160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
Open-defecation (OD) is one of the most widespread sanitation practices in low-income countries. This practice often causes diarrheal diseases and 760,000 deaths per year. To eradicate OD, several approaches have been developed, including Community-Led-Total Sanitation (CLTS) which is a participatory and community approach. The specificity of CLTS is that it is managed by the community itself, as its name implies, and that no subsidies or financial contributions from outside the community are used in the construction of the facilities. Although, the CLTS is effective in the short-term for eradicating OD, the long-term results are not encouraging: Open-Defecation-Free (ODF) communities revert to OD or partially use latrines. The present research is based on literature review and authors investigation in Burkina Faso. It was conducted to provide a comprehensive understanding of the factors that affect the sustainability of ODF-status leading to slippage in communities. It was found that these factors can be grouped into five categories: behavioral and social, technological, organizational, and vulnerability factors. The last one, socio-political factors, is a contribution from the authors as it was not reported in the literature yet. The authors have proposed graphical synthesis of all the slippage factors and their associated categories in the ODF-communities. Finally, authors have suggested that to sustain ODF-status of communities: include all stages of the sanitation value chain (SVC) in the CLTS, the follow-up activities after achieving ODF-status must be planned well in advance, sanitation marketing should be developed and the sanctions against the practice of OD have to be reinforced. Governments and donors should pay particular attention to the following options: raising awareness and regular monitoring after ODF certification, encouraging research on sustainable and pro-poor sanitation technologies, and building the capacity of implementing actors including facilitators. While obtaining ODF status is materialized by a sign with the status on it, this paper drew the attention of CLTS implementers to the lack of materialization of slippage when it occurs, and the absence of studies on the evolution of the community sanitation scale after ODF-status.
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Affiliation(s)
- Hemez Ange Aurélien Kouassi
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso.
| | - Harinaivo Anderson Andrianisa
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Maïmouna Bologo Traoré
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Seyram Kossi Sossou
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Rikyelle Momo Nguematio
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Sidesse Sonia Saapi Ymélé
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Mahugnon Samuel Ahossouhe
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
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Paul B, Jean Simon D, Kiragu A, Généus W, Emmanuel E. Socio-economic and demographic factors influencing open defecation in Haiti: a cross-sectional study. BMC Public Health 2022; 22:2156. [PMID: 36418991 PMCID: PMC9686112 DOI: 10.1186/s12889-022-14619-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Open defecation (OD) remains an important public health challenge in Haiti. The practice poses a significantly high risk of disease transmission. Considering these negative health consequences, this paper aims to identify socio-economic and demographic factors that influence OD practice among households in Haiti. METHODS The study used secondary data from 13,405 households from the Haiti Demographic and Health Survey 2016-2017. Descriptive statistics and bivariate analysis were used to find the preliminary results. Further, multivariate analysis was performed to confirm the findings. RESULTS Around one quarter (25.3%) of Haitian households still defecate in the open, almost 10% in urban areas, and nearly 36% in rural areas. Multivariate analysis revealed that the age and sex of the household head, household size, number of children aged 1-14 years old in the household, education level, wealth index, access to mass media, place of residence, and region were significant predictors of OD practice among households in Haiti. CONCLUSION To accelerate the elimination of OD by 2030 and therefore achieve sustainable open defecation-free status, the government of Haiti and its partners should consider wealth disparities among regions and mobilize mass media and community-based networks to raise awareness and promote education about sane sanitation practices. Furthermore, because the possibilities to build toilets differ between rural and urban areas, specific interventions must be spearheaded for each of these regions. The public program can subsidize individual toilets in rural areas with room to collect dry excreta for the preparation of fertilizers, while in urban areas collective toilets can be built in slums. Interventions should also prioritize households headed by women and young people, two underpriviledged socioeconomic groups in Haiti.
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Affiliation(s)
- Bénédique Paul
- Department of Agro-socio-economics, Chibas, Université Quisqueya, Port-au-Prince, Haiti.
- Groupe d'Etude sur les Sciences de la Durabilité, Université Quisqueya, Port-au-Prince, Haiti.
| | - David Jean Simon
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
| | - Ann Kiragu
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
| | - Woodley Généus
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
| | - Evens Emmanuel
- Espace universitaire One Health, Université Quisqueya, Port-au-Prince, Haiti
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Atangana E, Oberholster PJ. Assessment of water, sanitation, and hygiene target and theoretical modeling to determine sanitation success in sub-Saharan Africa. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2022; 25:1-25. [PMID: 36090188 PMCID: PMC9440466 DOI: 10.1007/s10668-022-02620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Accessing the status of clean drinking water, sanitation, and hygiene remains a challenge in sub-Saharan Africa (SSA). The current article contributes to the progress made by the WASH initiatives in ten SSA countries in eliminating open defecation by 2030, using theoretical data from 2017 to 2019. The authors used regression trend estimation to observe that rural and urban population growth had a statistically significant detrimental influence on the elimination of open defecation by 2030. According to the predicted data model, by 2030-2035, the urban population of SSA would be 65, 25, and 10 million in all the three categories of income groups. An increase in the number of modern pit users (C1) shows no improvement at the annual rate of change. The unimproved toilets and open-pit latrines (C2 and C3) show a linear growth rate, which expanded over time. Population growth, higher unemployment, and teen pregnancies contribute to this increase. Under current conditions, the curve of modern pit latrine users will increase linearly. Nigeria has the most significant number of spread pit latrine users, which has decreased linearly from 25 to 20% since 2017. It was evident that the power-law trend in Nigeria would increase the usage of unimproved pit latrines and open-pit latrines. Ghana had the highest rate (50%) of open-pit latrine users, while the data show that this situation remained stable (2001-2017). In the Democratic Rep. Congo, annual rates increased linearly from 25 to 33% (2000-2017), while Burundi was one of the countries in the region with the lowest number of open-pit latrine users, although the annual rate has increased from 6.13 to 11.75% since 2017 to 2019. Supplementary Information The online version contains supplementary material available at 10.1007/s10668-022-02620-z.
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Affiliation(s)
- Ernestine Atangana
- Centre for Environmental Management, University of the Free State Bloemfontein, Bloemfontein, 9300 South Africa
| | - Paul J. Oberholster
- Centre for Environmental Management, University of the Free State Bloemfontein, Bloemfontein, 9300 South Africa
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Spatiotemporal distribution and determinants of open defecation among households in Ethiopia: A Mixed effect and spatial analysis. PLoS One 2022; 17:e0268342. [PMID: 35588139 PMCID: PMC9119487 DOI: 10.1371/journal.pone.0268342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Open defecation is the disposal of human faeces in the fields, forests, bushes, and open bodies of water. It is practiced more in sub-Saharan African countries and is considered a sign of underdevelopment. Open defecation facilitates the transmission of pathogens that cause diarrheal diseases which is the second leading contributor to the global burden of disease. In Ethiopia, it kills half a million under-five children annually. Even though open defecation practice is a major cause of childhood mortality and morbidity in Ethiopia, there is minimal evidence on the trend, spatiotemporal distribution, wealth-related inequalities, and other determinates of open defecation practice. Objectives Therefore, this study aimed to investigate the trend, spatiotemporal distribution, and determinants of open defecation among households in Ethiopia. Methods Cross-sectionally collected secondary data analysis was conducted based on 2016 Ethiopian Demographic and Health Survey (EDHS). A total weighted sample of 16,554 households was included. We assessed the 16 years (2000–2016) trend of open defecation with 95% confidence intervals. Data were weighted, recoded, cleaned, and analyzed using STATA version 14.2 software. A mixed-effect analysis was employed to identify factors contributing to open defecation practice in Ethiopia. In the final multivariable analysis, the associations between dependent and independent variables were presented using adjusted odds ratios and 95% confidence intervals with a p-value of <0.05. The concentration index was used to assess wealth-related inequalities, while spatial analysis was used to explore the spatial distribution and significant windows of open defecation practice. Results The trend of open defecation practice in Ethiopia was significantly decreased from 81.96% (95% CI: 81.08, 82.8) in 2000 EDHS, to 32.23% (95% CI: 31.16, 33.31) in 2016 EDHS. Individual-level factors such as; age, educational attainment, marital status, media exposure, wealth status, and source of drinking water, as well as community-level factors such as residence, region, community-level poverty, and community level media usage, had a significant association. Open defecation practice was significantly and disproportionately concentrated on the poor households [C = -0.669; 95% CI: -0.716, -0.622]. A non-random open defecation practice was observed in Ethiopia. Among the 11 regions, primary clusters were identified in only 3 regions (Afar, Somali, and Eastern Amhara) Conclusion Open defecation practice remains a public health problem irrespective of the significant decrease seen in Ethiopia for the past 16 years. Individual and community-level factors had a significant association with this problem. Since it is a leading cause of under-five children mortality and morbidity, the Ethiopian ministry of health should plan and work on basic sanitation programs that focus on the poorest communities, rural societies, and small peripheral regions. These programs should include regional planning for sanitation, and translation of materials into local languages to prevent under-five mortality and morbidity due to diarrheal diseases caused by open defecation.
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Belay DG, Asratie MH, Aragaw FM, Tsega NT, Endalew M, Gashaw M. Open defecation practice and its determinants among households in sub-Saharan Africa: pooled prevalence and multilevel analysis of 33 sub-Saharan Africa countries demographic and health survey. Trop Med Health 2022; 50:28. [PMID: 35351215 PMCID: PMC8962481 DOI: 10.1186/s41182-022-00416-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/15/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Open defecation facilitates the transmission of pathogens that cause diarrheal diseases, which is the second leading contributor to the global burden of disease. It also exposed hundreds of millions of girls and women around the world to increased sexual exploitation. Open defecation is more practice in sub-Saharan African (SSA) countries and is considered an indicator of low socioeconomic status. However, there is little evidence on the pooled prevalence and factors contributing to open defecation practice among households in SSA. OBJECTIVES This study aimed to assess the pooled prevalence, wealth-related inequalities, and other determinants of open defecation practice among households in sub-Saharan Africa. METHODS Demographic and Health Survey data sets of 33 SSA countries with a total sample of 452,281 households were used for this study. Data were weighted, cleaned, and analyzed using STATA 14 software. Meta analyses were used to determine the pooled prevalence of open defecation practice among households in SSA. Multilevel analysis was employed to identify factors contributing to open defecation practice among households in SSA. Moreover, concentration index and graph were used to assess wealth-related inequalities of open defecation practice. The associations between dependent and independent variables were presented using adjusted odds ratios and 95% confidence intervals with a p value of < 0.05. RESULTS The pooled prevalence of open defecation practice among households in sub-Saharan African countries was 22.55% (95%CI: 17.49%, 27.61%) with I2 = 99.9% and ranges from 0.81% in Comoros to 72.75% in Niger. Individual level factors, such as age, educational attainment, media exposure, wealth status, and access to drinking water, as well community level factors, such as residence, country income status, and region in SSA, had a significant association with open defecation practice. The concentration index value [C = - 0.55; 95% CI: - 0.54, - 0.56] showed that open defecation practice was significantly disproportionately concentrated on the poor households (pro-poor distribution). CONCLUSIONS Open defecation practice remains a public health problem in sub-Saharan Africa. Individual level factors, such as age, educational attainment, media exposure, household wealth status, and access to drinking water had an association with open defecation practice. Moreover, community level factors such as residence, country income status and region in SSA have a significant effect on open defecation. There is a significantly disproportional pro-poor distribution of open defecation practice in SSA. Each country should prioritize eliminating open defecation practices that focused poorest communities, rural societies, and limited water access areas. Media exposure and education should be strengthened. Moreover, public health interventions should target to narrow the poor-rich gap in the open defecation practice among households including provisions of subsidies to the poor. Policymakers and program planners better use this evidence as preliminary evidence to plan and decide accordingly.
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Affiliation(s)
- Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Melaku Hunie Asratie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuhamin Tesfa Tsega
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mastewal Endalew
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Gashaw
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Paasche T, Whelan M, Nahirney M, Olemshumba S, Bastien S. An Application of the Integrated Behavioral Model for Water, Sanitation and Hygiene to Assess Perceived Community Acceptability and Feasibility of the Biosand Filter among Maasai Pastoralists in Rural Tanzania. Am J Trop Med Hyg 2022; 106:464-478. [PMID: 34749313 PMCID: PMC8832900 DOI: 10.4269/ajtmh.21-0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/10/2021] [Indexed: 02/03/2023] Open
Abstract
In addition to diarrheal disease risk, lack of access to safe water may have other indirect effects throughout one's life, such as school and workplace absenteeism, leading to less economic productivity. In contexts with scarce resources and unsafe drinking water, household water treatment and safe storage options such as the Biosand filter (BSF) allows households to directly reduce contamination and increase the quality of their drinking water. This study aimed to develop an understanding of perceived community acceptability and feasibility related to pre- and post-implementation of a BSF pilot project in rural Maasai households in the Ngorongoro Conservation Area (NCA), Tanzania. The study was guided by the Integrated Behavioral Model for Water Sanitation and Hygiene interventions (IBM-WASH) to understand the various factors influencing end-user perceptions of the BSF. In-depth interviews, group discussions and think tanks were conducted among a cross-section of community members, stakeholders, and other actors from May 2016 to September 2017. The data were analyzed using a thematic content analysis approach. A range of perceived contextual, technological, and psychosocial factors were found to potentially affect the acceptability and feasibility of BSF adoption in the NCA, highlighting the complex layers of influences in the setting. Whilst the BSF is seemingly an accepted option to treat water within the NCA, the community identified key barriers that may lower BSF adoption. The application of the IBM-WASH model served as a useful framework for evaluating the introduction of the BSF, identifying insights into contextual, technological, and psychosocial community factors.
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Affiliation(s)
- Tina Paasche
- Public Health Coordinator, Rogaland Fylkeskommune, Stavanger, Rogaland, Norway
| | - Mairead Whelan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marissa Nahirney
- Medical Student Intern, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sheri Bastien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;,Medical Student Intern, University of Alberta, Edmonton, Alberta, Canada;,Address correspondence to Sheri Bastien, Department of Public Health Science, Norwegian University of Health Sciences, Post Box 5003, 1432 Ås, Norway. E-mail:
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Malik MI, Nawaz SMN, Nadeem M. Overcoming open defecation for healthier environment in case of Pakistan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:19179-19185. [PMID: 33394408 DOI: 10.1007/s11356-020-11919-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
With the growing awareness of the linkage among open defecation (OD), environment, and health, it is important to understand the factors responsible for OD. It is a necessary step toward developing a strategy to end open defecation for ensuring a better environment and human health. There is no such study available for Pakistan. The study, therefore, aims to bridge this gap. Using household data of Pakistan Demographic and Health Survey (PDHS) 2017-2018, an association of OD with potential predictors, analysis of variance, and a logistic regression model are employed to develop the evidence. The results suggest that place of residence, education, poverty status, social norms, geopolitical regions, and living space significantly predict the OD behavior in Pakistan. This study recommends two things: first is to facilitate the households and communities to own latrines, second is to change the behavior through intervention. However, political commitment and effective administration will be key to ascertain ending OD.
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Affiliation(s)
- Muhammad Irfan Malik
- Department of Economics and Business Administration, University of Education, Lahore (Faisalabad Campus), Faisalabad, Pakistan.
- Punjab Economic Research Institute (PERI), Lahore, Pakistan.
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Cassivi A, Tilley E, Waygood EOD, Dorea C. Trends in access to water and sanitation in Malawi: progress and inequalities (1992-2017). JOURNAL OF WATER AND HEALTH 2020; 18:785-797. [PMID: 33095201 DOI: 10.2166/wh.2020.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Billions of people globally gained access to improved drinking water sources and sanitation in the last decades, following effort towards achieving the Millennium Development Goals. Global progress remains a general indicator as it is unclear if access is equitable across groups of the population. Agenda 2030 calling for `leaving no one behind', there is a need to focus on the variations of access in different groups of the population, especially in the context of low- and middle-income countries including Malawi. We analyzed data from Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) to describe emerging trends on progress and inequalities in water supply and sanitation services over a 25-year period (1992-2017), as well as to identify the most vulnerable populations in Malawi. Data were disaggregated with geographic and socio-economic characteristics including regions, urban and rural areas, wealth and education level. Analysis of available data revealed progress in access to water and sanitation among all groups of the population. The largest progress was generally observed in the groups that were further behind at the baseline year, which likely reflects good targeting in interventions/improvements to reduce the gap in the population. Overall, results demonstrated that some segments of the population - foremost poorest Southern rural populations - still have limited access to water and are forced to practise open defecation. Finally, we suggest including standardized indicators that address safely managed drinking water and sanitation services in future surveys and studies to increase the accuracy of national estimates.
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Affiliation(s)
- Alexandra Cassivi
- Department of Civil Engineering, Engineering and Computer Science (ECS) 304, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC V8 W 2Y2, Canada E-mail:
| | - Elizabeth Tilley
- Department of Environmental Health, University of Malawi, The Polytechnic, Malawi and Eawag: Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | | | - Caetano Dorea
- Department of Civil Engineering, Engineering and Computer Science (ECS) 304, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC V8 W 2Y2, Canada E-mail:
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Latrine Ownership and Its Determinants in Rural Villages of Tigray, Northern Ethiopia: Community-Based Cross-Sectional Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:2123652. [PMID: 32879630 PMCID: PMC7448124 DOI: 10.1155/2020/2123652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/25/2020] [Accepted: 07/31/2020] [Indexed: 01/22/2023]
Abstract
Background Open defecation was largely a rural phenomenon most widely attributed to poor latrine ownership at community level. We aimed at examining latrine ownership and its determinants in rural villages of the Tigray region, Northern Ethiopia. Methods Community-based cross-sectional study was conducted from June to July 2018. A total of 756 randomly selected households were involved in the study. The multistage cluster sampling technique was used to select study households. Data were checked, coded, and entered into Epi-Info version 7. Besides, it was exported to SPSS version 20 for data analysis. Multivariable logistic regression analysis was involved to estimate the net effect size of factors associated with latrine ownership. Results The proportion of households owning latrine was 35.7%. The majority (84.4%) of constructed latrines were utilized by household families. Households advocated latrine IEC by Health Extension Workers (HEWs) (AOR = 1.902, 95% CI: 1.269–2.852), living in their private house (AOR = 3.13, 95% CI: 1.528–6.401), and the occupation status of government employees (AOR = 3.54, 95% CI: 0.586–21.397) are more likely to lead to the construction of latrines. The availability of latrine made on slab floor (AOR = 1.790, 95% CI: 0.297–3.102), having a latrine constructed inside the household compound (AOR = 4.463, 95% CI: 1.021–19.516), and delivery of latrine IEC by Women Development Armies (WDAs) (AOR = 2.425, 95% CI: 0.728–8.083) may lead to better latrine utilization at the household level. Conclusion Households owning latrine at the community level were low. The desired level of latrine ownership will be realized if all sanitation and hygiene components are kept on eye side by side in line with identified predictor factors.
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Latrine Utilization and Associated Factors in Mehal Meda Town in North Shewa Zone, Amhara Region, Ethiopia, 2019. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7310925. [PMID: 32685523 PMCID: PMC7321497 DOI: 10.1155/2020/7310925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/19/2020] [Accepted: 06/04/2020] [Indexed: 12/03/2022]
Abstract
Background Worldwide lack of sanitation is a serious health risk, affecting billions of people around the world, particularly the poor and disadvantaged of people around the world. In Sub-Saharan Africa, the number of people who defecate remains the open field 215 million. According to the 2016 Ethiopian Demographic and Health Surveys report, 56% of the rural households use unimproved toilet facilities. One in every three households in the country has no toilet facility. However, achieving real gains in increasing latrine use and quality remained as a challenge. This study was used to assess the latrine utilization and associated factors in Mehal Meda town in North Shewa zone, Amhara region, Ethiopia, 2019. Result In this study, a total of 558 participants were included. Out of households, 509 (91.2%) utilized their latrine facility. On the other way, 503 (98.8%) households utilized latrine regularly. Significant variables that were associated to latrine utilization were the occupational status of head of households, observing feces around the compound/latrine, duration of latrine utilization, shape and structure of latrine facility, latrine status during observation, and distance between water well and latrine. According to this study, the magnitude of latrine utilization in Mehal Meda district was 91.2%. It was lower than Ethiopia national expected target of MDGs (100%). Significant variables that were associated to latrine utilization were occupational status of head of households, observing feces around the compound/latrine, shape and structure of latrine facility, latrine status during observation, and distance between water well and latrine facility. Therefore, health education about latrine utilization and its advantage should be given for community in the study area.
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Cobbinah PB, Kosoe EA, Diawuo F. Environmental planning crisis in urban Ghana: Local responses to nature's call. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 701:134898. [PMID: 31704399 DOI: 10.1016/j.scitotenv.2019.134898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/27/2019] [Accepted: 10/07/2019] [Indexed: 06/10/2023]
Abstract
Worldwide, there is increasing acknowledgement of the dangers of improper human waste management, particularly open defecation, on the environment and human wellbeing. With about 85.7% of Ghana's population without access to decent toilet facilities as of 2017, Ghana ranks highly in the world among countries with poor human waste management practices. Focusing on urban Ghana, the purpose of this article is twofold: first, to analyze the social, economic, institutional and cultural factors inhibiting the provision of household toilet facility in urban Ghana; and second, to assess how urban residents are coping with the absence of in-house toilet facilities, and the urban planning implications. Using Wa municipality as a case study, household survey and key informant interviews were conducted. Findings indicate that provision of in-house toilet facilities is influenced by complex interactions of socio-economic (e.g. income and educational levels) and cultural (community belief system in relation to toilet provision) factors as well as distortions in the urban planning regime (e.g. limited monitoring systems, inadequate logistics and personnel). Findings from a regression analysis between residents' attitudes to provision of toilet facilities and the benefits they receive or derive from the availability and/use of in-house toilet facilities indicated a positive correlation (correlation coefficient 0.750; degrees of freedom 13; p value 0.001), yet residents have resorted to the use of communal toilet facilities, open defecation and 'perching' (i.e. sharing with friends' with in-house toilet facilities). Implications of the findings for environmental planning are discussed.
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Affiliation(s)
- Patrick Brandful Cobbinah
- Faculty of Architecture, Building and Planning, The University of Melbourne, Melbourne, VIC 3010, Australia.
| | - Enoch Akwasi Kosoe
- Department of Environment and Resource Studies, University for Development Studies, Tamale, Ghana.
| | - Francis Diawuo
- Department of Environment and Resource Studies, University for Development Studies, Tamale, Ghana
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Busienei PJ, Ogendi GM, Mokua MA. Latrine Structure, Design, and Conditions, and the Practice of Open Defecation in Lodwar Town, Turkana County, Kenya: A Quantitative Methods Research. ENVIRONMENTAL HEALTH INSIGHTS 2019; 13:1178630219887960. [PMID: 31908471 PMCID: PMC6935769 DOI: 10.1177/1178630219887960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Poor latrine conditions, structure, and design may deter latrine use and provoke reversion to open defecation (OD). Statistics show that only 18% of the households in Turkana County, Kenya, have access to a latrine facility with most of these facilities in poor structural designs and poor hygienic conditions, which encourages rampant OD practices. AIM This article reports on quantitative aspects of a larger cross-sectional survey to assess latrine structure, design, and conditions, and the practice of OD in Lodwar. METHODS An observational study was carried out to examine latrine conditions, structure, and design in Lodwar, Kenya. A standardized questionnaire was also used to collect quantitative data. Stratified random sampling technique was employed to select respondents for this study with the sample drawn from 4 administrative units of Lodwar town covering the low-, medium-, and high-income households. Data were managed using Statistical Packages for Social Science (SPSS) software. RESULTS Nineteen percent of the sampled households did not possess a latrine facility at their homesteads with 73% of the latrines constructed using poor materials (mud, mats, polythene bags, and grass). Twenty percent of the respondents were scared of using a latrine with the main reason being loose soils that do not support strong constructions. Eighty-seven percent of the respondents agreed that the presence of feces on the latrine floor encouraged the practice of OD and 321 (80%) respondents stated that the latrine construction materials influenced latrine ownership and its subsequent use. CONCLUSIONS Respondents attributed rampant OD practices to poor latrine structure, design, and conditions. In addition, rampant cases of latrine sharing result in latrine filthiness, which eventually encourages OD practice. Inequality in sanitation, among counties, should be addressed in Kenya. The government should take charge of provision of good-quality communal latrines to the less-privileged societies like Turkana. Community empowerment and introduction of a small fee for cleaning and maintenance of these facilities will also improve their conditions. Ending the practice of OD will lead to increased positive public health and environmental outcomes in the study area.
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Affiliation(s)
- PJ Busienei
- Department of Environmental Science, Egerton University, Nakuru, Kenya
| | - GM Ogendi
- Department of Environmental Science, Egerton University, Nakuru, Kenya
- Dryland Research Training and Ecotourism Centre, Chemeron, Egerton University, Nakuru, Kenya
| | - MA Mokua
- Department of Environmental Science, Egerton University, Nakuru, Kenya
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Sahiledengle B. Prevalence and associated factors of safe and improved infant and young children stool disposal in Ethiopia: evidence from demographic and health survey. BMC Public Health 2019; 19:970. [PMID: 31331313 PMCID: PMC6647302 DOI: 10.1186/s12889-019-7325-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/16/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Infant and young children stools are often considered innocuous, and are not disposed of safely despite having a higher pathogen load than adult feces. In Ethiopia, sanitary management of young children's stool is often overlooked and transmission of fecal-oral diseases is still a significant health burden. The study, therefore, describes the prevalence and associated factors of safe and improved child stool disposal. METHODS Data from the fourth round of the Ethiopian Health and Demographic Survey (EDHS) conducted in 2016 was used for this analysis. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with safe and improved child stool disposal. RESULTS The prevalence of safe and improved child stool disposal in Ethiopia was 36.9% (95%CI: 33.4-40.5%) and 5.3% (95%CI: 4.3-6.5%) respectively. There was regional variation in the prevalence of safe and improved child stool disposal. The odds of safe stool disposal among households with richest wealth index had 4.54 (AOR: 4.54; 95%CI: 2.89-7.12), richer 3.64 (AOR: 3.64; 95%CI: 2.46-5.38), middle 3.26 (AOR: 2.26; 95%CI: 2.27-4.68), and poorer 1.93 (AOR: 1.93; 95%CI: 1.39-2.68) times higher odds of practicing safe child stool disposal than households with poorest wealth index. Similarly, households found in richest, richer, middle, and poorer wealth index had also (AOR: 20.23; 95%CI: 8.59-47.66), (AOR: 12.53; 95%CI: 5.59-28.10) (AOR: 4.91; 95%CI: 1.92-12.55), and (AOR: 4.50; 95%CI: 2.06-9.84) higher odds of practicing improved child stool disposal than households from poorest wealth index respectively. The odds of safe child stool disposal were higher among households whose children age between 6 and 11 months (AOR: 1.57; 95%CI: 1.17-2.09), 12-17 months (AOR: 1.39; 95%CI: 1.00-1.95), and 18-23 months (AOR: 1.43; 95%CI: 1.03-1.99) than households whose children age between 0 and 5 months. The odds of safe child stool disposal were 1.31 (AOR: 1.31; 95%CI: 1.00-1.72) and 1.44 (AOR: 1.44; 95%CI: 1.04-2.01) times higher among mothers whose age between 25 and 34 and greater than 34 years compared to mothers whose age between 15 and 24 years, respectively. In addition, children's stools are more likely to be disposed of safely in urban households than in rural households (AOR: 3.12; 95%CI: 1.86-5.22). The present study also revealed households with access to improved sanitation facilities fail to use them for disposal of child stool (AOR: 0.99; 95% CI: 0.67-1.45). CONCLUSIONS The prevalence of safe and improved child stool disposal in Ethiopia was found to be very low. Household socio-demographic and economic determinate were the key factors associated with child stool disposal. Appropriate strategic interventions to ensure safe and improved child stool disposal in Ethiopia is necessary. In addition, integrating child stool management into the existing sanitation interventions programs should be strongly recommended.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
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Busienei PJ, Ogendi GM, Mokua MA. Open Defecation Practices in Lodwar, Kenya: A Mixed-Methods Research. ENVIRONMENTAL HEALTH INSIGHTS 2019; 13:1178630219828370. [PMID: 30814843 PMCID: PMC6381438 DOI: 10.1177/1178630219828370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND As of the year 2014, about 2.5 billion people globally lacked access to improved sanitation. The situation is even worse in the sub-Saharan African countries including Kenya. The practice of open defecation (OD) peaks beyond 72% of the population in Turkana County, Kenya, despite various interventions to end it. METHODS This article reports on both qualitative and quantitative aspects of a cross-sectional study. A partially mixed sequential dominant (quantitative) status was used to understand various socioeconomic factors associated with OD practice in Lodwar's human settlements, Turkana County. Simple random sampling technique was chosen to select participants for this study with the sample drawn from various administrative units of Lodwar. Standardized questionnaires, focus group discussions, and key informant interviews were used to collect data. RESULTS The quantitative findings revealed that culture was the leading factor as to why people practiced OD with a frequency of 44%. The findings further revealed that poverty was the major influencing factor for latrine ownership among the households (frequency 27%). Pearson χ2 tests revealed that there was a significant association between latrine presence and education level of the household head (χ2 = 107.317; P < .05), latrine sharing (χ2 = 403; P < .05), and occupation of the household head (χ2 = 74.51; P < .05). The quantitative findings showed that culture was by far the most common factor that contributed to the OD practice with a theme intensity of 31.1%. Further analyses identified 5 major cultural aspects that were associated with OD practice. This included sexual immorality, OD as a common habit, nomadic pastoralism, bride's dignity and mixing of feces. Open defecation as a common habit among the respondents was the most cited factor that contributed to its rampant practice (theme intensity 31.3%) followed closely by nomadic pastoralism kind of life among the residents that limit latrine construction (theme intensity 28.1%). CONCLUSIONS In addition to cultural aspects, high poverty levels influence latrine adoption and consequently OD practices. Future sanitation interventions addressing OD should assess and factor in these cultural aspects in such communities to come up with appropriate eradication measures which have otherwise been difficult to solve through poverty eradication and sanitation campaigns that have been in existence.
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Affiliation(s)
| | - George Morara Ogendi
- Department of Environmental Science, Egerton University, Egerton, Kenya
- Dryland Research Training and Ecotourism Centre, Chemeron, Kenya
| | - Millicent A Mokua
- Department of Environmental Science, Egerton University, Egerton, Kenya
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Ricci C, Carboo J, Asare H, Smuts CM, Dolman R, Lombard M. Nutritional status as a central determinant of child mortality in sub-Saharan Africa: A quantitative conceptual framework. MATERNAL AND CHILD NUTRITION 2018; 15:e12722. [PMID: 30316202 DOI: 10.1111/mcn.12722] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/24/2018] [Accepted: 10/05/2018] [Indexed: 12/20/2022]
Abstract
Child mortality is a major public health problem in sub-Saharan Africa and is influenced by nutritional status. A conceptual framework was proposed to explain factors related to undernutrition. Previously proposed conceptual frameworks for undernutrition do not consider child mortality and describe factors related to undernutrition from a qualitative viewpoint only. A structural equation modelling approach was applied to the data from World Bank and FAO databases collected from over 37 sub-Saharan countries from 2000 to the most recent update. Ten food groups, exclusive breastfeeding, poverty and illiteracy rates, and environmental hygiene were investigated in relation to underweight, stunting, low birthweight, and child mortality. Standardized beta coefficient was reported, and graphical models were used to depict the relations among factors related to under-five mortality in sub-Saharan Africa. Child mortality in sub-Saharan Africa ranged between 76 and 127 × 1,000. In the same period, low birthweight rate was about 14%. Poverty and illiteracy are confirmed to affect health resources, which in turn influenced nutritional status and child mortality. Among nutritional factors, exclusive breastfeeding had a greater influence than food availability. Low birthweight, more than underweight and stunting, influenced child mortality. Structural equation modelling is a suitable way to disentangle the complex quantitative framework among factors determining child mortality in sub-Saharan Africa. Acting on poverty at the base appear to be the more effective strategy along with improvement of breastfeeding practice and improvement of hygiene conditions.
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Affiliation(s)
- Cristian Ricci
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Janet Carboo
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Hannah Asare
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
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Transition Management for Improving the Sustainability of WASH Services in Informal Settlements in Sub-Saharan Africa—An Exploration. SUSTAINABILITY 2018. [DOI: 10.3390/su10114052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This paper explores how transition management processes can be designed to address the unsustainability of water, sanitation, and hygiene (WASH) services in informal settlements in cities in Sub-Saharan Africa. The unsustainability of services related to WASH in informal settlements in Sub-Saharan Africa is deeply embedded in current societal and governance structures, cultures, and practices; it is context-dependent and involves numerous actors with different interests. Based on a literature review and empirical work in Arusha (Tanzania), Dodowa (Ghana), and Kampala (Uganda), we identify five context dimensions that account for the unsustainability of WASH services: (a) multiplicity of WASH practices, structures, and arrangements; (b) governance capacities for WASH services and maintenance; (c) landownership for sustainable access to WASH; (d) public participation in decision-making related to WASH; and (e) socio-economic inequalities governing access to WASH. These dimensions pose numerous conceptual and application challenges for transition management. Based on these challenges, recommendations are formulated for the design of a contextualized, participatory transition management process that is not only functional, but also emancipatory.
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Abubakar IR. Exploring the determinants of open defecation in Nigeria using demographic and health survey data. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 637-638:1455-1465. [PMID: 29801238 DOI: 10.1016/j.scitotenv.2018.05.104] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
There is increasing global attention to the threats of open defecation (OD) to human health and dignity, and the environment. With at least a quarter of Nigerians (25.1%) or 46 million people practicing OD in 2015, Nigeria ranks third in the world in OD prevalence after India and China. This study explores the socio-economic, demographic and geographic factors that influence and determine the practice of OD among Nigerian households. Data was obtained from 2013 Nigeria Demographic and Health Survey and analyzed using descriptive and inferential statistics. The results indicate that about 32% of Nigerian households, 8% in urban areas and 24% in rural areas, practiced OD in 2013. The practice is significantly influenced (p < 0.001) by households' place of residence (χ2 (1) = 2126.2), geo-political region (χ2 (5) = 1962.6) and wealth index (χ2 (4) = 4622.7), as well as by household head's education level (χ2 (3) = 1253.3), ethnicity (χ2 (3) = 1926.2) and gender (t = -7.1992). The article also discusses the implications of the findings for environmental and public health and recommends that facilitating ownership of latrines by households and communities, and behavioral change interventions are necessary towards substantially reducing or eliminating OD in Nigeria.
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Affiliation(s)
- Ismaila Rimi Abubakar
- College of Architecture and Planning, Imam Abdulrahman Bin Faisal University (formerly University of Dammam), P.O. Box 2397, Dammam 31451, Saudi Arabia.
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Ayalew AM, Mekonnen WT, Abaya SW, Mekonnen ZA. Assessment of Diarrhea and Its Associated Factors in Under-Five Children among Open Defecation and Open Defecation-Free Rural Settings of Dangla District, Northwest Ethiopia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:4271915. [PMID: 30275841 PMCID: PMC6157118 DOI: 10.1155/2018/4271915] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 07/13/2018] [Accepted: 07/31/2018] [Indexed: 11/17/2022]
Abstract
Background Open defecation (OD) is a widespread problem in the developing world. This practice facilitates the transmission of diarrheal diseases. In Ethiopia, still the national open defecation rate in 2014 was 34.1% (37.9% in rural and 8.7% in urban). Objective To assess diarrheal morbidity in under-five children and its associated factors in Dangla district, Northwest Ethiopia, 2016. Methods A community-based comparative cross-sectional study design with a multistage random sampling technique was applied. The total sample size was 550 (275 ODF and 275 OD). Descriptive and inferential statistics were done. Results A total of 525 participants were interviewed making the response rate 95.45%. The prevalence of diarrhea was 9.9% in ODF and 36.1% in OD kebeles. In ODF kebeles, child immunization (AOR = 0.037; 95% CI: 0.006-0.243), latrine presence (AOR = 0.036; 0.006-0.233), water shortage (AOR = 8.756; 95% CI: 1.130-67.831), and solid waste disposal (AOR = 0.143; 95% CI: 0.020-0.998) have statistically significant association with diarrhea occurrence. While in OD kebeles child immunization (AOR = 0.032; 95 CI: 0.008-0.123), water access of 7.5-15 liters/day (AOR = 0.029; 95% CI: 0.006-0.152), water shortage (AOR = 18.478; 95% CI: 4.692-72.760), and proper solid waste disposal (AOR = 0.023; 95% CI: 0.005-0.117) have significant association with diarrhea occurrence. Conclusions The overall prevalence of under-five diarrhea was low in ODF kebeles as compared with OD kebeles. The study showed that child immunization, latrine presence, water shortage in household, and solid waste disposal practices had statistically significant association with diarrhea occurrence in ODF kebeles, while water access at the individual level, water shortage in household, child immunization, and solid waste disposal have statistically significant association with diarrhea occurrence in OD kebeles. Integrated efforts are needed from the Ministry of Health together with line ministries and developmental partners in improving latrine utilization at household level, water shortage in households, and solid waste disposal practices.
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Leshargie CT, Alebel A, Negesse A, Mengistu G, Wondemagegn AT, Mulugeta H, Tesfaye B, Alamirew NM, Wagnew F, Belay YA, Ferede A, Sintayehu M, Dessie G, Boneya DJ, Birhanu MY, Kibret GD. Household latrine utilization and its association with educational status of household heads in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2018; 18:901. [PMID: 30029646 PMCID: PMC6053729 DOI: 10.1186/s12889-018-5798-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/04/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ethiopia has been experiencing a high prevalence of communicable diseases, which resulted in high morbidity, mortality, and hospital admission rates. One of the highest contributing factors for this is lower level of latrine utilization. There had been significantly varying finding reports with regard to the level of latrine utilization and its association with education level from different pocket studies in the country. Therefore, this systematic review and meta-analysis was aimed to estimate the pooled prevalence of household latrine utilization and its association with education status of household heads, in Ethiopia using available studies. METHODS This systematic review and meta-analysis was conducted using available data from the international databases, including PubMed, Google Scholar, Science direct, Cochrane library and unpublished reports. All observational studies reporting the prevalence of latrine utilization in Ethiopia were included. Four authors independently extracted all necessary data using a standardized data extraction format. STATA 13 statistical software was used to analyze the data. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity between the studies. A random effect model was computed to estimate the pooled level of latrine utilization in Ethiopia. In addition, the association between latrine utilization and the educational level of the users was analyzed. RESULTS After reviewing of 1608 studies, 17 studies were finally included in our meta-analysis. The result of 16 studies revealed that the pooled prevalence of latrine utilization level in Ethiopia was 50.02% (95%CI: 40.23, 59.81%). The highest level (67.4%) of latrine utilization was reported from Southern Nations Nationality and People regional state, followed by Amhara regional state (50.1%). Participants who completed their high school and above education were more likely (OR: 1.79, 95%CI: 1.05, 3.05) to utilize latrine compared to those who did not attend formal education. CONCLUSION In Ethiopia, only half of the households utilize latrine and the level of utilization has significant association with educational status.
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Affiliation(s)
- Cheru Tesema Leshargie
- Department of Public Health, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Animut Alebel
- Department of Nursing, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Ayenew Negesse
- Department of Human Nutrition and Food Science, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Getachew Mengistu
- Department of Medical Laboratory technology, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Amsalu Taye Wondemagegn
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debremarkos, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Bekele Tesfaye
- Department of Nursing, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | | | - Fasil Wagnew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Yihalem Abebe Belay
- Department of Public Health, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Aster Ferede
- Department of Public Health, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Mezinew Sintayehu
- Department of Nursing, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Getnet Dessie
- Department of Nursing, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Dube Jara Boneya
- Department of Public Health, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
| | - Getiye Dejenu Kibret
- Department of Public Health, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia
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Utazi CE, Sahu SK, Atkinson PM, Tejedor-Garavito N, Lloyd CT, Tatem AJ. Geographic coverage of demographic surveillance systems for characterising the drivers of childhood mortality in sub-Saharan Africa. BMJ Glob Health 2018; 3:e000611. [PMID: 29662690 PMCID: PMC5898321 DOI: 10.1136/bmjgh-2017-000611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022] Open
Abstract
A major focus of international health and development goals is the reduction of mortality rates in children under 5 years of age. Achieving this requires understanding the drivers of mortality and how they vary geographically to facilitate the targeting and prioritisation of appropriate interventions. Much of our knowledge on the causes of, and trends in, childhood mortality come from longitudinal demographic surveillance sites, with a renewed focus recently on the establishment and growth of networks of sites from which standardised outputs can facilitate broader understanding of processes. To ensure that the collective outputs from surveillance sites can be used to derive a comprehensive understanding and monitoring system for driving policy on tackling childhood mortality, confidence is needed that existing and planned networks of sites are providing a reliable and representative picture of the geographical variation in factors associated with mortality. Here, we assembled subnational data on childhood mortality as well as key factors known to be associated with it from household surveys in 27 sub-Saharan African countries. We then mapped the locations of existing longitudinal demographic surveillance sites to assess the extent of current coverage of the range of factors, identifying where gaps exist. The results highlight regions with unique combinations of factors associated with childhood mortality that are poorly represented by the current distribution of sites, such as southern Mali, central Nigeria and southern Zambia. Finally, we determined where the establishment of new surveillance systems could improve coverage.
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Affiliation(s)
- C Edson Utazi
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK.,Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Sujit K Sahu
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Peter M Atkinson
- Faculty of Science and Technology, Lancaster University, Lancaster, UK
| | - Natalia Tejedor-Garavito
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK.,GeoData, University of Southampton, Southampton, UK.,Flowminder Foundation, Stockholm, Sweden
| | - Christopher T Lloyd
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Andrew J Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK.,Flowminder Foundation, Stockholm, Sweden
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Okullo JO, Moturi WN, Ogendi GM. Open Defaecation and Its Effects on the Bacteriological Quality of Drinking Water Sources in Isiolo County, Kenya. ENVIRONMENTAL HEALTH INSIGHTS 2017; 11:1178630217735539. [PMID: 29051705 PMCID: PMC5637965 DOI: 10.1177/1178630217735539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/02/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND INFORMATION The post-2015 Sustainable Development Goals for sanitation call for universal access to adequate and equitable sanitation and an end to open defaecation by 2030. In Isiolo County, a semi-arid region lying in the northern part of Kenya, poor sanitation and water shortage remain a major problem facing the rural communities. OBJECTIVE The overall aim of the study was to assess the relationship between sanitation practices and the bacteriological quality of drinking water sources. The study also assessed the risk factors contributing to open defaecation in the rural environments of the study area. METHODS A cross-sectional study of 150 households was conducted to assess the faecal disposal practices in open defaecation free (ODF) and open defaecation not free (ODNF) areas. Sanitary surveys and bacteriological analyses were conducted for selected community water sources to identify faecal pollution sources, contamination pathways, and contributory factors. Analysis of data was performed using SPSS (descriptive and inferential statistics at α = .05 level of significance). RESULTS Open defaecation habit was reported in 51% of the study households in ODNF villages and in 17% households in ODF villages. Higher mean colony counts were recorded for water samples from ODNF areas 2.0, 7.8, 5.3, and 7.0 (×103) colony-forming units (CFUs)/100 mL compared with those of ODF 1.8, 6.4, 3.5, and 6.1 (×103) areas for Escherichia coli, faecal streptococci, Salmonella typhi, and total coliform, respectively. Correlation tests revealed a significant relationship between sanitary surveys and contamination of water sources (P = .002). CONCLUSIONS The water sources exhibited high levels of contamination with microbial pathogens attributed to poor sanitation. Practising safe faecal disposal in particular is recommended as this will considerably reverse the situation and thus lead to improved human health.
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Affiliation(s)
- Joab Odhiambo Okullo
- Joab Odhiambo Okullo, Department of Environmental Science, Egerton University, P.O. BOX 536-20115, Egerton, Kenya.
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25
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Ope M, Nyoka R, Unshur A, Oyier FO, Mowlid SA, Owino B, Ochieng SB, Okello CI, Montgomery JM, Wagacha B, Galev A, Abdow A, Esona MD, Tate J, Fitter D, Cookson ST, Arunmozhi B, Marano N. Evaluation of the Field Performance of ImmunoCard STAT! ® Rapid Diagnostic Test for Rotavirus in Dadaab Refugee Camp and at the Kenya-Somalia Border. Am J Trop Med Hyg 2017; 96:1302-1306. [PMID: 28719278 PMCID: PMC5462563 DOI: 10.4269/ajtmh.16-0885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rotavirus commonly causes diarrhea in children, leading to hospitalization and even death. Rapid diagnostic tests are feasible alternatives for determining rotavirus outbreaks in refugee camps that have inadequate laboratory capacity. We evaluated the field performance of ImmunoCard STAT!® Rotavirus (ICS-RV) in Dadaab Refugee Camp and at the Kenya–Somalia border. From May to December 2014, we prospectively enrolled children aged < 5 years hospitalized with acute diarrhea, defined as ≥ 3 episodes of loose stool in 24 hours for < 7 days. Stool samples were collected and tested by trained surveillance clerks using ICS-RV per manufacturer's instructions. The field performance characteristics of ICS-RV were evaluated against the gold standard test, Premier™ Rotaclone® enzyme immunoassay. The operational characteristics were evaluated using World Health Organization (WHO) ASSURED criteria to determine whether ICS-RV is appropriate as a point-of-care test by administering a standard questionnaire and observing surveillance clerks performing the test. We enrolled 213 patients with a median age of 10 months (range = 1–48); 58.2% were male. A total of 71 (33.3%) and 60 (28.2%) patients tested positive for rotavirus infection by immunoassay and ICS-RV, respectively. The sensitivity, specificity, and positive and negative predictive values of ICS-RV compared with the immunoassay were 83.1% (95% confidence interval [CI] = 72.3–91.0), 99.3% (95% CI = 96.1–100), 98.3% (95% CI = 91.1–100), and 92.1% (95% CI = 86.6–95.5), respectively. The ICS-RV fulfilled the WHO ASSURED criteria for point-of-care testing. ICS-RV is a field-ready point-of-care test with good field performance and operational characteristics. It can be useful in determining rotavirus outbreaks in resource-limited settings.
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Affiliation(s)
- Maurice Ope
- U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Raymond Nyoka
- U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | | | | | - Brian Owino
- Kenya Medical Research Institute, Dadaab, Kenya
| | | | | | | | - Burton Wagacha
- United Nations High Commissioner for Refugees, Nairobi, Kenya
| | | | | | - Mathew D Esona
- U.S Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline Tate
- U.S Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David Fitter
- U.S Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan T Cookson
- U.S Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nina Marano
- U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
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Nyoka R, Foote AD, Woods E, Lokey H, O’Reilly CE, Magumba F, Okello P, Mintz ED, Marano N, Morris JF. Sanitation practices and perceptions in Kakuma refugee camp, Kenya: Comparing the status quo with a novel service-based approach. PLoS One 2017; 12:e0180864. [PMID: 28704504 PMCID: PMC5509214 DOI: 10.1371/journal.pone.0180864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 06/22/2017] [Indexed: 11/19/2022] Open
Abstract
Globally, an estimated 2.5 billion people lack access to improved sanitation. Unimproved sanitation increases the risk of morbidity and mortality, especially in protracted refugee situations where sanitation is based on pit latrine use. Once the pit is full, waste remains in the pit, necessitating the construction of a new latrine, straining available land and funding resources. A viable, sustainable solution is needed. This study used qualitative and quantitative methods to design, implement, and pilot a novel sanitation system in Kakuma refugee camp, Kenya. An initial round of 12 pre-implementation focus group discussions (FGDs) were conducted with Dinka and Somali residents to understand sanitation practices, perceptions, and needs. FGDs and a supplementary pre-implementation survey informed the development of an innovative sanitation management system that incorporated the provision of urine and liquid-diverting toilets, which separate urine and fecal waste, and a service-based sanitation system that included weekly waste collection. The new system was implemented on a pilot scale for 6 weeks. During the implementation, bi-weekly surveys were administered in each study household to monitor user perceptions and challenges. At the end of the pilot, the sanitation system was assessed using a second round of four post-implementation FGDs. Those who piloted the new sanitation system reported high levels of user satisfaction. Reported benefits included odor reduction, insect/pest reduction, the sitting design, the appropriateness for special populations, and waste collection. However, urine and liquid diversion presented a challenge for users who perform anal washing and for women who had experienced female genital mutilation. Refugee populations are often culturally and ethnically diverse. Using residents' input to inform the development of sanitation solutions can increase user acceptability and provide opportunities to improve sanitation system designs based on specific needs.
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Affiliation(s)
| | | | | | | | - Ciara E. O’Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | | | - Eric D. Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Jamae F. Morris
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- African-American Studies, Georgia State University, Atlanta, GA, United States of America
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Dakouré MS, Traoré MB, Sossou SK, Maïga AH. Development of sanitation technologies in African context : how could we make it more sustainable? ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1755-1315/60/1/012032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Hetherington E, Eggers M, Wamoyi J, Hatfield J, Manyama M, Kutz S, Bastien S. Participatory science and innovation for improved sanitation and hygiene: process and outcome evaluation of project SHINE, a school-based intervention in Rural Tanzania. BMC Public Health 2017; 17:172. [PMID: 28173789 PMCID: PMC5297194 DOI: 10.1186/s12889-017-4100-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Background Diarrheal disease is a major cause of mortality and morbidity in low and middle income countries with children being disproportionately affected. Project SHINE (Sanitation & Hygiene INnovation in Education) is a grassroots participatory science education and social entrepreneurship model to engage youth and the wider community in the development of sustainable strategies to improve sanitation and hygiene. Methods Based in rural and remote Tanzania, this pilot study engaged pastoralist high-school students and communities in the development and evaluation of culturally and contextually relevant strategies to improve sanitation and hygiene. Using a train-the-trainer approach, key activities included teacher workshops, school-based lessons, extra-curricular activities, community events and a One Health sanitation science fair which showcased projects related to water, sanitation and hygiene in relation to human and animal health. The process and outcome of the study were evaluated through qualitative interviews and focus group discussions with diverse project participants, as well as pre- and post- questionnaires completed by students on knowledge, attitudes and practices concerning sanitation and hygiene. Results The questionnaire results at baseline and follow-up showed statistically significant improvements on key measures including a decrease in unhygienic behaviors, an increase in the perceived importance of handwashing and intention to use the toilet, and increased communication in the social network about the importance of clean water and improved sanitation and hygiene practices, however there were no significant changes in sanitation related knowledge. Qualitative data highlighted strong leadership emerging from youth and enthusiasm from teachers and students concerning the overall approach in the project, including the use of participatory methods. There was a high degree of community engagement with hundreds of community members participating in school-based events. Sanitation science fair projects addressed a range of pastoralist questions and concerns regarding the relationship between water, sanitation and hygiene. Several projects, such as making soap from local materials, demonstrate potential as a sustainable strategy to improve health and livelihoods in the long-term. Conclusions The Project SHINE model shows promise as an innovative capacity building approach and as an engagement and empowerment strategy for youth and communities to develop locally sustainable strategies to improve sanitation and hygiene.
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Affiliation(s)
- Erin Hetherington
- Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Matthijs Eggers
- Maastricht University, School for Public Health and Primary Care (Caphri), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Joyce Wamoyi
- National Institute for Medical Research, P.O Box 1462, Mwanza, Tanzania
| | - Jennifer Hatfield
- Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Mange Manyama
- Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, P.O Box 24144, Doha, Qatar
| | - Susan Kutz
- Faculty of Veterinary Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Sheri Bastien
- Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada. .,Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Post Box 5003, Akershus, 1432, Ås, Norway.
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Njuguna J. Effect of eliminating open defecation on diarrhoeal morbidity: an ecological study of Nyando and Nambale sub-counties, Kenya. BMC Public Health 2016; 15:712. [PMID: 27488385 PMCID: PMC4973028 DOI: 10.1186/s12889-016-3421-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/30/2016] [Indexed: 11/16/2022] Open
Abstract
Background Defecating in the open predisposes people to soil transmitted helminthes and diarrhoeal diseases. An estimated 5.6 million Kenyans defecate in the open. Kenya launched a program to eradicate open defecation by 2013 in the rural areas. By end of 2013, only two sub-counties had eliminated open defecation. These are Nambale and Nyando. The study looked at the impact of eradicating open defecation on diarrhea prevalence among children in these two sub-counties. Methods Data on diarrhoea morbidity among children under 5 years was extracted from the Kenya Health Information System for all the sub-counties in Busia and Kisumu counties for 2012, 2013 and 2014 respectively. Prevalence was calculated for each sub-county in Kisumu for comparison with Nyando’s. Prevalence was also calculated for each sub-county in Busia County and compared to that of Nambale sub-county. A Mann–Whitney U Test was done to test the null hypothesis that diarrhoea prevalence was similar in both open defecation and open defecation free sub-counties. Results A Mann–Whitney U Test revealed significant difference in diarrhoeal prevalence of open defecation sub-counties (Md = 18.4, n = 34) and open defecation free sub-counties (Md = 9.8, n = 5), U = 9, z = −3.2, p = .001. Among the two Counties, Nambale had the lowest prevalence. It recorded a decline from 9.8 to 5.7 % across the three years. Prevalence for diarrhoea cases in Nyando declined from 19.1 to 15.2 % across the three years. Nyando initially had the second highest prevalence in Kisumu County and by 2014 it had the lowest prevalence. Conclusions The two sub-counties with open defecation free status had lower prevalence of diarrhoea cases compared to sub-counties which were yet to attain open defecation free status. This suggests that elimination of open defecation may reduce the number of diarrhoea cases.
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Affiliation(s)
- John Njuguna
- Mukurwe-ini sub-County Public Health Office, P.O. Box 112-10103, Mukurwe-ini, Kenya.
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30
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Azage M, Kumie A, Worku A, Bagtzoglou AC. Childhood Diarrhea Exhibits Spatiotemporal Variation in Northwest Ethiopia: A SaTScan Spatial Statistical Analysis. PLoS One 2015; 10:e0144690. [PMID: 26690058 PMCID: PMC4687002 DOI: 10.1371/journal.pone.0144690] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 11/22/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Childhood diarrhea continues to be a public health problem in developing countries, including Ethiopia. Detecting clusters and trends of childhood diarrhea is important to designing effective interventions. Therefore, this study aimed to investigate spatiotemporal clustering and seasonal variability of childhood diarrhea in northwest Ethiopia. METHODS Retrospective record review of childhood diarrhea was conducted using quarterly reported data to the district health office for the seven years period beginning July 1, 2007. Thirty three districts were included and geo-coded in this study. Spatial, temporal and space-time scan spatial statistics were employed to identify clusters of childhood diarrhea. Smoothing using a moving average was applied to visualize the trends and seasonal pattern of childhood diarrhea. Statistical analyses were performed using Excel® and SaTScan programs. The maps were plotted using ArcGIS 10.0. RESULTS Childhood diarrhea in northwest Ethiopia exhibits statistical evidence of spatial, temporal, and spatiotemporal clustering, with seasonal patterns and decreasing temporal trends observed in the study area. A most likely purely spatial cluster was found in the East Gojjam administrative zone of Gozamin district (LLR = 7123.89, p <0.001). The most likely spatiotemporal cluster was detected in all districts of East Gojjam zone and a few districts of the West Gojjam zone (LLR = 24929.90, p<0.001), appearing from July 1, 2009 to June 30, 2011. One high risk period from July 1, 2008 to June 30, 2010 (LLR = 9655.86, p = 0.001) was observed in all districts. Peak childhood diarrhea cases showed a seasonal trend, occurring more frequently from January to March and April to June. CONCLUSION Childhood diarrhea did not occur at random. It has spatiotemporal variation and seasonal patterns with a decreasing temporal trend. Accounting for the spatiotemporal variation identified in the study areas is advised for the prevention and control of diarrhea.
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Affiliation(s)
- Muluken Azage
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abera Kumie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amvrossios C. Bagtzoglou
- Department of Civil and Environmental Engineering, School of Engineering, University of Connecticut, Storrs, CT 06269, United States of America
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Azage M, Haile D. Factors associated with safe child feces disposal practices in Ethiopia: evidence from demographic and health survey. Arch Public Health 2015; 73:40. [PMID: 26504520 PMCID: PMC4620604 DOI: 10.1186/s13690-015-0090-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/24/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND According to the WHO/UNICEF Joint Monitoring Programme (JMP) for water supply and Sanitation definition, safe child feces disposal practices include: children defecation into a latrine, disposal of child stools in a latrine or burial. Inappropriate disposal of human feces including unsafe child feces disposal facilitates the transmission of pathogens. However, the factors associated with safe child feces disposal practices have not been yet well explored in Ethiopia. This study aimed to identify factors associated with safe child feces disposal practices in Ethiopia. METHODS This study analyzed data from Ethiopian Demographic and Health Survey (EDHS) 2011. The practice of child's feces disposal was categorized into 'safe' and 'unsafe' based on the WHO/ UNICEF JMP for water supply & Sanitation definition. Binary and multivariable logistic regression models were employed to identify factors associated with safe child feces disposal practices. RESULT The prevalence of safe child feces disposal was 33.68 % (95 % CI: 32.82-34.55). In the final multivariable logistic regression model, the practice of safe disposal of child feces was significantly associated with urban residency (AOR = 1.25, 95 % CI: 1.01-1.55) and having access to an improved latrine (AOR = 1.92, 95 % CI: 1.56-2.36). Households found in the poorer, middle, richer and richest wealth quintile had (AOR = 2.22, 95 % CI: 1.70-2.89), (AOR = 2.94, 95 % CI: 2.27-3.81), (AOR = 4.20, 95 % CI: 3.42-5.72) and (AOR = 8.06, 95 % CI: 5.91-10.99) times higher odds to practice safe child feces disposal respectively as compared households from poorest wealth quintile. Mothers/caregivers with primary, secondary and higher educational status had (AOR = 1.29, 95 % CI: 1.10-1.50), (AOR = 1. 64, 95 % CI: 1.12-2.41) and (AOR = 2.16, 95 % CI: 1.25-3.72) times higher odds to practice safe child feces disposal respectively than those mothers who had no education. Those mothers/caregivers whose child was 48-59 months old had (AOR = 2.21, 95 % CI: 1.82-2.68) times higher odds to practice safe child feces disposal as compared to mothers/caregivers who had a child with age less than 12 months old. The odds of safe child feces disposal among households who had one two and three under five years old children were (AOR = 3.11, 95 % CI: 1.87-5.19),(AOR = 2.55, 95 % CI: 1.53-4.24) and (AOR = 1.92, 95 % CI: 1.13-3.24) times higher respectively than households with four and more children of under five years old. CONCLUSION Only one third of the mothers practiced safe child feces disposal in Ethiopia. Being an urban resident, having a higher wealth quintile, high levels of maternal education, older child age, having a lower number of under five years old children, and the presence of an improved latrine were factors associated with safe child feces disposal practices. Therefore interventions designed to improve safe child feces disposal practices should consider those factors identified. Further research is also needed to design intervention that will aim to improve safe child feces disposal.
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Affiliation(s)
- Muluken Azage
- />Department of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
| | - Demewoz Haile
- />Department of Reproductive Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Beyene A, Hailu T, Faris K, Kloos H. Current state and trends of access to sanitation in Ethiopia and the need to revise indicators to monitor progress in the Post-2015 era. BMC Public Health 2015; 15:451. [PMID: 25933607 PMCID: PMC4424569 DOI: 10.1186/s12889-015-1804-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Investigating the current level and trends of access and identifying the underlying challenges to sanitation system development will be useful in determining directions developing countries are heading as they plan to promote sustainable development goals (post 2015 agenda). This research investigates the status and trends of access to improved sanitation coverage (ISC) in relation to the MDG target in Ethiopia with the aim of identifying prevailing constraints and suggesting the way forward in the post-MDG era. METHOD We examined data from a nationwide inventory conducted in accordance with the sanitation ladder at the national level and from a household survey in randomly selected urban slums in Addis Ababa. The inventory data were analyzed and interpreted using the conceptual model of the sanitation ladder. We used administrative reports and survey results to plot the time trend of the ISC. RESULTS The data from the nationwide inventory of sanitation facilities, which are presented along the sanitation ladder reveal that more than half of the Ethiopian population (52.1%) still used unimproved sanitation facilities in 2014. The majority (35.6%) practiced open defecation, implying that the country is far from the MDG target for access to improved sanitation (56%). Most people in urban slums (88.6%) used unimproved sanitation facilities, indicating that the urban poor did not receive adequate sanitation services. Trend analysis shows that access to ISC has increased, but Central Statistical Authority (CSA) data reveal a decline. This discrepancy is due to differences in data collection methods and tools. Dry pit latrines are the most widely used toilet facilities in Ethiopia, accounting for about 97.5% of the ISC. CONCLUSION The sanitation coverage is far from the MDG target and the majority of the population, mainly the urban poor, are living in a polluted environment, exposed to water and sanitation-related diseases. The sanitation coverage estimates might be even lower if proper utilization, regular emptying, and fecal sludge management (FSM) of dry pit latrines were considered as indicators. In order to enhance sanitation services for all in the post-MDG era, urgent action is required that will establish proper monitoring and evaluation systems that can measure real access to ISC.
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Affiliation(s)
- Abebe Beyene
- Department of Environmental Health Science and Technology, Jimma University, P. O. Box: 378, Jimma, Ethiopia.
| | - Tamene Hailu
- Research and Development Directorate, Ministry of Water, Irrigation & Energy (MoWIE), P. O. Box: 5744, Addis Ababa, Ethiopia.
| | - Kebede Faris
- Water & Sanitation Program (WSP), the World Bank, Ethiopia Country Office, P. O. Box: 5515, Addis Ababa, Ethiopia.
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, 185 Berry Street, Box 0560, San Francisco, CA, 94143 - 0560, USA.
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Abstract
There is increasing agreement among the nutrition community about the use of length/height-for-age as the indicator to monitor the long-term impact of chronic nutritional deficiencies. Stunting, an indicator of linear growth failure, has both long- and short-term consequences affecting growth and development and adult work potential. The number of stunted children in sub-Saharan Africa is expected to increase by 2025 if the current trends remain. Stunting among African children peaks during the complementary feeding period, which coincides with the period when children are no longer on exclusive breastfeeding and infections are frequent. Addressing stunting has become the focus of global efforts. The World Health Assembly in 2012 set a 40 % reduction in the number of stunted children by 2025. To effectively address the issues of stunting in sub-Saharan Africa is it appropriate to examine the issue of what it takes. The WHO Multicentre Growth Reference Study (MGRS) conducted in several regions of the world, including Africa has lessons on what it would take to prevent in African children. The children in the MGRS had good socioeconomic background characteristics reflected by years of maternal education and availability of basic amenities, such as potable water and sanitary conditions. The prescription of exclusive breastfeeding, high-quality diversified diets and attention to care were critical factors contributing to healthy growth for the African children. Preventing stunting in sub-Saharan Africa is possible. It requires governments to put in place policies that would create the conducive environment needed. The complex and multiple causes of stunting offer the opportunity to address stunting in a multisectoral and within a food systems approach. The global resolve to make food systems deliver on healthy diet requires all stakeholders to work together to achieve the global goal of reducing stunting. This review highlights the key elements contributing to adequate growth in the Africa cohort of the WHO-MGRS and how these provide lessons for addressing stunting in children in sub-Saharan Africa.
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