Current state and trends of access to sanitation in Ethiopia and the need to revise indicators to monitor progress in the Post-2015 era

Prevalence and associated risk factors of soil-transmitted helminth infections among schoolchildren in Mekan Eyesus town, northwestern Ethiopia

Background

Little attention has been paid to determining the prevalence and associated factors of soil-transmitted helminth (STH) infections in some developing countries. This study was, therefore, carried out to determine the prevalence and associated factors of STH infections among schoolchildren attending three primary schools in Mekane Eyesus town, northwestern Ethiopia.

Methods

A school-based cross-sectional study was conducted from March to June 2023 in Mekane Eyesus town. Stool samples were collected from 401 children from three primary schools in the town. Wet-mount and formol ether concentration techniques were used to diagnose stool samples, and a structured questionnaire was used to collect data on socio-demographic characteristics and risk factors for STH infections.

Results

The overall prevalence of STH infection in this study was 18.2 % (73/401). The most common helminth species detected was Ascaris lumbricoides (A. lumbricoides) (7.5 % (30/401)). Not trimming fingernails regularly (adjusted odds ratio (AOR) = 3.75, 95 % CI = 1.87-7.50), having illiterate fathers (AOR = 2.29, 95 % CI = 1.18-4.44), and being aged 15-17 years (AOR = 2.37, 95 % CI = 1.06-5.30) were associated with increased odds of STH infection. Children who wash their hands after defecation (AOR = 0.43, 95 % CI = 0.21-0.88) and those whose mothers were housewives (AOR = 0.22, 95 % CI = 0.08-0.58) had lower odds of STH infection.

Conclusion

This study found a high prevalence of STH infection among schoolchildren in Mekane Eyesus town. Thus, STH infection preventive measures, including deworming of schoolchildren, should be implemented in the study area. Moreover, giving health-related knowledge about STH infection prevention strategies, such as regular fingernail trimming and hand washing after defecating, is vital for reducing the prevalence of STH infections in the study area.

Exploring compost production potential and its economic benefits and greenhouse gas mitigation in Addis Ababa, Ethiopia

The increasing amount of municipal organic waste (MOW) and human excreta (HE) has led to socio-economic and environmental challenges in the cities of developing countries. This study estimated MOW and HE, compost production potential from MOW and HE, and compost application potential for urban agriculture fertilization, economic benefits, soil carbon sequestration, and greenhouse gas (GHG) mitigation in Addis Ababa, Ethiopia, for the period 2025-2050. MOW was forecasted using the Holt-Winters forecasting model. HE was estimated using the daily average rate of HE generation. The compost production potential was estimated using the forecasted MOW and HE. Compost fertilization was determined by considering compost nitrogen (N), phosphorus (P), and potassium (K) and the fertilizer requirements of cereals and vegetables. The economic benefits of compost were determined by considering the price of compost-equivalent urea, NPS, and potassium chloride fertilizers. The mitigation of GHG emissions from compost application was estimated using the IPCC Tier 1 method. The forecasted quantities of MOW, HE, and compost for 2050 are 301, 462, and 343 Gg, respectively. The compost could supply 5 Gg of N and 2.2 Gg of P in 2050, sufficient to fertilize 14,129 ha of vegetable fields. The economic benefits of using compost as a substitute for synthetic fertilizers could reach 10 million USD in 2050. Compost production and application could offset the total GHG emissions of Addis Ababa by 13.1 % (10,241Gg CO2-eq year-1) in 2050. The application of compost generated from MOW and HE in Addis Ababa can substitute synthetic fertilizers, provide economic benefits, and mitigate GHG emissions.

Prevalence and Determinants of Household Access to Improved Latrine Utilization in Somalia: Health Demographic Survey (SHDS) 2020

The aim of this research paper is to determine the prevalence of improved household latrine utilization and its determinants in Somalia, using the Somali Health Demographic Survey (SHDS) 2020 dataset. Limited sanitation is a major global problem mainly for the poor and disadvantaged. According to the SHDS 2020 report, around 22.3% of households in Somalia utilize unimproved toilet facilities. In this study, a secondary data analysis was carried out on the SHDS 2020 dataset. The study included 15 826 households weighted for representativeness. Four models were constructed after identifying relevant factors for the outcome variable. The first model, null (empty), had no independent variables. The second model assessed the effect of individual-level determinants on the outcome. The third model determined how community-level variables influenced on the response variable. Finally, a multilevel multivariable logistic regression model examined the combined impact of individual- and community-level factors on the outcome variable. The prevalence of improved latrine utilization in Somalia was (41.1%). The factors: educational status (AOR: 1.899 (1.598, 2.258)), wealth index (AOR: 7.815 (6.990, 8.736)), urban residence (AOR: 2.467 (2.262, 2.690)), households living in various regions/states, including Hirshabelle, Galmudug, Southwest, Puntland, Jubaland, and Somaliland, indicate statistically significant findings and were more likely to utilize improved latrines (AOR: 0.259 (0.229, 0.294)), (AOR: 0.223 (0.196, 0.254)), AOR: 0.196 (0.168, 0.230)), (AOR: 0.220 (0.194, 0.251)), (AOR: 0.204 (0.180, 0.232)), (AOR: 0.086 (0.077, 0.095)). Hirshabelle had a 0.259 times more likelihood of improved latrine utilization than the rest of the regions/states, (AOR: 0.259 (0.229, 0.294)). The prevalence of improved latrine utilization was quite low in Somalia. Higher wealth index, living in more urbanized areas, and the household head's educational status were all significant predictors of improved latrine utilization. The finding implies a need to increase household's access to latrine facilities and improve latrine utilization, particularly for rural households in the country.

Health facility-based prevalence of typhoid fever, typhus and malaria among individuals suspected of acute febrile illnesses in Southwest Region, Ethiopia

Background

Acute febrile illnesses such as typhoid fever, typhus, and malaria are still major causes of hospital admission in many parts of Ethiopia. However, there are substantial gaps in the monitoring systems, which result in a lack of knowledge about the geographic distribution and role of common pathogens, particularly in rural areas. Thus, this study was aimed at assessing the seroprevalence of typhoid fever, typhus, and malaria among suspected acute febrile patients at the MTU Teaching Hospital and Mizan-Aman Health Center, Southwest region of Ethiopia.

Method

A health facility-based cross-sectional study was carried out from July to October 2022. Blood samples were collected from a total of 384 individuals. Widal and Weilfelix direct card agglutination and tube agglutination test methods were used for the Salmonella enterica serotype Typhi (S. typhi) and Rickettsia infections. The diagnosis of malaria was made using thick and thin blood smears. Questionnaires given by interviewers were used to gather information on risk factors and other sociodemographic factors. The data was analyzed using STATA/SE 14.0.

Result

A total of 371 patients were tested for S. Typhi and Rickettsia infections using direct card agglutination and tube agglutination methods. Using the screening test, 20.5% (76/371) patients were reactive either for O or H antigens or both, of which 55.3% (42/76) were reactive by the titration test at the cutoff value ≥ 1:80. About 17.5% (65/371) were reactive to OX19 antigen by card agglutination test, and of which 58.5% (38/65) were reactive by the titration test at the cutoff value ≥ 1:80. The overall seroprevalence of S. Typhi and Rickettsia infections using combined direct card and tube agglutination techniques was 11.3% (42/371) and 10.2% (38/371), respectively. Out of 384 suspected malaria patients, 43 (11.2%) were found positive either for P. falciparum, 27 (7.03%), or P. vivax, 16 (4.2%).

Conclusion

In this study, typhoid fever, typhus, and malaria were found among symptomatic acute febrile patients. To increase disease awareness, it is necessary to provide sustainable health education about risk factor behaviors, disease transmission, and prevention strategies. In addition, improving laboratory diagnosis services and early treatment may also lower the likelihood of potentially fatal consequences.

Mapping and predicting open defecation in Ethiopia: 2021 PMA-ET study

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.

Open Defecation Practice and Its Determinants Among Households Owned Toilet Facilities in Gambela Town, South West Ethiopia

The use of toilet facilities is a major sanitation intervention, as it reduces the spread of diarrheal diseases. In areas where toilets are misused, human excreta may be disposed of in open fields, bushes, and other open places. However, information about the level of utilization of toilet facilities in developing regions of Ethiopia is limited. Therefore, this study aimed to identify open defecation (OD) levels and determinants of OD among household-owned toilets in Gambella town, Ethiopia. A cross-sectional survey was conducted among 561 households in Gambela Town, using systematic random sampling and questionnaires. The level of OD was analyzed using frequency and percentage. The determinants of OD were assessed using binary logistic regression. Variables with a P-value less than .25 in univariable logistic regression were entered into the multivariable logistic regression model, and statistical significance was declared at a P-value less than .05. The model's fit was tested using Hosmer and Lemeshow's goodness of fit. The study found that OD was 47.2% [95% CI: 43.2%-51.4%] among those who owned toilet facilities. The determinants of OD were: occupation of household head [AOR: 5.27, 95% CI: 3.08-9.00], toilet facilities lacking a superstructure [AOR: 2.0, 95% CI: 1.16-3.43], toilet facilities lacking doors [AOR: 3.23, 95% CI: 1.97-5.27], large family size [AOR: 2.16, 95% CI: 1.29-3.60], knowledge of the respondents [AOR: 2.40, 95% CI: 1.50-3.99], and respondents with negative attitude [AOR: 1.76, 95% CI: 1.12-2.74]. Therefore, key stakeholders should focus on improving toilet utilization, considering those factors in their interventions.

Prevalence of intestinal parasitic infections and associated risk factors among patients attending Debarq Primary Hospital, northwest Ethiopia

Intestinal parasitic infections (IPIs) are major public health problems in developing countries. This study was conducted to determine the prevalence and associated risk factors of IPIs at Debarq Primary Hospital in northwest Ethiopia. A health facility-based cross-sectional study was conducted from March 2022 to June 2022. The study participants were recruited from patients who visited Debarq Primary Hospital during the study period. Stool samples were collected from each participant and examined for intestinal parasites using direct wet-mount and formal-ether concentration techniques. Socio-demographic data were collected using a structured questionnaire. Out of 422 individuals examined, 33.64% were infected with at least one intestinal parasite species. Entamoeba histolytica/dispar, Giardia intestinalis, Ascaris lumbricoides, and hookworm were found in 12.79%, 8.53%, 7.10%, and 1.65% of the participants, respectively. Double and triple parasite infections were found in 2.37% and 0.23% of the participants, respectively. A habit of eating unwashed vegetables (Adjusted odds ratio (AOR) = 9.98, 95% confidence interval (CI) = 2.68-37.14) and low income (AOR = 6.66, 95% CI = 1.87-23.70) were associated with increased odds of IPIs. Participants with a habit of hand washing after using the toilet had 0.05 (95% CI = 0.13-0.22) lower odds of IPIs than those who did not. In conclusion, IPIs are common among Debarq Primary Hospital patients and are associated with factors such as low income, not washing hands after using the toilet, and eating unwashed vegetation, necessitating control and prevention efforts in the study area that include health education and the provision and use of sanitary facilities.

Antimicrobial Susceptibility and Characterization of Extended-Spectrum β-Lactamase-Producing Escherichia coli Isolated from Stools of Primary Healthcare Patients in Ethiopia

Antimicrobial resistance of Escherichia coli is a growing problem in both developed and developing countries. This study aimed to investigate the phenotypic antimicrobial resistance of E. coli isolates (n = 260) isolated from the stool specimen of patients attending public health facilities in Addis Ababa and Hossana. This study also aimed to characterize phenotypically confirmed extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates (n = 22) using whole-genome sequencing. Resistance to 18 different antimicrobials was assessed using the disc diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The highest resistance rate among the E. coli isolates was found for ampicillin (52.7%), followed by trimethoprim-sulfamethoxazole (29.6%). Of all isolates, 50 (19.2%) were multidrug-resistant and 22 (8.5%) were ESBL producers. ESBL genes were detected in 94.7% of the sequenced E. coli isolates, and multiple β-lactamase genes were detected in 57.9% of the isolates. The predominant ESBL gene identified was blaCTX-M-15 (78.9%). The blaTEM-1B gene was detected in combination with other ESBL genes in 57.9% of the isolates, while only one of the sequenced isolates contained the blaTEM-1B gene alone. The blaCTX-M-3 gene was detected in three isolates. The genes blaCTX-M-15 and blaTEM-1B as well as blaCTX-M-15 and blaTEM-169 were confirmed to coexist in 52.6% and 10.5% of the sequenced E. coli isolates, respectively. In addition, blaOXA-1 was identified together with blaCTX-M-15 and blaTEM-1B in one isolate, and in one isolate, blaTEM-169 together with blaCTX-M-15 and blaTEM-1B was found. The results obtained show that measures need to be taken to reduce the spread of drug resistance and ensure the long-term use of available antimicrobials.

Latrine Utilization and its Associated Factors in Urban Slums Dwellers of Gondar City, Northwest Ethiopia: A Community-Based Cross-Sectional Study

Background

Sanitation facilities are critical for interrupting the transmission of feco-oral disease through proper use, not simply their physical presence. Latrine utilization is the actual behavior in a practice of regularly using existing latrines for the safe disposal of excreta. In slum regions of developing nations, such as Ethiopia, poor latrine use is a prevalent concern. As a result, the purpose of this study was to examine the state of latrine utilization and its determinant factors in the urban slums of Gondar City, Northwest Ethiopia.

Methods

A cross-sectional survey was done in slum regions of Gondar City from March 1 to April 30, 2021, with a total of 422 systematically chosen households. A structured pre-tested questionnaire and on-the-spot observational checklists were used to collect the data from each household.

Result

Latrine utilization was observed among 31.5% of households. Latrine utilization was also significantly associated with the age of the latrine (age ⩽10 years) (AOR: 2.31; 95% CI (1.15, 4.63)), cleanliness of the latrine (AOR: 3.70; 95% CI (1.16, 11.78)), pit being lined (AOR: 6.33; 95% CI (2.09, 19.15)), depth of latrine (⩽3 m) (AOR: 0.43; 95% CI (0.24, 0.77)), and cleaning materials for handwashing (AOR: 0.33; 95% CI (0.15, 0.75)).

Conclusion

Based on the present finding, most households didn't have proper latrine utilization practices. The age of the latrine, cleanliness of the latrine, pit being lined, depth of the pit, and cleaning materials for handwashing were associated factors of latrine utilization. As a result, sanitation interventions such as health education about improving the cleanliness and sanitary condition of existing latrine facilities and constructing lined and deep new latrines as the goal's standard should be implemented.

Unimproved source of drinking water and its associated factors: a spatial and multilevel analysis of Ethiopian demographic and health survey

BACKGROUND

Drinking water quality has been a major public health concern in lower and middle income countries where access to improved water supplies is limited. Ethiopia is thought to have one of the worst drinking water infrastructures in the world. This study aimed to assess the spatial variation and determinants of using unimproved sources of drinking water in Ethiopia using recent nationally representative data.

METHODS

A population-based cross-sectional study was employed with the recent EDHS data of 2019. A total of 8663 households were sampled using a stratified two-stage cluster sampling method. Kuldorff's SaTScan version 9.6 software was used to generate spatial scan statistics. ArcGIS version 10.7 software was used to visualize the spatial patterns of unimproved drinking water sources. A multilevel multivariable mixed-effect logistic regression was used to identify factors associated with the use of an unimproved drinking water source. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of using an unimproved source of drinking water.

RESULT

Around 31% (95% CI: 30%, 32%) of the population in Ethiopia uses unimproved sources of drinking water with significant spatial variation across the country. Households aged 41-60 [AOR = 0.69; 95%CI; 0.53, 0.89] as compared to the households aged 10-25, households having middle wealth index [AOR = 0.48; 95%CI; 0.40, 0.59], and households having a rich wealth index [AOR = 0.31; 95%CI; 0.25, 0.39] as compared to the poor households, living in high community literacy level [AOR = 0.36; 95%CI; 0.16, 0.80], living in high-level community poverty [AOR = 3.03; 95%CI; 1.32, 6.98], rural residence [AOR = 7.88; 95%CI; 2.74, 22.67] were significant predictors of use of unimproved source of drinking water. Hot spot areas of use of unimproved drinking water sources were observed in Amhara, Afar, and Somalia regions and some parts of SNNPR and Oromia regions in Ethiopia. The primary clusters were found in Ethiopia's Somalia and Oromia regions.

CONCLUSION

Around one third of the Ethiopian population utilizes unimproved source of drinking water and it was distributed non-randomly across regions of Ethiopia. The age of the household head, wealth status of the household, residence, community poverty level, and community literacy level were found to be significantly associated with utilizing unimproved drinking water source. State authorities, non-governmental organizations and local health administrators should work to improve the quality of drinking water particularly for high risk groups such as communities living in high poverty and low literacy, poor households, rural residents, and hot spot areas to decrease the adverse consequences of using unimproved drinking water source.

Latrine utilization and associated factors among districts implementing and not-implementing community-led total sanitation and hygiene in East Wollega, Western Ethiopia: A comparative cross-sectional study

INTRODUCTION

Discharge of excreta to the environment lead to surface and groundwater contamination and human exposure to disease-causing micro-organisms. There is limitation of evidences regarding the latrine utilization among community-led total sanitation and hygiene implemented and non-implemented districts of the East Wollega Zone. Hence, this study aimed to determine the magnitude and associated factors of latrine utilization among households in community-led total sanitation and hygiene implemented and non-implemented Districts in East Wollega Zone, Western Ethiopia.

METHODS

A cross-sectional study was conducted. A Multi-stage sampling technique was applied to select the 461 households. Data were collected using interviews and observations guided by a pre-structured questionnaire. Data were entered using Epi Data and exported to SPSS software version 25 for data recording, cleaning, and statistical analysis. Bivariable logistic regression was run to identify the candidate variables at p-value <0.25. Variables that had associations with latrine utilization in the bi-variable analysis were entered together into multivariable logistic regression. An Adjusted odds ratio with a 95% confidence interval was calculated and P-value< 0.05 was used to declare a statistically significant association.

RESULT

The overall prevalence of latrine utilization was found to be 52.7% (95%CI:48%, 57.3%). Religion (AOR = 0.149;95%CI:0.044,0.506), education (AOR = 3.861;95%CI:1.642,9.077), occupation, absence of children <5 years (AOR = 4.724;95%CI:2.313,9.648), toilet cleaning (AOR = 10.662;95%CI:5.571,20.403), frequency of latrine construction (AOR = 6.441;95%CI:2.203,18.826), maintenance need (AOR = 6.446; 95%CI:3.023,13.744), distance from health institution (AOR = 0.987; 95%CI:0.978, 0.996), distance from kebele office (AOR = 6.478; 95%CI:2.137,19.635), and latrine distance from dwelling (AOR = 11.656; 95%CI:2.108, 64.44) were the factors associated with latrine use.

CONCLUSION

The latrine utilization in this study is low as compared to other studies. Religion, education, occupation, absence of children <5 years, toilet cleaning, frequency of latrine construction, maintenance need of the toilet, distance from health institution, distance from kebele, and latrine distance from dwelling are the associated factors of latrine utilization. Both households and health workers have to work together to improve latrine utilization and the safe disposal of children's feces.

Self-Reported Personal Hygiene Practice and Associated Factors among Prison Inmates in Gondar City, Northwest Ethiopia: An Institution-Based Cross-Sectional Study

The growing prevalence of communicable diseases in prison is significantly attributed to poor hygiene practices and insufficient sanitary conditions. The aim of this study was to assess self-reported personal hygiene practice and its associated factors among prison inmates in Gondar, northwest Ethiopia. An institution-based cross-sectional study was conducted from December 1, 2018, to February 30, 2019. Data were gathered using a structured, interviewer-administered questionnaire and observational checklists. The mean age of the inmates was 36 years (±12.4) and the mean months spent in prison was 98.2 ± 15.4 months. The overall adherence to good personal hygiene practices among Gondar City Prison inmates was 54.3%, with a 95% CI of (49.4, 59.1). The number of prisoners per cell [adjusted odds ratio (AOR), 0.31; 95% CI, (0.16, 0.62)], daily water consumption [AOR, 6.78; 95% CI, (2.84, 16.15)], and good knowledge (AOR, 1.50; 95% CI, (1.23, 5.61)] were found to be significant predictors of personal hygiene practice among prison inmates. More than half of the study participants had good personal hygiene practices. Knowledge, daily water consumption, and the number of prisoners per cell were all found to be significantly associated with prisoners' personal hygiene practices. Improving the availability of water would be the best alternative way to improve the personal hygiene practices of the prisoners. Furthermore, prison inmates should be educated on proper hygiene measures and personal cleanliness to prevent the transmission of communicable diseases.

Prevalence of Entamoeba histolytica among schoolchildren in Dilla town, Gedeo zone, Ethiopia

BACKGROUND

To measure the prevalence of Entamoeba histolytica (E. histolytica) infections and associated risk factors among schoolchildren in Dilla town, Gedeo zone Ethiopia.

METHODS

A total of 501 schoolchildren were recruited by random sampling. Microscopically positive samples for E. histolytica cysts were further characterized using the E. histolytica II antigen detection kit. Univariate and multivariate logistic regression models were employed to analyze associations between E. histolytica infections, age, sex and study setting.

RESULTS

Overall prevalence of E. histolytica was 13.17%. Hand washing before eating, hand washing after defecation, mother's occupation, and awareness about amebiasis were the factors associated with parasite prevalence.

CONCLUSION

Prevalence of E. histolytica in the study population was high. Health promotion campaigns to create awareness about health and hygiene are clearly needed.

Challenges of sanitation in developing counties - Evidenced from a study of fourteen towns, Ethiopia

Rapid urbanization and population growth in the past few decades has been worsening the water supply and sanitation problems in Ethiopia putting the current water supply deficit of the country at a staggering 41%. Using Ethiopia as a case of rapidly growing countries in the Global South and struggling with water supply and sanitation management, the objective of this study was to examine the challenges of sanitation in Ethiopia by selecting 14 towns located under different climatic conditions and administrative regions with diversified culture, ethnicity, and religion. Data from these towns were collected through household survey, Focus Group Discussion (FGD), Key Informant Interview (KII) and site visits. The field observation was conducted with representatives from the municipality who have knowledge on the existing sanitation and associated problems. Analysis of the collected data shows that poor water supply, inadequate toilet facilities, poor toilet facility emptying practices, poor community perceptions on sanitation management and inadequate emptying services were major challenges associated with sanitation. Moreover, absence of wastewater dumping site, lack of integration among the different components of sanitation, insufficient collaboration among potential stakeholders and gaps between the existing population and sanitation services were the other key challenges of sanitation exacerbated by inadequate financial resources. From the 14 studied towns the average water deficit was found 35%, and the average households with no toilet facilities were 17%. Only about 20% households have flushed toilets and about 5% practiced open defecation. While 42% of the households use vacuum trucks for emptying wastewaters and about 37% of the households dump wastewater outside of their premises. Among the studied 14 towns, only four towns have their own vacuum trucks, no town possesses wastewater dumping site. The different components of sanitation were managed separately without integration. Moreover, the collaboration among the potential stakeholders of sanitation management was found poor and fragmented. Also, sanitation services have not developed along with the population growth as the finance allocated to sanitation management is much lower compared to other municipal services. Thus, sanitation in the studied towns is poor, though there are progresses when compared with previous decades. To improve the sanitation condition in these towns the water supply should be improved together with raising the perception of the local community. The present study recommends further studies to be conducted on the feasibility of sustainable sanitation and "country-wide comprehensive" study on water supply, sanitation and open defecation in Ethiopian in particular and in developing countries as a whole.

A Community-Based Cross-Sectional Study on Latrine Utilization and Associated Factors Among Rural Community of East Meskan District, Gurage Zone, Southern Ethiopia

Background

Using sanitary facilities is proven to enhance health and halt the spread of fecal-to-oral disease. Despite efforts to improve the availability of latrine facilities in developing countries like Ethiopia, finding a village that is entirely free of open defecation remains difficult. To determine the need for intervention programs and promote regular latrine usage, local data is essential.

Objectives

This study aimed to assess latrine utilization and associated factors among households in East Meskan District, Southern Ethiopia.

Methods

A community-based cross-sectional study was conducted among 630 households from April 15 to May 30, 2022. A simple random sampling technique was used to select the study households. Data were collected using an interviewer-administered structured questionnaire and an observational checklist. The collected data were then entered into Epi-Info version 7.1 and analyzed using SPSS version 21. In binary logistic regression analysis, independent variables with a P-value < .25 were considered candidates for multiple logistic regression analysis. The association was expressed in odds ratio with a 95% confidence interval (CI), and significance was declared at P-value < .05 in the final model.

Results

The magnitude of latrine utilization was 73.3% (95% CI: 69.7, 76.8) in the study district. Husband being family head (adjusted odds ratio [AOR] = 12.9; 95% CI: 5.78 ,28.90), being female (AOR = 16.4; 95% CI: 6.52, 41.27), family size less than 5 (AOR = 24.2; 95% CI: 11.49, 51.09), absence of school children (AOR = 0.3; 95% CI: 0.13, 0.51), and greater than 2 years since latrine was constructed (AOR = 14; 95% CI: 7.18, 27.41) had a significant association with latrine utilization.

Conclusion

In this study, utilization of latrines was low compared to the national target plan. Family head, sex, family size, presence of school children, and length of years in which the latrine was constructed were factors associated with latrine utilization. Thus, regular supervision of early latrine construction and utilization in communities is essential.

Prevalence and Associated Risk Factors of Soil-Transmitted Helminth Infections among Schoolchildren around Lake Tana, Northwest Ethiopia

Background

Soil-transmitted helminths (STHs) are among the most common neglected tropical diseases widely distributed in tropical countries with poor socioeconomic development. Ascaris lumbricoides, Trichuris trichiura, and hookworm are the three major STHs. This study aimed to determine the prevalence of STHs and associated risk factors among schoolchildren in selected primary schools around Lake Tana, Northwestern Ethiopia.

Methods

A school-based cross-sectional study was conducted from February to May 2021 involving 337 study participants. A systematic random sampling method was utilized to select the study participants from the selected schools. Data related to sociodemographic characteristics of the study participants and risk factors for STH infections were collected using a pretested questionnaire. Stool samples were collected in sterile plastic containers from each participant and processed using Kato-Katz thick fecal smear and Ritchie's concentration techniques. The data were analyzed using the Statistical Package for Social Sciences software tool version 23, and factors with a p < 0.05 were considered as statistically significant.

Results

The overall prevalence of STH infection was 38.3% (95% CI: 33.1-43.7). Hookworm infection was the predominant STH infection, which was detected in 26.1% schoolchildren followed by A. lumbricoides (14.8%) and T. trichiura (1.5%). Most of the study subjects (34.1%) had single infections, whereas only 4.2% study subjects had multiple helminthic infections. Among the risk factors considered in the study, lack of shoe wearing habit (adjusted odds ratio [AOR]=29.5; 95% confidence interval [CI]=6.59-132.55; p < 0.001), lack of knowledge on the prevention and control methods (AOR = 5.41; 95% CI = 2.44-11.98; p < 0.001), engagement in irrigation activities (AOR = 2.14; 95% CI = 1.02-4.57, p = 0.049), lack of toilet (AOR = 3.06; 95% CI = 1.31-7.16; p = 0.01), children grades of 5-8 (AOR = 2.62; 95% CI = 1.26-5.43; p = 0.01), playing on soils (AOR = 5.90; 95% CI = 2.79-12.49; p < 0.001), lack of fingernail trimming habit (AOR = 3.21; 95% CI = 1.57-6.55; p = 0.001), and male gender (AOR = 2.28; 95% CI: 1.19-4.39; p = 0.013) were significant explanatory factors for STH infection among schoolchildren in the study area.

Conclusions

The present study showed that STHs were common among schoolchildren around Lake Tana. Therefore, education on personal and environmental hygiene should be taken into account to reduce the prevalence of STH infection in the study area.

Parasitological and malacological surveys to identify transmission sites for Schistosoma mansoni in Gomma District, south-western Ethiopia

Schistosomiasis is a neglected tropical disease that disproportionately affects the poorest people in tropical and subtropical countries. It is a major parasitic disease causing considerable morbidity in Ethiopia. Despite significant control efforts, schistosomiasis transmission is still widespread in many rural areas of the country. The aim of this study was to determine the prevalence and intensity of intestinal schistosomiasis among schoolchildren, as well as to identify schistosomiasis transmission sites in Gomma District, southwestern Ethiopia. Between October 2018 and September 2019, cross-sectional parasitological and malacological surveys were conducted in the study area. The study comprised 492 school-children aged 6 to 15 years old from four primary schools in Gomma District. To identify and quantify eggs of Schistosoma mansoni from the children, stool specimens were collected and processed using double Kato-Katz thick smears. Water bodies adjacent to human settlements in the study area were surveyed for snail intermediate hosts of S. mansoni. Morphological identification of collected snails was conducted, followed by examining their infection status using a dissecting microscope. The overall prevalence of S. mansoni infection was 73.8% (95%CI: 69.9-77.7%) and 41.6% of them had moderate-to-heavy infections. The prevalence of S. mansoni infection differed considerably by age group, with the older age groups (12-15) having a higher prevalence than the younger age groups (6-11) (p < 0.001). The prevalence of infection also varied significantly among schools; Dedo Ureche had the highest prevalence (86.9%) (p = 0.034), while Goga Kilole had relatively the lowest prevalence of S. mansoni infection (59.6%) (p = 0.003). A total of 1463 Biomphalaria pfeifferi snails were collected from 11 survey sites throughout the study area, with 357 (24.4%) of the snails shedding schistosomes cercariae. Despite intensified efforts to scale up mass drug administration in Ethiopia, this study reported high levels of S. mansoni infection among schoolchildren and snail intermediate hosts in rural communities in Gomma. Such a high infection rate warrants pressing needs for targeted and integrated interventions to control the disease in the area.

Prevalence and associated risk factors of Entamoeba histolytica infection among school children from three primary schools in Arsi Town, West Zone, Ethiopia

Entamoeba histolytica is one of the major pathogenic intestinal parasites and is amongst the leading causes of diarrheal illness in children. Around 500 million people are infected worldwide, while 75,000 die of the disease annually. E. histolytica is associated with moderate to severe diarrhoea and increased mortality among children in African countries and negatively affects child growth and development. Malnutrition is also an important contributor to the prevalence of E. histolytica in Ethiopia. It is mostly associated with poor hygiene, poverty, illiteracy, lack of access to potable water, and a hot, humid tropical climate. Thus, the present investigation was aimed to assess the prevalence rate and associated factors of E. histolytica among schoolchildren in Arsi Town, West Zone, Oromia Regional State, Ethiopia. A cross-sectional study was conducted from February 1st to May 1st, 2020. A total number of 334 students were selected from three governmental elementary schools in the west zone using a systematic sampling method. A structured questionnaire was adopted to identify environmental, socio-demographic, and behavioral factors. Microscopically positive samples for E. histolytica cysts were further characterised using an E. histolytica II antigen detection kit. The statistical analysis of the data was done using SPSS software. A univariate and multivariate logistic regression analysis was done. P value < 0.05 was considered statistically significant. The overall prevalence of E. histolytica was 19.8%. Hand washing habits before eating [AOR = 0.32; 95% CI (0.12, 0.84)], hand washing habits after defecation [AOR = 0.396; 95% CI (0.165, 0.946)], and ameba awareness [AOR = 0.35; 95% CI (0.142, 0.889)] were factors associated with parasite prevalence. The findings of this study could assist the government in targeting infected areas, improving sanitation to prevent E. histolytica transmission, and implementing effective control measures in these rural communities, particularly among youngsters, who represent the nation's future.

Assessing Hygienic Status, Sanitation Issues, and Associated Problems in Dambi Dollo Town, Oromia Regional State, Ethiopia

The pollutants discharged untreated into water bodies become a challenge in Ethiopia. This study aims to assess sanitation and hygiene status and the associated problems. A total of 500 households were selected using a systematic random sampling technique. Questionnaires, interviews, and site observation were employed. The absence of public and communal latrines had been seen as the constraint. The present study confirmed that waste disposal management has serious problems. In conclusion, these findings revealed that part of the households are living in communities with the town-owned poor sanitary facilities and that further studies are encouraged on waste disposal management.

Determination of the Physicochemical Quality of Groundwater and its Potential Health Risk for Drinking in Oromia, Ethiopia

This study aimed to determine the physicochemical quality of groundwater and its potential health risk for drinking in Oromia, Ethiopia. The groundwater samples were collected from 17 sampling stations in the dry and wet season in the Sebeta zone, Oromia, from March to August 2020. Metals and physicochemical parameters, and selected heavy metals, such as iron (Fe), copper (Cu), manganese (Mn), chromium (Cr), zinc (Zn), and lead (Pb) were monitored. The data were analyzed using multivariate statistical methods (Pearson's Correlation and T-test). The means seasonal variations were higher in the dry season than in the wet season except for pH and Turbidity. The variation was significant for most parameters except Pb, Zn, chlorine, Total Alkaline, Magnesium Hardness, Calcium Hardness ), and Turbidity. There was a strong and positive correlation between Total dissolved solids (TDS) and Conductivity), (pH and Cr), (T.H. and Magnesium (Mg)), (bicarbonate and Calcium (Ca), (Zn and Turbidity) in the dry season; and (T.H. with Potassium (K), (Pb and Fe); (bicarbonate and T.H.); (Ca and Mg); (Na and T.A.,) in the wet season. The hazard index (H.I.) values in the dry season (HI = 1.331) were higher than in the wet season (HI_adults = 0.075). Likewise, the H.I. (dry season) was higher (HI_children = 1.861) than in the wet season (HI_children = 0.105). Chronic groundwater exposure at drinking sources in the dry season is a potential health risk to humans in general and is relatively high for children. Urgent management and close monitoring are required for drinking groundwater sources and other nearby residents' safety areas.

Utilization of Latrine and Associated Factors Among Rural Households in Takussa District, Northwest Ethiopia: A Community-Based Cross-Sectional Study

BACKGROUND

The use of sanitation facilities is known to interrupt the transmission of fecal-oral related diseases. However, the evidence was limited about the utilization of latrines within the rural community of Takussa district. Therefore, this study was conducted to assess the utilization of latrines and associated factors among households in Takussa district, northwest Ethiopia.

METHODS

A community-based cross-sectional study design was employed to survey 801 rural households among initially computed 812 participants from February 15 to March 15, 2019. A structured questionnaire with face-to-face interviews was used to collect the data. SPSS version 20 was used to analyze the completed data. A binary logistic regression model was used to process bivariate and multivariable analysis of the data. The adjusted odds ratio was used for the interpretation of the data after controlling for the confounders.

RESULTS

The proper latrine utilization rate was 41.9%, with a 95% confidence interval of (38.8, 45.3). Households with school-aged children (AOR: 2.27, 95% CI: (1.44, 3.56), a clean latrine (AOR: 3.34, 95% CI: (1.26, 4.93), the optimal distance from the living room (AOR: 1.56, 95% CI: (1.09, 2.25), and perceived benefit (AOR: 3.64, 95% CI: (1.13, 11.67) were statistically associated factors.

CONCLUSION

The Proper utilization of latrines was low among rural households in the Takussa district. School children, distance, cleanliness, and the benefit of latrines were statistically associated factors. As a result, encouraging health extension workers integrated into district schools to pay special attention to frequent follow-up in order to promote proper latrine utilization at the household level.

Transcriptional responses of Daphnia magna exposed to Akaki river water

Pollution of the aquatic environment is a global problem, with industrial waste, farming effluents, sewage, and wastewater as the main contributors. Many pollutants are biologically active at low concentrations, resulting in sublethal effects, which makes it a highly complex situation and difficult to assess. In many places, such as the Akaki river in Ethiopia, the pollution situation has resulted in streams with minimal presence of invertebrates or vertebrates. As it is difficult to perform a complete chemical analysis of the waters, the present study focused on using gene expression analysis as a biological end point to determine the effects of Akaki river contaminants. The present study was conducted using the small planktonic crustacean Daphnia magna with toxicogenomic molecular markers. Daphnia magna neonates were exposed to Akaki water samples collected from two different sites on the river and analyzed for mortality and expression of genes involved in different biological pathways. Despite the poor quality of Akaki river water, 48 h acute toxicity tests showed no mortality. Interestingly, analysis of sublethal toxicogenomic responses showed that exposure to Akaki water altered the expression of 25 out of 37 genes involved in metal regulation, immune response, oxidative stress, respiration, reproduction, and development. The toxicogenomic data gives insight into the mechanisms involved in causing potential adverse effects to aquatic biota harboring the Akaki river system.

Limited access to improved drinking water, unimproved drinking water, and toilet facilities among households in Ethiopia: Spatial and mixed effect analysis

BACKGROUND

Most people in sub-Saharan countries had limited drinking water services and toilet facilities. The collection of water can affect the health of the whole family, particularly children. Therefore this study aims to investigate determinants of limited access to drinking water services and spatial distributions of limited access to drinking water services, unimproved drinking water sources, and toilet facilities among households in Ethiopia.

METHOD

Cross-sectional collected secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS). A mixed-effect logistic regression model was used for analysis. The total weighted sample of 10, 183 households was included in the analysis. The study population is comprised of all households who had recorded the time taken to fetch improved drinking water during the survey. The primary outcome of this study is the proportion of households that have limited access to drinking water services. Whereas the secondary outcomes are determinants of limited access to drinking water services and spatial distributions of limited drinking water services, unimproved drinking water sources, and toilet facilities among households in Ethiopia.

RESULTS

In this study, 39.74% [95% CI: 38.79, 40.69] of households in Ethiopia had limited access to drinking water services. This proportion ranges from 2.64% in Addis Ababa to 57.35% in the Somali region. Household head, education, residence, and regions were associated with limited access to drinking water services. The spatial analysis showed that the eastern part of Amhara, Afar and the Somali region predicted the highest limited drinking water services. The unimproved drinking water source was detected in the Central part of Amhara, Somalia regions. Almost all regions except Addis Ababa and Diredewa predicted the highest prevalence of unimproved toilet facilities.

CONCLUSION

Access to improved drinking water is relatively poor throughout Ethiopia, with some regions experiencing more limited access than others. From individual level variables age, educational level, and sex household head, whereas from community level variables residences, and region were factors significantly associated with access to limited drinking water services. The spatial analysis confirmed that there are inequalities in unimproved drinking water sources, and toilet facilities between regions in Ethiopia. The government of Ethiopia should work to increase the accessibility of improved drinking water at the national level and to narrow the gap in its accessibility between urban and rural residences and between regions. Accessibility to drinking water programs should focus on the disadvantaged group such as non-educated, male head households and living rural residences. All stalk holders should work to improve the quality of drinking water and sanitation facilities.

Trend Analysis of Intestinal Parasitic Infections at Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia from 2017 to 2021: A Five-Year Retrospective Study

Introduction

In Ethiopia, intestinal parasites are common due to poverty, poor personal hygiene, poor environmental sanitation, overcrowding, a lack of safe drinking water, and a lack of knowledge. As a result, evaluating the intestinal parasite morbidity pattern in low-income countries such as Ethiopia is important for designing intestinal parasite intervention programs that minimize the illness burden. Despite the high prevalence of the disease in the Debre Tabor catchment areas, there is a lack of data on the trend of intestinal parasites. As a result, the study’s goal was to close the gap on the patterns of intestinal parasite infection for better control and intervention programs.

Methods

A retrospective study was conducted from 2017 to 2021 at Debre Tabor comprehensive specialized hospital to determine the trend of intestinal parasite infection. The findings of 7965 saline wet mount stool examinations were collected from the laboratory registration book by trained data collectors over the last five years. The study excluded any data that lacked sociodemographic characteristics and the year of the stool examination. Finally, the data were analyzed by SPSS version 25.

Results

The overall prevalence of intestinal parasites during the study period (2017–2021) was 2171 (27.3%) out of 7965 patients. Entamoeba histolytica/dispar (18.6%) was the predominant parasite, followed by Giardia lamblia (5.7%) and Ascaris lumbricoides (1%). Males (28.6%) were infected at a higher rate than females (26.2%) (P = 0.02). The intestinal parasite was reported in all age groups in the area, but the highest and the lowest prevalence were reported in the age groups of above 14 years (27.7%) and under five years (23.4%), respectively (P = 0.03).

Conclusion

The finding showed cyclic patterns of fluctuations in the prevalence of intestinal parasitic infections. Therefore, it is important to develop effective prevention and control strategies to prevent the distribution of intestinal parasites.

Moving Up the Sanitation Ladder: A Study of the Coverage and Utilization of Improved Sanitation Facilities and Associated Factors Among Households in Southern Ethiopia

BACKGROUND

Improved sanitation facilities offer numerous advantages, ranging from the reduction of diarrheal illnesses and helminth infections to the improvement of psychosocial well-being. At the household level, attaining universal access to improved sanitation facilities demands a thorough understanding of the factors that influence their adoption and use. As a result, the purpose of this study was to assess the availability and utilization of improved sanitation facilities, as well as the factors that influence the adoption and proper use of such a facility among households in the Gedeb district of Southern Ethiopia.

METHODS

A community-based cross-sectional household survey was conducted from March to April 2019. A systematic random sampling technique was used to select 630 households at random. A pre-tested questionnaire was used to collect the respondents' self-reported data, which comprised socio-demographic, home characteristics, behavioral, and environmental elements. The factors related to the availability and utilization of improved sanitation facilities were identified using multivariable logistic regression.

RESULT

Improved sanitation facilities were present in 172 (27.3%) of the 630 households surveyed, with 111 (64.5%) of them being used properly. The availability of improved sanitation was associated with educational status [AOR = 2.73, 95% CI (1.59, 4.67)], upper wealth quintile [AOR = 2.18, 95% CI (1.21, 3.93)], ever hearing educational messages about latrines [AOR = 3.9, 95% CI (1.86, 8.18)], favorable attitude toward latrine construction [AOR = 2.81, 95% CI (1.67, 4.74)], and receiving support during construction [AOR = 3.78, 95% CI (2.15, 6.65)]. Furthermore, utilization was associated with the absence of children under the age of 5, knowledge of sanitation-related diseases, and a positive attitude toward latrine use.

CONCLUSION

Both the availability of improved sanitation facilities and the rate at which they were used properly fell far short of the National Hygiene and Environmental Health Strategy's goals. This study contributes to the body of knowledge on how to improve the availability of improved sanitation in Ethiopia.

Latrine utilization and associated factors in East Gojjam Zone, North-West Ethiopia: A community-based cross-sectional study

Objective

This research was aimed at assessing latrine utilization and associated factors in East Gojjam Zone, North West Ethiopia.

Methods

A community-based cross-sectional study was conducted on households of East Gojjam Zone, from 1 February to 30 May 2021. Multistage cluster sampling technique was used to select 806 study participants into the study. Data were collected through pretested structured interview questionnaires and direct observation. Collected data were entered and cleaned using EPI info version 7.2 and analysed using SPSS version 23 software package. Bivariable and multivariable logistic regression was employed to assess association of the variables and controlling the effect of confounders, respectively. P value less than 0.05 was taken as statistically significant.

Results

The overall latrine utilization in East Gojjam Zone was found to be 45.4% (95% confidence interval = 42.2-49.1). Occupation (adjusted odds ratio = 2.248, 95% confidence interval = 1.037-4.876), participating in model family training (adjusted odds ratio = 2.481, 95% confidence interval = 1.802-3.415), water availability (adjusted odds ratio = 2.456, 95% confidence interval = 1.514-3.983), and type of latrine (adjusted odds ratio = 2.013, 95% confidence interval 1.648-2.972) had statistically significant association with latrine utilization.

Conclusion

Latrine utilization in East Gojjam Zone was found to be low relative to other studies and the country's plan. It is very far apart from the Ethiopian latrine coverage and utilization plan (100%). Occupational status, participated in the model family training, water availability, and type of toilet were significantly associated with toilet utilization. Encouraging private latrine construction with accessibility of water and all households participating in model family training may increase latrine utilization in East Gojjam Zone. Further observational study triangulated with qualitative research should be conducted to provide more strong evidence for further improvement of household latrine utilization status in East Gojjam Zone.

The impact of access to water supply and sanitation on the prevalence of active trachoma in Ethiopia: A systematic review and meta-analysis

Background

Trachoma is a worldwide infectious disease causing blindness. Trachoma continued as a public health problem in Ethiopia due to a lack of sanitation and inadequate prevention strategies. This study aimed to identify the impact of water supply and sanitation intervention on preventing active trachoma among children.

Methods

Systematic literature searches were performed from 4 international databases. The search involved articles published from January 1995 up to March 2019. The Cochran Q and I² statistical tests were used to check heterogeneity among the studies. A random-effect meta-analysis was employed to determine the pooled estimates with a 95% confidence interval (CI). Data analysis was performed using the CMA V.3 and RevMan 5 software program, and the result of the systematic review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Findings

Out of 211 studies screened for the analysis, only 29 studies were finally included in this systematic review and meta-analysis. The result revealed factors that are significantly associated with increased odds of active trachoma. Accordingly, households with no access to toilet facilities (odds ratio [OR]: 2.04, 95% CI: 1.75–2.38), no access to improved water (OR: 1.58, 95% CI: 1.27–1.96), and do not practice regular face washing for children (OR: 4.19, 95% CI: 3.02–5.81) have shown increased odds of active trachoma. Besides, the results show a higher prevalence of active trachoma among children who did not wash their faces with soap and frequently.

Conclusions

The study found strong evidence that lack of access to water, sanitation, and hygiene (WASH) was associated with increased prevalence of active trachoma among children. Therefore, a comprehensive and partnership-oriented program is needed to tackle the problem, but further study will be required to strengthen its implementation.

Knowledge, Attitudes, Practices, and Determinants Towards Wastewater Management in Northwest Ethiopia: A Community-Based Cross-Sectional Study

Background

Globally, waste management has been a major public health problem. Public knowledge, attitudes, practices (KAP) and participation are key elements of any waste management program. In Ethiopia, however, the level of KAP and associated factors regarding wastewater management (WWM) at the household level are not well studied and understood. This study was, therefore, conducted to assess the knowledge, attitude, practice and associated factors of wastewater management (WWM) among the residents in Gondar town, Ethiopia.

Methods

A community-based cross-sectional study was conducted during March and April, 2016. A total of 422 participants were selected using the systematic random sampling technique. A structured questionnaire was employed to collect data which were entered and analyzed using the Statistical Package for Social Science (SPSS) version 20. A multivariable binary logistic regression analysis was used to ascertain the significance of associations at <0.05 p-value and the adjusted odds ratio (AOR) with a 95% confidence interval (CI).

Results

Among 422 study participants included, 63.5%, 43.4%, and 48.6% of them had good knowledge, attitudes, and self-reported practices regarding WWM, respectively. Knowledge of participants was significantly associated with house rent (AOR 1.12, 95% CI (1.22, 3.69), civil servant (AOR 5.47, 95% CI (1.87, 8.02), and positive attitudes (AOR 2.69, 95% CI (1.68, 4.30), while space availability (AOR 1.84, 95% CI (1.23, 2.75), and good knowledge (AOR 2.46, 95% CI (1.61, 3.77) were associated factors of attitudes. Moreover, good knowledge (AOR 1.32, 95% CI (1.87, 2.02), and positive attitudes (AOR 1.03, 95% CI (1.01, 2.34) were significantly associated factors of self-reported practices.

Conclusion

Limited knowledge, attitudes and practices were seen among study population. A great emphasis on improvement of knowledge, attitudes and practices towards WWM is necessary. Moreover, it would be better to qualitatively explore variables which explain the qualitative attributes of the community, like community Attitudes and knowledge.

Prevalence and factors associated with intestinal schistosomiasis and human fascioliasis among school children in Amhara Regional State, Ethiopia

Background

Schistosomiasis and fascioliasis are digenean parasitic infections and are among the neglected tropical diseases that have both medical and veterinary importance. They are found mainly in areas having limited access to safe water supply and improved sanitation.

Methods

A cross-sectional study was conducted to determine the prevalence of Schistosoma mansoni and Fasciola species infections and to identify associated risk factors among school children in Amhara Regional State, Ethiopia. Stool specimens were collected from 798 children (419 males, 379 females) and processed using Kato-Katz and formol-ether concentration techniques. A semi-structured questionnaire was used to collect socio-demographic and other exposure information to explore potential risk factors for the infections.

Results

The overall prevalence of S. mansoni and Fasciola species infections was 25.6% (95% confidence interval (CI): 22.5-28.6) and 5.5% (95% CI: 3.9-7.1), respectively. S. mansoni was present in all surveyed schools with the prevalence ranging from 12.8% (16/125; 95% CI = 5.6-20.0) to 39.7% (64/161; 95% CI = 32.2-47.2) while Fasciola species was identified in five schools with the prevalence ranging from 2.5% (4/160; 95% CI = 0.001–4.9) to 9.8% (13/133; 95% CI = 4.7–14.8). The prevalence of S. mansoni infection was significantly associated with swimming in rivers (Adjusted odds ratio (AOR): 1.79, 95% CI, 1.22–2.62; P=0.003), bathing in open freshwater bodies (AOR, 2.02; 95% CI, 1.39–2.94; P<0.001) and engaging in irrigation activities (AOR, 1.69; 95% CI, 1.19-2.39; P=0.004), and was higher in children attending Addis Mender (AOR, 2.56; 95% CI, 1.20–5.46; P=0.015 ) and Harbu schools (AOR, 3.53; 95% CI, 1.64–7.59; P=0.001). Fasciola species infection was significantly associated with consumption of raw vegetables (AOR, 2.47; 95% CI, 1.23-4.97; P=0.011) and drinking water from unimproved sources (AOR, 2.28; 95% CI, 1.11–4.70; P=0.026).

Conclusion

Both intestinal schistosomiasis and human fascioliasis are prevalent in the study area, affecting school children. Behaviors and access to unimproved water and sanitation are among significant risk factors. The findings are instrumental for targeted interventions.

Determinants of water source use, quality of water, sanitation and hygiene perceptions among urban households in North-West Ethiopia: A cross-sectional study

BACKGROUND

Clean water is an essential part of human healthy life and wellbeing. More recently, rapid population growth, high illiteracy rate, lack of sustainable development, and climate change; faces a global challenge in developing countries. The discontinuity of drinking water supply forces households either to use unsafe water storage materials or to use water from unsafe sources. The present study aimed to identify the determinants of water source types, use, quality of water, and sanitation perception of physical parameters among urban households in North-West Ethiopia.

METHODS

A community-based cross-sectional study was conducted among households from February to March 2019. An interview-based a pre-tested and structured questionnaire was used to collect the data. Data collection samples were selected randomly and proportional to each of the kebeles' households. MS Excel and R Version 3.6.2 were used to enter and analyze the data; respectively. Descriptive statistics using frequencies and percentages were used to explain the sample data concerning the predictor variable. Both bivariate and multivariate logistic regressions were used to assess the association between independent and response variables.

RESULTS

Four hundred eighteen (418) households have participated. Based on the study undertaken,78.95% of households used improved and 21.05% of households used unimproved drinking water sources. Households drinking water sources were significantly associated with the age of the participant (x2 = 20.392, df = 3), educational status (x2 = 19.358, df = 4), source of income (x2 = 21.777, df = 3), monthly income (x2 = 13.322, df = 3), availability of additional facilities (x2 = 98.144, df = 7), cleanness status (x2 = 42.979, df = 4), scarcity of water (x2 = 5.1388, df = 1) and family size (x2 = 9.934, df = 2). The logistic regression analysis also indicated that those factors are significantly determining the water source types used by the households. Factors such as availability of toilet facility, household member type, and sex of the head of the household were not significantly associated with drinking water sources.

CONCLUSION

The uses of drinking water from improved sources were determined by different demographic, socio-economic, sanitation, and hygiene-related factors. Therefore; the local, regional, and national governments and other supporting organizations shall improve the accessibility and adequacy of drinking water from improved sources in the area.

Households access to improved drinking water sources and toilet facilities in Ethiopia: a multilevel analysis based on 2016 Ethiopian Demographic and Health Survey

OBJECTIVE

This study aimed to assess households access to improved drinking water sources and sanitation facilities and their associated factors in Ethiopia.

DESIGN

Cross-sectional study.

SETTING

Ethiopia.

PARTICIPANTS

Household heads.

PRIMARY OUTCOMES

Access to improved drinking water sources and toilet facilities.

METHODS

We conducted an in-depth secondary data analysis of 2016 Ethiopian Demographic and Health Survey. Data from a total of 16 650 households and 645 clusters were included in the analysis. The households were selected using a stratified two-stage cluster sampling technique. Multilevel binary logistic regression analyses were performed to identify factors associated with access to an improved drinking water source and toilet facilities. Adjusted OR with a 95% CI was reported with p value <0.05 was used to declare a significant association between the covariates and the outcome variables.

RESULTS

The proportions of households' access to improved sources of drinking water and toilet facilities were 69.94% (95% CI: 69.23% to 70.63%) and 25.36% (95% CI: 24.69% to 26.03%), respectively. Households headed by women and households with a better wealth index were positively associated with access to improved drinking water sources. Whereas rural households, ≥30 min round trip to obtain drinking water and region were factors negatively associated with households access to improved drinking water sources. A higher probability of having access to improved toilet facilities: households with heads who had attained higher education, households having better access to improved sources of drinking water and households with better wealth index. While the following households were less likely to have access to improved toilet facilities: households with heads were widowed, households with four to six members, rural households and region.

CONCLUSION

The study found that the proportions of households' access to improved drinking water sources and toilet facilities in Ethiopia were relatively low, which demands the need to tailor strategies to increase the coverage of access to improved drinking water sources and toilet facilities.

Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries

Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors require urgent policy attention. This specifically includes the lack of safe MHM spaces which threaten the health and dignity of women and girls.

Bacteriological and Physicochemical Quality of Drinking Water in Adis Kidame Town, Northwest Ethiopia

Drinking water pollution and the resulting waterborne diseases have been among the major public health burden in low-income countries such as Ethiopia. A high prevalence of waterborne diseases, up to 65%, has been reported in Adis Kidame Town (Ethiopia). Moreover, there have been poor waste disposal practices in this town. Thus, this study aimed to assess bacteriological and physicochemical drinking water quality in Adis Kidame Town to get insight into any potential health risks due to waterborne diseases. A total of 90 water samples were analyzed for enumeration of coliform bacteria and basic physicochemical parameters. In this study, total and faecal coliform counts (CFU/100 ml) ranged from 0 to 23 and 0 to 18, respectively. In all cases, 89 and 77% of the water samples in terms of total and faecal coliforms, respectively, did not comply with WHO guidelines. The highest level of coliforms was found in drinking water samples from households' containers and taps, where 100% and 90% of samples were tested positive for total and faecal coliforms, respectively. Among the physicochemical parameters recorded, only temperature and residual chlorine did not comply with WHO guidelines. Temperature values in all samples ranged from 20 to 28°C, while the values of residual chlorine were below the recommended range in the 56.7% of water samples from the reservoir and almost in all (96.7%) water samples from the taps and households' containers. High coliform count in the water system demands proper chlorination, regular inspection of the distribution line, and good hygienic practices to improve the microbiological quality of drinking water in Adis Kidame Town.

Exploring barriers to the adoption and utilization of improved latrine facilities in rural Ethiopia: An Integrated Behavioral Model for Water, Sanitation and Hygiene (IBM-WASH) approach

BACKGROUND

Even though evidence shows that access to and use of improved latrines is related to healthful families and the public, obstacles to the adoption and use of improved latrine facilities remain. Globally, not many inquiries appear to have been carried out to satisfactorily inform us regarding the multi-level barriers influencing the adoption and utilization of improved latrines facilities. Related studies in Ethiopia are even fewer.

METHODS

Two qualitative data gathering methods, viz., key informant interviews and focus group discussions, were employed to collect data for this study. A total of fifteen focus group discussions were conducted with members of the community in the rural Wonago district of Ethiopia. Similarly, ten key informant interviews were conducted with water, sanitation, and hygiene officers, and health extension workers responsible for coordinating sanitation and hygiene activities. Open code software 4.03 was used for thematic analysis.

RESULT

Barriers to adoption and use of improved latrine facilities were categorized into Contextual factors (e.g. Gender, educational status, personal preference for using the field, limited space, population density, the status of land ownership), Psychosocial factors (Culture, beliefs, attitudes, and perceptions of minimal health threat from children's feces), and Technological factors (inconveniences in acquiring materials and cost of constructing a latrine).

CONCLUSION

There are a series of multi-leveled barriers to the sustained adoption and use of latrines. Providing funding opportunities for the underprivileged and offering training on the engineering skills of latrine construction at the community level based on the contextual soil circumstances could expand the latrine coverage and use. Similarly, taking into account the variability in motivations for adopting and using latrines among our study in Ethiopia and other studies, we implore public health experts to recognize behaviors and norms in their target communities in advance of implementing sanitation interventions.

Prevalence and Determinants of Stunting and Thinness/Wasting Among Schoolchildren of Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Several studies have been carried out assessing the prevalence of undernutrition and possible determinants among schoolchildren in Ethiopia, but there is a lack of systematically gathered and analyzed information.

OBJECTIVE

This systematic review and meta-analysis aimed to summarize epidemiological data on undernutrition and possible determinants among schoolchildren in Ethiopia.

METHODS

We conducted a systematic review using open access articles that report the prevalence of stunting and wasting/thinness among schoolchildren from PubMed Central, Scopus, and Science direct. The pooled prevalence was determined using a random-effect model while heterogeneities between studies were evaluated by I ² test.

RESULTS

A total of 24 716 schoolchildren were included in the 39 eligible articles. The prevalence of stunting and wasting/thinness among schoolchildren in Ethiopia were 23.1% (95% CI: 19.0-27.0) and 22% (95% CI: 17-26), respectively. There was a marked difference in the prevalence of stunting and wasting/thinness across regions of Ethiopia. The risk of stunting was increased with meal frequency ≤3 times a day (odds ratio [OR] = 3.02, 95% CI: 1.90-4.14), age >10 years (OR = 2.16, 95% CI: 1.47-2.85), and family size ≥5 (OR = 1.88, 95% CI: 1.40-2.35). Similarly, the risk of wasting/thinness was increased with male sex (OR = 2.06, 95% CI: 1.54-2.58), low family income (OR = 2.16, 95% CI: 1.30-3.01), and age >10 years (OR = 1.78, 95% CI: 0.74-2.82).

CONCLUSION

This study revealed that more than one-fifth of schoolchildren are stunted or wasted/thin in Ethiopia. Large family size, male sex, and student age were consistently associated with stunting and wasting/thinness among schoolchildren. This study highlights the importance of an integrated effort to reduce undernutrition in Ethiopia.

Prevalence of Soil-Transmitted Helminth Infection Among School-Aged Children of Ethiopia: A Systematic Review and Meta-Analysis

Background:

Soil-transmitted helminths (STH) are still major health problems in resource-poor countries. Despite several epidemiological studies were available in Ethiopia, summarized data on the prevalence of STH among school-aged children (SAC) is lacking in the country.

Objective:

This study was aimed to summarize the existing published studies of STH among SAC children in Ethiopia.

Methods:

The search was carried out in open access databases such as Science Direct, Scopus, and PubMed Central which reported STH in Ethiopia. Open access articles published between 2000 and 2019 were included in this meta-analysis. The pooled prevalence was determined using a random-effect model while heterogeneities between studies were evaluated by I² test.

Results:

A total of 46 338 children (Male = 23 374 and Female = 22 964) were included in the 70 eligible studies for this meta-analysis. The pooled prevalence of STH among SAC was 33.4%; 95% CI, 29.3% to 37.7% in Ethiopia. Ascaris lumbricoides (19.9%; 95% CI, 17.2%-22.6%) was the most prevalent STH followed by Trichuris trichiura (12.4%; 95% CI, 10.6%-14.1%), and hookworm (7.9%; 95% CI, 6.9%-8.9%) infection in the country. High prevalence of STH was observed in Oromia (42.5%; 95% CI, 31.6%-53.4%) followed by SNNPR (38.3%; 95% CI, 27.7%-48.8%) and Amhara (32.9%; 95% CI, 27.0%-38.8%) regional states. High heterogeneity on the prevalence of STH was observed across studies within and among regions (I² > 96% and P < .001).

Conclusion:

This review showed that more than one-third of the Ethiopian SAC were infected with STH. The high prevalence of STH observed in this review highlight the needs of improved control and prevention strategies in Ethiopia.

Estimating access to drinking water and sanitation: The need to account for uncertainty in trend analysis

Nationally representative household surveys are the main source of data for tracking drinking water, sanitation and hygiene (WASH) coverage. However, all survey point estimates have a certain degree of error that must be considered when interpreting survey results for policy and decision making. In this article, we develop an approach to characterize and quantify uncertainty around WASH estimates. We apply it to four countries - Bolivia, Gambia, Morocco and India - representing different regions, number of data points available and types of trajectories, in order to illustrate the importance of communicating uncertainty for temporal estimates, as well as taking into account both the compositional nature and non-linearity of JMP data. The approach is found to be versatile and particularly useful in the WASH sector, where the dissemination and analysis of standard errors lag behind. While it only considers the uncertainty arising from sampling, the proposed approach can help improve the interpretation of WASH data when evaluating trends in coverage and informing decision making.

Associations between Water, Sanitation and Hygiene (WASH) and trachoma clustering at aggregate spatial scales, Amhara, Ethiopia

Background

Trachoma is the leading infectious cause of blindness globally. The WHO has recommended the SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvements) strategy to eliminate trachoma as a public health problem. The F and E arms of the strategy will likely be important for sustained disease reductions, yet more evidence is needed detailing relationships between hygiene, sanitation and trachoma in areas with differing endemicity. This study addressed whether the regional differences in water, sanitation, and hygiene (WASH) variables were associated with the spatial distribution of trachomatous inflammation-follicular (TF) among children aged 1 to 9 years in the Amhara National Regional State of Ethiopia.

Methods

Data from 152 multi-stage cluster random trachoma surveys were used to understand the degree of clustering of trachoma on two spatial scales (district and village) in Amhara using a geographical information system and the Getis-Ord G_i* (d) statistic for local clustering. Trained and certified graders examined children for the clinical signs of trachoma using the WHO simplified system. Socio-demographic, community, and geoclimatic factors thought to promote the clustering of the disease were included as covariates in a logistic regression model.

Results

The mean district prevalence of TF among children aged 1 to 9 years in Amhara was 25.1% (standard deviation = 16.2%). The spatial distribution of TF was found to exhibit global spatial dependency with neighboring evaluation units at both district and village level. Specific clusters of high TF were identified at both the district and the village scale of analysis using weighted estimates of the prevalence of the disease. Increased prevalence of children without nasal and ocular discharge as well as increased prevalence of households with access to a water source within 30 minutes were statistically significantly negatively associated with clusters of high TF prevalence.

Conclusions

Water access and facial cleanliness were important factors in the clustering of trachoma within this hyperendemic region. Intensified promotion of structural and behavioral interventions to increase WASH coverage may be necessary to eliminate trachoma as a public health problem in Amhara and perhaps other hyper-endemic settings.

Assessment of sanitary condition of services as implication for intestinal parasitic infections among prison inmates: institutional based cross-sectional study in eastern Tigrai zonal prison, northern Ethiopia, 2018

OBJECTIVE

The study aimed to assess the sanitary condition of services and its implication for intestinal parasitic infections among prison inmates in eastern Tigrai, northern Ethiopia.

RESULTS

We have assessed the availability and sanitary condition of services at Adigrat prison. Frequent water cuts and unavailability of soap in the prison have challenged prisoners and food handlers to maintain their hygiene. The living rooms were overcrowded and poorly ventilated besides to unsatisfactory kitchen rooms. The prevalence of intestinal parasites among the participants was 40% (108/270). The dominant parasite was Entamoeba histolytica/dispar (60, 22.2%) followed by Giardia lamblia, 39 (14.4%). The mixed infections of Entamoeba histolytica/dispar and Giardia lamblia were detected among 17 (6.3%) of the participants. In multivariate analysis, participants who were feeding in groups were more likely to harbor intestinal parasites than those who were feeding alone (AOR: 2.1; CI 1.05-4.3). Intestinal parasites are significant health problems to the prisoners of Adigrat prison with poor sanitation of services. Therefore, provision of necessary facilities such as hand washing basins, soaps, disinfectants, disinfestations, and food utensils could significantly reduce the burden of intestinal parasites in the prison.

Application of Kingdon and Hall Models to Review Environmental Sanitation and Health Promotion Policy in Ethiopia: A Professional Perspective as a Review

Background

In the world, many countries, including Ethiopia, are framing policies to roll back the problem of the sanitation. For this, the Kingdon and Hall models are the two distinct models formed to articulate the policy agenda to the health problem. The Kingdon model includes problem, policy and politics streams whereas the Hall model includes legitimacy, feasibility and support of the health policies. Therefore, this review aims to integrate the two models with diseases prevention and health promotion policies of Ethiopia.

Methods

We used the existing frameworks of the models as a guiding principle. Then, we applied the frameworks of the two models as an important consideration to interlink policy agenda to a given health problem. We also described the existing scientific literature about the sanitation and health promotion. After thoroughly reviewing, possible policy inputs and country setups were included with a brief discussion by comparing different kinds of literatures.

Results

The two models are recognized as an opportunity to get an essential sanitation policy. The government settled and has closed links to the new innovation as an emerged discourse. Therefore, the two model streams came together for setting sanitation problem on the policy agenda. The technical feasibility, public acceptability and congruence with existing values were all judged to be favorable.

Conclusion

The integration of policies within the policy frameworks has very important outputs in various countries. Therefore, the field specialists should figure out the problem of policy integration through policy evaluation researches.

Spatial distribution and determinant factors of anaemia among women of reproductive age in Ethiopia: a multilevel and spatial analysis

OBJECTIVE

The aim of this study was to assess the spatial distribution and determinant factors of anaemia among reproductive age women in Ethiopia.

METHODS

An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey data was undertaken. Getis-Ord Gi* statistics were used to identify the hot and cold spot areas for anaemia among women of reproductive age. A multilevel logistic regression model was used to identify independent predictors of anaemia among women of reproductive age.

RESULTS

Older age (adjusted OR [AOR]=0.75; 95% CI 0.64 to 0.96), no education (AOR=1.37; 95% CI 1.102 to 1.72), lowest wealth quantile (AOR=1.29; 95% CI 1.014 to 1.60), currently pregnant (AOR=1.28; 95% CI 1.10 to 1.51, currently breast feeding (AOR=1.09; 95% CI 1.025 to 1.28), high gravidity (AOR=1.39; 95% CI 1.13 to 1.69) and HIV positive (AOR=2.11; 95% CI 1.59 to 2.79) are individual factors associated with the occurrence of anaemia. Likewise, living in a rural area (AOR=1.29; 95% CI 1.02 to 1.63) and availability of unimproved latrine facilities (AOR=1.18; 95% CI 1.01 to 1.39) are community-level factors associated with higher odds of anaemia. The spatial analysis indicated that statistically high hotspots of anaemia were observed in the eastern (Somali, Dire Dawa and Harari regions) and north-eastern (Afar) parts of the country.

CONCLUSION

The prevalence rate of anaemia among women of reproductive age varied across the country. Significant hotspots/high prevalence of anaemia was observed in the eastern and north-eastern parts of Ethiopia. Anaemia prevention strategies need to be targeted on rural residents, women with limited to no education, women who are breast feeding, areas with poor latrine facilities and women who are HIV positive.

Assessment of Bacteriological and Physicochemical Quality of Drinking Water from Source to Household Tap Connection in Nekemte, Oromia, Ethiopia

In Ethiopia, access to improved water supply and sanitation has been very low and hence majority of the communicable diseases are associated with unsafe and inadequate water supply. Thus, the aim of this study was to assess physicochemical and bacteriological characteristics of water from sources to household connection in Nekemte town. A cross-sectional study was conducted from November 2015 to March 2016. Water samples were collected in triplicates from selected 30 sampling points from source, disinfection point, main distribution system tank, and household taps. All samples were analysed for bacteriological, chemical, and physical quality parameters using standard procedures. The results showed that temperature, pH, turbidity, total dissolved substances, and electrical conductivity of the water samples were varied between 16.9 and 22°C, 6.8–7.0, nil-12 NTU, 50–70 mg/l, and 40–46 µS/cm, respectively. Phosphate and nitrate concentrations of the water samples also ranged between 0.65 and 1 mg/l and 2.2–6.5 mg/l, respectively. Free residual chlorine concentration in the majority of the water samples was less than 0.5 mg/l. All samples were positive for total coliform with counts ranging from 12 to 120 CFU/100 ml, whereas faecal coliforms were detected in only 37% of tap water samples. In general, the majority of the tested parameters were within the permissible range of both the WHO and Ethiopian drinking water standards. However, Fe, Mn, faecal coliforms, total coliforms, and temperature did not conform to both WHO and Ethiopian drinking water standards. Based on the results, we can conclude that water quality deterioration was both at the sources and in the supply networks. Hence, proper drainage, sewage disposal systems, and sufficient disinfection of water with chlorine are of prime importance to deliver safe drinking water to the residents of Nekemte town.

Methods to reliably estimate faecal sludge quantities and qualities for the design of treatment technologies and management solutions

Sanitation access in urban areas of low-income countries is provided through unstandardized onsite technologies containing accumulated faecal sludge. The demand for infrastructure to manage faecal sludge is increasing, however, no reliable method exists to estimate total accumulated quantities and qualities (Q&Q) This proposed approach averages out complexities to estimate conditions at a centralized to semi-centralized scale required for management and treatment technology solutions, as opposed to previous approaches evaluating what happens in individual containments. Empirical data, demographic data, and questionnaires were used in Kampala, Uganda to estimate total faecal sludge accumulation in the city, resulting in 270 L/cap∙year for pit latrines and 280 L/cap∙year for septic tanks. Septic tank sludge was more dilute than pit latrine sludge, however, public toilet was not a distinguishing factor. Non-household sources of sludge represent a significant fraction of the total and have different characteristics than household-level sludge. Income level, water connection, black water only, solid waste, number of users, containment volume, emptying frequency, and truck size were predictors of sludge quality. Empirical relationships such as a COD:TS of 1.09 ± 0.56 could be used for more resource efficient sampling campaigns. Based on this approach, spatially available demographic, technical and environmental (SPA-DET) data and statistical relationships between parameters could be used to predict Q&Q of faecal sludge.

Availability and utilization of sanitation facilities in Enderta district, Tigray, Ethiopia

Introduction

Despite concerted efforts by governmental and non-governmental organizations, water and adequate sanitation still remain a challenge worldwide. Therefore, this study assessed the availability and utilization of sanitation facilities in Enderta district of Tigray, Ethiopia.

Methods

A cross-sectional study was conducted in May 2016. An interview and observation were conducted in a total of 450 households. An interviewer administered questionnaire and observation checklist were used to collect the data. Multivariable logistic regression was done to identify the predictors of availability and utilization of latrine, hand washing, and drinking water.

Results

Out of 450 households, only 68.4% had latrine of which only 21.4% had hand washing facility near the toilet. Likewise, only 9.3% washed their hand after toilet. However, all households had access to improved water source. In this study, proper utilization of latrine, hand washing, and water facilities was observed in 53%, 42.4% and 36.2% of the study households, respectively. The family size and getting sanitation information from health care providers, health extension workers, and health development army had a positive effect on availability and utilization.

Conclusions

Though Community-Led total sanitation and hygiene approach has been implemented in the study area, the availability and proper utilization of latrine, and hand washing are still low. Only few households used drinking water properly. The education or information on hygienic practices found to affect the availability and utilization of the sanitation facilities positively. Therefore, strengthening the health extension workers and health development army to provide sustainable education and health information is needed.

Factors associated with latrine utilization among model and non-model families in Laelai Maichew Woreda, Aksum, Tigray, Ethiopia: comparative community based study

Objective

The study was conducted on 313 model and 313 non model households to assess latrine utilization and factors affecting among model and non-model families.

Result

About 225 (71.9%) model and 144 (46%) non-model participants declared that they utilize their latrine which gave the overall utilization rate of 369 (58.9%). Households with primary and above education were two times (AOR = 2.03, 95% CI 1.427, 4.638) more likely to utilize latrine as compared with illiterate households. Cleanness of the latrine was also found to be associated with latrine utilization in both model and non-model families. Age, type of latrine, latrine supper structure, cleanness and observable soap near the latrine in model families and age, educational status, occupation, latrine privacy and cleanness in non-model families were identified as a statistical significant factor for latrine utilization.

Sanitation facilities, hygienic conditions, and prevalence of acute diarrhea among under-five children in slums of Addis Ababa, Ethiopia: Baseline survey of a longitudinal study

BACKGROUND

In developing countries, children under the age of five years who live in slums are highly vulnerable to diarrhea. However, there is a paucity of information on the relationship between sanitation facilities and hygienic conditions to acute diarrhea among under-five children in slum areas of Addis Ababa, Ethiopia. Therefore, this study examines the sanitation facilities and hygienic conditions in the slums of Addis Ababa and identifies the main factors significantly associated with acute diarrhea among children aged 0-50 months in those slums.

METHODS

A community-based cross-sectional household survey was carried out between September and November 2014, that then served as the baseline survey of a longitudinal study. For this survey, 697 children aged 0-50 months were recruited from two slum districts in Addis Ababa. A pre-tested structured questionnaire and an observational checklist were used for data collection. Multivariable logistic regression analysis was used to identify sanitation facilities and hygiene-related factors that were significantly associated with acute diarrhea by controlling potential confounding effects of selected socio-demographic factors. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was used to quantify the strength of association.

MAIN FINDINGS

The prevalence of acute diarrhea among children aged 0-50 months in the study area was 11.9% and 94.6% of the sanitation facilities were unimproved. Sharing of a sanitation facility by six or more households (AOR = 4.7; 95% CI: 2.4-9.4), proximity of sanitation facilities within 15 meters of homes (AOR = 6.6; 95% CI: 2.5-17.0), presence of feces (AOR = 3.9; 95% CI: 1.5-10.3) and flies (AOR = 2.5; 95% CI: 1.3-5.0) on the floor of and/or around sanitation facilities, and presence of uncollected garbage inside house compounds (AOR = 3.2; 95% CI: 1.2-8.4) were significantly associated with acute diarrhea.

CONCLUSION

This study reveals the slum environment to be high risk for diarrhea due to close proximity of sanitation facilities to homes, sharing of sanitation facilities, and poor hygiene of the sanitation facilities and housing compounds. We recommend the development of a comprehensive diarrheal disease prevention program that focuses on improving the cleanliness of the sanitation facilities and housing compounds. Increasing the number of improved sanitation facilities at an appropriate distance from houses is also essential in order to reduce the number of households that share one latrine.

The Role of Perceived Social Norms in Rural Sanitation: An Explorative Study from Infrastructure-Restricted Settings of South Ethiopia

The perception of social sanitation norms (PSSNs) around unacceptability of open defecation has been a key aspect of recent sanitation interventions. However, underlying mechanisms through which “reconstructed” PSSNs affect sanitation outcomes have been a black box. This explorative cross-sectional study examines direct and indirect links between PSSNs and sanitation safety using data from structured interviews and observations in 368 households in rural South Ethiopia. In addition to a positive association between PSSNs and sanitation safety, we propose and examine the following two mechanisms: First, we confirm a potentially adverse feedback of PSSNs on future sanitation safety by enhancing the emotional satisfaction with current sanitation practice (satisfaction independent of the functionality of sanitation facilities). Second, inspired by the social amplification/attenuation of risk framework, we demonstrate that PSSNs work as a “social filter” that can amplify or attenuate the effects of other variables targeted in sanitation interventions such as perceived health-related and non-health risks and benefits associated with open defecation and private latrine ownership, respectively, and factual hygiene and sanitation knowledge. These findings imply that PSSNs are not only important per se, but they are also important instrumentally because sanitation outcomes depend upon the capacity of social influences to shape the perception of sanitation risks and benefits and sanitation-related awareness in desirable ways. The mechanisms outlined in this paper as well as the sustainability of sanitation outcomes depend on whether and how social sanitation norms are internalized.