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Adugna EA, Weldetinsae A, Alemu ZA, Daba AK, Dinssa DA, Tariku T, Weldegebriel MG, Serte MG, Teklu KT, Kenea MA, Yehuala GK, Tessema M, Girmay AM. Prevalence and epidemiological distribution of indicators of pathogenic bacteria in households drinking water in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2024; 24:2511. [PMID: 39285409 PMCID: PMC11404037 DOI: 10.1186/s12889-024-20067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 09/12/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Ensuring the availability of safe drinking water remains a critical challenge in developing countries, including Ethiopia. Therefore, this paper aimed to investigate the prevalence of fecal coliform and E. coli bacteria and, geographical, children availability, and seasonal exposure assessment through a meta-analysis. METHODS Two independent review groups extensively searched internet databases for English-language research articles published between 2013 and 2023. This systematic review and meta-analysis followed PRISMA guidelines. The methodological quality of each included study was evaluated using the STROBE guidelines. Publication bias was assessed by visual inspection of a funnel plot and then tested by the Egger regression test, and meta-analysis was performed using DerSimonian and Laird random-effects models with inverse variance weighting. Subgroup analyses were also conducted to explore heterogeneity. RESULTS Out of 48 potentially relevant studies, only 21 fulfilled the inclusion criteria and were considered for meta-analysis. The pooled prevalence of fecal coliform and E. coli was 64% (95% CI: 56.0-71.0%, I2 = 95.8%) and 54% (95% CI: 45.7-62.3%, I2 = 94.2%), respectively. Subgroup analysis revealed that the prevalence of fecal coliform bacteria increased during the wet season (70%) compared to the dry season (60%), particularly in households with under-five children (74%) compared to all households (61%), in rural (68%) versus urban (66%) areas, and in regions with high prevalence such as Amhara (71%), Gambela (71%), and Oromia (70%). Similarly, the prevalence of E. coli was higher in households with under-five children (66%) than in all households (46%). CONCLUSIONS The analysis highlights the higher prevalence of fecal coliform and E. coli within households drinking water, indicating that these bacteria are a significant public health concern. Moreover, these findings emphasize the critical need for targeted interventions aimed at improving drinking water quality to reduce the risk of fecal contamination and enhance public health outcomes for susceptible groups, including households with under-five children, in particular geographical areas such as the Amhara, Gambela, and Oromia regions, as well as rural areas, at point-of-use, and during the rainy season. REGISTRATION This review was registered on PROSPERO (registration ID - CRD42023448812).
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Yonas B, Sisay T, Gizeyatu A, Feleke A, Daba C, Gebrehiwot M. To do's after war: Priorities for acute diarrheal diseases intervention among under-five children in conflict settings of Raya Kobo district, Northeastern Ethiopia. Heliyon 2024; 10:e28394. [PMID: 38633653 PMCID: PMC11021898 DOI: 10.1016/j.heliyon.2024.e28394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 10/25/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Diarrheal diseases are significant causes of under-five children mortality and morbidity in developing countries. This is particularly alarming among the community living in conflict zones where less attention is given for basic services including water, food, and health. However, there are no detailed investigations on acute diarrhea among under-five children in conflict-affected areas, which impedes intervention approaches. Therefore, this study was designed to assess the prevalence of acute diarrhea and associated factors among under-five children in conflict-affected setting of Raya Kobo, Northeast Ethiopia. Methods A community-based cross-sectional study was employed among 463 under-five children in Raya Kobo district, from February to March 2021. The study participants were selected from ten rural kebeles. Pre-tested questionnaire and observational checklist were used to collect the data. Bivariate and multivariable logistic regression analyses were computed to identify factors associated with the prevalence of acute diarrhea. Results The prevalence of acute diarrhea among under-five children was 21% (95% confidence interval (CI): 18.50-23.91%). Unimproved drinking water source (Adjusted odds ratio (AOR) = 2.89; 95%CI: 1.38-6.06), disposal of garbage in open field (AOR = 3.33; 95%CI:1.66-6.67), having low monthly income (AOR = 5.73; 95%CI: 3.07-10.59), absence of latrine facility (AOR = 3.18; 95%CI: 1.09-8.78), poor hand washing practice at critical times (AOR = 2.52; 95%CI:1.28-4.05), not regularly cleaning food utensil before child feeding (AOR = 2.54; 95%CI:1.31-4.94), and not received Rota vaccine (AOR = 4.28; 95%CI: 1.82-10.11) were the determinant factors. Conclusions To reduce the burden of acute diarrheal diseases, post-war intervention approaches should emphasize on advocating for Rota virus vaccination, regularly cleaning food utensils before feeding, improving hand washing practice at critical times, provision of improved drinking water source, and use of proper solid and domestic sewage discharge/disposal methods.
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Affiliation(s)
| | - Tadesse Sisay
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Adinew Gizeyatu
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alelgne Feleke
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Chala Daba
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mesfin Gebrehiwot
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Aydamo AA, Robele Gari S, Mereta ST. Seasonal Variations in Household Water Use, Microbiological Water Quality, and Challenges to the Provision of Adequate Drinking Water: A Case of Peri-urban and Informal Settlements of Hosanna Town, Southern Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241238940. [PMID: 38525297 PMCID: PMC10958793 DOI: 10.1177/11786302241238940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024]
Abstract
Several studies have been conducted on household water use and microbial water quality globally. However, studies that considered seasonal variability of household water use and microbial water quality were limited. Therefore, this study investigated the seasonal variability of household water use, microbiological water quality, and challenges to the provision of adequate water in the peri-urban and informal settlements of Hosanna town, Southern Ethiopia. A longitudinal study was conducted on 288 households. The data was gathered using a pretested structured questionnaire, laboratory-analysis, interviews, storage-container inventories, focus group discussions, key-informant interviews, and an observational checklist. The data was analyzed using stepwise-multiple linear regression, bivariate and multivariable logistic regression, thematic-analysis, t-tests, and non-parametric-tests. Households were visited for 7 consecutive days during the dry and rainy seasons to account for changes in daily and seasonal variation of water use. 440 stored water and 12 source samples were analyzed for E. coli presence during dry and rainy seasons. The prevalence of stored water contamination with E. coli was 43.2% and 34.5% during the dry and rainy seasons, respectively. The per capita water consumption was 19.4 and 20.3 l during the dry and rainy seasons, respectively. Piped water on-premises, small family size, volume, and number of water storage containers were significant predictors of per capita water consumption in both seasons. Piped water off-premises, storing water for more than 3 days, uncovered, and wide-mouthed water storage containers were significantly associated with the presence of E. coli in water in both seasons. Seasonal variability of household water use and microbiological water quality was statistically significant, which is a significant public health concern and needs intervention to enhance water quantity and quality to mitigate the risk of waterborne diseases. Findings also suggest seasonal monitoring of the safety of drinking water to ensure that the water is safe and healthy.
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Affiliation(s)
- Abiot Abera Aydamo
- Ethiopian Institute of Water Resources (EiWR), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Environmental Sciences, Wachemo University, Hosanna, Ethiopia
| | - Sirak Robele Gari
- Ethiopian Institute of Water Resources (EiWR), Addis Ababa University, Addis Ababa, Ethiopia
| | - Seid Tiku Mereta
- Department of Environmental Health and Technology, Jimma University, Jimma, Ethiopia
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Altaseb T, Lingerew M, Adane M. Prevalence of trachomatous inflammation-follicular and associated factors among children aged 1-9 years in northeastern Ethiopia. BMC Pediatr 2024; 24:128. [PMID: 38373921 PMCID: PMC10875859 DOI: 10.1186/s12887-024-04587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Trachoma is the most prevalent eye disease in Ethiopia, especially among children aged 1-9 years and continues to be a public health concern. Nevertheless, in Ethiopia's rural Jamma district in South Wollo Zone of Amhara Regional State, factors associated with trachomatous inflammation-follicular (TF) among children aged 1-9 years have not yet been studied. METHODS A community-based cross-sectional study was conducted among 616 children aged 1-9 years in rural Jamma district in Ethiopia from January-March, 2019. Data were collected using a pre-tested structured questionnaire, an observation checklist and clinical examination of study participants for active trachoma. The presence of TF and trachomatous inflammation-intense (TI) was clinically assessed by integrated eye care workers using the World Health Organization simplified grading system. Data were analysed using SPSS (Statistical Package for Social Sciences) Version 25.0. A logistic regression model with 95% CI was used. From the multivariable analysis, variables with p-value < 0.05 were declared as associated factors of TF. RESULT The prevalence of TF was 10.9% (95% CI [8.6 - 13.6%]) among the rural children aged 1-9 years. The mean family size was 5.5 ± 1.9 persons. About one-fifth (20.6%) of households kept domestic animals overnight in the same room as family. Almost one-sixth (17.5%) of the children involved in this study had an ocular discharge. Two-thirds of the children (68.8%) washed their hands once per day and just over half (55.8%) washed their faces once per day. From multivariable analysis, we found that the presence of domestic animals kept overnight in the same room as the family (adjusted odds ratio [AOR] = 4.32; 95%CI [2.49-9.52]), mother's/caregiver's illiteracy (AOR = 2.01; 95%CI [1.11-4.67]), household size (> 7 persons) (AOR = 3.50; 95%CI [1.66-8.50]), washing of children's hands and face without soap (AOR = 2.41; 95%CI [1.29-5.18]), feces observed in the compound (AOR = 5.10; 95%CI [2.01-10.14]), presence of ocular discharge (AOR = 7.23, 95%CI [4.10-12.51]) and nasal discharge (AOR = 4.54, 95%CI [1.95-9.26]) were significantly associated with TF. CONCLUSION The prevalence of TF among rural children aged 1-9 years in this study was almost two times higher than the WHO-recommended threshold (TF < 5%) for trachoma elimination and beyond the trachoma control target (TF < 10%). Presence of domestic animals kept overnight in the same room as the family, mother's/caregiver's illiteracy, household size (> 7 persons), washing of children's hands and face without soap, feces observed in the compound, presence of ocular and nasal discharge were significantly associated with TF. We recommended interventions that will help household income to be improved to enable families to be able to construct separate rooms in which to keep animals overnight. Furthermore, we also recommend to policy makers to design mechanisms for enhancement of behavioural change among householders to keep household compounds clean and creating awareness among mothers/caregivers about prevention of trachoma.
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Affiliation(s)
- Tadesse Altaseb
- Jamma District Health Office, South Wollo Zone, Amhara Region, Ethiopia
| | - Mistir Lingerew
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
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Juvakoski A, Rantanen H, Mulas M, Corona F, Vahala R, Varis O, Mellin I. Evidence of waste management impacting severe diarrhea prevalence more than WASH: An exhaustive analysis with Brazilian municipal-level data. WATER RESEARCH 2023; 247:120805. [PMID: 37976622 DOI: 10.1016/j.watres.2023.120805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
Adequate housing protects from diarrhea, which is a substantial health concern in low- and middle-income countries. The purpose of this study was to quantify the relationship between severe diarrhea and housing features at the municipal level to help in public health planning. Regression analyses were performed on annual (2000-2012) datasets on Brazilian municipalities (5570) in six household feature categories (e.g., waste management) and four severe diarrhea outcomes (e.g., diarrhea deaths of under-5 children). Household data were not available elsewhere of this magnitude and granularity, highlighting the scientific value-add of this study. Municipalities were clustered prior to regression analysis because of data heterogeneity. The compositional household feature data were also subjected to principal component analysis to diminish feature variable multicollinearity. The highest explanatory power was found for diarrhea deaths of under-5 children (R2 = 10-22 %), while those in the over-5 population were the least best explained (R2 = 0.3-7 %). Household features predicted diarrhea outcomes more accurately in the "advanced" housing municipality cluster (R2 = 16-22 %) than in the "mid-level" (R2 = 7-20 %) and "basic" (R2 = 6-12 %) ones (over-5 diarrhea deaths excluded). Under-5 children's diarrhea death prevalence was three times higher in the "basic" cluster than in the "advanced" cluster. Importantly, the impact of waste management was overall the largest of all household features, even larger than those of WASH, i.e., water supply, sanitation, and household drinking water treatment. This is surprising in the context of existing literature because WASH is generally regarded as the most important household factor affecting gastrointestinal health. In conclusion, public health interventions could benefit from customizing interventions for diarrhea outcomes, municipality types, and household features. Waste management's identified stronger association with diarrhea compared to WASH may have important implications beyond the water field and Brazil.
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Affiliation(s)
- Anni Juvakoski
- Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland.
| | | | - Michela Mulas
- Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland; Department of Teleinformatics Engineering, Federal University of Ceará, Campus do Pici, Fortaleza, Brazil
| | - Francesco Corona
- Department of Chemical and Metallurgical Engineering, Aalto University, PO Box 16100, Espoo, FI-00076, Aalto, Finland
| | - Riku Vahala
- Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland
| | - Olli Varis
- Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland
| | - Ilkka Mellin
- Department of Mathematics and Systems Analysis, Aalto University, PO Box 11100, FI-00076, Aalto, Finland
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Ali AS, Gari SR, Goodson ML, Walsh CL, Dessie BK, Ambelu A. Prevalence and risk factors of childhood diarrhea among wastewater irrigating urban farming households in Addis Ababa. PLoS One 2023; 18:e0288425. [PMID: 37939075 PMCID: PMC10631672 DOI: 10.1371/journal.pone.0288425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/27/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION Childhood diarrhea is one of the major contributors to the morbidity of under-five children in Ethiopia. Although researchers determine the risk factors varyingly, the exposure route to the pathogens is usually complicated. This study aims to investigate the prevalence and risk factors of diarrhea among children under the age of five among wastewater irrigation farming households in Addis Ababa, Ethiopia. METHODS Cross-sectional study was conducted among 402 farming households from November 2021 to February 2022. Data was collected using a face-to-face interviewer-administered questionnaire. Stata version 14 software was used to analyze data. Factors associated with the prevalence of diarrhea was identified using binary logistic regression. Multivariable analysis was carried out to determine an adjusted odds ratio at a confidence level of 95% and level of significance at 0.05. RESULTS The overall prevalence of under-five children diarrheal cases was 22.3%. The odds of diarrhea are associated with a multitude of variables. Major wastewater-related determinants associated with diarrhea are body washing with irrigation water [AOR: 37.7, 95%CI (3.1, 358)], contaminated cloth with irrigation water [AOR:10.8,95%CI(0.6, 205)], use of protective clothing during farm work [28.9,95%CI (3.9, 215)], use of farm work cloths at home [AOR: 31.7, 95%CI (4.4, 226)], and bringing unwashed farm tools to home [94 (5.7, 1575)]. CONCLUSION The high prevalence of under-five children diarrheal disease among wastewater irrigation households was strongly associated with factors related to occupational exposure. Thus, to decrease childhood diarrheal among urban agriculture farmers, appropriate precautions need to be taken.
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Affiliation(s)
- Adane Sirage Ali
- Division of Water and Health, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Urban Environmental Management, Kotebe University of Education, Addis Ababa, Ethiopia
| | - Sirak Robele Gari
- Division of Water and Health, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Claire L. Walsh
- School of Engineering, Newcastle University, Newcastle, United Kingdom
| | - Bitew K. Dessie
- Water and Land Resource Centre, Addis Ababa University, Addis Ababa, Ethiopia
| | - Argaw Ambelu
- Division of Water and Health, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
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Espira LM, Gessese B, Kassa BA, Wu CC, Riley J, Bedru S, Sahilu G, Desta A, Baye K, Jones AD, Love NG, Eisenberg JNS. Multiscalar Evaluation of the Water Distribution System and Diarrheal Disease Risk in Addis Ababa, Ethiopia. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:13313-13324. [PMID: 37642551 PMCID: PMC10501120 DOI: 10.1021/acs.est.2c08976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
Despite growing urbanization, our understanding of the impacts of water and sanitation on human health has largely come from studies in rural sectors. To this end, we collected data at both regional (water quality measures from water treatment systems) and community (cross-sectional surveys) scales to examine determinants of enteric pathogen infection and diarrheal disease among infants in Addis Ababa, Ethiopia. Regionally, the Legedadi water treatment plant had significantly lower heterotrophic plate counts, total coliform counts, and fecal coliform counts compared with the Gefersa water treatment plant. The number of pathogen types in infant stool also differed by plant. Decreases in chlorine levels and increases in the relative abundance of Gammaproteobacteria with distance from treatment plants suggest a compromised water distribution system. In communities, infants in households that obtained water from yard pipes or public taps had significantly lower odds of diarrhea compared to households that had water piped into their dwellings (OR = 0.35, 95% CI 0.16, 0.76, and OR = 0.39, 95% CI 0.15, 1.00, respectively). Similarly, infants in households that boiled or filtered water had significantly lower odds of diarrhea compared to households that did not treat water (OR = 0.40, 95% CI 0.19, 0.86 and OR = 0.23, 95% CI 0.06, 0.84, respectively). Integrating multiscalar data better informs the health impacts of water in urban settings.
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Affiliation(s)
- Leon M. Espira
- Department
of Epidemiology, University of Michigan
School of Public Health, Ann Arbor, Michigan 48109, United States
| | - Brook Gessese
- Ethiopian
Institute of Water Resources, Addis Ababa
University, Addis
Ababa 150461, Ethiopia
| | - Bayable A. Kassa
- Institute
of Biotechnology, Addis Ababa University, Addis Ababa 1176, Ethiopia
| | - Chia-Chen Wu
- Institute
of Environmental Engineering, National Yang
Ming Chiao Tung University, Hsinchu City 30010, Taiwan
| | - Joshua Riley
- Department
of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Seifedin Bedru
- School of
Civil and Environmental Engineering, Addis
Ababa University, Addis Ababa 1176, Ethiopia
| | - Geremew Sahilu
- School of
Civil and Environmental Engineering, Addis
Ababa University, Addis Ababa 1176, Ethiopia
| | - Adey Desta
- Department
of Microbial and Cellular Biology, Addis
Ababa University, Addis Ababa 1176, Ethiopia
| | - Kaleab Baye
- Center
for
Food Science and Nutrition, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa 1176, Ethiopia
| | - Andrew D. Jones
- Department
of Nutritional Sciences, University of Michigan
School of Public Health, Ann Arbor, Michigan 48109, United States
| | - Nancy G. Love
- Department
of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Joseph N. S. Eisenberg
- Department
of Epidemiology, University of Michigan
School of Public Health, Ann Arbor, Michigan 48109, United States
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Zelelie TZ, Eguale T, Yitayew B, Abeje D, Alemu A, Seman A, Jass J, Mihret A, Abebe T. Molecular epidemiology and antimicrobial susceptibility of diarrheagenic Escherichia coli isolated from children under age five with and without diarrhea in Central Ethiopia. PLoS One 2023; 18:e0288517. [PMID: 37450423 PMCID: PMC10348587 DOI: 10.1371/journal.pone.0288517] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Diarrhea is a serious health problem in children, with the highest mortality rate in sub-Saharan Africa. Diarrheagenic Escherichia coli (DEC) is among the major bacterial causes of diarrhea in children under age five. The present study aims to determine molecular epidemiology and antimicrobial resistance profiles of DEC and identify contributing factors for acquisition among children under age five in Central Ethiopia. METHODS A health facility-centered cross-sectional study was conducted in Addis Ababa and Debre Berhan, Ethiopia, from December 2020 to August 2021. A total of 476 specimens, 391 from diarrheic and 85 from non-diarrheic children under age five were collected. Bacterial isolation and identification, antimicrobial susceptibility, and pathotype determination using polymerase chain reaction (PCR) were done. RESULTS Of the 476 specimens analyzed, 89.9% (428/476) were positive for E. coli, of which 183 were positive for one or more genes coding DEC pathotypes. The overall prevalence of the DEC pathotype was 38.2% (183/476). The predominant DEC pathotype was enteroaggregative E. coli (EAEC) (41.5%, 76/183), followed by enterotoxigenic E. coli (21.3%, 39/183), enteropathogenic E. coli (15.3%, 28/183), enteroinvasive E. coli (12.6%, 23/183), hybrid strains (7.1%, 13/183), Shiga toxin-producing E. coli (1.6%, 3/183), and diffusely-adherent E. coli (0.6%, 1/183). DEC was detected in 40.7% (159/391) of diarrheic and 28.2% (24/85) in non-diarrheic children (p = 0.020). The majority of the DEC pathotypes were resistant to ampicillin (95.1%, 174/183) and tetracycline (91.3%, 167/183). A higher rate of resistance to trimethoprim-sulfamethoxazole (58%, 44/76), ciprofloxacin (22%, 17/76), ceftazidime and cefotaxime (20%, 15/76) was seen among EAEC pathotypes. Multidrug resistance (MDR) was detected in 43.2% (79/183) of the pathotypes, whereas extended spectrum ß-lactamase and carbapenemase producers were 16.4% (30/183) and 2.2% (4/183), respectively. CONCLUSION All six common DEC pathotypes that have the potential to cause severe diarrheal outbreaks were found in children in the study area; the dominant one being EAEC with a high rate of MDR.
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Affiliation(s)
- Tizazu Zenebe Zelelie
- Department of Medical Laboratory Science, Debre Berhan University, Debre Birhan, Ethiopia
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
- Armeur Hansen Research Institue (AHRI), Addis Ababa, Ethiopia
| | - Tadesse Eguale
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Ohio State University Global One Health LLC, Addis Ababa, Ethiopia
| | - Berhanu Yitayew
- Department of Medical Laboratory Science, Debre Berhan University, Debre Birhan, Ethiopia
| | - Dessalegn Abeje
- Armeur Hansen Research Institue (AHRI), Addis Ababa, Ethiopia
| | - Ashenafi Alemu
- Armeur Hansen Research Institue (AHRI), Addis Ababa, Ethiopia
| | - Aminu Seman
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jana Jass
- The Life Science Centre—Biology, School of Science and Technology, Orebro University, Örebro, Sweden
| | - Adane Mihret
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
- Armeur Hansen Research Institue (AHRI), Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
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Eugenia Afocha E, Abiodun Iwalokun B, Deji-Agboola MA, Ayorinde James B, Abayomi Banjo T, Adu F, Chukwujekwu Ezechi O, Adegbola R, Lawal Salako B. Prevalence and spatiotemporal distribution of rotavirus diarrhea among children younger than five years old in Lagos, Nigeria. J Immunoassay Immunochem 2023; 44:117-132. [PMID: 36576163 DOI: 10.1080/15321819.2022.2159430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Data on spatiotemporal distribution of rotavirus diarrhea are limited in many endemic settings. This study determined the prevalence and seasonal distribution of rotavirus among Nigerian children with diarrhea. Here, a total of 406 fecal samples were collected from patients attending six health facilities in Lagos between January - December 2019. Socio-demographic data of each enrolled child were collected. Rotavirus VP6 antigen was detected by enzyme-linked immunoassay (ELISA) and confirmation by VP7 gene detection by reverse transcription polymerase-chain reaction. The overall rotavirus diarrhea prevalence was 16.3% by ELISA with children above 2 years having 29.2% of this prevalence and higher occurrence in females (59.1%) than males (40.9%) (P < .05). Rotavirus diarrhea diagnosis using RT-PCR showed 100% concordance with ELISA. Cases of rotavirus diarrhea were detected from March to July and from September to November with the highest number of cases detected in May and June (22.7% each), followed by July (21.2%). The prevalence of rotavirus diarrhea remains high in Lagos with an emerging higher disease activity in children above 2. A different rotavirus transmission dynamics compared to previous studies from Nigeria and other African countries was found. VP6 ELISA may reliably be used for continuous rotavirus surveillance in Nigeria.
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Affiliation(s)
- Ebelechukwu Eugenia Afocha
- Medical Microbiology & Parasitology Department, Olabisi Onabanjo University, Nigeria.,Centre for Infectious Disease Research, Microbiology Department, Nigerian Institute of Medical Research, Nigeria
| | - Bamidele Abiodun Iwalokun
- Medical Microbiology & Parasitology Department, Olabisi Onabanjo University, Nigeria.,Molecular Biology & Biotechnology Department, Nigerian Institute of Medical Research, Nigeria.,Central Research Laboratory Department, Nigerian Institute of Medical Research, Nigeria
| | | | | | - Taiwo Abayomi Banjo
- Medical Microbiology & Parasitology Department, Olabisi Onabanjo University, Nigeria
| | - Festus Adu
- All Saints University Medical School, Cnr Hillborough and Great George Street, Common Wealth of Dominica, West Indies
| | | | - Richard Adegbola
- Centre for Infectious Disease Research, Microbiology Department, Nigerian Institute of Medical Research, Nigeria
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Angnunavuri PN, Attiogbe F, Mensah B. Microbial contamination and quantitative microbial risk assessment of high-density polyethylene (HDPE) film sachet drinking water in Ghana. JOURNAL OF WATER AND HEALTH 2022; 20:1587-1603. [PMID: 36308501 DOI: 10.2166/wh.2022.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The present research estimated the impact of storage on the microbial quality of high-density polyethylene drinking water. Samples were taken from two popular companies in Greater Accra using a two-sided exact test in SAS JMP to estimate the sample size. The samples were stored across three temperature profiles at 8 °C, 30 °C (average room temperature), and 40 °C (average outdoor temperature) for 28 days. The samples were examined using standard microbiological methods for heterotrophic plate counts (HPCs), faecal coliforms, and Escherichia coli. The data were described and regressed with Microsoft Excel, Argo 4.3.1, and SAS JMP software. The results demonstrated increasing deterioration of the water samples for all microbial indices at all temperatures with increasing storage duration. The highest HPC, faecal coliforms, and E. coli were 1,312; 622; and 252 cfu/100 mL, respectively, all at 40 °C. The daily risk of infection due to E. coli O157:H7 was 5.22 × 10-5 infections per child per day for children under 5 years, and 1.6 × 10-4 attacks per adult per day, compared to the upper limit of 1.0 × 10-6. These results are higher than recommended exposures, and interventions along the sachet drinking water value chain are needed to protect public health.
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Affiliation(s)
- Prosper Naah Angnunavuri
- School of Engineering, Department of Civil and Environmental Engineering, University of Energy and Natural Resources, Sunyani, Ghana E-mail:
| | - Francis Attiogbe
- School of Engineering, Department of Civil and Environmental Engineering, University of Energy and Natural Resources, Sunyani, Ghana E-mail:
| | - Bismark Mensah
- School of Engineering, University of Ghana, Legon, Ghana
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Atnafu B, Desta A, Assefa F. Microbial Community Structure and Diversity in Drinking Water Supply, Distribution Systems as well as Household Point of Use Sites in Addis Ababa City, Ethiopia. MICROBIAL ECOLOGY 2022; 84:73-89. [PMID: 34410455 DOI: 10.1007/s00248-021-01819-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
Understanding ecology of microbiomes in drinking water distribution systems is the most important notion in delivering safe drinking water. Drinking water distribution systems harbor various microbiota despite efforts made in improving water infrastructures in the water industry, especially, in developing countries. Intermittent water supply, long time of water storage, low water pressure, and contaminated source water are among many of the factors responsible for poor drinking water quality affecting health of people. The aim of this study was to explore microbial diversity and structure in water samples collected from source water, treated water, reservoirs, and household points of use locations (taps). High-throughput Illumina sequencing technology was employed by targeting the V4 region of the 16S rRNA gene and the V1-V3 region of the 18S rRNA gene to analyze the microbial community structure. Proteobacteria followed by Firmicutes, Bacteroidetes, and Actinobacteria were the core dominating taxa. Gammaproteobacteria was also dominant among other proteobacterial classes across all sampling points. Opportunistic bacterial genera such as Pseudomonas, Legionella, Klebsiella, Escherichia, and Actinobacteria, as well as eukaryotic microbes like Cryptosporidium, Hartmannella, Acanthamoeba, Aspergillus, and Candida were also abundant taxa found along the distribution systems. The shift in microbial community structure from source to point of use locations was influenced by basic factors such as residual chlorine, intermittent water supply, and long-time storage at the household. The complex microbiota detected in different sampling sites in this study brings drinking water quality problem which further causes significant health problems to both human and animal health. Treatment ineffectiveness, disinfection inefficiency, poor maintenance actions, leakage of sewage, and other domestic wastes are few among many other factors responsible for degraded drinking water quality in this study putting health at high risk. Findings of this research provide important and baseline information to understand the microbial profiles of drinking water along source water and distribution systems. Moreover, knowing the microbial profile will help to design proper water quality assurance approaches.
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Affiliation(s)
- Bayable Atnafu
- Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Adey Desta
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fasil Assefa
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
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Zambrana JV, Bustos Carrillo FA, Ojeda S, Lopez Mercado B, Latta K, Schiller A, Kuan G, Gordon A, Reingold A, Harris E. Epidemiologic Features of Acute Pediatric Diarrhea in Managua, Nicaragua, from 2011 to 2019. Am J Trop Med Hyg 2022; 106:1757-1764. [PMID: 35895434 PMCID: PMC9209918 DOI: 10.4269/ajtmh.21-0793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/18/2022] [Indexed: 11/12/2022] Open
Abstract
Diarrhea remains a leading cause of death in children in developing countries, including Nicaragua, but little is known about patterns of diarrhea occurrence in Central America over long periods of time. The purpose of this study was to determine the incidence, risk factors, long-term trends, and seasonality of diarrhea in children age 2 to 14 years in Managua, Nicaragua. From 2011 to 2019, we examined episodes of diarrhea among 6,485 children who participated in a prospective cohort study and presented for care in a primary care facility. We performed a longitudinal analysis considering time-varying variables and the intra-subject correlation of outcomes. In addition, we analyzed the weekly incidence of diarrhea, applying seasonal trend decomposition to extract secular and seasonal patterns. The overall incidence rate of diarrhea was 133.4 episodes per 1,000 person-years (95% CI, 128.3–138.7). We observed a slight increase in the incidence of diarrhea from 2011 to 2019. Younger age was the strongest predictor of the risk of diarrhea, and incidence increased with every additional hour without running water in the household per day. Diarrhea incidence in Managua was seasonal, with high peaks each year between May and July. Despite reductions in childhood mortality since 1990 in Nicaragua, diarrheal morbidity remains a major problem in Managua.
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Affiliation(s)
| | - Fausto Andres Bustos Carrillo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | | | - Krista Latta
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Amy Schiller
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Guillermina Kuan
- Centro de Salud Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Arthur Reingold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California
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Masinaei M. Estimating the seasonally varying effect of meteorological factors on the district-level incidence of acute watery diarrhea among under-five children of Iran, 2014-2018: a Bayesian hierarchical spatiotemporal model. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1125-1144. [PMID: 35288786 DOI: 10.1007/s00484-022-02263-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 05/16/2023]
Abstract
Under-five years old acute watery diarrhea (U5AWD) accounts for most diarrheal diseases' burden, but little is known about the adjusted effect of meteorological and socioeconomic determinants. A dataset containing the seasonal numbers of U5AWD cases at the district level of Iran is collected through MOHME. Accordingly, the district-level standardized incidence ratio and Moran's I values are calculated to detect the significant clusters of U5AWD over sixteen seasons from 2014 to 2018. Additionally, the author tested twelve Bayesian hierarchical models in order to determine which one was the most accurate at forecasting seasonal number of incidents. Iran features a number of U5AWD hotspots, particularly in the southeast. An extended spatiotemporal model with seasonally varying coefficients and space-time interaction outperformed other models, and so became the paper's proposal in modeling U5AWD. Temperature demonstrated a global positive connection with seasonal U5AWD in districts (IRR: 1.0497; 95% CrI: 1.0254-1.0748), owing to its varying effects during the winter ((IRR: 1.0877; 95% CrI: 1.0408-1.1375) and fall (IRR: 1.0866; 95% CrI: 1.0405-1.1357) seasons. Also, elevation (IRR: 0.9997; 95% CrI: 0.9996-0.9998), piped drinking water (IRR: 0.9948; 95% CrI: 0.9933-0.9964), public sewerage network (IRR: 0.9965; 95% CrI: 0.9938-0.9992), years of schooling (IRR: 0.9649; 95% CrI: 0.944-0.9862), infrastructure-to-household size ratio (IRR: 0.9903; 95% CrI: 0.986-0.9946), wealth index (IRR: 0.9502; 95% CrI: 0.9231-0.9781), and urbanization (IRR: 0.9919; 95% CrI: 0.9893-0.9944) of districts were negatively associated with seasonal U5AWD incidence. Strategically, developing geoinformation alarm systems based on meteorological data might help predict U5AWD high-risk areas. The study also anticipates increased rates of U5AWD in districts with poor sanitation and socioeconomic level. Therefore, governments should take appropriate preventative actions in these sectors.
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Affiliation(s)
- Masoud Masinaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Tamene A, Habte A, Woldeyohannes D, Afework A, Endale F, Gizachew A, Sulamo D, Tesfaye L, Tagesse M. Food safety practice and associated factors in public food establishments of Ethiopia: A systematic review and meta-analysis. PLoS One 2022; 17:e0268918. [PMID: 35622837 PMCID: PMC9140249 DOI: 10.1371/journal.pone.0268918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In terms of global impact, foodborne infections have been likened to major infectious diseases such as HIV/AIDS, malaria, and tuberculosis, with 1 in 10 people becoming ill and 420,000 deaths per year. A large number of these incidents are caused by improperly handled food in foodservice establishments. Therefore, this systematic review and meta-analysis aims to estimate the proportion of food handlers in Ethiopian commercial food service establishments who have safe food handling practices and their associated factors. METHODS Studies conducted before 02-05-2022 were explored in PubMed, Science Direct, Web of Science, Scopus, Embase, Google Scholar, ProQuest, and Ovid MEDLINE®, as well as other sources. A total of fourteen studies were included in the final synthesis. Data were extracted using a standardized data extraction format prepared in Microsoft excel and the analysis was done using STATA 16 statistical software. The quality of included studies was assessed using the Joanna Briggs Institute's Critical assessment checklist for prevalence studies. To evaluate publication bias, a funnel plot and Egger's regression test were employed. The I2 statistic was calculated to examine for study heterogeneity. To assess the pooled effect size, odds ratios, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis. RESULTS Of 323 identified articles, 14 studies were eligible for analysis (n = 4849 participants). The pooled prevalence estimate of safe food handling practices among Ethiopian food handlers was 47.14% (95% CI: 39.01-55.26, I2 = 97.23%). Foodservice training (OR, 3.89; 95% CI: 2.37-5.40), having on-site water storage facilities (OR, 4.65; 95% CI: 2.35-6.95), attitude (OR, 4.89; 95% CI: 1.39-8.29), hygiene and sanitary inspection certification (OR, 3.08; 95% CI: 1.62-4.45) were significantly associated with safe food handling practice among food handlers. CONCLUSION This review identified that improvements are needed in food handling training, government regulation, and infrastructure. Standard regulations for food service enterprises must be implemented on a local and national level. Though long-term food safety requires legislation and training, failure to address infrastructure challenges can harm public health efforts. Access to safe drinking water and the presence of sanitary waste management systems should all be part of the basic infrastructure for ensuring the safety of food in food businesses.
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Affiliation(s)
- Aiggan Tamene
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Demelash Woldeyohannes
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Abel Afework
- Dilla University Comprehensive Referral Hospital, Dilla University, Dilla, Ethiopia
| | - Fitsum Endale
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Addisalem Gizachew
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Dawit Sulamo
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Legesse Tesfaye
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Mihretu Tagesse
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
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15
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Hailu K, Alemu ZA, Adane M. Barriers to cleaning of shared latrines in slums of Addis Ababa, Ethiopia. PLoS One 2022; 17:e0263363. [PMID: 35271588 PMCID: PMC8912180 DOI: 10.1371/journal.pone.0263363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
Shared latrines and other shared sanitation facilities are vital for communities that lack private latrines. However, the cleanliness of shared latrines continues to be a problem in sub-Saharan Africa, including slums of Addis Ababa, Ethiopia. Investigating the barriers to cleaning of shared latrines may inform the future strengthening of comprehensive sanitation programs in slums of Addis Ababa, Ethiopia. Thus, a community-based unmatched case–control study was conducted among 100 case and 200 control households that were users of shared latrines from September to November 2017 in a slum district in Addis Ababa. Cases were those who had not cleaned their shared latrines and controls were those who had cleaned their shared latrines at least once during the week prior to data collection. Data were collected using a structured questionnaire and an on-the-spot-observational checklist and analyzed using bivariate (crude odds ratio [COD]) and multivariable (adjusted odds ratio [AOR]) unconditional logistic regression model. Variables having a p-value of less than 0.25 from the bivariate logistic regression analysis were retained into multivariable analysis. From the multivariable analysis, variables with p<0.05 were declared as factors significantly associated with barriers to cleaning of shared latrines. We found that about half 99 (49.5%) of shared latrines used by cases and almost one-third 32 (32.0%) of the shared latrines used by controls had visible cracks and spaces in the floor and slabs. The barriers to cleaning of shared latrines were found to be monthly household income of less than $55.60 USD (AOR = 1.80; 95%CI: 1.2–3.10), users feeling a lack of privacy during latrine use (AOR = 2.95; 95% CI: 1.60–5.43), no locking latch on the latrine door (AOR = 4.60; 95% CI: 2.43–8.79), inadequate ventilation of latrine (AOR: 4.88; 95% CI: 2.44–9.63), lack of regular monitoring of latrine by health extension workers (AOR = 2.86; 95%CI: 1.32–6.21) and a lack of enough water at home for cleaning the latrine (AOR = 4.91; 95% CI: 1.07–9.48). This study found several barriers to cleaning of shared latrines in slums of Addis Ababa. We recommend that stakeholders promote cleaning of shared latrines by designing programs to improve latrine privacy by adding or modifying the superstructure and including a door with locking latch, to make adjustments to the structure for better ventilation, to ensure regular monitoring of latrines by health extension workers and to make enough water consistently available for regular latrine cleaning.
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Affiliation(s)
- Kidist Hailu
- Infection Prevention and Control (IPC) Unit, Bethzatha General Hospital, Addis Ababa, Ethiopia
| | - Zewdie Aderaw Alemu
- Department of Public Health, Health Sciences College, Debre Markos University, Debre Markos, Ethiopia
- GAMBY Medical and Business College, Addis Ababa, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
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Abstract
Intermittent water supply systems (IWSSs) are prevalent in most developing countries and some developed ones. Their usage is driven by necessity rather than as a principal objective, mostly due to technical and economic deficiencies. Major health risks and socio-economic inequities are associated with such systems. Their impacts are aggravated by climate changes and the COVID-19 crisis. These are likely to have profound implications on progress toward advancing sustainable development goals (SDGs). Motivated by providing a comprehensive overview of global knowledge on IWSSs, the present work proposed to track and analyze research works on IWSSs utilizing bibliometric techniques and visual mapping tools. This includes investigating the trends and growth trajectories of research works on IWSSs and analyzing the various approaches proposed to expand our understanding with respect to the management, modeling, optimization, and impacts of IWSSs. The national and international contributions and collaboration figures are further analyzed at country, institution, author, and source levels. This analysis indicates that research works conducted on IWSSs have certain expectations in terms of productivity (total global productivity; 197 documents). The United States was the best country in terms of productivity (58 documents; 29.4%), while the Water Switzerland journal was the most productive journal (19 documents; 9.6%). The impacts of IWSSs on health and well-being have attracted considerable attention. The outcomes showed deep and justified worries in relation to the transition from intermittent to continuous supply, equity, and mitigating the health risks associated with IWSSs in the foreseen future. The utilization of artificial intelligence techniques and expert systems will drive and shape future IWSS-related research activities. Therefore, investments in this regard are crucial.
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Potgieter N, van der Loo C, Barnard TG. Co-Existence of Free-Living Amoebae and Potential Human Pathogenic Bacteria Isolated from Rural Household Water Storage Containers. BIOLOGY 2021; 10:biology10121228. [PMID: 34943143 PMCID: PMC8698325 DOI: 10.3390/biology10121228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022]
Abstract
Simple Summary In many households in rural communities, water needed for drinking and cooking is fetched from rivers, fountains, or boreholes shared by the community. The water is then stored in various storage containers for several days without treatment and exposed to several conditions that could potentially contaminate the water and cause diseases. If the storage containers are not regularly and properly cleaned, biofilms can form inside the containers. Several microorganisms can be found inside the biofilm that can potentially cause diseases in humans. One such group of organisms is called free-living amoebae, which graze on the bacteria found inside the biofilm. Several of these potentially harmful bacteria have adapted and can survive inside these free-living amoebae and potentially cause diseases when ingested by humans. Abstract This study investigated the co-existence of potential human pathogenic bacteria and free-living amoebae in samples collected from stored water in rural households in South Africa using borehole water as a primary water source. Over a period of 5 months, a total of 398 stored water and 392 biofilm samples were collected and assessed. Free-living amoebae were identified microscopically in 92.0% of the water samples and 89.8% of the biofilm samples. A further molecular identification using 18S rRNA sequencing identified Vermamoeba vermiformis, Entamoeba spp., Stenamoeba spp., Flamella spp., and Acanthamoeba spp. including Acanthamoeba genotype T4, which is known to be potentially harmful to humans. Targeted potential pathogenic bacteria were isolated from the water samples using standard culture methods and identified using 16S rRNA sequencing. Mycobacterium spp., Pseudomonas spp., Enterobacter spp., and other emerging opportunistic pathogens such as Stenotrophomonas maltophilia were identified. The results showed the importance of further studies to assess the health risk of free-living amoebae and potential human pathogenic bacteria to people living in rural communities who have no other option than to store water in their homes due to water shortages.
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Affiliation(s)
- Natasha Potgieter
- One Health Research Group, Department of Biochemistry and Microbiology, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, Limpopo Province, South Africa
- Correspondence:
| | - Clarissa van der Loo
- Water and Health Research Centre, Doornfontein Campus, University of Johannesburg, Johannesburg 2112, Gauteng, South Africa; (T.G.B.); (C.v.d.L.)
| | - Tobias George Barnard
- Water and Health Research Centre, Doornfontein Campus, University of Johannesburg, Johannesburg 2112, Gauteng, South Africa; (T.G.B.); (C.v.d.L.)
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Omotayo AO, Olagunju KO, Omotoso AB, Ogunniyi AI, Otekunrin OA, Daud AS. Clean water, sanitation and under-five children diarrhea incidence: Empirical evidence from the South Africa's General Household Survey. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:63150-63162. [PMID: 34226996 DOI: 10.1007/s11356-021-15182-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/24/2021] [Indexed: 04/16/2023]
Abstract
Sufficient supply of potable water, hygiene facilities, and sanitation are major factors enhancing healthy living. Using the dataset from the 2018 South Africa General Household Survey, this study employed the logistic regression model to examine the effects of accessibility to potable water and sanitation on the incidence of diarrhea among under-five children. The findings from the research reveal that the majority of children have access to safe drinking water, although a substantial percentage (32%) of the households had to pay for access. The results of the logistic regression model show that households with access to clean water, to improved toilet facilities, and to water within their residence are less likely to record incidence of diarrhea among under-five children. Moreso, the likelihood of reporting diarrhea among the children decreases with the age of children and the age of household heads. Therefore, to contribute to the designing policies targeted at reducing the incidence of diarrhea among children, this study emphasized that the availability and accessibility of clean water, water-storage facilities, and improved fecal discharge facilities among the South African households are key.
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Affiliation(s)
- Abiodun Olusola Omotayo
- Food Security and Safety Niche Area, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho, North West Province, 2745, South Africa.
| | - Kehinde Oluseyi Olagunju
- Economics Research Branch, Agri-Food and Biosciences Institute (AFBI), 18a Newforge Lane, Belfast, BT9 5PX, UK
| | | | - Adebayo Isaiah Ogunniyi
- International Food Policy Research Institute (IFPRI), Oro-Ago Crescent Garki II, Abuja, 901101, Nigeria
| | - Olutosin Ademola Otekunrin
- Department of Agricultural Economics and Farm Management, Federal University of Agriculture, (FUNAAB), Abeokuta, Nigeria
| | - Adebola Saidat Daud
- Oyo State College of Agriculture and Technology, P.M.B. 10, Igboora, Oyo State, Nigeria
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Sahiledengle B, Agho K. Determinants of Childhood Diarrhea in Households with Improved Water, Sanitation, and Hygiene (WASH) in Ethiopia: Evidence from a Repeated Cross-Sectional Study. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211025180. [PMID: 34220201 PMCID: PMC8221697 DOI: 10.1177/11786302211025180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Determinants of childhood diarrhea in households with improved WASH (ie, households with improved drinking water sources, improved sanitation facilities, and those who practiced safe child stool disposal) are limited. This study aimed to identify the determinants of diarrhea among under-five children exclusively in households with improved Water, Sanitation, and Hygiene (WASH). METHODS A repeated cross-sectional study design was followed, and data from the Demographic and Health Survey (DHS) conducted between 2005 and 2016 in Ethiopia was used. A total of 1,975 child-mother pairs (257 children with diarrhea and 1718 children without diarrhea) in households with improved WASH were included in this study. Hierarchical conditional logistic regression models were used. Adjusted odds ratios (AOR) with corresponding 95% confidence intervals (CI) were estimated to determine the strength of association. RESULTS Children aged 13 to 24 months (Adjusted Odds Ratio [AOR] = 2.70, 95%CI: 1.69-4.32), children who did not receive the measles vaccine (AOR = 2.33, 95%CI: 1.60-3.39), and those residing in the agrarian region (AOR = 1.66, 95%CI: 1.10-2.49) were significantly more likely to develop diarrheal morbidity. The size of the child at birth was also found to be significantly associated with diarrheal morbidity. CONCLUSION In this study, child factors (age of the child, vaccinated for measles, and the size of a child at birth), and household-related factors (contextual region) had a significant effect on the risk of childhood diarrheal morbidity in households with improved WASH in Ethiopia.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kingsley Agho
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
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20
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Mutono N, Wright JA, Mutembei H, Muema J, Thomas ML, Mutunga M, Thumbi SM. The nexus between improved water supply and water-borne diseases in urban areas in Africa: a scoping review. AAS Open Res 2021; 4:27. [PMID: 34368620 PMCID: PMC8311817 DOI: 10.12688/aasopenres.13225.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The sub-Saharan Africa has the fastest rate of urbanisation in the world. However, infrastructure growth in the region is slower than urbanisation rates, leading to inadequate provision and access to basic services such as piped safe drinking water. Lack of sufficient access to safe water has the potential to increase the burden of waterborne diseases among these urbanising populations. This scoping review assesses how the relationship between waterborne diseases and water sufficiency in Africa has been studied. Methods: In April 2020, we searched the Web of Science, PubMed, Embase and Google Scholar databases for studies of African cities that examined the effect of insufficient piped water supply on selected waterborne disease and syndromes (cholera, typhoid, diarrhea, amoebiasis, dysentery, gastroneteritis, cryptosporidium, cyclosporiasis, giardiasis, rotavirus). Only studies conducted in cities that had more than half a million residents in 2014 were included. Results: A total of 32 studies in 24 cities from 17 countries were included in the study. Most studies used case-control, cross-sectional individual or ecological level study designs. Proportion of the study population with access to piped water was the common water availability metrics measured while amounts consumed per capita or water interruptions were seldom used in assessing sufficient water supply. Diarrhea, cholera and typhoid were the major diseases or syndromes used to understand the association between health and water sufficiency in urban areas. There was weak correlation between the study designs used and the association with health outcomes and water sufficiency metrics. Very few studies looked at change in health outcomes and water sufficiency over time. Conclusion: Surveillance of health outcomes and the trends in piped water quantity and mode of access should be prioritised in urban areas in Africa in order to implement interventions towards reducing the burden associated with waterborne diseases and syndromes.
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Affiliation(s)
- Nyamai Mutono
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Jim A Wright
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Henry Mutembei
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya
- Department of Clinical Studies, Faculty of Veterinary Medicine,, University of Nairobi, Nairobi, Kenya
| | - Josphat Muema
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Mair L.H Thomas
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Mumbua Mutunga
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Samuel Mwangi Thumbi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, USA
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
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Getahun W, Adane M. Prevalence of acute diarrhea and water, sanitation, and hygiene (WASH) associated factors among children under five in Woldia Town, Amhara Region, northeastern Ethiopia. BMC Pediatr 2021; 21:227. [PMID: 33975587 PMCID: PMC8111769 DOI: 10.1186/s12887-021-02668-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diarrhea among children under five is one of the significant public health concerns in developing countries, such as Ethiopia that is mainly attributed to inadequate water, sanitation and hygiene (WASH) services. Lack of data on the prevalence and factors associated with acute diarrhea in Woldia Town impedes the effectiveness of WASH programs in the area. Therefore, the aim of this study was to investigate the prevalence and WASH-associated factors of acute diarrhea among under-five children in this area. This study will help guide local diarrhea prevention and control programs. METHODS A community-based cross-sectional study was conducted among 485 children under age five from March to June 2018. The study participants were allocated proportionally and then households with children of this age group were selected from each kebele (the smallest administrative unit in Ethiopia) using a systematic random sampling technique. Data were collected from mothers/caregivers of the under-five children using a structured questionnaire and on-the-spot observation checklist. A binary logistic regression model with 95 % CI (confidence interval) was used to measure the association between dependent and independent variables. From the multivariable analysis, variables with a p-value < 0.05 were taken as factors significantly associated with acute diarrhea among under-five children. RESULTS The prevalence of acute diarrhea among the children was 17.6 % (95 % CI: 14.2-21.0 %). Almost two-thirds 307 (63.4 %) of study participants' main source of drinking water was a private tap; 320 (66.1 %) of households used less than 20 l per capita per day. About one-fifth 99 (20.5 %) of households used an improved sanitation facility. Only one-fifth (21.1 %) of the latrines had nearby handwashing facilities. Less than half 225 (46.5 %) of mothers/caregivers had good handwashing practice at critical times. Water consumption of less than 20 l per capita per day (adjusted odds ratio [AOR] = 2.45; 95 % CI: 1.36-5.84), unimproved sanitation facility (AOR = 3.57; 95 %CI: 1.64-6.51), practicing unsafe child feces disposal (AOR = 2.51; 95 % CI: 1.69-4.64), poor handwashing practice at critical times (AOR = 1.85; 95 % CI: 1.34-3.56) and having no information about diarrhea being prevented by handwashing with water and soap (AOR = 3.12; 95 % CI: 1.64-6.27) were significantly associated with acute diarrhea. CONCLUSIONS More than one in six children under age five had acute diarrhea, a proportion that could be considered relatively high. We recommend that government organizations and concerned stakeholders strengthen urban WASH programs to focus on increasing the availability of sufficient water for adequate daily consumption, and promote safe disposal of child feces and good handwashing practices at critical times. Further effort is needed to sensitize mothers/caregivers about diarrhea prevention through effective WASH activity to reduce the burden of this problem among children under five.
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Affiliation(s)
- Weldehawariyat Getahun
- Organization for Rehabilitation and Development in Amhara (ORDA) Ethiopia, Bahir Dar, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
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Baye A, Adane M, Sisay T, Hailemeskel HS. Priorities for intervention to prevent diarrhea among children aged 0-23 months in northeastern Ethiopia: a matched case-control study. BMC Pediatr 2021; 21:155. [PMID: 33789606 PMCID: PMC8011117 DOI: 10.1186/s12887-021-02592-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The global public health problem of diarrhea is most prevalent in developing countries including Ethiopia, especially among children under two years of age. Limited information on the determinants of diarrhea among children aged 0-23 months hinders the design and prioritization of intervention strategies to address childhood diarrhea in Dessie City, northeastern Ethiopia. Therefore, this study was designed to assess the determinants of diarrhea in order to identify priority interventions for its control. METHODS A community-based matched case-control study was conducted among children aged 0-23 months during January-February 2018. Cases defined as children with acute diarrhea, and controls defined as children without acute diarrhea, were matched by child's age (months) and place of residence (residing in the same kebele, the lowest local administrative unit, each of which has a population of approximately 5000) during the two weeks prior to data collection. Data were collected from mothers/caregivers of the 119 cases and 238 matched controls using a pre-tested structured questionnaire and an observational checklist. Data were analyzed using conditional logistic regression model with 95% confidence interval (CI); variables with p < 0.05 from multivariable analysis were considered as significantly associated with acute diarrhea among children aged 0-23 months. RESULTS Age of mothers/caregivers (> 35 years of age) (adjusted matched odds ratio [adjusted mOR] = 2.00; 95% CI: 1.37-5.8); divorced/widowed marital status (adjusted mOR = 1.40; 95% CI: 1.26-3.3); lack of exclusive breastfeeding (adjusted mOR = 2.12; 95% CI: 1.15-3.70); presence of feces within/around latrines (adjusted mOR = 1.37; 95% CI: 1.21-3.50); lack of handwashing facility near latrine (adjusted mOR = 1.50; 95% CI: 1.30-5.30); presence of domestic sewage discharge within and/or outside the compound (adjusted mOR = 3.29; 95% CI: 1.85-7.50) and practice of handwashing at fewer than three of the five critical daily times (adjusted mOR = 4.50; 95% CI: 2.54-9.50) were significantly associated with acute diarrhea among children aged under two years. CONCLUSION To reduce acute diarrheal disease among children under two, priority should be given to interventions that focus on improving exclusive breastfeeding practices, regular cleaning of latrines, advocating for availability of handwashing facility within/around latrines, use of proper domestic sewage discharge methods and improving handwashing practice at the five critical times each day. Strengthening communication that promotes hygiene and behavioural change may also raise awareness among mothers/caregivers and empower them to enhance handwashing practices at critical times.
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Affiliation(s)
- Alemwork Baye
- Neonatal Intensive Care Unit, Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Tadesse Sisay
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtamu Shimels Hailemeskel
- Department of Pediatrics and Neonatal Nursing, Health Science College, Debre Tabor University, Debre Tabor, Ethiopia
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Asnake D, Adane M. Household latrine utilization and associated factors in semi-urban areas of northeastern Ethiopia. PLoS One 2020; 15:e0241270. [PMID: 33180832 PMCID: PMC7660512 DOI: 10.1371/journal.pone.0241270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Latrine utilization is the actual behavior in a practice of regularly using existing latrines for safe disposal of excreta. Latrine utilization is a common problem in semi-urban areas of developing countries, including Ethiopia. Since the status of latrine utilization and associated factors among semi-urban areas of northeastern Ethiopia, including Alansha in South Wollo Zone is unknown, local data is needed in order to assess the need for planning of intervention programs for the improvement of latrine utilization to support consistent and sustained latrine utilization. This study is designed to address this knowledge gap. METHODS A cross-sectional study was conducted from February to March, 2019 among 401 systematically selected households. Data were collected by trained workers using a pre-tested, structured questionnaire via face-to-face interviews and on-the-spot observations of the latrines. A systematic random sampling method was used to select participant households. Data were entered using EpiData version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 25.0 for data cleaning and analysis. The wealth index status of participants was estimated using principal component analysis. Data were analyzed using a binary logistic regression model at 95% confidence interval (CI). From the multivariable logistic regression analysis, variables with p-value < 0.05 were taken as statistically significant and independently associated with latrine utilization. Model fitness was checked using Hosmer-Lemeshow test. RESULT We found that the prevalence of latrine utilization among households was 71.8% (95% CI [67.5-76.1%]) while 28.2% (95% CI [23.9-32.5%]) did not utilize latrines. About one-fifth (21.7%) of participant households were found to have a pit latrine with slab and 78.3% (311) used pit latrines without slab. The hygienic condition of the majority (82.9%) of the latrines was dirty and only 17.1% clean. Household family size from one to three persons (AOR: 3.99, 95% CI [1.20-6.24]), presence of primary or secondary school student in a house (AOR: 2.33, 95% CI [1.42-3.83]), number of years since latrine was constructed (≥ 2 years) (AOR: 1.82, 95% CI [1.12-2.95]) and a frequency of daily cleaning of the latrine (AOR: 2.19, 95% CI [1.12-4.28]) were factors significantly associated with latrine utilization. CONCLUSION Seven out of ten households utilized a latrine. Factors significantly associated with latrine utilization were household family size from one to three persons, presence of primary or secondary school student in the house, time since household latrine had been constructed of two or more years and daily frequency of latrine cleaning. Therefore, it is recommended that measures to promote behavioral change towards further improvement in sustainable and consistent latrine utilization should be carried out based on the evidence of the determinant factors found in this study.
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Affiliation(s)
- Deres Asnake
- Quality Improvement Unit, Woldia Comprehensive Specialized Hospital, Woldia, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Eshete Tadesse S, Chane Mekonnen T, Adane M. Priorities for intervention of childhood stunting in northeastern Ethiopia: A matched case-control study. PLoS One 2020; 15:e0239255. [PMID: 32970709 PMCID: PMC7514084 DOI: 10.1371/journal.pone.0239255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 09/02/2020] [Indexed: 12/03/2022] Open
Abstract
Background Stunting is a worldwide public health problem caused by factors that vary across regions, including in Ethiopia. Limited evidence to prevent stunting makes it difficult to design and prioritize appropriate interventions. Therefore, this study investigated the intervention priorities for the prevention of stunting among children 6–59 months old in Kemissie City Administration, northeastern Ethiopia. Methods A community-based individual matched case-control study was conducted from January to April 2017 including 107 cases and 214 controls. Controls were selected and matched with cases using the matching variable of child’s age. Data were collected by open data kit (ODK) software using a structured questionnaire. Data were analyzed using STATA version 13.0 and WHO (World Health Organization) Anthro 2005. A conditional logistic regression model was used for data analysis. From multivariable conditional logistic regression analysis, determinants of stunting were identified. A statistically significant level was declared by a conditional adjusted odds ratio (cAOR) with 95% confidence interval (CI) and p-value of less than 0.05. Main findings The wealth index 52 (48.6%) of the cases and 108 (50.5%) controls were categorized as poor. The mean height-for-age z-score (HAZ) for the cases and controls was -2.79±.67 and -0.55±.92, respectively. One-sixth (16.8%) of the cases and 29 (13.6%) of the controls were given prelacteal feeding. A majority 82 (86.9%) of the cases and 137 (69.1%) of the controls had undernourished mothers/care-givers. Slightly less than one-third 35 (32.7%) of cases and one-fourth 53 (24.8%) of controls were affected by repeated episodes of diarrhea. Mother’s body mass index (BMI) (conditional adjusted odds ratio [cAOR]) = 2.64; 95% CI: 1.28, 5.43), giving food priority to father (cAOR = 2.42; 95% CI: 1.23, 4.75), lack of exclusive breastfeeding for at least 6 months (cAOR = 2.44; 95% CI: 1.15, 5.17), no intake of meat by child (cAOR = 2.35; 95% CI: 1.21, 4.58) and child having repeated diarrheal episodes (cAOR = 2.0: 95% CI: 1.07, 3.86) were factors associated with childhood stunting. Conclusion Maternal nutritional status, food priority, duration of exclusive breastfeeding, no intake of meat and repeated episodes of diarrhea were the main determinants of stunting among children aged 6–59 months. Therefore, intervention measures to avert childhood stunting should include strengthening action on provision of essential nutrition, providing counseling to parents on giving food priority to children, promotion of optimal duration of breastfeeding and preventing diarrheal disease among children 6–59 months old.
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Affiliation(s)
- Sisay Eshete Tadesse
- Department of Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tefera Chane Mekonnen
- Department of Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
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25
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Zenebe T, Mitiku M, Alem Y. Prevalence of Escherichia coli in Under-Five Children with Diarrhea in Ethiopia: A Systematic Review and Meta-Analysis. Int J Microbiol 2020; 2020:8844294. [PMID: 32963539 PMCID: PMC7492924 DOI: 10.1155/2020/8844294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
Abstract
Diarrhea remains as a high health burden, especially to children in low-income countries including Ethiopia. Diarrheagenic Escherichia coli have been commonly associated as bacterial pathogens causing diarrheal disease among children. This systemic review and meta-analysis was intended to determine the pooled prevalence of Escherichia coli in under-five children with diarrhea in Ethiopia. A comprehensive search in PubMed, Google Scholar, ScienceDirect, ResearchGate, and Google search engine and manual searching were done for this systematic review and meta-analysis. The eligibility criteria for selecting studies were studies involving under-five children with diarrhea in Ethiopia, published articles, cross-sectional studies, and articles reported in English. The study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The data analysis was done using STATA 16.0 software. Cochran's Q-test and I 2 statistics were used for the assessment of heterogeneity. The random-effect model was used to estimate the pooled prevalence of Escherichia coli. A total of 797 articles were initially retrieved, and finally, 11 studies met the eligibility criteria and were included in the final meta-analysis. The pooled prevalence of Escherichia coli was 25% (95% CI: 9, 41). The pooled prevalence was varied by region, detection method, and sample size. The high prevalence emphasizes that Escherichia coli is a potential pathogen in under-five children with diarrhea in Ethiopia.
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Affiliation(s)
- Tizazu Zenebe
- Department of Medicine, Medical Microbiology Unit, DebreBerhan University, DebreBerhan, Ethiopia
| | - Meseret Mitiku
- Department of Medical Laboratory Sciences, MaddaWalabu University, Bale Robe, Ethiopia
| | - Yonas Alem
- Department of Medical Laboratory Sciences, Ambo University, Ambo, Ethiopia
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Rosinger AY, Brewis A, Wutich A, Jepson W, Staddon C, Stoler J, Young SL. Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments. GLOBAL ENVIRONMENTAL CHANGE : HUMAN AND POLICY DIMENSIONS 2020; 64:102148. [PMID: 33071475 PMCID: PMC7566692 DOI: 10.1016/j.gloenvcha.2020.102148] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Water problems due to scarcity, inaccessibility, or poor quality are a major barrier to household functioning, livelihood, and health globally. Household-to-household water borrowing has been posited as a strategy to alleviate unmet water needs. However, the prevalence and predictors of this practice have not been systematically examined. Therefore, we tested whether water borrowing occurs across diverse global contexts with varying water problems. Second, we tested if household water borrowing is associated with unmet water needs, perceived socio-economic status (SES), and/or water-related system failures, and if water access moderated (or changed) these relationships. Using survey data from the Household Water Insecurity Experiences (HWISE) study from 21 sites in 19 low- and middle-income countries (n = 5495 households), we found that household-to-household water borrowing was practiced in all 21 sites, with 44.7% (11.4-85.4%) of households borrowing water at least once the previous month. Multilevel mixed-effect logistic regression models demonstrate that high unmet water needs (odds ratio [OR] = 2.86], 95% confidence interval [CI] = 2.09-3.91), low perceived SES (OR = 1.09; 95% CI = 1.05-1.13), and water-related system failures (23-258%) were all significantly associated with higher odds of water borrowing. Significant interactions (all p < 0.01) between water access, unmet water needs, and water-related system failures on water borrowing indicate that water access moderates these relationships. These data are the first to demonstrate that borrowing water is commonly used by households around the world to cope with water insecurity. Due to how prevalent water borrowing is, its implications for social dynamics, resource allocation, and health and well-being are likely vast but severely under-recognized.
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Affiliation(s)
- Asher Y. Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA
- Department of Anthropology, Pennsylvania State University, University Park, PA 16802, USA
- Corresponding author at: 219 Biobehavioral Health Building, University Park, PA 16802, USA. (A.Y. Rosinger)
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Phoenix, Arizona State University, Tempe, AZ 85287, USA
| | - Amber Wutich
- School of Human Evolution and Social Change, Phoenix, Arizona State University, Tempe, AZ 85287, USA
| | - Wendy Jepson
- Department of Geography, Texas A&M University, College Station, TX 77843, USA
| | - Chad Staddon
- Centre for Water, Communities and Resilience, University of the West of England, Bistol BS161QY, UK
| | - Justin Stoler
- Department of Geography, University of Miami, Coral Gables, FL 33146, USA
| | - Sera L. Young
- Department of Anthropology & Institute for Policy Research, Northwestern University, Evanston, IL 60208, USA
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Ademas A, Adane M, Sisay T, Kloos H, Eneyew B, Keleb A, Lingerew M, Derso A, Alemu K. Does menstrual hygiene management and water, sanitation, and hygiene predict reproductive tract infections among reproductive women in urban areas in Ethiopia? PLoS One 2020; 15:e0237696. [PMID: 32822377 PMCID: PMC7444535 DOI: 10.1371/journal.pone.0237696] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/31/2020] [Indexed: 11/18/2022] Open
Abstract
Reproductive tract infections (RTIs) are a public health concern in Ethiopia. However, the relationship between menstrual hygiene management (MHM) and water, sanitation, and hygiene (WASH) factors to RTIs have not been well addressed. A community-based cross-sectional study was conducted from January to March 2019 among 602 systematically selected reproductive-age women aged 15-49 years in Dessie City. Data were collected using a questionnaire and a direct observation checklist. RTIs were identified by the presence during one year before data collection of one or more signs of vaginal discharge, itching/irritation or ulcers/lesions around the vulva, pain during urination and sexual intercourse, and lower abdominal pain and lower back pain. Data were analyzed using multivariable logistic regression analysis with 95%CI (confidence interval). The self-reported prevalence of RTIs was 11.0%(95%CI:8.5-13.7%) during one year prior to the survey. The most commonly reported symptoms of RTI were burning micturition (9.1%) and vaginal discharge (6.1%). Three-fourths 443(75.0%) of households used traditional pit latrines and the majority of the study participants 527(89.2%) did not meet the basic access requirement of 20 liters of water per capita per day. The majority 562(95.1%) of the study participants did not have multiple sexual partners during the last year and 97.8% did not practiced sexual intercourse during menstruation. The most common type of blood-absorbent material used was a sanitary pad 497(84.8%) followed by cloth 89(15.2%). Factors significantly associated with RTIs were using unclean latrines (AOR: 4.20; 95%CI:2.00-8.80), not washing hands with soap before touching the genital area (AOR: 3.94; 95%CI:1.49-10.45), history of symptoms of RTIs in the past year (AOR: 5.88; 95%CI:2.30-14.98), having multiple sexual partners in the past year (AOR: 4.46; 95%CI:1.59-12.53), changing absorbent material only once per day (AOR: 8.99; 95%CI:4.51-17.92), and washing the genital area only once per day during menstruation (AOR: 5.76; 95%CI:2.07-16.05). The self-reported prevalence of RTI showed that one women experienced RTI among ten reproductive-age women. Designing a women's health policy that focuses on ensuring availability of WASH facilities and improving MHM at the community level is key for sustainably preventing RTIs.
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Affiliation(s)
- Ayechew Ademas
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tadesse Sisay
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| | - Betelhiem Eneyew
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Awoke Keleb
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mistir Lingerew
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Atimen Derso
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Nadimpalli ML, Marks SJ, Montealegre MC, Gilman RH, Pajuelo MJ, Saito M, Tsukayama P, Njenga SM, Kiiru J, Swarthout J, Islam MA, Julian TR, Pickering AJ. Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. Nat Microbiol 2020; 5:787-795. [PMID: 32467623 DOI: 10.1038/s41564-020-0722-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/07/2020] [Indexed: 12/24/2022]
Abstract
Antimicrobial resistance (AMR) is a growing public health challenge that is expected to disproportionately burden lower- and middle-income countries (LMICs) in the coming decades. Although the contributions of human and veterinary antibiotic misuse to this crisis are well-recognized, environmental transmission (via water, soil or food contaminated with human and animal faeces) has been given less attention as a global driver of AMR, especially in urban informal settlements in LMICs-commonly known as 'shanty towns' or 'slums'. These settlements may be unique hotspots for environmental AMR transmission given: (1) the high density of humans, livestock and vermin living in close proximity; (2) frequent antibiotic misuse; and (3) insufficient drinking water, drainage and sanitation infrastructure. Here, we highlight the need for strategies to disrupt environmental AMR transmission in urban informal settlements. We propose that water and waste infrastructure improvements tailored to these settings should be evaluated for their effectiveness in limiting environmental AMR dissemination, lowering the community-level burden of antimicrobial-resistant infections and preventing antibiotic misuse. We also suggest that additional research is directed towards developing economic and legal incentives for evaluating and implementing water and waste infrastructure in these settings. Given that almost 90% of urban population growth will occur in regions predicted to be most burdened by the AMR crisis, there is an urgent need to build effective, evidence-based policies that could influence massive investments in the built urban environment in LMICs over the next few decades.
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Affiliation(s)
- Maya L Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.,Center for Integrated Management of Antimicrobial Resistance (CIMAR), Tufts University, Boston, MA, USA
| | - Sara J Marks
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | | | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.,Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Monica J Pajuelo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.,Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Pablo Tsukayama
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Medicina Tropical 'Alexander von Humboldt', Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Jenna Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Timothy R Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA. .,Center for Integrated Management of Antimicrobial Resistance (CIMAR), Tufts University, Boston, MA, USA.
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Lee GO, Whitney HJ, Blum AG, Lybik N, Cevallos W, Trueba G, Levy K, Eisenberg JNS. Household coping strategies associated with unreliable water supplies and diarrhea in Ecuador, an upper-middle-income country. WATER RESEARCH 2020; 170:115269. [PMID: 31739243 PMCID: PMC6962559 DOI: 10.1016/j.watres.2019.115269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 06/10/2023]
Abstract
The Sustainable Development Goals recognize that the availability and quality of improved water sources affect how households use and benefit from these sources. Although unreliability in piped water supplies in low- and middle-income countries (LMICs) has been described, few studies have assessed household coping strategies in response to unreliable water supplies and associated health outcomes. We characterized unreliability in the piped water supply of the town of Borbón, Ecuador over the twelve years following a major upgrade, as well as household coping strategies and associations with diarrhea. We examined trends in primary and secondary drinking water sources, water storage, and water treatment using longitudinal data collected from 2005 to 2012. In 2017, a follow-up survey was administered (N = 202) and a subset of 84 household water samples were tested for chlorine residual levels and microbial contamination. From 2005 to 2017, access to a household water connection increased from 19.4% to 90.3%. However, reliability decreased over time, as in the latter half of 2009, households had access to piped water 79% of the time, compared to 63% by 2017. Piped water samples were highly contaminated with total coliforms (100% of samples) and Escherichia coli (89% of samples). From 2005 to 2017, households less likely to report drinking water treatment (50.6%-5.0%). And from 2009 to 2017, bottled water was increasingly consumed as the primary drinking water source (18.8%-62.4%). From 2005 to 2012, having a household connection was not statistically significantly associated with diarrhea case status (OR: 0.86 95%CI: 0.53, 1.39). Neither household water treatment nor bottled water consumption were negatively associated with diarrhea. Increased water storage was associated with diarrhea (OR: 1.33 per 10L of water stored, 95%CI: 1.05, 1.69). Household water treatment, and consumption of purchased bottled water, two coping strategies that households may have undertaken in response to an unreliable water supply, were not associated with a reduced likelihood of diarrhea. These data suggest a need to understand how impoverished rural households in LMICs respond to unreliable water supplies, and to develop heath messaging appropriate for this context.
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Affiliation(s)
- Gwenyth O Lee
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Holly J Whitney
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Annalise G Blum
- Department of Earth and Planetary Science, Johns Hopkins University, Baltimore, MD, USA
| | - Noah Lybik
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - William Cevallos
- Instituto de Biomedicina, Carrera e Medicina, Universidad Central de Ecuador, Ecuador
| | - Gabriel Trueba
- Institutito de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Karen Levy
- Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Joseph N S Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Soboksa NE, Gari SR, Hailu AB, Alemu BM. Association between microbial water quality, sanitation and hygiene practices and childhood diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia. PLoS One 2020; 15:e0229303. [PMID: 32074128 PMCID: PMC7029864 DOI: 10.1371/journal.pone.0229303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Diarrhea is one of the leading causes of child morbidity and mortality in low- and middle-income countries like Ethiopia. The use of safe drinking water and improved sanitation are important practices to prevent diarrhea. However, limited research has been done to link water supply, sanitation and hygiene practices and childhood diarrhea. Therefore, this study aimed at assessing the association between microbial quality of drinking water, sanitation and hygiene practices and childhood diarrhea. METHODS Community-based matched case-control study design was applied on 198 paired children from June to July 2019 in Kersa and Omo Nada districts of Jimma Zone, Ethiopia. Cases are children < 5 years of age with diarrhea during the two weeks before the survey. The controls are children without diarrhea during the two weeks before the survey. Twenty-five percent matched pair samples of water were taken from households of cases and controls. Data were collected using structured questionnaire by interviewing mothers/caregivers. A sample of water was collected in nonreactive borosilicate glass bottles and analyzed by the membrane filtration method to count fecal indicator bacteria. A conditional logistic regression model was used; variables with p-value less than 0.05 were considered as significantly associated with childhood diarrhea. RESULTS A total of 396 (each case matched with control) under-five children with their mothers/caregivers were included in this study. In the analysis, variables like presence of under-five child in their home (AOR = 2.76; 95% CI: 1.33-5.71), wealth status (AOR = 5.39; 95% CI: 1.99-14.55), main sources of drinking water (AOR = 4.01; 95% CI: 1.40-11.44), hand washing practice before water collection (AOR = 4.28; 95% CI: 1.46-12.56), treating water at household level (AOR = 1.22; 95% CI: 0.48-3.09), latrine use all the times of the day and night (AOR = 0.22; 95% CI: 0.06-0.78), using pit as method of waste disposal (AOR = 4.91; 95% CI: 1.39-13.29) and use of soap for hand washing (AOR = 2.89; 95% CI: 1.35-6.15) were significantly associated with childhood diarrhea. Moreover, 30% of sampled water from cases and 26% of sampled water from controls families were free from Escherichia coli whereas all sampled water analyzed for Total coliforms were positive. CONCLUSIONS We conclude that the main sources of drinking water, hand washing before water drawing from a storage container, domestic waste disposal place and use of soap for hand washing were the most important factors for the prevention of childhood diarrhea.
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Affiliation(s)
- Negasa Eshete Soboksa
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sirak Robele Gari
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Beyene Hailu
- Department of Environmental Health Sciences, Jimma University, Jimma, Ethiopia
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Disparities in the prevalence and risk factors of anaemia among children aged 6–24 months and 25–59 months in Ethiopia. J Nutr Sci 2020; 9:e36. [PMID: 32983421 PMCID: PMC7503181 DOI: 10.1017/jns.2020.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022] Open
Abstract
Despite global efforts made to address anaemia, the prevalence remains high in most Sub-Saharan African countries. In Ethiopia, anaemia poses a very strong public health concern. The purpose of the present study was to examine the key risk factors related to anaemia among children aged 6–24 months (younger age group) and 25–59 months (older age group). We used the 2016 Ethiopian Demographic and Health Survey data, collected from 11 023 mothers with under five children. Ordered logistic regression modelling was used for assessing risk factors of childhood anaemia. The results suggest that the prevalence of anaemia was 72 % in the younger and 49 % in the older age groups. The risk factors for anaemia in the younger age group were morbidity (odds ratio (OR) 1⋅77; CI 1⋅21, 2⋅60), having no piped water source (OR 1⋅76; CI 1⋅07, 3⋅01) and no toilet facility (OR 1⋅60; CI 1⋅07, 2⋅38). The key risk factors for anaemia in the older age group were no micronutrient intake (OR 1⋅69; CI 1⋅23, 2⋅31), having a young mother (15–24 years old) (OR 1⋅35; CI 0⋅84, 1⋅91) and a non-working mother (OR 1⋅50; CI 1⋅15, 1⋅96). Anaemia also varied by region, place of residence and economic factors. Multiple factors contributed to the high prevalence of anaemia. Given the structural problem that the country has intervention strategies should consider the unique characteristics of regions and rural residences where the prevalence of anaemia is above the national average.
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Rosinger AY, Brewis A. Life and death: Toward a human biology of water. Am J Hum Biol 2019; 32:e23361. [PMID: 31782854 DOI: 10.1002/ajhb.23361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania.,Department of Anthropology, Pennsylvania State University, University Park, Pennsylvania
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona
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Singh U, Colosi LM. Water-energy sustainability synergies and health benefits as means to motivate potable reuse of coalbed methane-produced waters. AMBIO 2019; 48:752-768. [PMID: 30218269 PMCID: PMC6509300 DOI: 10.1007/s13280-018-1098-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/23/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
Management of coalbed methane (CBM)-produced water is a crucial part of the water-energy nexus, especially as CBM is projected to play a key role as a bridge fuel in major economies. In this paper, we consider one management technique, i.e., desalination of CBM-produced water to generate potable water. We discuss a confluence of geographic, sociotechnical, regulatory, and other circumstances that could make this concept viable for select coal-bearing regions. Having said that, for maximizing benefits, it is prudent to take a synergistic view targeting multiple objectives (water access, health, environmental impacts, and ease of waste management). Thus, we make design recommendations and suggest a system-evaluation framework for making sustainable decisions related to produced-to-potable water systems. For instance, a key question is whether such systems should be centralized or decentralized-and this paper highlights crucial tradeoffs that are present in both the cases.
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Affiliation(s)
- Udayan Singh
- Department of Civil and Environmental Engineering, University of Virginia, 351 McCormick Road, P.O. Box 400742, Charlottesville, VA 22904 USA
| | - Lisa M. Colosi
- Department of Civil and Environmental Engineering, University of Virginia, 351 McCormick Road, P.O. Box 400742, Charlottesville, VA 22904 USA
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Mekonnen GK, Alemu BM, Mulat W, Sahilu G, Kloos H. Risk factors for acute childhood diarrhea: A cross-sectional study comparing refugee camps and host communities in Gambella Region, Ethiopia. Travel Med Infect Dis 2019; 31:101385. [PMID: 30772602 DOI: 10.1016/j.tmaid.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 12/26/2018] [Accepted: 02/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diarrhea is one of the most common causes of child morbidity and mortality in refugee camps, aggravated by inadequate water, sanitation and hygiene services, and malnutrition, particularly in developing countries. METHODOLOGY A comparative cross-sectional study was conducted to assess acute diarrhea and associated risk factors among under-five children in refugee and host communities in Gambella Region, Ethiopia. Descriptive statistics were used, and bivariate and multivariate logistic regressions were performed to identify variables associated with diarrhea. RESULTS A total of 1667 under-five children was included in this study, and prevalence of diarrhea differed between the refugee (38%) and host (33%) communities [OR = 1.37, 95% CI 1.04, 1.8]. Refugee camp households using uncovered water containers, consuming low quantities of water, and lacking hand washing setups were more likely to report children with diarrhea. Within host communities, households were more likely to report acute childhood diarrhea if they consumed surface water or did not have a latrine. CONCLUSION The two-week prevalence of diarrhea was significantly higher among children in the refugee camps than those in the host communities. Therefore, further collaboration between government and non-government organizations is required to identify persisting factors of diarrhea transmission in various communities in the region.
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Affiliation(s)
- Getachew Kabew Mekonnen
- Addis Ababa University, Ethiopian Institute of Water Resources, Ethiopia; Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia.
| | | | - Worku Mulat
- University of Connecticut, Department of Civil and Environmental Engineering, Storrs, USA.
| | - Geremew Sahilu
- Addis Ababa University, Ethiopian Institute of Water Resources, Ethiopia.
| | - Helmut Kloos
- University of California, Department of Epidemiology and Biostatistics, San Francisco, USA.
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Adane M, Mengistie B, Mulat W, Medhin G, Kloos H. The Most Important Recommended Times of Hand Washing with Soap and Water in Preventing the Occurrence of Acute Diarrhea Among Children Under Five Years of Age in Slums of Addis Ababa, Ethiopia. J Community Health 2019; 43:400-405. [PMID: 29138957 DOI: 10.1007/s10900-017-0437-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adequate hand washing with soap at five recommended times is particularly important in urban slums in developing countries, but which of the recommended times are the most important in the prevention of diarrhea among children under five years of age living in these areas remains unclear. To address this gap, a community-based cross-sectional study was undertaken in the slums of Addis Ababa, Ethiopia between September and November 2014. Data were collected using a pre-tested structured questionnaire and an observational checklist. Multivariable logistic regression with 95% confidence interval (CI) was used for data analysis. Only 4.4% of the households had hand washing facilities within or near a latrine with soap and water access. The average prevalence of hand washing with soap at the five recommended times was 19.8%. One quarter (24.8%) of caregivers washed their hands with soap before feeding a child, 23.8% before preparing food, and 17.1% after defecation. The most important recommended times in preventing acute diarrhea were before preparing food [adjusted odds ratio (AOR) 0.2; 95% CI 0.1-0.7] and after defecation (AOR 0.3; 95% CI 0.1-0.9). Household size of six or more persons (AOR 2.3; 95% CI 1.4-3.9) and low monthly household income (AOR 2.4; 95% CI 1.4-4.0) were significantly associated with acute diarrhea. Promoting hand washing with soap and advocacy programs at the five recommended times, especially before preparing food and after defecation, and implementation of socioeconomic development programs targeting poor households are essential for increasing the prevalence of hand washing with soap and preventing acute diarrhea in the slums of Addis Ababa.
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Affiliation(s)
- Metadel Adane
- Ethiopian Institute of Water Resources (EIWR), Addis Ababa University, Addis Ababa, Ethiopia.
| | - Bezatu Mengistie
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Worku Mulat
- Department of Civil and Environmental Engineering, University of Connecticut, Storrs, USA
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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Feleke H, Medhin G, Kloos H, Gangathulasi J, Asrat D. Household-stored drinking water quality among households of under-five children with and without acute diarrhea in towns of Wegera District, in North Gondar, Northwest Ethiopia. ENVIRONMENTAL MONITORING AND ASSESSMENT 2018; 190:669. [PMID: 30353421 PMCID: PMC6208974 DOI: 10.1007/s10661-018-7033-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 10/08/2018] [Indexed: 05/28/2023]
Abstract
Contamination of drinking water in household water storage containers and inadequate water supplies are common public burdens in low- and middle-income countries, including towns in Wegera District, Ethiopia. Our study aimed to assess the quality of drinking water and identify factors associated with diarrhea in households with under-five (U5) children with and without diarrhea in Ambagiorgis and Gedebge towns in Wegera District. Stored drinking water samples from households with U5 children with and without diarrhea had fecal coliform (FC) counts of 59 (86.8%) and 55 (82.1%) (p > 0.05) and fecal streptococci (FS) counts of 29 (42.7%) and 24 (35.8%) (p > 0.05), respectively. The very high sanitary risk scores were 32 (47.1%) and 21 (31.3%) for FC (p > 0.05); 25 (36.8%) and 3 (4.5%) for FS (p < 0.001), respectively. Contamination of the stored drinking water samples with FS was significantly higher in households with diarrhetic U5 children in the low- and medium-risk ranges (p < 0.05). Water turbidity of 47 (69.1%) and 23 (34.3%) in households with U5 children with and without diarrhea, respectively, was above the permissible level (p < 0.001). The residual free chlorine (RFC) in all the household-stored drinking water samples was below the World Health Organization (WHO) permissible level and temperatures of all the household-stored drinking water samples were permissible. Promotion and advocacy of good stored drinking water handling practices are essential for decreasing the high risk of microbial contamination in both study areas. We recommend education interventions targeting personal hygiene and drinking water handling at the household level.
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Affiliation(s)
- Hailemariam Feleke
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Daniel Asrat
- Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Falkenberg T, Saxena D, Kistemann T. Impact of wastewater-irrigation on in-household water contamination. A cohort study among urban farmers in Ahmedabad, India. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 639:988-996. [PMID: 29929337 DOI: 10.1016/j.scitotenv.2018.05.117] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 06/08/2023]
Abstract
This cohort study explores the contribution of wastewater irrigation, in the context of WASH (Water, Sanitation, Hygiene), on in-household water contamination among urban farming households in Ahmedabad, India. Drinking water samples of 204 households in four peri-urban farming communities were collected from the point-of-source (PoS) and point-of-use (PoU) of each household four times over the 12-month follow-up period. Next to the quantification of E. coli, three household surveys (baseline, hygiene and farm) were conducted. Additionally, an observational spot-check was undertaken in bi-monthly intervals throughout the follow-up period. Significant positive differences in water quality between PoS and PoU samples were identified in 78% of households. During the monsoon, the peak of contamination, only 6% of households had access to safe drinking water at PoU. The Average Treatment Effect (ATE) of wastewater irrigation indicates an adverse effect on in-household water contamination, larger in effect size than the mitigation effect of access to sanitation or personal hygiene. To control transmission of fecal pathogens, effective barriers are required for wastewater irrigation similar to the necessity of ensuring access to sanitation and practicing adequate hygiene behavior.
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Affiliation(s)
- Timo Falkenberg
- Center for Development Research, University Bonn, Genscherallee. 3, 53113 Bonn, Germany; GeoHealth Centre, Institute for Hygiene and Public Health, University Bonn, Sigmund-Freud Str. 25, 53105 Bonn, Germany.
| | - Deepak Saxena
- Indian Institute of Public Health - Gandhinagar, NH-147, Palaj Village Opp. New Air Force Station HQ, Gandhinagar, Gujarat 382042, India
| | - Thomas Kistemann
- Center for Development Research, University Bonn, Genscherallee. 3, 53113 Bonn, Germany; GeoHealth Centre, Institute for Hygiene and Public Health, University Bonn, Sigmund-Freud Str. 25, 53105 Bonn, Germany
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Building a Methodology for Assessing Service Quality under Intermittent Domestic Water Supply. WATER 2018. [DOI: 10.3390/w10091164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This document proposes a methodology for assessing the quality of water distribution service in the context of intermittent supply, based on a comparison of joint results from literature reviews and feedback from drinking water operators who had managed these networks, with standards for defining the quality of drinking water service. The paper begins by reviewing and proposing an analysis of the definition and characterization of intermittent water supply (IWS), highlighting some important findings. The diversity of approaches used to address the issue and the difficulty of defining a precise and detailed history of water supply in the affected systems broadens the spectrum of intermittency characterization and the problems it raises. The underlined results are then used to structure an evaluation framework for the water service and to develop improvement paths defined in the intermittent networks. The resulting framework highlights the means available to water stakeholders to assess their operational and management performance in achieving the improvement objectives defined by the environmental and socio-economic contexts in which the network operates. Practical examples of intermittent system management are collected from water system operators and presented for illustration purposes (Jeddah, Algiers, Port-au-Prince, Amman, Cartagena, Barranquilla, Mexico, Cancun, Saltillo, Mumbai, Delhi, Coimbatore …).
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Taylor DDJ, Slocum AH, Whittle AJ. Analytical scaling relations to evaluate leakage and intrusion in intermittent water supply systems. PLoS One 2018; 13:e0196887. [PMID: 29775462 PMCID: PMC5959068 DOI: 10.1371/journal.pone.0196887] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/21/2018] [Indexed: 11/18/2022] Open
Abstract
Intermittent water supplies (IWS) deliver piped water to one billion people; this water is often microbially contaminated. Contaminants that accumulate while IWS are depressurized are flushed into customers' homes when these systems become pressurized. In addition, during the steady-state phase of IWS, contaminants from higher-pressure sources (e.g., sewers) may continue to intrude where pipe pressure is low. To guide the operation and improvement of IWS, this paper proposes an analytic model relating supply pressure, supply duration, leakage, and the volume of intruded, potentially-contaminated, fluids present during flushing and steady-state. The proposed model suggests that increasing the supply duration may improve water quality during the flushing phase, but decrease the subsequent steady-state water quality. As such, regulators and academics should take more care in reporting if water quality samples are taken during flushing or steady-state operational conditions. Pipe leakage increases with increased supply pressure and/or duration. We propose using an equivalent orifice area (EOA) to quantify pipe quality. This provides a more stable metric for regulators and utilities tracking pipe repairs. Finally, we show that the volume of intruded fluid decreases in proportion to reductions in EOA. The proposed relationships are applied to self-reported performance indicators for IWS serving 108 million people described in the IBNET database and in the Benchmarking and Data Book of Water Utilities in India. This application shows that current high-pressure, continuous water supply targets will require extensive EOA reductions. For example, in order to achieve national targets, utilities in India will need to reduce their EOA by a median of at least 90%.
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Affiliation(s)
- David D. J. Taylor
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- * E-mail:
| | - Alexander H. Slocum
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Andrew J. Whittle
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
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Adane M, Mengistie B, Kloos H, Medhin G, Mulat W. 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. PLoS One 2017; 12:e0182783. [PMID: 28854200 PMCID: PMC5576656 DOI: 10.1371/journal.pone.0182783] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/23/2017] [Indexed: 01/12/2023] Open
Abstract
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.
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Affiliation(s)
- Metadel Adane
- Ethiopian Institute of Water Resources (EIWR), Addis Ababa University, Addis Ababa, Ethiopia
| | - Bezatu Mengistie
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States of America
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Worku Mulat
- Department of Civil and Environmental Engineering, University of Connecticut, Storrs, United States of America
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