The Status of School Water, Sanitation, and Hygiene Services in Addis Ababa, Ethiopia: Progress Towards Achieving the SDG 6.

Background: The provision of safe water, sanitation, and hygiene (WASH) facilities and services for schools is vital to students' health, development, and educational performance. However, school WASH coverage in developing countries remains low. This study aimed to assess the adequacy of WASH services in Addis Ababa, Ethiopia. Methods: A school-based quantitative cross-sectional study was conducted from January to March 2020 in 98 schools. A multistage sampling technique was used to select schools included in the study. Data were collected using observational checklists and pretested interviewer-administered questionnaires. We entered the data into EPI Info version 7.2.2.6 and analyzed using SPSS 22.0. Logistic regression was used to examine the associated factors with school WASH services. Results: The basic school water, sanitation, and hygiene services were found to be 65.3%, 31.6%, and 36.7%, respectively. The facility-to-student ratio was 1:48 for drinking water point, 1:59 for toilet stance, and 1:147 for handwashing point. The analysis of facilities access by sex revealed that the toilet to student ratio was 1:68 for females and 1:49 for males, whereas the handwashing point-to-student ratio was 1:179 for females and 1:114 for males, indicating disparities in facilities access by sex. The non-functionality rates for drinking water, toilets, and handwashing facilities were 22.5%, 8%, and 19.5%, respectively. School ownership was significantly associated with the availability of basic water services [COR = 4.6, 95% CI: 1.466-14.426] and basic sanitation services [COR = 15, 95% CI: 3.27-68.28]. Moreover, the results demonstrate training on WASH [COR = 5, 95% CI: 1.087-23.018] and teaching programs on WASH [COR = 0.21, 95% CI: 0.056-0.810] were significantly associated with basic hygiene services. Conclusions: The provision of WASH facilities and services in schools was inadequate and not on track to meet the targets of SDG 6. Training, WASH education program, and stakeholder commitment and cooperation at all levels are required to achieve the goal.

Menstrual hygiene management practices and determinants among schoolgirls in Addis Ababa, Ethiopia: The urgency of tackling bottlenecks - Water and sanitation services.

Background: Menstrual hygiene management (MHM) service provision and improving schoolgirls' hygienic practices in schools are among the major challenges for low and middle income countries, including Ethiopia, in meeting the 2030 Sustainable Development Goals. This study was conducted to assess schoolgirls' MHM practices and what influences those practices in Addis Ababa, the capital city of Ethiopia. Methods: A cross-sectional study was conducted on 401 adolescent schoolgirls and 98 school directors that were selected using a multistage sampling method. Pretested semi-structured interviewer-administered questionnaires and observational checklists were used to collect data. Results: During menstruation, about 90% of schoolgirls used commercially made disposable sanitary pads. However, only 45.9% of girls had access to emergency pads from their schools. Of the 98 directors, 79 (80.6%) responded that they had MHM provisions for schoolgirls. However, 42 (42.9%) schools had no water and soap in the pad changing rooms/toilets, and 70% lacked a covered dustbin for disposal/storage of soiled sanitary pads. Besides, more than 55% of the schools practiced open burning and dumping to dispose of used menstrual materials. More than half of the schools had no sanitary pad changing rooms, three-quarters of them lack MHM education, and only 2.5% had a bathing area. The location of schools (AOR = 5.44, 95% CI: (2.34-12.66)), health club availability (AOR = 3.14, 95% CI: (1.53, 6.42)), being informed about MHM before menarche (AOR = 2.04, 95% CI: (1.04, 4.00)), and availability of emergency sanitary pad at schools (AOR = 2.59, 95% CI: (1.36, 4.91)) were significantly associated with the status of schoolgirls menstrual hygiene practices. Conclusions: About one-quarter of the schoolgirls had poor menstrual hygiene practices. Being a student in inner-city schools, attending a school that had a health club, being informed about MHM before menarche, and having access to emergency pads from schools were the determinant factors for good menstrual hygiene practices. However, most schools lack water, soap, and a covered dustbin in the pad changing rooms/toilets. Moreover, only a few schools provided MHM education and emergency pads. Improving water and sanitation services along with tailored MHM education are urgently needed to circumvent unsafe MHM practices among adolescent schoolgirls.

Handwashing Practices and Associated Factors Among School Children in Kirkos and Akaki Kality Sub-Cities, Addis Ababa, Ethiopia.

Background: Provision of handwashing facilities and proper practices are essential for preventing fecal-oral and acute respiratory infectious diseases. The aim of this study was to assess availability of handwashing facilities and predictors to students' good hygiene practices in Addis Ababa, Ethiopia. Methods: A mixed-methods study design was conducted in schools of Addis Ababa from January to March 2020 in 384 students, 98 school directors, 6 health clubs, and 6 school administrators. Data were collected using pretested interviewer-administered questionnaires, interview guide, and observational checklists. The quantitative data were entered into EPI Info version 7.2.2.6 and analyzed using SPSS 22.0. A bivariable at P < .2 and multivariable logistic regression analysis at P < .05 for quantitative and thematic analysis for qualitative data were used. Results: Handwashing stations were available in 85 (86.7%) of the schools. However, 16 (16.3%) schools had neither water nor soap near the handwashing facilities while 33 (38.8%) of schools had both. There was no high school that had both soap and water. Approximately one-third (135, 35.2%) of students practiced proper handwashing, among which 89 (65.9%) were from private schools. The handwashing practices were significantly associated with gender (AOR = 2.45, 95% CI: (1.66-3.59)), having trained coordinator (AOR = 2.16, 95% CI: (1.32-2.48)) and health education program (AOR = 2.53, 95% CI: (1.73-3.59)), school ownership (AOR = 0.49, 95% CI: (0.33-0.72)), and training (AOR = 1.74, 95% CI: (1.82-3.69)). Water supply interruption, and lack of budget, adequate space, training, health education, maintenance, and coordination were the main barriers that prevent students from practicing proper handwashing. Conclusions: Handwashing facilities and materials provision and good handwashing practices of students were low. Moreover, providing soap and water for handwashing was insufficient to promote good hygiene practices. There should be regular hygiene education, training, maintenance, and better coordination among stakeholders to create a healthy school environment.

COVID-19 infection prevention practices among a sample of food handlers of food and drink establishments in Ethiopia.

BACKGROUND: Cases of coronavirus disease (COVID-19) are increasing at an alarming rate throughout the world, including Ethiopia. Food handlers in food and drink establishments are at high risk of exposure to the virus due to their many daily contacts with customers. Since there is a paucity of evidence about infection prevention practices and associated factors among this high-risk group in Ethiopia including in Dessie City and Kombolcha Town, this study was designed to address this gap. METHOD: An institution-based cross-sectional study was conducted among 422 food handlers in Dessie City and Kombolcha Town food and drink establishments in July and August 2020. The study participants were selected using a simple random sampling technique. Data were collected by trained data collectors using a pretested structured questionnaire and an on-the-spot observational checklist. Data were entered into EpiData version 4.6 and exported to STATA version 14.0 for data cleaning and analysis. Data were analyzed using bivariable and multivariable logistic regression model at 95% confidence interval (CI). From the bivariable analysis, variables with a p-value <0.25 were retained into multivariable analysis. Finally, variables that had a p-value <0.05 were declared as factors significantly associated with good infection prevention practices of COVID-19 among food handlers. MAIN FINDINGS: The overall rate of good practice in infection prevention among food handlers was 43.9% (95% CI: 39.2-48.4%). Among the total 401 food handlers, 79.8% had good knowledge and 58.4% had a favorable attitude about COVID-19 infection prevention. Factors significantly associated with good COVID-19 infection prevention practices were: educational status of college or above (AOR = 1.97; 95% CI: 1.32-3.75), food handling work experience greater than five years (AOR = 2.55; 95% CI: 1.43-5.77), availability of written guidelines within the food and drink establishment (AOR = 2.68; 95% CI: 1.52-4.75), and taking training about infection prevention (AOR = 3.26; 95% CI: 1.61-6.61). CONCLUSION: Our findings showed that around one-third of food handlers had good infection prevention practices. Thus, to reduce COVID-19 transmission, integrated work is urgently needed to further improve food handlers' good practices, knowledge and attitude about infection prevention through providing health education, training and by making written infection prevention guidelines available in food and drink establishments.

Risk perceptions and attitudinal responses to COVID-19 pandemic: an online survey in Ethiopia.

BACKGROUND: Effective risk communication is one of the critical strategies in the response to COVID-19. This study examined risk perceptions and attitudinal responses to COVID-19 among the educated section of the society in Ethiopia. METHODS: An internet-based survey was conducted from April 22 to May 04, 2020, in Ethiopia. A questionnaire addressing the perception of health threat-combination of perceived vulnerability (PV) and perceived seriousness (PS), and perceived efficacy-combinations of perceived response efficacy (PRE), perceived self-efficacy (PSE), and perceived collective efficacy (PCE). The data were analyzed using SPSS 21.0. Descriptive statistics were computed after the standardization of the scores. The scores for overall efficacy and threat were split by median value and response classifications were generated through threat by efficacy interactions. For statistical significance, 95% CI and p-value < 0.05 were used. RESULTS: A total of 929 respondents submitted their responses. Eight hundred and twenty-eight (89.1%) of the respondents were male and 753 (81.1%) were Christian. The perceived threat to COVID-19 was generally low (median = 58.3). The median score for overall efficacy, PRE, and PSE were 79.8, 87.5, and 80.0, respectively. However, the median value (66.7) for PCE was relatively low. Perceived threat significantly varied by age, education, occupation, and place of residence (p < 0.05). Perceived efficacy significantly differed by gender, residence, and use of some sources of information (p < 0.05). In terms of response to COVID-19, 290 (31.2%), 239 (25.7%), 175 (18.8%) and 225 (24.2%) of the respondents were in the responsive, pro-active, avoidant, and indifferent attitudinal categories, respectively. The avoidant and indifferent groups constituted a fear control response (mal-adaptive motivation towards COVID-19 protective behavior) whereas responsive and pro-active categories formed a danger control response (self-protective motivation). These responses varied significantly by residence, region, religion, and sources of information (p < 0.05). CONCLUSIONS: Understanding people's perceived health threat and efficacy is a critical step toward creating risk communication campaigns. Hence, this study provided an insight that has the potential to inform the COVID-19 risk communication campaigns targeting the educated section of the society, by ensuring a balanced combination of threat appeals and efficacy messages for improved self-protective responses.

The application of predictive modelling for determining bio-environmental factors affecting the distribution of blackflies (Diptera: Simuliidae) in the Gilgel Gibe watershed in Southwest Ethiopia.

Blackflies are important macroinvertebrate groups from a public health as well as ecological point of view. Determining the biological and environmental factors favouring or inhibiting the existence of blackflies could facilitate biomonitoring of rivers as well as control of disease vectors. The combined use of different predictive modelling techniques is known to improve identification of presence/absence and abundance of taxa in a given habitat. This approach enables better identification of the suitable habitat conditions or environmental constraints of a given taxon. Simuliidae larvae are important biological indicators as they are abundant in tropical aquatic ecosystems. Some of the blackfly groups are also important disease vectors in poor tropical countries. Our investigations aim to establish a combination of models able to identify the environmental factors and macroinvertebrate organisms that are favourable or inhibiting blackfly larvae existence in aquatic ecosystems. The models developed using macroinvertebrate predictors showed better performance than those based on environmental predictors. The identified environmental and macroinvertebrate parameters can be used to determine the distribution of blackflies, which in turn can help control river blindness in endemic tropical places. Through a combination of modelling techniques, a reliable method has been developed that explains environmental and biological relationships with the target organism, and, thus, can serve as a decision support tool for ecological management strategies.

The impact of traditional coffee processing on river water quality in Ethiopia and the urgency of adopting sound environmental practices.

Although waste from coffee processing is a valuable resource to make biogas, compost, and nutrient-rich animal food, it is usually dumped into nearby water courses. We carried out water quality assessment at 44 sampling sites along 18 rivers that receive untreated waste from 23 coffee pulping and processing plants in Jimma Zone, Ethiopia. Twenty upstream sampling sites free from coffee waste impact served as control, and 24 downstream sampling sites affected by coffee waste were selected for comparison. Physicochemical and biological results revealed a significant river water quality deterioration as a result of disposing untreated coffee waste into running water courses. During coffee-processing (wet) season, the highest organic load (1,900 mg/l), measured as biochemical oxygen demand, depleted dissolved oxygen (DO) to a level less than 0.01 mg/l, and thus curtailed nitrification. During off season, oxygen started to recuperate and augmented nitrification. The shift from significantly elevated organic load and reduced DO in the wet season to increased nitrate in the off season was found to be the determining factor for the difference in macroinvertebrate community structure as verified by ordination analysis. Macroinvertebrate diversity was significantly reduced in impacted sites during the wet season contrary to the off season. However, there was a significant difference in the ratio of sensitive to pollution-tolerant taxa in the off season, which remained depreciated in the longer term. This study highlights the urgency of research exploring on the feasibility of adopting appropriate pollution abatement technologies to implement ecologically sound coffee-processing systems in coffee-growing regions of Ethiopia.