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

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

Experimental evaluation of fresh human feces biogas and compost potential: Evidence for circular economy from waste streams in Ethiopia.

Biogas toilets are one of the most resource-efficient sanitation technologies. The technology has dual purposes of generating energy and stabilizing waste-producing biofertilizers. In Ethiopia, knowledge of human feces' energy potential is limited to optimize the development of biogas toilet facilities. Therefore, this study was aimed to evaluate the biogas and biofertilizer potential of human feces in Jimma City, Ethiopia, which may contribute to the development of sustainable sanitation technologies. The study was lab-based experimental design. In the lab-scale batch experiment, fresh human excreta samples were collected using a urine diversion raised toilet. Using ultimate and proximate laboratory analyses, the theoretical yield of biogas was predicted. Then a series of anaerobic digestion batch experiments were conducted to determine the practical energy yield. The bio-fertilizer potential of human feces was determined by analyzing the nutrient contents of human feces. The findings of this study showed that the bio-methane yield from the experimental results has a mean of 0.393 m3 kg-1, which is 14.16 MJ kg-1. The bio-methane meter cube per capita per head per year were 28.71 (28.03-29.27) from the experimental result and 45.26 for the theoretical yield of methane. In this study, the bio-fertilizer potential of human feces was evaluated using nutrient analysis, specifically the NPK (nitrogen, phosphorus, and potassium). Accordingly, human feces contain potassium (2.29 mg kg-1), phosphorus (1.12 mg kg-1), and nitrogen (3.71 mg kg-1). This finding suggests the bio-methane potential of human feces can be used for energy recovery and alternative sanitation options, providing a positive remedy for the sanitation crisis in urban settings.

Health risk assessment of indoor air quality, sociodemographic and kitchen characteristics on respiratory health among women responsible for cooking in urban settings of Oromia region, Ethiopia: a community-based cross-sectional study.

OBJECTIVES: In Ethiopia, where biomass fuel is used by the majority of the population, women who are primarily responsible for cooking are at a higher risk of having respiratory symptoms. However, there is limited information on the respiratory symptoms of exposed women. This study assessed the magnitude of respiratory disease symptoms and associated factors among women responsible for cooking in Mattu and Bedele towns, south-west Ethiopia. METHODS: A community-based cross-sectional study was conducted among 420 randomly selected women in urban settings in south-west Ethiopia. Data were collected through face-to-face interviews using a modified version of the American Thoracic Society Respiratory Questionnaire. The data were cleaned, coded and entered into EpiData V.3.1 and exported into SPSS V.22 for analysis. Bivariable and multivariable logistic regression analyses were used to identify factors associated with respiratory symptoms at a value of p<0.05. RESULTS: It is found that 34.9% of the study participants have respiratory symptoms (95% CI 30.6% to 39.4%). Unimproved floor (adjusted OR (AOR)=2.4 at 95% CI 1.42 to 4.15), presence of thick black soot in the ceiling (AOR=2.1 at 95% CI 1.2 to 3.6), using fuel wood (AOR=2.3 at 95% CI 1.1 to 4.7), using a traditional stove (AOR=3.37 at 95% CI 1.85 to 6.16), long duration of cooking (AOR=2.52 at 95% CI 1.4 to 4.5) and cooking room without a window (AOR=2.4 at 95% CI 1.5 to 3.9) were significantly associated with women's respiratory symptoms. CONCLUSION: More than two in six women who cook had respiratory symptoms. Floor, fuel and stove type, soot deposits in the ceiling, duration of cooking and cooking in a room without a window were the identified factors. Appropriate ventilation, improved floor and stove design and the switch to high-efficiency, low-emission fuels could help to lessen the effects of wood smoke on women's respiratory health.

Spatial and multilevel analysis of sanitation service access and related factors among households in Ethiopia: Using 2019 Ethiopian national dataset.

BACKGROUND: Billions of people have faced the problem of accessing appropriate sanitation services. This study aimed to explore the spatial distribution of households' access to sanitation services and identify associated factors in Ethiopia. METHODS: The 2019 Ethiopian Mini Demographic and Health Survey data was used with a total of 6261 weighted samples. A cross-sectional study design with a two-stage cluster sampling technique was used. Global Moran's I statistic measure, Getis-Ord Gi*, and the ordinary Kriging Gaussian interpolation were used for spatial autocorrelation, hot spot analysis, and interpolation of unsampled areas, respectively. A purely spatial Bernoulli-based model was employed to determine the geographical locations of the most likely clusters. A multilevel logistic regression model was used, and predictors with a P value of less than 0.05 with a 95% CI were considered significant factors. RESULTS: Overall, 19.7% of households had access to improved sanitation services in Ethiopia. Poor sanitation service access was significantly clustered, with hotspots of poor access identified in the South Nations Nationality and People's Region (SNNPR), Oromia, Amhara, and Benishangul Gumuz regions. A total of 275 significant clusters were identified. Households in the circled area were more vulnerable to poor sanitation service access. Rural households, on-premises water access, media exposure, and rich wealth status were statistically significant factors for access to sanitation services. CONCLUSIONS: Access to sanitation services among households in Ethiopia is insufficient. The majority of the households had no access to sanitation services. Stakeholders are recommended to raise household members' awareness of sanitation services, give priority to the hotspot areas, and encourage poor households to have access to toilet facilities. Household members recommended using the available sanitation service and keeping the sanitation service clean. Households are recommended to construct clean shared sanitation facilities.

Household waste sorting practice, and factors associated with sorting practice in Bedelle town, Southwest Ethiopia.

Household solid waste generation rate in low-income countries is increasing due to population growth and changes in people's lifestyles. Sorting waste into categories is an important step in household waste management. However, there is limited information about sorting practices in a low-income setting like Ethiopia. Therefore, this study aimed to assess household solid waste (HSW) sorting practices, and factors associated with sorting practices.A community-based cross-sectional study was conducted from April to May 2021 in Bedelle town. Households were randomly selected, and household heads were interviewed using a pre-tested questionnaire. A total of 209 households were included. The proportion of households that practice waste sorting was calculated. Logistic regression was used to assess the association between HSW sorting practices and associated factors. A P-value of less than 0.05 was declared as significant. The Hosmer and Lemeshow tests were used to check for model fitness.The result of the study shows that the proportion of householders who practiced waste sorting practice in the setting was 21.53%. The sex of the household head, information on sorting benefits, and the availability of private waste collectors for resource recovery were factors in practicing waste sorting at the household level. Accordingly, male-headed households are 88% less likely to practice sorting practice than female-headed households, and those having access to information on waste sorting benefits are 3.68 times more likely to practice sorting, and similarly, households, where private waste collectors are active, are about 4 times more likely to practice waste sorting at the household level than their counterpart. This finding calls on the municipality to create awareness about solid waste sorting practices at the household level, involving both male and female householders in waste management and mobilizing waste collectors at the household level to facilitate effective waste sorting and reuse as sustainable solid waste management options in the town.

Qualitative Analysis of Onsite Sanitation Challenges in an Urban Setting: The Case of Jimma Town, Ethiopia.

On-site sanitation is the most popular sanitation option for households in many African countries, including Ethiopia. Despite the option being common, there are challenges attributed to the sustainability of those facilities. This community-based exploratory study aimed to explore the challenges in the provision of safe urban on-site sanitation in Jimma town, Ethiopia. Data were collected through key informant semi-structured interviews, transit walks through the village, and focus group discussion (FGD). The FGD was audio recorded and notes were taken by experts. Records and notes were transcribed separately and thematically analyzed. Three major themes or challenges were discovered. Accordingly, the first theme was the community's perception and taboos surrounding human waste. The second theme was urban land use and informal settlements. Ensuring standards separately for sanitation facilities is difficult because of the expansion of illegal settlements. The third theme was poor sanitation planning, operation and maintenance, and institutional setting. Urbanization without infrastructure generally has a complex nature that leads to a fragile sanitation situation in the future. The results suggest the need for multi-dimensional system development and a collaborative sanitation master plan. Furthermore, interventions aimed at breaking the taboo on human waste as a sanitation platform may turn challenges into opportunities.

Healthcare waste management practice and its predictors among health workers in private health facilities in Ilu Aba Bor Zone, Oromia region, South West Ethiopia: a community-based cross-sectional study.

OBJECTIVES: A lack of safe healthcare waste management (HCWM) practice poses a risk to healthcare staff, patients and communities. In low-income countries like Ethiopia, studies on the level of safe HCWM practices in private healthcare facilities are limited. This study was designed to assess the level of good HCWM practice and associated factors among health workers in private health facilities. METHODS: An institution-based cross-sectional study was conducted in the Ilu Aba Bor zone, South West Ethiopia. A random sample of 282 health workers from 143 private health facilities was included in the study. Data were collected using a pretested structured questionnaire that included sociodemographic characteristics, healthcare factors, knowledge assessment and an observation checklist adapted from WHO guidelines. The collected data were entered into EpiData V.3.1 and analysed with SPSS V.25.0. Multivariable logistic regression analysis was used to identify factors associated with HCWM practice. Variables with a p value of <0.05 at 95% CI were declared significant. RESULTS: More than half (58.7%) of private-sector health workers had good HCWM practice. The presence of the HCWM committee (adjusted OR (AOR)=9.6, 95% CI 4.5 to 20.6), designated healthcare waste storage site (AOR=3.0, 95% CI 1.5 to 6.5), reading the HCWM manual (AOR=4.4, 95% CI 2.2 to 9.0) and having good knowledge of HCWM (AOR=2.6, 95% CI 1.06 to 6.15) were factors associated with good HCWM practice. CONCLUSION: About three out of five health workers in private healthcare facilities were practising good HCWM. The presence of an HCWM committee, waste management utilities, reading HCWM guidelines and knowledge of health workers were the identified factors. Health workers should read guidelines to improve their knowledge, and the presence of committees and waste management utilities in private clinics should be followed to ensure compliance with safe HCWM practice.

Evidence-Based User Interface Sanitation Technology Selection for Urban Slums: A Multi-Criteria Analysis; The Case of Jimma Town, Ethiopia.

Slums are urban areas with insufficient public services and access to sanitation. Evidence-based selection of sustainable sanitation options is critical for addressing the sanitation crisis in slums. This mixed methods study was conducted in Jimma Town, southwest Ethiopia, to assess sanitation status and prioritize sustainable sanitation options for slums. The study was done in 2 phases: quantitative and qualitative. The quantitative cross-sectional household survey aimed to assess sanitation status and the qualitative exploratory method to explore alternative sanitation options and prioritize sustainable alternatives. A total of 310 households were chosen using systematic random sampling methods, of which 302 participated. Data was gathered through interviews, which were supplemented with questionnaires and observation checklists, and 2 focus group discussions (FGD) were held. First, FGD was with expertise in the sanitation sector, and the second was with community members. The state of sanitation was summarized, and multi-criteria analysis (MCA) was used to prioritize sustainable sanitation options. According to our findings, 68% of households had access to improved facilities, and 22.5% didn't have any form of toilet facility. About 7 off-site and on-site user interface sanitation technology options were considered in the selection of alternative sanitation technologies, and each option was evaluated against 17 health, economic, social, technical, and environmental criteria. In the final analysis, the options with the highest scores for the setting were flush to septic tanks, compost toilets, and biogas toilets. Mobilizing such a promising sanitation option is recommended for future interventions.

Digital Health Literacy During the COVID-19 Pandemic Among Health Care Providers in Resource-Limited Settings: Cross-sectional Study.

BACKGROUND: Digital health literacy is the use of information and communication technology to support health and health care. Digital health literacy is becoming increasingly important as individuals continue to seek medical advice from various web-based sources, especially social media, during the pandemics such as COVID-19. OBJECTIVE: The study aimed to assess health professionals' digital health literacy level and associated factors in Southwest Ethiopia in 2021. METHODS: An institution-based cross-sectional study was conducted from January to April 2021 in Ethiopia. Simple random sampling technique was used to select 423 study participants among health professionals. SPSS (version 20) software was used for data entry and analysis. A pretested self-administered questionnaire was used to collect the required data. Multivariable logistic regression was used to examine the association between the digital health literacy skill and associated factors. Significance value was obtained at 95% CI and P<.05. RESULTS: In total, 401 study subjects participated in the study. Overall, 43.6% (n=176) of respondents had high digital health literacy skills. High computer literacy (adjusted odds ratio [AOR] 4.43, 95% CI 2.34-5.67; P=.01); master's degree and above (AOR 3.42, 95% CI 2.31-4.90; P=.02); internet use (AOR 4.00, 95% CI 1.78-4.02; P=.03); perceived ease of use (AOR 2.65, 95% CI 1.35-4.65; P=.04); monthly income of >15,000 Ethiopian birr (>US $283.68; AOR 7.55, 95% CI 6.43-9.44; P<.001); good knowledge of eHealth (AOR 2.22, 95% CI 1.32-4.03; P=.04); favorable attitudes (AOR 3.11, 95% CI 2.11-4.32; P=.04); and perceived usefulness (AOR 3.43, 95% CI 2.43-5.44; P=.02) were variables associated with eHealth literacy level. CONCLUSIONS: In general, less than half of the study participants had a high digital health literacy level. High computer literacy, master's degree and above, frequent internet use, perceived ease to use, income of >15,000 Ethiopian birr (>US $283.68), good knowledge of digital health literacy, favorable attitude, and perceived usefulness were the most determinant factors in the study. Having high computer literacy, frequent use of internet, perceived ease of use, perceived usefulness, favorable attitude, and a high level of education will help to promote a high level of digital health literacy.

Spatial distribution of vitamin A rich foods intake and associated factors among children aged 6-23 months in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey.

BACKGROUND: Inadequate micronutrients in the diet and vitamin A deficiency are worldwide public health problems. In developing regions, many preschool children are undernourished, become blind every year and died before the age of 23 months. This study was aimed to explore the spatial distribution of vitamin A rich foods intake among children aged 6-23 months and identify associated factors in Ethiopia. METHODS: Ethiopian Mini Demographic and Health Survey 2019 dataset with a total 1407 children aged 6-23 months was used. Data management and processing were done using STATA version 15 software and Microsoft Office Excel. ArcMap version 10.7 software was used for mapping and spatial visualization of the distribution. Spatial scan statistics was performed using SaTScan version 9.5 software for Bernoulli-based model. Multilevel mixed effect logistic regression model was employed to identify associated factors. RESULTS: Overall, 38.99% (95% CI: 36.46-41.62) of children aged 6- 23 months took vitamin A rich foods. Poor intake of vitamin A rich foods was significantly clustered Dire Dawa city, Somali and Harari regions of Ethiopia. Children aged 6-23 months lived in the primary cluster were 70% (RR = 1.70, P-value < 0.001) more likely to intake vitamin A rich foods than children lived outside the window. In the multilevel mixed effect logistic regression analysis, Primary educational status (AOR:1.42, 95% CI: 1.05, 1.93) and higher educational status (AOR:3.0, 95% CI: 1.59, 5.65) of mother, Dire Dawa (AOR:0.49, 95% CI: 0.22, 1.12) city, Afar (AOR: 0.16, 95% CI: 0.07, 0.36), Amhara (AOR: 0.37, 95% CI: 0.19, 0.71) and Somali (AOR: 0.02, 95% CI: 0.003, 0.08) regions of Ethiopia, children aged 13-23 months (AOR: 1.80, 95% CI: 1.28, 2.36), Mothers' exposure to media (AOR: 1.41, 95% CI: 1.04, 1.92) were statistically significant factors for vitamin A rich foods intake among children aged 6-23 months. CONCLUSIONS: Only 4 out of ten children took vitamin A rich foods which is too low compared to the national target and significantly clustered in Ethiopia. Mother's educational status, Region, Child age and Mother's media exposure are significant factors vitamin A rich foods intake. Stakeholders should strengthen mothers' education status, creating awareness for mothers on child feeding and using locally available natural resource to produce vitamin A rich foods.

Prevalence of Tungiasis and its risk factors of among children of Mettu woreda, southwest Ethiopia, 2020.

Tungiasis is caused by the flea tunga penetrans and results in painful skin lesions, skin infections, and permanent disability. However, limited information is available that shows the magnitude of the problem and its risk factors that help for intervention in Ethiopia. The goal of this study was to determine the prevalence and risk factors of tungiasis in children aged 5 to 14 in Mettu woreda in 2020. A community based cross sectional study was conducted among randomly selected kebeles of Mettu woreda, in Southwest Ethiopia. To select study participants, multistage sampling was used. The data were collected through physical examination of the children, interview of parents/guardians of the children, and observation of the home environment using checklists and questionnaires. The descriptive analysis was done for socio-demographic characteristics, prevalence of tungiasis, and housing conditions. A logistic regression analysis was performed, and variables in multivariable regression reported odds ratios and their 95% confidence intervals once the variables were identified using a p-value of 0.05 as a risk factor of statistical significance. The prevalence of tungiasis among children 5-14 years of age in Mettu rural woreda was 52 percent (n = 821). As a risk factor, large family size (AOR: 2.9, 95% CI: 2.13, 4.40); school attendance (AOR: 1.5, 95% CI: 1.02, 2.18), floor inside the house (AOR: 3.8, 95% CI: 1.76, 8.43); having sleeping bed (AOR: 0.16, 95% CI: 0.03, 0.82); access to protected water sources (AOR: 0.24, 95% CI: 0.15, 0.39); access to improved toilet facilities(AOR: 0.63: 95% CI: 0.44, 0.89); access to electric services (AOR: 0.30, 95% CI: 0.15, 0.62); and lack of own farmland (AOR: 0.36, 95% CI: 0.26, 0.50) were found. Therefore, planning and implementation of interventions focus on those risk factors that are particularly important. Water, sanitation and hygiene interventions, and livelihood improvement interventions are required to solve the problem in the setting.

Effectiveness of solar disinfection water treatment method for reducing childhood diarrhoea: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to pool out the available evidence on the effectiveness of the solar disinfection water treatment method for reducing childhood diarrhoea. DESIGN: Systematic review and meta-analysis. SETTING: Global. METHODS: Searches were conducted in Medline/PubMed, Scopus, Google Scholar, Cochrane Library databases and references to other studies. The review included all children living anywhere in the world regardless of sex, ethnicity and socioeconomic status published in English until December 2019. Studies that compared the diarrhoea incidence between the intervention group who were exposed to solar disinfection water treatment and the control group who were not exposed to such water treatment were included. The outcome of interest was the change in observed diarrhoea incidence and the risk from baseline to postintervention. Two independent reviewers critically appraised the selected studies. Effect sizes were expressed as risk ratios, and their 95% CIs were calculated for analysis. RESULTS: We identified 10 eligible studies conducted in Africa, Latin America and Asia that included 5795 children aged from 1 to 15 years. In all identified studies, solar disinfection reduced the risk of diarrhoea in children, and the effect was statistically significant in eight of the studies. The estimated pooled risk ratio of childhood diarrhoea among participants that used the solar disinfection water treatment method was 0.62 (95% CI 0.53 to 0.72). The overall pooled results indicated that the intervention of solar disinfection water treatment had reduced the risk of childhood diarrhoea by 38%. CONCLUSIONS: The intervention of solar disinfection water treatment significantly reduced the risk of childhood diarrhoea. However, the risk of bias and marked heterogeneity of the included studies precluded definitive conclusions. Further high-quality studies are needed to determine whether solar disinfection water treatment is an important method to reduce childhood diarrhoea. PROSPERO REGISTRATION NUMBER: CRD42020159243.

The effectiveness of solar disinfection water treatment method for reducing childhood diarrhea: a systematic review and meta-analysis protocol.

BACKGROUND: Several studies employing the effectiveness of solar disinfection water treatment method for reducing diarrhea have reported heterogeneous outcomes, necessitating a systematic review to provide an exhaustive summary of current evidence. Thus, the objective of this review is to pool out the available evidence on the effectiveness of solar disinfection water treatment method for reducing childhood diarrhea. METHODS: Searches will be conducted in PubMed/Medline, Scopus, Google Scholar, Cochrane Library databases, and reference of other studies published through in December 2019. Studies that compare the diarrhea incidence among the intervention group who were exposed to solar disinfection water treatment and the control group who were not exposed to such water treatment were included. The primary outcome of the study is the change in observed diarrhea incidence risk from baseline to post-intervention. Randomized controlled trial study designs will be included. Selected studies will be critically appraised by two independent reviewers. Extracted data will include details about the interventions, populations, study methods, and outcomes of significance to the review question and objectives. Effect sizes will be expressed as risk ratio, and their 95% confidence intervals will be calculated for analysis. DISCUSSION: This review and meta-analysis will systematically explore and integrate the evidence available on the effectiveness of solar disinfection water treatment method for reducing diarrhea. In this review, information about the potential impact of solar disinfection water treatment to inactivate pathogenic microbes for reducing diarrhea will be gathered and summarized. The findings from this study will provide directions for future research and public health professionals with an understanding of the importance of solar disinfection water treatment and point to directions for applicability of the interventions in the community.