Animal Handling Practice Among Rural Households in Northwest Ethiopia Increases the Risk of Childhood Diarrhea and Exposure to Pathogens From Animal Sources.

Background: In Ethiopia, domestic animals and their feces are not properly contained. However, the risk of exposure to zoonotic pathogens is not well documented. This study was conducted to assess animal handling practices and the risk of childhood diarrhea among rural households in northwest Ethiopia. Methods: This study was done among 403 randomly selected households. Information on animal handling was collected using a questionnaire and spot-check observation. The occurrence of childhood diarrhea in 14 days prior to the survey was assessed based on the reports of female head of households. Multivariable binary logistic regression analysis was performed to identify the association between animal handling practices and childhood diarrhea. Results: All the female head of households had contact with animal feces when preparing fuel disks and plastering the house components with animal dung. Domestic animals shared a corral within the living space of the humans in 20% of the households. Animals entered the human living quarters and accessed foods in 32% of the households. Moreover, 24% of the children aged 24 to 59 months had diarrhea in a 2-week period prior to the survey. Childhood diarrhea was associated with domestic animals sharing the same house as humans (AOR: 3.3, 95% CI: 1.3, 8.6), presence of animal excreta in child playing areas (AOR: 2.4, 95% CI: 1.2, 4.6), contact of domestic animals with stored foods (AOR: 3.5, 95% CI: 2.0, 5.9), trapped dirt under fingernails of female heads (AOR: 3.7, 95% CI: 1.9, 7.5), open defecation (AOR: 3.24, 95% CI: 1.8, 5.9), and unprotected sources (AOR: 4.2, 95% CI: 1.1, 15.3). Conclusion: Domestic animals and their excreta are not hygienically contained in the area. Animal handling practices including their excreta and the hygiene behavior of female head of households (eg, handwashing and food handling practices) should be improved to prevent childhood diarrhea.

Oral hygiene practices and associated factors among rural communities in northwest Ethiopia.

BACKGROUND: Poor oral hygiene affects the overall health and quality of life. However, the oral hygiene practice in rural communities and contributing factors are not well documented. Accordingly, this study was conducted to assess oral hygiene practices and associated factors among rural communities in northwest Ethiopia. METHODS: A cross-sectional study was conducted among 1190 households. Data were collected using a structured and pretested questionnaire, prepared based on a review of relevant literature. The questionnaire comprises socio-demographic information, access to health and hygiene messages, oral hygiene practices, and water quality. We assessed oral hygiene practices with these criteria: mouth wash with clean water in every morning, mouth wash with clean water after eating, brushing teeth regularly, and avoiding gum pricking. Gum pricking in this study is defined as sticking needles or wires into gums to make the gums black for beauty. Multivariable logistic regression was used to identify factors associated with oral hygiene practices. Significant associations were declared on the basis of adjusted odds ratio with 95% confidence interval and p-values < 0.05. RESULTS: Results showed that all the family members usually washed their mouth with clean water in everyday morning and after eating in 65.2% and 49.6% of the households, respectively. Furthermore, 29.9% of the households reported that all the family members regularly brushed their teeth using toothbrush sticks and one or more of the family members in 14.5% of the households had gum pricking. Overall, 42.9% (95% CI: 39.9, 45.6%) of the households had good oral hygiene practices. Health and/or hygiene education was associated with good oral hygiene practices in the area (AOR: 1.66, 95% CI: 1.26, 2.21). CONCLUSION: More than half of the households had poor oral hygiene practices in the area and cleaning of teeth with toothpastes is not practiced in the area, where as gum pricking is practiced in more than one-tenth of the households. The local health department needs provide community-level oral health education/interventions, such as washing mouth with clean water at least twice a day, teeth brushing using indigenous methods such as toothbrush sticks or modern methods such as toothpastes, and avoiding gum pricking to promote oral health.

Diarrhea Prevalence and Associated Factors among Children in Azezo Sub-City, Northwest Ethiopia: A Community-Based Cross-Sectional Study.

Globally, diarrheal disease continues to be a major cause of morbidity and mortality among children under 5 years of age, especially in low-income countries such as Ethiopia. However, there is still limited evidence in the study area quantifying the burden of diarrheal disease among children under 5 years. A community-based cross-sectional study was conducted in April 2019 to estimate the prevalence of childhood diarrhea and to identify its associated factors in Azezo sub-city, northwest Ethiopia. A simple random sampling technique was applied to recruit the eligible cluster villages with children under 5 years. Data were collected by interviewing mothers or guardians using structured questionnaires. The completed data were entered into EpiInfo version 7 and exported to SPSS version 20 for analysis. Binary logistic regression model was used to identify factors associated with diarrheal disease. Adjusted odds ratio (AOR) with 95% CI was used to measure the strength of association between the dependent and independent variable. The period prevalence of diarrheal disease among children under 5 years was 24.9% (95% CI: 20.4-29.7%). Age group between 1 and 12 months [AOR: 9.22, 95% CI: (2.93-29.04)] and 13 and 24 months [AOR: 4.44, 95% CI: (1.87-10.56)], as well as low monthly income (AOR: 3.68, 95% CI: (1.81-7.51)] and poor handwashing practice [AOR: 8.37, 95% CI: (3.12-22.52), were significantly associated with high risk of childhood diarrhea. In contrast, small family size [AOR: 0.32, 95% CI: (0.16-0.65)], and immediate consumption of prepared meals [AOR: 0.39, 95% CI: (0.19-0.81)] were significantly associated with low risk of childhood diarrhea. Diarrheal diseases were a common health problem among children under 5 years of age in Azezo sub-city. Therefore, an appropriate hygiene intervention program through health education is recommended with a focus on identified risk factors to reduce the burden of diarrheal diseases.

Household drinking water quality and its predictors in flood-prone settings of Northwest Ethiopia: A cross-sectional community-based study.

Globally, the deterioration of drinking water quality is a major public health problem that contributes to the spread of disease and causes death. Therefore, it is important to have regular quality control monitoring. This study aimed to assess the level of physicochemical and bacteriological quality of household drinking water and its contributing factors in flood-prone settlements of South Gondar Zone, Ethiopia. A community-based cross-sectional study was conducted in flood-prone settings of Northwest Ethiopia from January 17 to March 30, 2021. Structured questionnaires were used to gather the sociodemographic, environmental, and behavioral data. A total of 675 drinking water samples were collected from water storage containers of selected households. Logistic regression models were used for both univariate and multivariable studies. The survey included a total of 675 households. The mean values of pH (5.9 ± 1.03), turbidity (6.7 ± 2.21 NTU), and free residual chlorine (0.02 ± 0.01 mg/l) did not meet the WHO recommended limits for drinking water. The prevalence of fecal contamination of drinking water in the study area was 62.2% with [95% CI (53-60%)]. Family size [AOR = 2.205, 95% CI (1.375-3.536), absence of latrine [AOR = 3.449, 95% CI (1.349-8.823)], and lack of a separate container to draw water from its storage [AOR = 0.454, 95% CI (0.249-0.827)] were significant predictors for fecal contamination of household drinking water. In conclusion, the water quality in terms of pH, turbidity, residual chlorine, and bacteriological parameters was poor and not suitable for consumption. High prevalence of fecal contamination of water was found, and it was significantly associated with family size, the absence of a latrine, and the lack of a separate cap to take water from the storage. Therefore, continuous chlorination and monitoring its concentration, educating the community on how to use stored water, educating the advantage of having a latrine, and promoting point-of-use treatments such as filtration and boiling are needed.

Quality assessment of raw and pasteurized milk in Gondar city, Northwest Ethiopia: A laboratory-based cross-sectional study.

Milk is a complete and highly nutritious source of food for human beings. However, in many developing countries, including Ethiopia, the quality of milk products has become a major health concern for consumers, particularly for infants and children. Therefore, the aim of the present study was to assess the quality of raw and pasteurized milk marketed in Gondar city, Northwest Ethiopia. A laboratory-based cross-sectional study was conducted on 90 milk samples. The samples were chosen using a simple random sampling technique. For statistical analysis, ANOVA and the Pearson correlation coefficient were used. The specific gravity of pasteurized milk, farm milk, and milk vendors were found to be 1.021, 1.027, and 1.026, respectively. Farm milk, milk vendors, and pasteurized milk had fat contents of 3.38%, 3.22%, and 3.09%, respectively. The total bacterial count in pasteurized milk, farm milk, and milk vendors was found to be 7.08, 6.73, and 6.94 log10 CFU/mL, respectively. In raw milk, hydrogen peroxide (7.7%), formalin (7.7%), and water (3.8%) were found, whereas in pasteurized milk, hydrogen peroxide (50%), formalin (50%), and water (19.8%) were found. Based on the findings of this study, the quality of both raw and pasteurized milk was found to be poor as per the milk quality standards. This may cause significant public health-related problems. Therefore, an appropriate intervention should be conducted to improve the quality of milk.

Prevalence of diarrheal disease and associated factors among under-five children in flood-prone settlements of Northwest Ethiopia: A cross-sectional community-based study.

Background: Diarrheal illnesses are a long-standing public health problem in developing countries due to numerous sanitation issues and a lack of safe drinking water. Floods exacerbate public health issues by spreading water-borne infectious diseases such as diarrhea through the destruction of sanitation facilities and contamination of drinking water. There has been a shortage of studies regarding the magnitude of diarrheal disease in flood-prone areas. Therefore, this research aimed to evaluate the prevalence of diarrheal disease and its predictors among under-five children living in flood-prone localities in the south Gondar zone of Northwest Ethiopia. Method: A community-based cross-sectional research was carried out in flood-prone villages of the Fogera and Libokemkem districts from March 17 to March 30, 2021. Purposive and systematic sampling techniques were used to select six kebeles and 717 study units, respectively. Structured and pretested questionnaires were used to collect the data. A multivariable analysis was performed to determine the predictors of diarrheal disease, with P-value <0.05 used as the cut-off point to declare the association. Result: The prevalence of a diarrheal disease among under-five children was 29.0%. The regular cleaning of the compound [AOR: 2.13; 95% CI (1.25, 3.62)], source of drinking water [AOR: 2.36; 95% CI: (1.26, 4.41)], animal access to water storage site [AOR: 3.04; 95% CI: (1.76, 5.24)], vector around food storage sites [AOR: 9.13; 95% CI: (4.06, 20.52)], use of leftover food [AOR: 4.31; 95% CI: (2.64, 7.04)], and fecal contamination of water [AOR: 12.56; 95% CI: (6.83, 23.20)] remained to have a significant association with diarrheal diseases. Conclusion: The present study found that the prevalence of the diarrheal disease among under-five children was high. Routine compound cleaning, the source of drinking water, animal access to a water storage site, vectors near food storage sites, consumption of leftover food, and fecal contamination of water were significant predictors of diarrheal disease. Therefore, it is advised to provide improved water sources, encourage routine cleaning of the living area, and offer health education about water, hygiene, and sanitation.

On-Site Solid Waste Handling Practice and Associated Factors among Condominium Residents in Gondar City, Northwest Ethiopia, 2021: A Community-Based Cross-Sectional Study.

Background: Solid waste is one type of waste that is released from human day-to-day activities and it is considered useless or unwanted for further use. Population growth, rapid urbanization, a booming economy, and an increase in the standards of living of the community have substantially enhanced the rate of solid waste generation in developing countries. Solid wastes can be used as a resource for industrial production or energy generation. However, it causes environmental and human health problems due to poor management. There is scanty information about on-site solid waste management practice in the study area. Therefore, assessing on-site solid management practices and their associated factors, especially for condominium residents is very important. Objective: To assess on-site solid waste handling practice and its associated factors among condominium residents in Gondar city, northwest Ethiopia, 2021. Methods: A community-based cross-sectional study was conducted from March 1 to June 15/2021 among condominium residents in Gondar city. The study included a total of 450 condominium households, with a 99.3% response rate. A binary logistic regression model was used to assess the association between dependent and independent variables. Those variables which have a p value <0.25 in the bivariate analysis were entered into a multivariable logistic regression model. A p value of less than 0.05 with 95% CI was considered a statistically significant factor. Result: In this study, 79.8% with 95% CI (76.4%, 83.3%) of condominium residents had poor on-site solid waste handling practices. The finding also showed that 42.2% and 50.2% of study participants have favorable attitudes and good knowledge towards on-site solid waste handling practices, respectively. In multivariable logistic regression analysis, male household heads (AOR = 1.90; 95% CI, 1.11-3.28), large family size (AOR = 1.87; 95% CI, 1.03-3.40), negative attitude towards on-site solid waste handling practices (AOR = 1.79; 95% CI, 1.07-3.00), not receiving training (AOR = 3.40; 95% CI, 1.77-6.55), and not having legal enforcement (AOR = 2.85; 95% CI, 1.39-5.84) were significantly associated with on-site solid waste handling practices. Conclusion: The on-site solid waste handling practice of condominium households was very poor. The provision of training and enforcement of rules regarding solid waste handling is necessary.

Stunting among children aged 24-59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia.

Stunting is a public health issue of global concern. Despite, poor sanitation, diarrhea, parasitic infections, and environmental enteric dysfunction (EED) are associated with stunting, their link is poorly understood and has not been investigated in Ethiopia. This study was conducted to assess the associations of stunting with sanitation, enteric infections, and EED among children aged 24-59 months in rural northwest Ethiopia. A community-based cross-sectional study was conducted among 224 randomly selected children aged 24-59 months in rural areas of the east Dembiya district. We collected information on household food insecurity and dietary diversity using pre-tested questionnaires adopted from the food and nutrition technical assistance (FANTA) project. We used height-for-age-z score (HAZ) to define stunting. We also used the data collected to measure the environmental exposures of children to intestinal parasitic infections and fecal biomarkers of EED. A multivariable binary logistic regression model was used to assess the association of stunting with sanitation, enteric infections, and EED. Of the 224 children, 33% (95% CI 27, 39%) were stunted. Stunting in children was significantly associated with poor dietary intake (AOR 3.0, 95% CI 1.2, 7.3), open defecation practice (AOR 3.0, 95% CI 1.2, 7.9), presence of animal excreta in the living environment (AOR 3.4, 95% CI 1.2, 9.9), E. coli contamination of drinking water (AOR 4.2, 95% CI 1.1, 15.3), diarrheal disease incidence (AOR 3.4, 95% CI 1.5, 7.7), intestinal parasites in children (AOR 3.3, 95% CI 1.3, 8.8), and higher EED disease activity scores (AOR 2.9, 95% CI 1.2, 6.7). One-third of the children in the study area were stunted and this high prevalence of stunting was associated with poor dietary intake, poor hygiene and sanitation conditions, enteric infections, and EED. Thus, stunting can be prevented by improving sanitation and hygienic conditions to prevent repeated enteric infections in children and by promoting dietary diversity of children.

Effects of local handwashing agents on microbial contamination of the hands in a rural setting in Northwest Ethiopia: a cluster randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of handwashing with water and wood ash in reducing faecal contamination of the hands. DESIGN: A cluster randomised controlled trial was employed with two arms: handwashing with water and wood ash versus handwashing with water alone. SETTING: Rural households of East Dembiya District, Central Gondar Zone, Amhara National Regional State, Ethiopia. PARTICIPANTS: 440 mothers and caregivers of children younger than 5 years assigned (1:1, 220 in each group) in clusters, with buffer zones between each cluster. INTERVENTION: Health education on effective handwashing was given to the intervention and control groups. Participants in the intervention group used wood ash of the same quantity (ie, one closed palm). OUTCOME MEASURES: The primary outcome was microbial contamination of the hands, measured by means of Escherichia coli counts before and after handwashing. RESULTS: At baseline, 75.9% and 67.7% of the participants in the intervention and control groups, respectively, had dirt on their fingernails, and the hands of all participants in both groups were contaminated with E. coli. The mean E. coli counts recovered at baseline were 3.07 log10 colony forming unit (CFU)/swab in the intervention group and 3.03 log10 CFU/swab in the control group, while at endline it was 1.4 log10 CFU/swab in the intervention group and 3.02 log10 CFU/swab in the control group. The mean E.coli counts was reduced by 1.65 log10 due to the intervention (difference-in-differences: ß= -1.65, 95% CI= -1.84 to -1.46). CONCLUSION: Two-thirds of the swab samples tested positive for E. coli after handwashing with water and wood ash, which indicates wood ash is not very effective in terms of completely removing micro-organisms on the hands. However, wood ash was significantly better than water alone in reducing the concentration of faecal coliform organisms on the hands. Local health authorities should primarily promote handwashing with soap. However, in the absence of soap, use of wood ash over water alone might be appropriate. TRIAL REGISTRATION NUMBER: PACTR202011855730652.

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

Background: The use of sanitation facilities is known to interrupt the transmission of fecal-oral related diseases. However, the evidence was limited about the utilization of latrines within the rural community of Takussa district. Therefore, this study was conducted to assess the utilization of latrines and associated factors among households in Takussa district, northwest Ethiopia. Methods: A community-based cross-sectional study design was employed to survey 801 rural households among initially computed 812 participants from February 15 to March 15, 2019. A structured questionnaire with face-to-face interviews was used to collect the data. SPSS version 20 was used to analyze the completed data. A binary logistic regression model was used to process bivariate and multivariable analysis of the data. The adjusted odds ratio was used for the interpretation of the data after controlling for the confounders. Results: The proper latrine utilization rate was 41.9%, with a 95% confidence interval of (38.8, 45.3). Households with school-aged children (AOR: 2.27, 95% CI: (1.44, 3.56), a clean latrine (AOR: 3.34, 95% CI: (1.26, 4.93), the optimal distance from the living room (AOR: 1.56, 95% CI: (1.09, 2.25), and perceived benefit (AOR: 3.64, 95% CI: (1.13, 11.67) were statistically associated factors. Conclusion: The Proper utilization of latrines was low among rural households in the Takussa district. School children, distance, cleanliness, and the benefit of latrines were statistically associated factors. As a result, encouraging health extension workers integrated into district schools to pay special attention to frequent follow-up in order to promote proper latrine utilization at the household level.

Development and validation of questionnaire to assess exposure of children to enteric infections in the rural northwest Ethiopia.

In areas where children have multiple environmental exposures to enteric pathogens, identifying the sources of exposure by measuring external and internal exposures to enteric pathogens and complementing by questionnaire and observational checklist to capture behaviors resulting risk of exposure is critical. Accordingly, this study was conducted to design valid and reliable questionnaire to assess behaviors and environmental conditions resulting exposure to enteric pathogens in the rural northwest Ethiopia. We began with a thorough exploration of relevant literature to understand the theoretical framework on the research objectives to identify variables to highlight what the questionnaire is measuring. We then generated items in each domain that can effectively address the study objectives and we refined and organized the items in a suitable format. Then after, we conducted face and content validity by involving experts on the research subject. After pre-testing a pre-final version of the instrument generated in the content validity study, we conducted a pilot study in 150 randomly selected rural households to test the internal consistency reliability. We used content validity ratio (CVR), item-level content validity index (I-CVIs), scale-level content validity index (S-CVI/UA), and modified kappa statistics to measure content validity of items. Moreover, we used agreement and consistency indices (i.e., Cronbach's alpha) to assess the internal consistency of items. The content validity test result showed that the value of CVR was 0.95, I-CVIs was 0.97, and modified kappa was 0.97 for the whole items, indicating all the items are appropriate. The scale-level content validity index (S-CVI/UA) was 0.95 for the whole items indicating the agreement among judges to each items is higher. The internal consistency reliability test result indicated that Cronbach's alpha for the pre-final version of the pre-final tool was 0.85, indicating the strong reliability of the tool. The final version of the questionnaire was, therefore, prepared with 8 dimensions and 80 items. In this study, we designed valid and reliable questionnaire to assess behaviors and environmental conditions that result high risk of exposure to enteric infections in rural settings. The questionnaire can be used as a tool in the rural settings of developing countries with some amendments to account local contexts. However, this questionnaire alone does not measure exposure of children to enteric infections. It only complements external and internal exposure assessments.

Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24-59 months in east Dembiya district, northwest Ethiopia.

BACKGROUND: Environmental enteric dysfunction is a subclinical intestinal disorder characterized by gut inflammation accompanied by morphological changes, such as blunted villi and crypt hyperplasia. This is a common illness in low and middle-income countries. However, environmental enteric dysfunction evidence is limited in Ethiopia. Accordingly, this study was conducted to measure fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24-59 months in rural northwest Ethiopia. METHODS: A community-based cross-sectional study was employed among 235 randomly selected children in a rural setting of the east Dembiya district. Stool samples were collected without fixative and analyzed for fecal biomarkers of environmental enteric dysfunction (Alpha-1-antitrypsin, neopterin, and myeloperoxidase) using commercial enzyme-linked immunosorbent assay kits and analyzed for intestinal parasites using wet mount and Kato-Katz techniques. Child behaviors related with exposure to enteropathogens, condition of the living environment and socio-demographic information were collected using interviewer-administered questionnaire and structure observation. We fitted multivariable linear regression model to assess the association between environmental factors and concentration of fecal biomarkers of environmental enteric dysfunction in the stool. Statistically significant associations were declared based on adjusted betas with the corresponding 95% confidence interval and p-value < 0.05. RESULTS: The median concentration of fecal markers of environmental enteric dysfunction was 350 µg/ml for Alpha-1-antitrypsin, 3320.2 ng/ml for myeloperoxidase, and 1562 nmol/l for neopterin. The median concentration of Alpha-1-antitrypsin among 161 (68.5%), myeloperoxidase among 168 (71.5%), and neopterin among 188 (80%) of the stool samples were above the normal values in non-tropical settings. Moreover, 100 (42.6%) of the children had high EED disease activity score (above the median score). The elevated concentrations of fecal biomarkers of gut inflammation and the high EED disease activity score were significantly associated with open defecation practice, mouthing of soil contaminated materials, Escherichia coli (E. coli)  contamination of drinking water, E. coli contamination of foods, E. coli contamination of soil, and intestinal parasites. CONCLUSION: Overall, Alpha-1-antitrypsin, myeloperoxidase, and neopterin levels among the children in the studied region were highly elevated in comparison to populations in high-income countries. Moreover, the EED disease activity score in significant proportion of children was high, suggesting widespread intestinal inflammation and increased intestinal permeability. Extensive E. coli contamination of the living environment (drinking water, ready-to-eat foods, and courtyard soil), hygiene and sanitation behaviors (such as open defecation and mouthing of soil contaminated materials), and a high burden of intestinal parasites were identified as factors associated with the elevated concentration of fecal biomarkers of environmental enteric dysfunction. Parental care to children to avoid mouthing of soil contaminated materials and other risky behaviors that increase exposure enteric infections, and protecting the living environment (water, food and soil) from fecal contamination are important.

Fecal indicator bacteria along multiple environmental exposure pathways (water, food, and soil) and intestinal parasites among children in the rural northwest Ethiopia.

BACKGROUND: Children in low-resource settings are exposed to multiple risk factors for enteropathogens. However, the probability of exposures may be different across exposure pathways. Accordingly, this study was conducted to assess environmental exposures of children to intestinal parasites in the east Dembiya district of Ethiopia. METHODS: A cross-sectional study was conducted for 372 households with children aged 24-59 months. The potential for external exposure of children to intestinal parasites was assessed by determining the presence of fecal indicator organism (Escherichia coli (E. coli)) in drinking water at point of use, ready-to-eat foods, and courtyard soil from children's outdoor play areas. For internal exposure assessment, ova of parasites in stool samples was detected using wet mount and Kato-Katz techniques to estimate exposure to intestinal parasites. The external and internal exposure assessments were also complemented using questionnaire and spot-check observations to assess behaviors that result in high risk of exposure. Individual and community-level predictors of intestinal parasites were identified using a multilevel logistic regression model. Statistically significant variables were identified on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05. RESULTS: Ova of one or more intestinal parasites was detected among 178 (47.8%) (95% CI 42.8, 52.6%) of the children. The most common intestinal parasites were A. lumbricoides (20.7%) and S. mansoni (19.1%). Furthermore, E. coli was detected in 69.1% of drinking water samples at point of use, 67.5% of ready-to-eat food samples, and 83.1% of courtyard soil samples from children's outdoor play areas. Exposure of children to intestinal parasites among children in the studied region was associated with poor hand hygiene of mothers (AOR 1.98, 95% CI (1.07, 3.66), poor hand hygiene of children (AOR 3.20, 95% CI (1.77, 5.77), mouthing of soil contaminated materials (AOR 2.31, 95% CI (1.26, 4.24), open defecation practices (AOR 2.22, 95% CI (1.20, 4.10), limited access to water (AOR 2.38, 95% CI (1.13, 5.01), water contamination (AOR 2.51, 95% CI (1.31, 4.80), food contamination (AOR 3.21, 95% CI (1.69, 6.09), and soil contamination (AOR 2.56, 95% CI (1.34, 4.90). CONCLUSION: An extensive E. coli contamination of water, foods, and courtyard soil was found in the studied region and the potential sources of contamination were open defecation practices, unhygienic disposal of wastes, poor animal husbandry and keeping practices, and poor water and food safety measures at household level. Moreover, fecal contamination of water, foods, and soil linked to exposure of children to intestinal parasites in the studied region. Thus, it is critical to implement individual-level interventions (such as latrine utilization, hand hygiene promotion, food safety, home-based water treatment, and containment of domestic animals), plus community-level interventions (such as protecting water sources from contamination, source-based water treatment, and community-driven sanitation).

Effects of local handwashing agents on microbial contamination of hands in the rural settings of northwest Ethiopia: protocol for a two-arm, clustered-randomised controlled trial.

INTRODUCTION: Hands play a part in the transmission of infections. Handwashing with soap sufficiently reduces the level of hand contamination and the spread of infections. As soap is not usually available due to cost, ash is often used as a zero-cost alternative to soap in the rural settings of developing countries. However, there is limited evidence on the effectiveness of ash to reduce microbial contamination of hands. This study is, therefore, designed to assess the effect of ash on microbial contamination of hands in the rural settings of northwest Ethiopia. METHODS AND ANALYSIS: A two-arm clustered-randomised controlled trial will be employed. A total of 11 clusters per arm will be selected using simple random sampling technique. A total of 220 mothers or caregivers of under-5 children will be included in each arm. After providing health education on effective handwashing process, we will ask study subjects to do the usual activities. We will then take swab samples from the dominant hand before washing. After swabbing, participants will be asked to wash their hands with water only and with ash by following effective handwashing procedures. We will again take swab samples from the dominant hand after washing and drying. Finally, we will compare each intervention arm against the control. A generalised estimating equation (GEE) with robust SE estimation will be used to account the cluster nature of data. ETHICS AND DISSEMINATION: Results will be published in peer-reviewed journal and presented at international conferences. The protocol is approved by the Institutional Review Board of the University of Gondar, Ethiopia. TRIAL REGISTRATION NUMBER: Pan African Clinical Trial Registry; PACTR202011855730652.

Barriers and Enabling Factors Associated with the Implementation of Household Solar Water Disinfection: A Qualitative Study in Northwest Ethiopia.

Household water treatment including solar disinfection (SODIS) is recognized worldwide as an important intervention for prevention and control of diarrheal and other waterborne diseases. However, in Ethiopia's countryside, SODIS is not being practiced. Therefore, the objective of this qualitative study conducted in villages of Dabat district in northwest Ethiopia was to explore barriers to and enabling factors for consistent and wider implementation of SODIS. This phenomenological study design included four focus group discussions with 25 parents of children younger than 5 years and interviews with four key informants to elicit their experiences and opinions. ATLAS.ti 8.0 software (GmbH, Berlin, Germany) was used for data organization, and the content was analyzed thematically. Enabling factors were categorized into four themes, such as supportive values for SODIS (positive attitude, advantage of SODIS, and cultural acceptance of SODIS), consistent use of SODIS (community's interest, health education, availability of bright sunlight, and simplicity of the method), participation of family and community in daily implementation of the SODIS process (controlling theft of bottles and recognizing the importance of SODIS technology), and willingness to pay for new polyethylene terephthalate (PET) bottles. On the other hand, barriers were grouped into three themes such as sociocultural (poor knowledge, hesitation to leave SODIS bottles unguarded outdoor, less attention, and unplanned social events), environmental (cloud, shadow over SODIS bottles, turbidity and leeches in source water, and geographical settings), and behavioral (mishandling of SODIS bottles and drinking water). The analysis of the data revealed that all the participants had positive attitude toward the implementation of SODIS, and it was culturally accepted. They identified the barriers to and enabling factors for the implementation of SODIS. Promoting enabling factors and mitigating barriers are substantially important for consistent implementation of SODIS as a long-term interventional measure widely in rural Ethiopia for the achievement of the goal of safe drinking water for all.

Assessment of quality of edible vegetable oils accessed in Gondar City, Northwest Ethiopia.

OBJECTIVE: Edible vegetable oils are prone to quality deterioration through oxidation and microbial degradation resulting in nutritional loss and off-flavors. Quality deterioration may contribute in the formation of oxidation products that are reactive and toxic, which ultimately pose health risks including cancer and inflammation. The objective of this study was to assess quality of both imported and locally made edible vegetable oils accessed in Gondar City, Ethiopia. Cross-sectional study design was used to collect 60 samples randomly; 30 from locally made (Niger seed at market 14, Niger seed at production center 11, sunflower at the market 5) and 30 from imported palm oil brands (Avena 11, Hayat 4, Jersey 5 and Chef 10). RESULTS: The mean value for: moisture content (%) (0.333 ± 0.08 while 0.089 ± 0.11), specific-gravity (0.823 ± 0.14 and 0.807 ± 0.115), peroxide value (15.09 ± 1.61 and 7.05 ± 0.102 mill-equivalents of oxygen/kg), acid value (2.43 ± 0.9 and 0.98 ± 0.23 mg KOH/g oil) and iodine value (115.63 ± 6.77 and 21.8 ± 3.4 g I2/100 g oil) for local and imported edible oils, respectively. The results highlight that all rancidity quality parameters of the locally made oil samples were not within the joint WHO/FAO standards whilst the imported oils showed a greater fatty acid saturation.

Prevalence of growth monitoring practice and its associated factors at public health facilities of North Gondar zone, northwest Ethiopia: an institution-based mixed study.

BACKGROUND: Growth monitoring is used to assess the growth rate of a child by periodic and frequent anthropometric measurements in comparison to a standard. However, since the practice has been poor in Ethiopia, this study aimed to assess it and its associated factors among health workers in North Gondar zone, northwest Ethiopia. METHODS: An institution-based mixed study was conducted from April 1 to May 7, 2017, among 500 health workers. The multistage sampling technique was used to select participants. A structured questionnaire was used to collect quantitative data, while non-participant observation and in-depth interviews were used to generate qualitative information. Qualitative data were coded, grouped, and discussed using the identified themes. A binary logistic regression was fitted, odds ratio with a 95% confidence interval was estimated to identify the predictors of growth monitoring practice, and qualitative data were analyzed using thematic analysis. RESULTS: Growth monitoring practice among health workers was 50.4% (95% CI: 45, 55). Work experience (AOR = 4.27, 95%CI: 1.70, 10.72), availability of growth monitoring materials (AOR = 1.52, 95%CI: 1.05, 2.20), attitude (AOR = 0.68, 95%CI: 0.47, 0.98), midwifery occupation (AOR = 0.42, 95%CI: 0.19, 0.94), and diploma level qualification (AOR = 2.20, 95%CI: 1.09, 4.45) were statistically significantly associated with growth monitoring practice. CONCLUSION: In this study, growth monitoring practice among health workers was lower than those of most studies. Jobs, educational status, work experience, attitude, and availability of materials were significantly associated with growth monitoring practices. Therefore, giving training to health extension and less experienced staff about growth monitoring, and providing growth monitoring equipment are important to improve health workers growth monitoring practices.

Knowledge and practice of health workers about control and prevention of multidrug-resistant tuberculosis in referral hospitals, Ethiopia: a cross-sectional study.

OBJECTIVE: The aim of this study was to assess the knowledge and practice of health workers about multidrug-resistant tuberculosis (MDR-TB) prevention and control. STUDY DESIGN AND SETTINGS: A cross-sectional study was conducted at Gondar University Referral Hospital and Felege Hiwot Referral Hospital. PARTICIPANTS: Randomly selected health workers (ie, medical doctor, nurse, health officer, pharmacy, medical laboratory and midwifery) were the study participants. OUTCOME MEASURES: The main outcomes were knowledge and self-reported practice of health workers about MDR-TB. RESULTS: A total of 377 health workers (with a response rate of 93.7%) participated in the study. The majority of respondents were nurses (52.5%, n=198) and medical doctors (15.6%, n=59). The mean knowledge score was seven out of 10; 149 (39.5%) of respondents scored seven or more which was considered as good knowledge. MDR-TB knowledge of health workers was significantly associated with having a postgraduate degree (adjusted odds ratio (AOR)=5.78; 95% CI 2.33 to 14.33), taking infection prevention training (AOR=1.79; 95% CI 1.00, to 3.17) and having a history of tuberculosis (TB) (AOR=1.85; 95% CI 1.12, to 3.03). The mean self-reported practice score was four out of seven; one-fifth (19.6%) of respondents scored four or more which was considered as good practice. Self-reported practice of health workers was significantly associated with working at internal medicine (AOR=4.64; 95% CI 1.99, to 10.81) and paediatrics (AOR=3.85; 95% CI 1.11, to 13.34) wards, being in the age groups of 26-30 years (AOR=2.70; 95% CI 1.27, to 5.76), and 30 years and above (AOR=4.42; 95% CI 1.77, to 11.00). CONCLUSIONS: This study found low knowledge and self-reported practice score among health workers. MDR-TB knowledge of health workers was significantly associated with educational status, infection prevention training and previous history of TB. This finding highlights the potential of providing MDR-TB training for health workers to increase their knowledge about MDR-TB.

The effect of SODIS water treatment intervention at the household level in reducing diarrheal incidence among children under 5 years of age: a cluster randomized controlled trial in Dabat district, northwest Ethiopia.

BACKGROUND: Solar Disinfection (SODIS) of water is an economical, user-friendly, and environmentally safe household water treatment method that has been advocated as a means of decreasing the burden of diarrhea among children under 5 years of age. Laboratory studies have consistently shown the efficacy of the SODIS method to destroy waterborne pathogens. However, the evidence-based health effect of a SODIS intervention at the household level is limited. The main aim of the study was to examine the effectiveness of a SODIS intervention in reducing the incidence of diarrhea among under-five children. METHODS: A community-based, cluster randomized controlled trial was conducted, over 6 months from 10 January to 7 July 2016, in 28 rural villages of northwest Ethiopia. In the intervention group, 384 children in 279 households received polyethylene terephthalate (PET) bottles, and in the control group 394 children in 289 households who continued to use their usual drinking-water sources were included in the trial. The study compared diarrheal incidence among the intervention group children who were exposed to SODIS household water treatment and the control group children who were not exposed to such water treatment. A generalized estimating equation (GEE) model was used to compute the adjusted incidence rate ratio and the corresponding 95% confidence interval. RESULTS: In this trial, the overall SODIS compliance was 90.6%. The incidence of diarrhea was 8.3 episodes/100 person-week observations in the intervention group compared to 15.3 episodes/100 person-week observations in the control group. A statistically significant reduction was observed in the incidence of diarrhea in the intervention group compared to the control (adjusted IRR 0.60 (95% CI 0.52, 0.70) with a corresponding prevention of 40% (95% CI: 34, 48). CONCLUSION: The SODIS intervention substantially reduced the incidence of diarrhea among under-five children in a rural community of northwest Ethiopia. This indicates that a SODIS intervention is an invaluable strategy that needs to be integrated with the National Health Extension Program to be addressed to rural communities. TRIAL REGISTRATION: Clinical Trial Registry India, ID: CTRI/2017/09/009640 . Registered retrospectively on 5 September 2017.

Acute malnutrition among children aged 6-59 months of the nomadic population in Hadaleala district, Afar region, northeast Ethiopia.

BACKGROUND: Acute malnutrition to be a major health burden in the world, particularly in the developing world. Acute malnutrition is associated with more than one third of the global disease burden for children. Malnourished children are physically, emotionally and intellectually less productive and suffer more from chronic illnesses and disabilities. The nature, magnitude and determinants of acute malnutrition are determined among the general populations; however, there is a lack of evidence in the nomadic communities. METHODS: A cross-sectional study was conducted to assess the magnitude and factors associated with acute malnutrition among children aged 6-59 months in Hadaleala district, Afar Region. A total of 591 under-five children were included in this study, and subjects were recruited by the multistage cluster sampling technique. Data were collected by a pre-tested questionnaire and a simple anthropometric index so called mid-upper arm circumference (MUAC). The multivariable binary logistic regression analysis was used to identify factors associated with acute malnutrition on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05. RESULTS: The prevalence of acute malnutrition was 11.8% (95% CI = 9.3, 14.8%). The highest prevalence (50%) of acute malnutrition occurred among children aged between 12.0-23.0 months. Childhood acute malnutrition was associated with the presence of two (AOR = 2.49, p < 0.05) and three (AOR = 12.87, p < 0.001) children in each household, unprotected drinking water sources (AOR = 3.78, p < 0.05), absence of the latrine (AOR = 5.24, p < 0.05), hand washing with soap (AOR = 0.21, p < 0.05), childhood diarrheal disease (AOR = 2.72, p < 0.05), and child vaccination (AOR = 0.15, p < 0.001). CONCLUSION: The prevalence of acute malnutrition among children aged 6-59 months was was higher than the national prevalence. The number of children in each household, drinking water sources, latrine availability, hand washing practice before food preparation and child feeding, childhood diarrheal disease, and child vaccination were identified as factors affecting the childhood acute malnutrition in the nomadic community. Protecting drinking water sources from possible contaminants, improving hand washing practices, utilization of latrine, preventing diarrheal diseases and vaccinating children integrated with the access of nutrition education is important to improve nutrition of children of the nomadic people.