Prevalence of diarrheal diseases among schools with and without water, sanitation and hygiene programs in rural communities of north-eastern Ethiopia: a comparative cross-sectional study.

INTRODUCTION: Diarrheal diseases are a significant cause of morbidity among school-aged children due to inadequate sanitation, lack of access to potable water and poor hygiene practices. Although the incidence of these illnesses can be reduced through improved water quality and the introduction of sanitation and hygiene programs in schools, there is limited evidence to demonstrate the impact of interventions in schools in Ethiopia. The purpose of this study was to compare the prevalence and associated factors of diarrheal diseases in school-aged children between schools in Habru District, north-eastern Ethiopia that adopted water, sanitation and hygiene (WASH) interventions and those that did not. METHODS: A comparative cross-sectional study was conducted among 640 randomly selected school children (160 from schools that adopted WASH interventions and 480 from schools that did not). Trained data collectors used a pre-tested structured questionnaire and an observational checklist to collect the data. Descriptive statistics, such as frequencies and percentages, were computed to present the prevalence of diarrheal disease. Bivariate and multivariate logistic regression analyses were used to identify factors associated with diarrheal disease. RESULTS: The overall 2-week prevalence of diarrhea among school children was 30.5%. In WASH-implementing schools, the prevalence was 21.9%, significantly lower than in non-WASH-implementing schools (33.3%). In non-WASH-implementing schools, the odds of diarrheal diseases among students were significantly decreased in those students who used a clean school latrine, self-reported latrine utilization at home and were aware of the causes of diarrhea. Similarly, among students in WASH-implementing schools, self-reported latrine utilization at home, personal hygiene inspection and awareness of the causes of diarrhea were factors associated with decreasing odds of diarrhea occurrence. CONCLUSION: This study identified a high prevalence of a diarrheal disease among children in schools with no WASH interventions compared with schools that do have WASH interventions. This provides strong evidence for strengthening WASH programs in all rural schools to reduce the burden of diarrheal diseases.

Assessment of knowledge and practices of healthcare workers towards infection prevention and associated factors in healthcare facilities of West Arsi District, Southeast Ethiopia: a facility-based cross-sectional study.

BACKGROUND: The prevention of healthcare associated infections is central to the provision of safe, high quality healthcare. Infections acquired in healthcare facilities are a major public health concern, contributing to increased morbidity, mortality, and cost in both developed and developing countries. Although most of these infections can be prevented with relatively inexpensive infection prevention and control measures in many developing countries, in sub-Saharan African healthcare facilities have no effective infection prevention programs. Additionally, there is limited information on healthcare worker infection prevention knowledge and practice in countries such as Ethiopia. The aim of this study was to assess the knowledge and practices of healthcare workers with respect to infection prevention and associated factors in healthcare facilities in southeast Ethiopia. METHODS: A facility-based cross-sectional study design was used to study healthcare workers in the southeast, Ethiopia. Multi-stage sampling was employed to select 680 healthcare workers from 30 randomly selected healthcare facilities. Data was collected using a self-administered structured questionnaire. Descriptive statistics were computed. Multivariable logistic regression was performed to identify factors associated with healthcare workers infection prevention knowledge and practice. RESULTS: A total of 648 healthcare workers participated in this study, for a response rate of 95.3%. Of these, 53.7% (95% CI: 49.8, 57.4%) and 36.3% (95% CI: 32.4, 40.1%) of the respondents were assessed as knowledgeable and reported safe infection prevention practices respectively. The likelihood of self-reporting safe infection prevention practice significantly increased if healthcare workers had received training (AOR = 5.31; 95% CI: 2.42,11.63) and had infection prevention guidelines available (AOR = 3.34; 95% CI: 1.65, 6.76). Healthcare workers were more likely to have infection prevention knowledge if they worked longer ten years or more (AOR = 3.41; 95% CI: 1.22, 9.55); worked in facilities with infection prevention committees (AOR = 1.78; 95% CI: 1.01, 3.13), had infection prevention guidelines available (AOR = 2.44; 95% CI: 1.45, 4.12); had training (AOR = 5.02; 95% CI: 1.45, 8.59). CONCLUSIONS: Inadequate infection prevention knowledge and unsafe practices were frequent among study participants, reflecting a potentially common problem at public healthcare facilities in southeast Ethiopia. Healthcare workers have better knowledge and safer practices if they had received infection prevention training and had infection prevention guidelines in their workplace. Interventions should be designed to consider these identified factors.