Assessment of composition and generation rate of healthcare wastes in selected public and private hospitals of Ethiopia.

In many developing countries, the inadequacy of data regarding the quantity and composition of healthcare waste is one of the major reasons for improper healthcare waste management. We investigated the generation rate and composition of healthcare wastes in six public and three private hospitals. We conducted healthcare waste composition and characterization measurements for seven consecutive days in the selected hospitals following the protocol described by the World Health Organization (WHO). The results revealed that the total generation rate of healthcare wastes of hospitals ranged from 0.25 to 2.77 kg/bed/day with a median value of 1.67 kg/bed/day for inpatients to 0.21-0.65 in kg/patient/day with a median value of 0.31 kg/patient/day for outpatients. The waste generation rate in private hospitals (median 3.9 kg/bed/day) was significantly greater (Kruskal-Wallis test, P < 0.05) than in government hospitals (median 1.5 kg/bed/day). The median values of percent hazardous waste estimated for private and government hospitals were 63.4% and 52.2%, respectively. These figures are about three times greater than the threshold values recommended by the WHO. This situation might be attributed to the improper practice of healthcare waste segregation by health professionals and auxiliary health workers due to inadequate risk perception and lack of enforced public health regulations. The study revealed that the generation rate and proportion of hazardous waste significantly varies between public and private hospitals and number of patients treated per day.

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.

Malaria and water resource development: the case of Gilgel-Gibe hydroelectric dam in Ethiopia.

BACKGROUND: Ethiopia plans to increase its electricity power supply by five-fold over the next five years to fulfill the needs of its people and support the economic growth based on large hydropower dams. Building large dams for hydropower generation may increase the transmission of malaria since they transform ecosystems and create new vector breeding habitats. The aim of this study was to assess the effects of Gilgel-Gibe hydroelectric dam in Ethiopia on malaria transmission and changing levels of prevalence in children. METHODS: A cross-sectional, community-based study was carried out between October and December 2005 in Jimma Zone, south-western Ethiopia, among children under 10 years of age living in three 'at-risk' villages (within 3 km from dam) and three 'control' villages (5 to 8 km from dam). The man-made Gilgel-Gibe dam is operating since 2004. Households with children less than 10 years of age were selected and children from the selected households were sampled from all the six villages. This included 1,081 children from 'at-risk' villages and 774 children from 'control' villages. Blood samples collected from children using finger prick were examined microscopically to determine malaria prevalence, density of parasitaemia and identify malarial parasite species. RESULTS: Overall 1,855 children (905 girls and 950 boys) were surveyed. A total of 194 (10.5%) children were positive for malaria, of which, 117 (60.3%) for Plasmodium vivax, 76 (39.2%) for Plasmodium falciparum and one (0.5%) for both P. vivax and P. falciparum. A multivariate design-based analysis indicated that, while controlling for age, sex and time of data collection, children who resided in 'at-risk' villages close to the dam were more likely to have P. vivax infection than children who resided farther away (odds ratio (OR) = 1.63, 95% CI = 1.15, 2.32) and showed a higher OR to have P. falciparum infection than children who resided in 'control' villages, but this was not significant (OR = 2.40, 95% CI = 0.84, 6.88). A classification tree revealed insights in the importance of the dam as a risk factor for malaria. Assuming that the relationship between the dam and malaria is causal, 43% of the malaria occurring in children was due to living in close proximity to the dam. CONCLUSION: This study indicates that children living in close proximity to a man-made reservoir in Ethiopia are at higher risk of malaria compared to those living farther away. It is recommended that sound prevention and control programme be designed and implemented around the reservoir to reduce the prevalence of malaria. In this respect, in localities near large dams, health impact assessment through periodic survey of potential vectors and periodic medical screening is warranted. Moreover, strategies to mitigate predicted negative health outcomes should be integral parts in the preparation, construction and operational phases of future water resource development and management projects.

Urban impact on ecological integrity of nearby rivers in developing countries: the Borkena River in highland Ethiopia.

Accelerated pollution and eutrophication of rivers and streams because of human activity are a concern throughout the world and severe in Africa where Ethiopia is case in point. The objective of this study was to assess the urban impact on the ecological integrity of the Borkena River at the eastern escarpment of the central Ethiopian highlands. The water quality status and macroinvertebrate distribution and diversity of the river were assessed during the dry and wet seasons. Diversity indices revealed that a severe decline in the ecological integrity of the Borkena River downstream of Dessie and within Kombolcha towns in terms of macroinvertebrate abundance and composition. Clustering and ordination analysis clearly separated reference sites from urban impacted sites. At the urban-impacted sites, dissolved oxygen was also depleted to 0.5 mg/l and BOD5 values were reached to a level of above 1,000 mg/l, with extremely low biological diversity of pollution-sensitive taxa. These patterns are the result of a combination of rampant dumping of untreated wastes exacerbated by geologic, topographic, climatic and land use factors.

Assessment of siltation and nutrient enrichment of Gilgel Gibe dam, Southwest Ethiopia.

Gilgel Gibe hydroelectric power dam was located in the submerging part of the Addis Ababa, Jimma highway in Ethiopia which is about 55 km far from Jimma was constructed in 2004. A cross-sectional study was conducted during 2005 to assess the siltation and nutrient enrichment level of the dam. It was found from the study that siltation and nutrient enrichment were the major problems in this reservoir. The sheet erosion of catchment area was found to be 4.47x10(7) ton/year and hence 2210 ton/km(2). The contribution of the sediment load deposition of the Gilgel Gibe River to the dam was 277,437 ton/year and the total sediment load was 4.50x10(7)ton/year and this amount could cover 3.75x10(7) m(3)/year of the dam. From the analysis of water samples of Gilgel Gibe dam, the concentrations of ammonia, chlorophyll a, total dissolved solids (TDS), dissolved oxygen (DO), biological oxygen demand (BOD), pH and temperature were found within the permissible limits as prescribed by WHO standards, but other parameters like phosphate, nitrate, sulphate, total solids (TS), total suspended solids (TSS) and visibility were much higher than the permissible limits. Due to the high concentration of suspended and sediment load, the secchi disc visibility of Gilgel Gibe dam was 0.72 m which indicated that it was well within the range of eutrophic lakes.

Solar disinfection: an approach for low-cost household water treatment technology in Southwestern Ethiopia.

Disinfection of contaminated water using solar radiation (SODIS) is known to inactivate bacteria. Its inactivation efficiency depends on local conditions where the disinfection is made. This study was aiming to test the efficiency of solar disinfection using different water parameters as low-cost household water treatment technology. Inactivation of microbes was tested using fecal coliform as test organism. The SODIS experiment was carried out at turbidity 2NTU, pH 7, and various water temperature (38.1°C, 41.8°C, 45.6°Cand 51.1°C) and solar intensities, using clear and black plastic bottles filled to different depths. The results show that the rate of microbial inactivation in relation to depth of water, turbidity, container type, intensity of light and color of container was statistically significant (p < 0.05). However, bottle placement, exposure and water pH were unrelated to microbial inactivation. Bacterial re-growth was not observed after solar disinfection. By adjusting the parameters, complete and irreversible fecal coliform inactivation was achieved within an exposure time of less than four hours in the areas where the solar irradiance is about 3.99 kW/m2 and above. Our results indicate that application of SODIS could play a significant role in the provision of safe water in rural communities of developing countries where there is ample sunshine, specifically in sub-Saharan African countries.

Physico-chemical and biological characterization of anopheline mosquito larval habitats (Diptera: Culicidae): implications for malaria control.

BACKGROUND: A fundamental understanding of the spatial distribution and ecology of mosquito larvae is essential for effective vector control intervention strategies. In this study, data-driven decision tree models, generalized linear models and ordination analysis were used to identify the most important biotic and abiotic factors that affect the occurrence and abundance of mosquito larvae in Southwest Ethiopia. METHODS: In total, 220 samples were taken at 180 sampling locations during the years 2010 and 2012. Sampling sites were characterized based on physical, chemical and biological attributes. The predictive performance of decision tree models was evaluated based on correctly classified instances (CCI), Cohen's kappa statistic (κ) and the determination coefficient (R2). A conditional analysis was performed on the regression tree models to test the relation between key environmental and biological parameters and the abundance of mosquito larvae. RESULTS: The decision tree model developed for anopheline larvae showed a good model performance (CCI = 84 ± 2%, and κ = 0.66 ± 0.04), indicating that the genus has clear habitat requirements. Anopheline mosquito larvae showed a widespread distribution and especially occurred in small human-made aquatic habitats. Water temperature, canopy cover, emergent vegetation cover, and presence of predators and competitors were found to be the main variables determining the abundance and distribution of anopheline larvae. In contrast, anopheline mosquito larvae were found to be less prominently present in permanent larval habitats. This could be attributed to the high abundance and diversity of natural predators and competitors suppressing the mosquito population densities. CONCLUSIONS: The findings of this study suggest that targeting smaller human-made aquatic habitats could result in effective larval control of anopheline mosquitoes in the study area. Controlling the occurrence of mosquito larvae via drainage of permanent wetlands may not be a good management strategy as it negatively affects the occurrence and abundance of mosquito predators and competitors and promotes an increase in anopheline population densities.

High load of multi-drug resistant nosocomial neonatal pathogens carried by cockroaches in a neonatal intensive care unit at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia.

BACKGROUND: Cockroaches have been described as potential vectors for various pathogens for decades; although studies from neonatal intensive care units are scarce. This study assessed the vector potential of cockroaches (identified as Blatella germanica) in a neonatal intensive care unit setup in Tikur Anbessa Hospital, Addis Ababa, Ethiopia. METHODS: A total of 400 Blatella germanica roaches were aseptically collected for five consecutive months. Standard laboratory procedures were used to process the samples. RESULTS: From the external and gut homogenates, Klebsiella oxytoca, Klebsiella pneumoniae, Citrobacter spp. Enterobacter cloacae, Citrobacter diversus, Pseudomonas aeruginosa, Providencia rettgeri, Klebsiella ozaenae, Enterobacter aeruginosa, Salmonella C1, Non Group A streptococcus, Staphylococcus aureus, Escherichia coli, Acinetobacter spp. and Shigella flexneri were isolated. Multi-drug resistance was seen in all organisms. Resistance to up to all the 12 antimicrobials tested was observed in different pathogens. CONCLUSION: Cockroaches could play a vector role for nosocomial infections in a neonatal intensive care unit and environmental control measures of these vectors is required to reduce the risk of infection. A high level of drug resistance pattern of the isolated pathogens was demonstrated.