Multiscalar Evaluation of the Water Distribution System and Diarrheal Disease Risk in Addis Ababa, Ethiopia.

Despite growing urbanization, our understanding of the impacts of water and sanitation on human health has largely come from studies in rural sectors. To this end, we collected data at both regional (water quality measures from water treatment systems) and community (cross-sectional surveys) scales to examine determinants of enteric pathogen infection and diarrheal disease among infants in Addis Ababa, Ethiopia. Regionally, the Legedadi water treatment plant had significantly lower heterotrophic plate counts, total coliform counts, and fecal coliform counts compared with the Gefersa water treatment plant. The number of pathogen types in infant stool also differed by plant. Decreases in chlorine levels and increases in the relative abundance of Gammaproteobacteria with distance from treatment plants suggest a compromised water distribution system. In communities, infants in households that obtained water from yard pipes or public taps had significantly lower odds of diarrhea compared to households that had water piped into their dwellings (OR = 0.35, 95% CI 0.16, 0.76, and OR = 0.39, 95% CI 0.15, 1.00, respectively). Similarly, infants in households that boiled or filtered water had significantly lower odds of diarrhea compared to households that did not treat water (OR = 0.40, 95% CI 0.19, 0.86 and OR = 0.23, 95% CI 0.06, 0.84, respectively). Integrating multiscalar data better informs the health impacts of water in urban settings.

Etiologies of diarrhea and drug susceptibility patterns of bacterial isolates among under-five year children in refugee camps in Gambella Region, Ethiopia: a case control study.

BACKGROUND: Despite substantial global effort and updated clinical management guidelines, diarrhea continues to be among leading worldwide causes of morbidity and mortality in children. Infectious diarrhea, the most common form of diarrhea causes substantial morbidity and mortality among children in developing countries, and the muddled use of antibiotics needs caution due to potential problems of drug-resistance. The aim of this study is to identify etiologies of diarrhea and drug susceptibility patterns of bacterial isolates in under-five children in refugee camps in Gambella Region, Ethiopia. METHODS: An institution- based matched case control study was conducted using a questionnaire-based interview from June to December 2017 in Pugnido and Teirkidi refugee camps. Stool samples were collected and parasites causing diarrhea were identified by wet mount microscopy. Conventional culture supplemented with API 20E identification kit was used to identify Salmonella and Shigella species. Antibiotic susceptibility of bacterial isolates was investigated by using the disk diffusion method. The association between etiologies and diarrhea was analyzed using McNemar test or Fisher exact test with 95% confidence interval at a level of significance of P < 0.05. RESULTS: The overall prevalence of enteric pathogens were 55 (41.0%) in diarrhea cases and 18 (13.4%) in healthy controls. The detected etiologies include Giardia lambia (28), Shigella spp. (16), E. hystolyotica/dispar (13), Ascaris lumbricoides (10), Salmonella spp. (6), Cryptosporidium parvum (6), Hymenolepis nana (4) and Isospora belli (3). All isolates were sensitive to kanamycine and ceftazidime. The high resistance rate was observed against ampicillin (100%), amoxicillin (100%), erythromycin (52%), chloramphenicol (47.5%), tetracycline (40.5%), cotrimoxazole (34.8%) and amoxicillin-clavulanic acid (33%). The majorities of the isolates had a low rate of resistance to ciprofloxacin (8.7%), naldxic acid (8.7%) and amikacin (13%). CONCLUSIONS: Giardia lamblia, E. Hystolytica/dispar, and Shigella spp are the common etiologies of diarrhea in children in the studied refugee camps. The study also showed that significant numbers of bacterial isolates were resistant to the commonly used antimicrobial drugs. Therefore, improving clinical laboratory services and promoting evidence-based drug prescription may reinforce proper use of antibiotics and reduce the emergence of microbial resistance.

Consistent point-of-use water chlorination among households using unimproved water sources and treatment preference in Eastern Ethiopia.

A consistent and correct use of water treatment options is fundamental for health gain from point-of-use water chlorination. In Ethiopia, empirical evidence about the consistent use and preference for by end users is scarce. The current study is intended to explore these issues using Waterguard and Bishan Gari in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia. Data were collected every 2 week for 4 months and analyzed using mixed effects logistic regression. Of 377 households, 31% consistently used Waterguard and Bishan Gari in all the study waves. Product use over time within a household varied based on the perception about the products and the type of products each household received. From the exit assessment, 56% of households stated a preference for Waterguard significantly different from 5.6% of households that stated a preference for Bishan Gari. An intervention for consistent use beyond their availability and accessibility to end users is needed.

Appropriate household water treatment methods in Ethiopia: household use and associated factors based on 2005, 2011, and 2016 EDHS data.

BACKGROUND: Diarrheal disease attributable to water and sanitation can be prevented using point-of-use water treatment. In Ethiopia, a small number of households treat water at point-of-use with appropriate methods. However, evidence on factors associated with household use of these treatment methods is scarce. Therefore, this study is intended to explore the household use of appropriate point-of-use water treatment and associated factors in Ethiopia. METHODS: The data of 2005, 2011, and 2016 Ethiopian demographic and health surveys were used for analysis. Households reportedly treating water with bleach, boiling, filtration, and solar disinfection in each survey are considered as treating with appropriate treatment methods. Household water treatment with these treatment methods and factors associated was assessed using bivariate and multivariable regression. In addition, a region level difference in the treatment use was assessed by using multilevel modeling. RESULTS: The number of households that reported treating water with appropriate water treatment methods was 3.0%, 8.2%, and 6.5% respectively in 2005, 2011, and 2016. Household heads with higher education had 5.99 (95% CI = 3.48, 10.33), 3.61 (95% CI = 2.56, 5.07), and 3.43 (95% CI = 2.19, 6.37) times higher odds of using the treatment methods respectively in 2005, 2011, and 2016 compared to household heads who had no education. There was a significantly high number of households that used appropriate water treatment methods in 2011 (AOR = 2.78, 95% CI = 2.16, 3.57) and 2016 (AOR = 2.18, 95% CI = 1.64, 3.89) compared to 2005 data. In pooled data analysis, the reported use of the treatment methods is associated with household head education, residency, drinking water sources, and owning radio and television. From a multilevel modeling, within-region variation is higher than between-region variations in the use of treatment methods in each survey. CONCLUSIONS: Below 10% of households reportedly treating water at point-of-use in each survey attributable to different factors. Designing intervention strategies for wide-scale use of treatment methods at the country level is fundamental.

Vulnerability Assessment and Protection Zone Delineation for Water Supply Schemes in the Upper Awash Subbasin, Ethiopia, Sub-Saharan Africa.

Water quality issues in Ethiopia necessitate the implementation of the Water Safety Plan (WSP) to safeguard drinking water. Despite its benefits, WSP implementation is underutilized, a situation exacerbated by urbanization, agriculture, pollution, and climate change. This study evaluated water supply system vulnerability and delineated protection zones in the Upper Awash River subbasin. By employing the DRASTIC model, the National WASH Inventory-2 (NWI-2), and qualitative methods, this research aims to integrate the NWI-2 with vulnerability assessments. The study revealed that, among 2864 schemes, only 14.4% had a water safety plan, while 20.7% practiced water safety, and 6% reported the occurrence of waterborne diseases. Over 39.23% of the schemes were in high vulnerability areas, 12.32% were in very high vulnerability areas, and only 8% were in low vulnerability areas. The validation revealed a 61.7% association between the vulnerability indices and nitrate concentration. The strengths of the strategy included coordination and guideline development, but challenges such as institutionalization, catchment protection, the legal framework, and climate information remain for the Water Safety Plan. To promote public health, these findings help to demonstrate and integrate the NWI-2 with vulnerability assessments to protect drinking water sources. The conclusion also calls for all concerned authorities to implement water source protection, emphasizing the use of GIS technology and the adoption of integrated watershed management practices, which encompass regulatory control and conservation strategies. Furthermore, more research on the pollutant time of travel, assimilation capacity, and land use priorities is needed to delineate specific protection zones.

Public health risks associated with drinking water consumption in the upper Awash River sub-basin, Ethiopia, sub-Saharan Africa.

The Upper Awash sub-basin characterized by urban, industrial, agricultural and population growth, has impacted the quality of its water sources. This study focuses on the assessment of public health risks associated with drinking water sources in the sub-basin. In accordance with WHO guidelines, 120 water samples were collected from 60 water supply schemes in dry and wet seasons located in areas with low and high water pollution risk (WPR). Multi-meter, Photometer, Digital Arsenator, and Microbiological test kit measured the concentration of parameters. The assessment uses methods of hazard identification, exposure and dose-response analysis, and risk characterization, including Hazard Quotient (HQ), Cancer Risk (CR), Hazard Index (HI), and probability of infection. Monte Carlo simulation analyzes non-cancer risks from Nitrite, Nitrate, Chromium, Iron, Fluoride, and Arsenic, and CRs from Chromium and Arsenic, and infection risks from Escherichia coli (E.coli). As a result, the Hazard Quotient (HQ) of Nitrate was beyond unity (HQ > 1) in the dry season for all groups. HQ of Chromium was HQ > 1 for Women (1.1E+00) and Children (1.4E+00) in the wet season in the high WPR area. Chromium HQ > 1 for children (1.4E+00) in the wet season and Fluoride (HQ > 1) for Children (3.2E+00) in the dry season in the low WPR area. Arsenic CR was above 1 in 10,000 persons for children in the dry season, for all groups, and for women and children in the wet season in the high WPR areas. The CR of chromium ranged from 1 in 1000 persons, which is beyond the limit. Moreover, the Hazard Index (HI) was higher than the unity (HI > 1) for most cases. All E coli infection risks daily and annually exceeded the acceptable risks. Therefore, Public health concerns in the Sub-basin were quantified, and evidences were generated for risk management to undertake source protection through integrated watershed management and appropriate water treatment technologies.

Assessment of native plants for their potential to remove trace metals around Legadembi tailings dam, Southern Ethiopia.

Native plant species growing on metal contaminated soil at the foot of the Legadembi tailings dam were selected to evaluate their phytoremediation potential. For this purpose, soil, aboveground tissues, and roots of plant samples were analyzed for the concentrations of Zn, Cu, Ni, Pb, and Cd. The bioaccumulation and transfer of metals were evaluated in terms of translocation factor (TF), bioconcentration factor (BCF), and biological accumulation coefficient (BAC). The results showed that most of the species were efficient to take up and translocate more than one trace element (TE) from roots to shoots. Argemone mexicana L., Rumex nepalensis Spreng., Cyperus alopecuroides Rottb., and Schoenoplectu sconfusus (N.E.Br.) Lye showed potential for phytoextraction of Cu, while R. nepalensis and C. alopecuroides can accumulate in their above-ground parts and are suitable for phytoextraction of Ni. Rumex nepalensis, C. alopecuroides, and Typha latifolia L. have the ability for phytostabilization of Zn metal. Findings suggest concentrations of some metals in plants' tissue showed above the normal range which suggests their potential use in phytoremediation.

Risk factors for acute childhood diarrhea: A cross-sectional study comparing refugee camps and host communities in Gambella Region, Ethiopia.

BACKGROUND: Diarrhea is one of the most common causes of child morbidity and mortality in refugee camps, aggravated by inadequate water, sanitation and hygiene services, and malnutrition, particularly in developing countries. METHODOLOGY: A comparative cross-sectional study was conducted to assess acute diarrhea and associated risk factors among under-five children in refugee and host communities in Gambella Region, Ethiopia. Descriptive statistics were used, and bivariate and multivariate logistic regressions were performed to identify variables associated with diarrhea. RESULTS: A total of 1667 under-five children was included in this study, and prevalence of diarrhea differed between the refugee (38%) and host (33%) communities [OR = 1.37, 95% CI 1.04, 1.8]. Refugee camp households using uncovered water containers, consuming low quantities of water, and lacking hand washing setups were more likely to report children with diarrhea. Within host communities, households were more likely to report acute childhood diarrhea if they consumed surface water or did not have a latrine. CONCLUSION: The two-week prevalence of diarrhea was significantly higher among children in the refugee camps than those in the host communities. Therefore, further collaboration between government and non-government organizations is required to identify persisting factors of diarrhea transmission in various communities in the region.

Caregivers' knowledge and attitudes about childhood diarrhea among refugee and host communities in Gambella Region, Ethiopia.

BACKGROUND: Maternal knowledge, attitudes, and practices related to hygiene, breastfeeding, sanitary food preparation, and appropriate weaning practices are potentially important determinants in the occurrence of diarrhea in children. However, few studies have been carried out about the knowledge and attitudes about childhood diarrhea among parents in refugee camps and host communities. OBJECTIVE: This study aims at assessing the caregivers' knowledge and attitudes regarding acute diarrhea in under-five children among refugee and host communities in Gambella Region, Ethiopia. METHODOLOGY: This cross-sectional study, employing multistage sampling, was carried out from September to December 2016. Data was collected by a questionnaire-based interview, and 1667 caregivers were included in this study. A composite knowledge score was calculated, and a five-point Likert type of attitude scale was developed to assess the attitudes of the caregivers towards childhood diarrhea. Appropriate descriptive statistics and logistic regression models were used. Odds ratios (ORs) are presented with their 95% confidence intervals (CIs), and all analyses were performed at the 5% significance level (p < 0.05). RESULT: The study indicates that 633 (28.0%) of the caregivers had poor knowledge, while 393 (23.6%) of them had unfavorable attitudes towards childhood diarrhea. Knowledge of the caregivers was significantly associated with formal education (AOR, 1.3; 95% CI, 1.03-1.5) and health information obtained from a health care institution (AOR, 1.8; 95% CI, 1.28-2.3). Caregivers' knowledge is a single predictor of their attitude (p < 0.001), and Pearson's correlation coefficient revealed that there was a significant positive correlation (r = 0.2, p < 0.001) between knowledge and attitude scores. CONCLUSION: The study indicates that significant numbers of caregivers had inadequate knowledge and unfavorable attitudes about diarrhea in under-five children. Designing and implementing an inclusive health education intervention focusing on uneducated child caregivers may be beneficial for improving knowledge and attitudes towards reducing the incidence of acute childhood diarrhea in the region.