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Asgedom AA, Abirha BT, Tesfay AG, Gebreyowhannes KK, Abraha HB, Hailu GB, Abrha MB, Tsadik M, Gebrehiwet TG, Gebreyesus A, Desalew T, Alemayehu Y, Mulugeta A. Unimproved water and sanitation contributes to childhood diarrhoea during the war in Tigray, Ethiopia: a community based assessment. Sci Rep 2023; 13:7800. [PMID: 37179380 PMCID: PMC10182988 DOI: 10.1038/s41598-023-35026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/11/2023] [Indexed: 05/15/2023] Open
Abstract
Access to water, sanitation, and hygiene (WASH) is a global public health problem. The situation is worst in conflict areas, where people are displaced from their usual homes. Household supply of WASH and the incidence of diarrhoeal disease among children during the war in Tigray are not known or documented. The objective of this study was to investigate the sources of drinking water, sanitation and hygiene practices, and the incidence of diarrhoeal diseases among children during the war in Tigray, Ethiopia. A cross-sectional study was conducted to collect data on selected WASH indicators in six zones of Tigray from August 4-20, 2021. Data were collected from a total of 4381 sample households selected by lottery. Descriptive analysis was performed and the analysed data are presented in tables, figures and explanatory notes. Binary logistic regression was performed to examine the relationship between independent and dependent variables. A total of 4381 households from 52 woredas participated in the study. Approximately 67.7% of the study participants reported that they relied on an improved source of drinking water during the war. Coverage of sanitation, hand washing, and menstrual hygiene during the war was reported as 43.9%, 14.5%, and 22.1%, respectively. The prevalence of diarrhoeal diseases among children was 25.5% during the war. Water source, latrine type, solid waste disposal and health extension worker visits were the significant predictors of the likelihood of diarrhoea in children (p < 0.05). The results of the study show that a decrease in services from WASH is associated with a higher prevalence of diarrhoeal disease among children during the war in Tigray. To prevent the high prevalence of diarrhoeal disease among children in war-torn Tigray, Ethiopia, improved access to water and sanitation is recommended. In addition, collaborative efforts are needed to engage health extension workers to provide appropriate promotion and prevention services to war-affected communities in Tigray, Ethiopia. Further comprehensive surveys of households with children over one year of age are recommended to assess access to WASH and the burden of WASH associated diseases.
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Affiliation(s)
- Akeza Awealom Asgedom
- Department of Environmental Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | | | - Askual Girmay Tesfay
- Department of Hygiene and Environmental Health, Tigray Health Bureau, Mekelle, Ethiopia
| | | | | | - Gessessew Bugssa Hailu
- Department of Medical Parasitology and Entomology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mesele Bahre Abrha
- Department of Environmental Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mache Tsadik
- Department of Reproductive Health, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Aregawi Gebreyesus
- Department of Epidemiology, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tilahun Desalew
- OXFAM Emergency Response - Tigray Field Office, Mekelle, Ethiopia
| | | | - Afework Mulugeta
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Karambizi NU, McMahan CS, Blue CN, Temesvari LA. Global estimated Disability-Adjusted Life-Years (DALYs) of diarrheal diseases: A systematic analysis of data from 28 years of the global burden of disease study. PLoS One 2021; 16:e0259077. [PMID: 34705878 PMCID: PMC8550424 DOI: 10.1371/journal.pone.0259077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 10/12/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Diarrheal disease (DD)-associated mortality has declined since 1990; however, the incidence of DD has experienced a less-pronounced decrease. Thus, it is important to track progress in managing DD by following loss of healthy years. A disability-adjusted life-year (DALY), which combines data on years-of-life lost (YLL) and years-lived with-disability (YLD), is a metric that can track such a burden. METHODS AND FINDINGS Using all 28 years of data in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we compared DD DALYs among different demographic subsets including sex, age, country, and World Bank (WB) income level. We also evaluated DD DALYs as a function of the socio-demographic index (SDI), a measure of a region's socio-demographic development. On a global level, DD DALYs have decreased by approximately 85.43% from 1990 to 2017. Incidence and prevalence have decreased by 1.53% and 4.45%, respectively. A dramatic decrease in DD DALYs were observed for WB low-income countries, but not for WB high-income constituents. The temporal decrease in DD DALY rates in WB low-income countries was likely driven by a decrease in YLL. Alternatively, temporal increases in both YLL and YLD may have contributed to the apparent lack of progress in WB high-income countries. Regardless of WB income classification, children under the age of five and the elderly were the most vulnerable to DD. In nearly every year from 1990 to 2017, DD DALYs for females were higher than those for males in WB high-income regions, but lower than those for males in WB low-income constituents. The reason for these differences is not known. We also observed that the rate of DD DALYs was highly correlated to SDI regardless of WB income classification. CONCLUSIONS To the best of our knowledge, this is the only temporal study of DD DALYs that encompasses all 28 years of data available from the GBD. Overall, our analyses show that temporal reductions in DD DALYs are not equivalent across regions, sexes and age groups. Therefore, careful attention to local and demography-specific risk factors will be necessary to tailor solutions in region- and demography-specific manners.
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Affiliation(s)
- Natacha U. Karambizi
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, United States of America
- Eukaryotic Pathogens Innovations Center (EPIC), Clemson University, Clemson, South Carolina, United States of America
| | - Christopher S. McMahan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Carl N. Blue
- Department of Graphic Communications, Clemson University, Clemson, South Carolina, United States of America
| | - Lesly A. Temesvari
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, United States of America
- Eukaryotic Pathogens Innovations Center (EPIC), Clemson University, Clemson, South Carolina, United States of America
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Makali SL, Malembaka EB, Lambert AS, Karemere HB, Eboma CM, Mwembo AT, Ssali SB, Balaluka GB, Donnen P, Macq J. Comparative analysis of the health status of the population in six health zones in South Kivu: a cross-sectional population study using the WHODAS. Confl Health 2021; 15:52. [PMID: 34215304 PMCID: PMC8254209 DOI: 10.1186/s13031-021-00387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population's health. Most research in public health explores measures that focus on a specific health problem rather than overall population health status. The aim of this study was to assess the health status of the population and its predictors in conflict settings of South Kivu province, using the World Health Organization Disability Assessment Schedule (WHODAS). METHODS Between May and June 2019, we conducted a community-based cross-sectional survey among 1440 adults in six health zones (HZ), classified according to their level of armed conflict intensity and chronicity in four types (accessible and stable, remote and stable, intermediate and unstable). The data were collected by a questionnaire including socio-demographic data and the WHODAS 2.0 tool with 12 items. The main variable of the study was the WHODAS summary score measuring individual's health status and synthesize in six domains of disability (household, cognitive, mobility, self-care, social and society). Univariate analysis, correlation and comparison tests as well as hierarchical multiple linear regression were performed. RESULTS The median WHODAS score in the accessible and stable (AS), remote and stable (RS), intermediate (I) and unstable (U) HZ was 6.3 (0-28.6); 25 (6.3-41.7); 22.9 (12.5-33.3) and 39.6 (22.9-54.2), respectively. Four of the six WHODAS domain scores (household, cognitive, mobility and society) were the most altered in the UHZs. The RSHZ and IHZ had statistically comparable global WHODAS scores. The stable HZs (accessible and remote) had statistically lower scores than the UHZ on all items. In regression analysis, the factors significantly associated with an overall poor health status (or higher WHODAS score) were advanced age, being woman, being membership of an association; being divorced, separated or widower and living in an unstable HZ. CONCLUSIONS Armed conflicts have a significantly negative impact on people's perceived health, particularly in crisis health zones. In this area, we must accentuate actions aiming to strengthen people's psychosocial well-being.
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Affiliation(s)
- Samuel Lwamushi Makali
- Ecole Régionale de Santé Publique, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.
- Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of Congo.
| | - Espoir Bwenge Malembaka
- Ecole Régionale de Santé Publique, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Anne-Sophie Lambert
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
| | - Hermès Bimana Karemere
- Ecole Régionale de Santé Publique, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Christian Molima Eboma
- Ecole Régionale de Santé Publique, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Albert Tambwe Mwembo
- Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | | | - Ghislain Bisimwa Balaluka
- Ecole Régionale de Santé Publique, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Phillippe Donnen
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Macq
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
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