Prediction of Low Community Sanitation Coverage Using Environmental and Sociodemographic Factors in Amhara Region, Ethiopia

Assessing the Sustainability of an Integrated Rural Sanitation and Hygiene Approach: A Repeated Cross-Sectional Evaluation in 10 Countries

An evaluation of area-wide sanitation interventions in 10 countries found that 6 of the 12 program areas had sustained similar levels of basic sanitation 1–2 years post-implementation, with varying levels of slippage in the other program areas.

Introduction:

While many studies have implemented programs to increase sanitation coverage throughout the world, there are limited rigorous studies on the sustainability of these sanitation programs.

Methods:

Between 2014 and 2018, the rural Sustainable Sanitation and Hygiene for All (SSH4A) approach was implemented by SNV in sub-Saharan Africa and Asia. Repeated cross-sectional household surveys were administered annually throughout program implementation and 1 to 2 years following completion of program activities. We characterize to what extent sanitation coverage was sustained 1 to 2 years after implementation of this SSH4A intervention.

Results:

Surveys were conducted in 12 program areas in 10 countries, with 22,666 households receiving a post-implementation survey. Six of 12 program areas (Bhutan, Ghana, Kenya, both Nepal sites, Tanzania) had similar coverage levels of basic sanitation 1–2 years post-implementation, whereas there were varying levels of slippage in the other program areas (both Ethiopia sites, Indonesia, Mozambique, Uganda, Zambia), ranging from a drop of 63 percentage points in coverage in Ethiopia to a drop of only 4 percentage points in Indonesia. In countries that experienced losses in the coverage of household sanitation, sanitation sharing among neighbors generally did not increase, whereas open defecation did increase. In each of the areas where slippage occurred, the sanitation coverage levels at the final time point were all still higher than the initial time point before SNV started working in these areas. We found several factors to be associated with the sustainability of sanitation coverage, including household socioeconomic status, having household members with disabilities, baseline sanitation coverage levels of the program areas, and rate of change of coverage during program activities.

Conclusions:

Data revealed sustained gains in sanitation coverage in some program areas, yet slippage in other areas. This work may serve to benchmark the sustainability of sanitation interventions in sub-Saharan Africa and Asia.

Household-level sanitation in Ethiopia and its influencing factors: a systematic review

BACKGROUND

Within the past two decades, Ethiopia has achieved one of the fastest reductions of open defecation worldwide. This change can be attributed to the implementation of a national sanitation strategy that focused on facilitating community demand for latrine adoption and use of basic self-constructed latrines but less on other preconditions of hygienic sanitation. Recognition of sanitation by policymakers also catalyzed primary research in this area. As such, the synthesis of the available evidence is both warranted and possible. In this article, we thus decided to assess available primary evidence on the household-level sanitation in Ethiopia and its influencing factors.

METHODS

We searched primary studies that present findings on the role of factors influencing household-level sanitation outcomes in Ethiopia. We typologically classified sanitation outcomes analyzed in identified literature and computed pooled estimates for the most prevalent ones (measures of latrine availability and use). We characterized thematic types (themes and sub-themes) of influential sanitation drivers and used network analysis to examine the relational patterns between sanitation outcomes and their influencing factors.

FINDINGS

We identified 37 studies that met our inclusion criteria-all but one published after 2009. The general latrine coverage pooled across 23 studies was 70% (95% CI: 62-77%), the share of improved latrines pooled across 15 studies was 55% (95% CI: 41-68%), and latrine use pooled across 22 studies was 72% (95% CI: 64-79%). Between-study heterogeneity was high, and no time trends were identified. The identified sanitation outcomes were classified into eight types and factors reported to influence these outcomes were classified into 11 broader themes and 43 more specific sub-themes. Factors around the quality of latrines represented the most frequent sub-theme of consequential drivers. We found that the available research focused predominantly on outcomes concerning the initial adoption and use of basic latrines, emulating the main focus of national sanitation strategy. By contrast, research on drivers of the sustainability of sanitation change and, in particular, on the upgrading of latrines, has been rare despite its urgency. There is a high need to redirect the focus of sanitation research in Ethiopia towards understanding these factors on both the demand and supply side.

Patterns and Drivers of Household Sanitation Access and Sustainability in Kwale County, Kenya

Many sanitation interventions suffer from poor sustainability. Failure to maintain or replace toilet facilities risks exposing communities to environmental pathogens, yet little is known about the factors that drive sustained access beyond project life spans. Using data from a cohort of 1666 households in Kwale County, Kenya, we investigated the factors associated with changes in sanitation access between 2015 and 2017. Sanitation access is defined as access to an improved or unimproved facility within the household compound that is functional and in use. A range of contextual, psychosocial, and technological covariates were included in logistic regression models to estimate their associations with (1) the odds of sustaining sanitation access and (2) the odds of gaining sanitation access. Over two years, 28.3% households sustained sanitation access, 4.7% lost access, 17.7% gained access, and 49.2% remained without access. Factors associated with increased odds of households sustaining sanitation access included not sharing the facility and presence of a solid washable slab. Factors associated with increased odds of households gaining sanitation access included a head with at least secondary school education, level of coarse soil fragments, and higher local sanitation coverage. Results from this study can be used by sanitation programs to improve the rates of initial and sustained adoption of sanitation.

Exploring barriers to the adoption and utilization of improved latrine facilities in rural Ethiopia: An Integrated Behavioral Model for Water, Sanitation and Hygiene (IBM-WASH) approach

BACKGROUND

Even though evidence shows that access to and use of improved latrines is related to healthful families and the public, obstacles to the adoption and use of improved latrine facilities remain. Globally, not many inquiries appear to have been carried out to satisfactorily inform us regarding the multi-level barriers influencing the adoption and utilization of improved latrines facilities. Related studies in Ethiopia are even fewer.

METHODS

Two qualitative data gathering methods, viz., key informant interviews and focus group discussions, were employed to collect data for this study. A total of fifteen focus group discussions were conducted with members of the community in the rural Wonago district of Ethiopia. Similarly, ten key informant interviews were conducted with water, sanitation, and hygiene officers, and health extension workers responsible for coordinating sanitation and hygiene activities. Open code software 4.03 was used for thematic analysis.

RESULT

Barriers to adoption and use of improved latrine facilities were categorized into Contextual factors (e.g. Gender, educational status, personal preference for using the field, limited space, population density, the status of land ownership), Psychosocial factors (Culture, beliefs, attitudes, and perceptions of minimal health threat from children's feces), and Technological factors (inconveniences in acquiring materials and cost of constructing a latrine).

CONCLUSION

There are a series of multi-leveled barriers to the sustained adoption and use of latrines. Providing funding opportunities for the underprivileged and offering training on the engineering skills of latrine construction at the community level based on the contextual soil circumstances could expand the latrine coverage and use. Similarly, taking into account the variability in motivations for adopting and using latrines among our study in Ethiopia and other studies, we implore public health experts to recognize behaviors and norms in their target communities in advance of implementing sanitation interventions.

Latrine Ownership and Its Determinants in Rural Villages of Tigray, Northern Ethiopia: Community-Based Cross-Sectional Study

Background

Open defecation was largely a rural phenomenon most widely attributed to poor latrine ownership at community level. We aimed at examining latrine ownership and its determinants in rural villages of the Tigray region, Northern Ethiopia.

Methods

Community-based cross-sectional study was conducted from June to July 2018. A total of 756 randomly selected households were involved in the study. The multistage cluster sampling technique was used to select study households. Data were checked, coded, and entered into Epi-Info version 7. Besides, it was exported to SPSS version 20 for data analysis. Multivariable logistic regression analysis was involved to estimate the net effect size of factors associated with latrine ownership.

Results

The proportion of households owning latrine was 35.7%. The majority (84.4%) of constructed latrines were utilized by household families. Households advocated latrine IEC by Health Extension Workers (HEWs) (AOR = 1.902, 95% CI: 1.269–2.852), living in their private house (AOR = 3.13, 95% CI: 1.528–6.401), and the occupation status of government employees (AOR = 3.54, 95% CI: 0.586–21.397) are more likely to lead to the construction of latrines. The availability of latrine made on slab floor (AOR = 1.790, 95% CI: 0.297–3.102), having a latrine constructed inside the household compound (AOR = 4.463, 95% CI: 1.021–19.516), and delivery of latrine IEC by Women Development Armies (WDAs) (AOR = 2.425, 95% CI: 0.728–8.083) may lead to better latrine utilization at the household level.

Conclusion

Households owning latrine at the community level were low. The desired level of latrine ownership will be realized if all sanitation and hygiene components are kept on eye side by side in line with identified predictor factors.

Detecting extra-ocular Chlamydia trachomatis in a trachoma-endemic community in Ethiopia: Identifying potential routes of transmission

BACKGROUND

Trachoma elimination efforts are hampered by limited understanding of Chlamydia trachomatis (Ct) transmission routes. Here we aimed to detect Ct DNA at non-ocular sites and on eye-seeking flies.

METHODS

A population-based household survey was conducted in Oromia Region, Ethiopia. Ocular and non-ocular (faces, hands, clothing, water containers and sleeping surfaces) swabs were collected from all individuals. Flies were caught from faces of children. Flies, ocular swabs and non-ocular swabs were tested for Ct by quantitative PCR.

RESULTS

In total, 1220 individuals in 247 households were assessed. Active trachoma (trachomatous inflammation-follicular) and ocular Ct were detected in 10% and 2% of all-ages, and 21% and 3% of 1-9-year-olds, respectively. Ct was detected in 12% (95% CI:8-15%) of tested non-ocular swabs from ocular-positive households, but in none of the non-ocular swabs from ocular-negative households. Ct was detected on 24% (95% CI:18-32%) of flies from ocular-positive households and 3% (95% CI:1-6%) of flies from ocular-negative households.

CONCLUSION

Ct DNA was detected on hands, faces and clothing of individuals living in ocular-positive households suggesting that this might be a route of transmission within Ct infected households. In addition, we detected Ct on flies from ocular-positive households and occasionally in ocular-negative households suggesting that flies might be a vector for transmission within and between Ct infected and uninfected households. These potential transmission routes may need to be simultaneously addressed to suppress transmission.

Community-Led Total Sanitation and the rate of latrine ownership

Objective

Lack of sanitation affecting billions of people worldwide is a serious public health problem of Ethiopia. So, we aimed at examining the influence of community interventions on households’ latrine ownership status in Northwest Ethiopia.

Results

The proportion of households owning latrines were 47% (95% CI 42.5, 52.0). Community Lead Total Sanitation practice in the kebele [AOR = 1.78, 95% CI (1.57, 2.03)], health facilities available in the village [AOR = 2.37, 95% CI (2.14, 2.64)], and increased educational attainment of the head of the household were statistically significantly associated with households’ latrine ownership. So, we recommend expansion of community interventions for those who are not yet reached.