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Women’s Access to and Utilization of Sanitation and their Determinant Factors in Some Selected Rural Areas of East Gojjam Zone, North West Ethiopia
Abstract
This study aimed to examine women’s sanitation access and utilization level and their determinants in some selected rural areas of East Gojjam Zone. The research employed cross sectional study design and data was collected from 380 women selected through multistage cluster sampling technique. Proportional odds model and partial proportional odds model were used to estimate the association between different factors and women’s sanitation access and utilization level. The result indicated that out of 380 sampled women, about 42.6% have high sanitation access compared with 34.7% medium and 22.6% low respectively. Despite this however; about 50.9% respondents have low sanitation utilization suggesting a mismatch between sanitation access at household level and women’s utilization status. Household size, access to sanitation facilities, and knowledge about the benefit of latrine utilization were found to be statistically significant determinants of women’s sanitation utilization while marital status, district, household income, participation in women health development team, and dependency ratio were found to be determinants of sanitation access. The study suggests that besides promotions to increase sanitation facility availability, monitoring on the utilization of the facilities need to be strengthened. Income creation capacity of women and their households should be strengthened as well.
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Background
Clean water is an essential part of human healthy life and wellbeing. More recently, rapid population growth, high illiteracy rate, lack of sustainable development, and climate change; faces a global challenge in developing countries. The discontinuity of drinking water supply forces households either to use unsafe water storage materials or to use water from unsafe sources. The present study aimed to identify the determinants of water source types, use, quality of water, and sanitation perception of physical parameters among urban households in North-West Ethiopia.
Methods
A community-based cross-sectional study was conducted among households from February to March 2019. An interview-based a pre-tested and structured questionnaire was used to collect the data. Data collection samples were selected randomly and proportional to each of the kebeles’ households. MS Excel and R Version 3.6.2 were used to enter and analyze the data; respectively. Descriptive statistics using frequencies and percentages were used to explain the sample data concerning the predictor variable. Both bivariate and multivariate logistic regressions were used to assess the association between independent and response variables.
Results
Four hundred eighteen (418) households have participated. Based on the study undertaken,78.95% of households used improved and 21.05% of households used unimproved drinking water sources. Households drinking water sources were significantly associated with the age of the participant (x² = 20.392, df = 3), educational status (x² = 19.358, df = 4), source of income (x² = 21.777, df = 3), monthly income (x² = 13.322, df = 3), availability of additional facilities (x² = 98.144, df = 7), cleanness status (x² = 42.979, df = 4), scarcity of water (x² = 5.1388, df = 1) and family size (x² = 9.934, df = 2). The logistic regression analysis also indicated that those factors are significantly determining the water source types used by the households. Factors such as availability of toilet facility, household member type, and sex of the head of the household were not significantly associated with drinking water sources.
Conclusion
The uses of drinking water from improved sources were determined by different demographic, socio-economic, sanitation, and hygiene-related factors. Therefore; the local, regional, and national governments and other supporting organizations shall improve the accessibility and adequacy of drinking water from improved sources in the area.
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.
Ensuring access to improved water and sanitation remains a public health challenge in Ethiopia. Exploring access to improved drinking-water supply and sanitation will help to track the progress towards achieving the Sustainable Development Goals. The aim of this study was to explore geographical variations and inequalities in access to improved drinking water and sanitation in Ethiopia. A total of 16,650 households from 643 enumeration areas of the recent Ethiopian Demographic and Health Survey 2016 data were extracted and included in the analysis. World Health Organization recommended definitions were used to measure indicators of improved drinking water and sanitation at enumeration areas. SaTScan™ software was used for spatial analysis using enumeration areas as centers for exploring geographical variations of improved water and sanitation. Absolute and relative inequalities were used to quantify regional inequalities in access to improved water and sanitation. Nationwide access to improved drinking water and sanitation in Ethiopia was 49.6% (95% CI: 48.4–50.7) and 6.3% (5.8–6.8), respectively, with large variations between and within regions (using the categories and definitions that were in effect for monitoring coverage in 2016). Access to improved drinking water ranged from 28.5% in Somali Region to 95.3% in Addis Ababa city whereas access to improved sanitation ranged from 1.7% in Amhara Region to 24% in Dire Dawa city. Households lacking access to improved water and sanitation were clustered in northern (Amhara Region) and southern (Southern Nations, Nationalities, and Peoples' Region) parts of Ethiopia. Most enumeration areas had very low level of access to improved drinking water and/or sanitation. This analysis demonstrated the existence of geographical variations and inequalities in access to improved drinking water and sanitation in Ethiopia. Therefore strategies to improve access for safe drinking water and sanitation should consider geographical variations and inequalities at a subnational scale.
Introduction
Despite advancements in food science and technology, foodborne disease remains one of the major public health problems. Poor sanitation and hygiene conditions of food establishments are the major causes for the occurrence of foodborne disease. Therefore, this study aimed to investigate core determinants of sanitation and hygiene status among food establishments.
Methods
Institution-based cross-sectional study design was conducted in Addis Ababa city. A stratified random sampling technique was deployed to select 413 study participants. Data were collected through interview and using observational checklist. Sample size was determined by using a single population proportion formula. To analyze the data, binary logistic regression and multivariable logistic regression analysis was conducted. In all analysis, P-value less than .05 were considered statistically significant.
Results
The study revealed that 57.4% of the food establishments were under poor sanitation status. In the multivariable analysis, presence of trained managers on hygiene and sanitation (adjusted odds ratio [AOR] = 6.10 with 95% confidence interval [CI]: 2.41-15.45), presence of renewed licenses (AOR = 3.07 with 95% CI: 1.18-7.99), absence of bureaucratic function to obtain permission to renew the food establishment buildings (AOR = 2.43 with 95% CI: 1.25-4.70), and presence of at least 10-m distance between toilet and kitchen (AOR = 9.19, at 95% CI: 5.63-15.02) were associated significantly with sanitation and hygiene status.
Conclusions
Above average of the food establishments were found to be in poor sanitation and hygiene state. Many core determinant factors that influence sanitation and hygienic status of food establishments were identified. The researchers suggest that formal training on sanitation and hygiene for managers of food establishments should be provided to reduce the occurrence of foodborne diseases. Moreover, strong food and water safety policy and strategy should be promulgated to improve sanitation and hygiene status of food establishments.
Background:
Poor hygienic practices, inadequate water supply, and poor sanitary conditions play a major role in the spread of infectious diseases. Lack of knowledge, attitude, and practices (KAP) on WASH is one of the most imperative causes for transmission of infectious diseases. Therefore, the aim of this study was to assess knowledge, attitude, and practice of rural residents on water, sanitation, and hygiene in Tigray, Ethiopia.
Methods:
A community-based cross-sectional study was conducted from June to July 2018. Multistage cluster sampling technique was used to collect data from 759 households in Tigray region, Northern Ethiopia. A standardized questionnaire was used to collect data on knowledge, attitude, and practice on water, sanitation, and hygiene (WASH). Descriptive data analysis was done to present the study findings.
Results:
The response rate was 99.6%, and 574 (75.9%) of the respondents were females. Good knowledge, favorable attitude, and good practice on WASH were observed in 42.2% (95% CI: 38.7%, 45.7%), 48.5% (95% CI: 44.9%, 52.0%), and 49.2% (95% CI: 45.6%, 52.7%) of the respondents, respectively.
Conclusions:
Poor knowledge, unfavorable attitude, and poor practice on WASH were common amongst the residents in rural Tigray, Northern Ethiopia. Therefore, the health extension programs at primary health care should be revitalized in a way that can enhance the interventional measures to improve knowledge, attitude, and practice on WASH.
The attainment of the Sustainable Development Goals (SDGs) for water, sanitation and hygiene (WASH) requires the elimination of all forms of inequalities in WASH services. Hence, this study was aimed at the assessment of the dimensions of inequality in urban and rural WASH services in sub-Saharan Africa. This study adopted a descriptive design based on secondary data obtained from the 2015, Joint Monitoring Programme (JMP) report that contains global estimates on WASH services. The obtained data were presented in tables and analyzed using percentages. The study revealed that generally there exist inequalities in WASH services at different levels in the region and particularly between urban and rural areas. These disparities are threats toward the attainment of the SDGs for WASH in the region. To avoid these threats, all countries in the region must develop WASH policies that eliminate inequalities to WASH services, promote education and alleviate poverty; reduce corruption in the WASH sector and develop the capacity of institutions charged with WASH services with improved funding and accountability.
Keywords: Hygiene, Inequality, Rural, Sanitation, Urban, Water
Background Lack of safe water, sanitation and hygiene remains one of the most pressing global health issues of our time. Water and sanitation-related improvements are crucial in meeting the Global Sustainable Development Goals. This study was conducted to determine the access, utilization and determinants of access to sanitation facilities among pastoral communities in rural areas of northern Tanzania.
Methods: This cross-sectional study was carried out in Ngorongoro Conservation Area of Ngorongoro District in northern Tanzania. The survey included key measures adapted from the Joint WHO/UNICEF Core Questions on drinking-water and sanitation for Household Surveys. An observation checklist was also completed at each household. Geographical positions of the households were recorded using a Global Positioning System.
Results: A total of 175 households participated in the study. More than half (61.7%, n=108) of the participants reported access to an improved water source throughout the year. The majority (50.3%, n=88) of the households reportedly practised open defecation. The multivariate analysis identified that the key determinants to access a sanitation facility at a household were socio-economic status, family size, presence of under-five years of age in the household, history of diarrhoeal diseases, having ever received education on sanitation and motivation for improvement in defecation place.
Conclusion: There is limited access to water and sanitation facilities in communities in the Ngorongoro Conservation Area. Individual and community factors are key determinants for a household to own a sanitation facility. Findings from this study indicate a need for interventions to improve access to water, and sanitation facilities in the area.
Keywords: access, water, sanitation, hygiene, pastoralists, Tanzania
Background
Despite evidence showing that access to and use of improved sanitation is associated with healthier households and communities, barriers influencing the adoption and sustainablity of sanitation facilities remain unclear. We conducted a qualitative case study to explore barriers influencing the adoption, sustainablity and consistent use of sanitation facilities in rural Ethiopia. MethodsA qualitative study was conducted in the rural district of Becho, in central Ethiopia, from June to August 2016. A socio-ecological model and Integrated Behavioural Model (IBM) for a Water Hygiene and Sanitation (WASH) framework were employed to design the study and analyse data. A total of 10 in-depth interviews (IDI) were conducted with latrine adopters (n = 3), latrine non-adopters (n = 3), health extension workers (n = 3) and the district WASH coordinator (n = 1). Eight Focus Group Discussions (FGD) were undertaken with 75 participants, of which 31 were women. The FGDs and IDIs were tape-recorded, transcribed verbatim and translated into English. The analysis was supported using Nvivo version 10 software. ResultsBarriers to sustained adoption and use of sanitation facilities were categorized into 1) individual level factors (e.g., past latrine experience, lack of demand and perceived high cost to improved latrines), 2) household level factors (e.g., unaffordability, lack of space and absence of a physically strong family member), 3) community level factors (e.g., lack of access to public latrines, lack of shared rules against open defecation, lack of financial access for the poor), and 4) societal level factors (e.g., lack of strong local leadership, flooding, soil conditions, lack of appropriate sanitation technology, lack of promotion and demand creation for improved latrines). Conclusion
The use of the socio-ecological model and IBM-WASH framework helped to achieve a better understanding of multi-level and multi-dimensional barriers to sustained latrine adoption. The results indicate that there is a need to consider interventions that address multi-level factors concurrently.
Introduction
Monitoring of sanitation programs is often limited to sanitation access and coverage, with little emphasis on use of the facilities despite increasing evidence of widespread non-use.
Objectives
We assessed patterns and determinants of individual latrine use over 12 months in a low- income rural study population that had recently received latrines as part of the Government of India’s Total Sanitation Campaign (TSC) in coastal Puri district in Odisha, India.
Materials and methods
We surveyed 1938 individuals (>3 years) in 310 rural households with latrines from 25 villages over 12 months. Data collection rounds were timed to correspond with the seasons. The primary outcome was reported use by each member of the household over the prior 48 h. We classified use into three categories—“never”, “sometimes” and “always/usually”. We also assessed consistency of use over six days across the three seasons (dry cold, dry hot, rainy). We explored the association between individual and household-level variables and latrine use in any given season and longitudinally using multinomial logistic regression. We also inquired about reasons for non-use.
Results
Overall, latrine use was poor and inconsistent. The average response probability at any given round of never use was 43.5% (95% CI = 37.9, 49.1), sometimes use was 4.6% (95% CI = 3.8, 5.5), and always/usual use was 51.9% (95% CI = 46.2, 57.5). Only two-thirds of those who reported always/usually using a latrine in round one reported the same for all three rounds. Across all three rounds, the study population was about equally divided among those who reported never using the latrine (30.1%, 95% CI = 23.0, 37.2), sometimes using the latrine (33.2%, 95% CI = 28.3, 38.1) and always/usually using the latrine (36.8%, 95% CI = 31.8, 41.8). The reported likelihood of always/usually versus never using the latrine was significantly greater in the dry cold season (OR = 1.50, 95% CI = 1.18, 1.89, p = 0.001) and in the rainy season (OR = 1.34, 95% CI = 1.07, 1.69, p = 0.012), than in the dry hot season.
Across all three seasons, there was increased likelihood of always/usually and sometimes using the latrine versus never using it among females and where latrines had a door and roof. Older age groups, including those aged 41–59 years and 60+ years, and increase in household size were associated with a decreased likelihood of always/usually using the latrine versus never using it. The leading reason for non-use was a preference for open defecation.
Conclusion
Results highlight the low and inconsistent use of subsidized latrines built under the TSC in rural Odisha. This study identifies individual and household levels factors that may be used to target behavior change campaigns to drive consistent use of sanitation facilities by all.
Background:
It is estimated that more than two-thirds of the population in sub-Saharan Africa (SSA) must leave their home to collect water, putting them at risk for a variety of negative health outcomes. There is little research, however, quantifying who is most affected by long water collection times.
Objectives:
This study aims to a) describe gender differences in water collection labor among both adults and children (< 15 years of age) in the households (HHs) that report spending more than 30 minutes collecting water, disaggregated by urban and rural residence; and b) estimate the absolute number of adults and children affected by water collection times greater than 30 minutes in 24 SSA countries.
Methods:
We analyzed data from the Demographic Health Survey (DHS) and the Multiple Indicator Cluster Survey (MICS) (2005-2012) to describe water collection labor in 24 SSA countries.
Results:
Among households spending more than 30 minutes collecting water, adult females were the primary collectors of water across all 24 countries, ranging from 46% in Liberia (17,412 HHs) to 90% in Cote d'Ivoire (224,808 HHs). Across all countries, female children were more likely to be responsible for water collection than male children (62% vs. 38%, respectively). Six countries had more than 100,000 households (HHs) where children were reported to be responsible for water collection (greater than 30 minutes): Burundi (181,702 HHs), Cameroon (154,453 HHs), Ethiopia (1,321,424 HHs), Mozambique (129,544 HHs), Niger (171,305 HHs), and Nigeria (1,045,647 HHs).
Conclusion:
In the 24 SSA countries studied, an estimated 3.36 million children and 13.54 million adult females were responsible for water collection in households with collection times greater than 30 minutes. We suggest that accessibility to water, water collection by children, and gender ratios for water collection, especially when collection times are great, should be considered as key indicators for measuring progress in the water, sanitation and hygiene sector.
When outcome variables are ordinal rather than continuous, the ordered logit model, aka the proportional odds model (ologit/po), is a popular analytical method. However, generalized ordered logit/partial proportional odds models (gologit/ppo) are often a superior alternative. Gologit/ppo models can be less restrictive than proportional odds models and more parsimonious than methods that ignore the ordering of categories altogether. However, the use of gologit/ppo models has itself been problematic or at least sub-optimal. Researchers typically note that such models fit better but fail to explain why the ordered logit model was inadequate or the substantive insights gained by using the gologit alternative. This paper uses both hypothetical examples and data from the 2012 European Social Survey to address these shortcomings.
Background:
Open defecation is widely practiced in India. To improve sanitation and promote better health, the Government of India (GOI) has instituted large scale sanitation programmes supporting construction of public and institutional toilets and extending financial subsidies for poor families in rural areas for building individual household latrines. Nevertheless, many household latrines in rural India, built with government subsidies and the facilitation and support of non-government organizations (NGO), remain unused. Literature on social, cultural and behavioural aspects that constrain latrine adoption and use in rural India is limited. This paper examines defecation patterns of different groups of people in rural areas of Odisha state in India to identify causes and determinants of latrine non-use, with a special focus on government-subsidized latrine owners, and shortcomings in household sanitation infrastructure built with government subsidies.
Methods:
An exploratory study using qualitative methods was conducted in rural communities in Odisha state. Methods used were focus group discussions (FGDs), and observations of latrines and interviews with their owners. FGDs were held with frontline NGO sanitation program staff, and with community members, separately by caste, gender, latrine type, and age group. Data were analysed using a thematic framework and approach.
Results:
Government subsidized latrines were mostly found unfinished. Many counted as complete per government standards for disbursement of financial subsidies to contracted NGOs were not accepted by their owners and termed as 'incomplete'. These latrines lacked a roof, door, adequate walls and any provision for water supply in or near the cabin, whereas rural people had elaborate processes of cleansing with water post defecation, making presence of a nearby water source important. Habits, socialising, sanitation rituals and daily routines varying with caste, gender, marital status, age and lifestyle, also hindered the adoption of latrines. Interest in constructing latrines was observed among male heads for their female members especially a newlywed daughter-in-law, reflecting concerns for their privacy, security, and convenience. This paper elaborates on these different factors.
Conclusions:
Findings show that providing infrastructure does not ensure use when there are significant and culturally engrained behavioural barriers to using latrines. Future sanitation programmes in rural India need to focus on understanding and addressing these behavioural barriers.
In Ethiopia up to 60% of the current disease burden is attributable to poor sanitation. Latrine facility coverage is increasing since Health Extension Program started, whereas less attention to quality and utilization of latrine facilities in rural Ethiopia.
A community based cross-sectional study design with multistage sampling technique was employed to collect data from total of 806 households.
A total of 801 households with latrines were assessed for their latrine utilization status. The extent of latrine utilization among 490 (61.2%) households was satisfactory. Presence of ≤5 children (AOR: 0.379, 95% CI :( 0.196, 0.732)), job of mothers (being farmer) (AOR: 0.321, 95%CI :( 0.136, 0.757)) and rare cleaning frequency (AOR: 0.055, 95% CI :( 0.005, 0.620)) were a factor negatively associated with latrine utilization. Whereas the presence of secondary school children (AOR: 3.739, 95% CI (1.884, 7.419), educational status of mothers (AOR: 2.437, 95% CI (1.032, 5.756), latrine constructed for the second time (AOR: 2.676, 95% CI :( 1.352, 5.299)), presence of door (AOR: 3.201, 95% CI: (1.437, 7.130)), the hygienic condition of latrine (AOR: 4.327, 95% CI: (2.05, 9.134)) were factors positively associated with latrine utilization.
Latrine utilization rate of household latrines was satisfactory. The presence of ≤ 5 years children, job of mother (farmer), educational status of mothers, presence of secondary school student, the presence of the door, frequency of latrine construction, and hygienic condition of latrine were significant predictors of latrine utilization.
Background
Lack of sanitation facilities is a serious health risk and obliges people to practice open defecation, thereby increasing the risk of disease transmission. The aim of this study was to assess latrine coverage and the associated factors among the rural communities in district of Bahir Dar Zuria, Ethiopia.
Methods
A community-based cross-sectional study was conducted on 608 households in district of Bahir Dar Zuria. First, the district was stratified based on the distance from Bahir Dar city. Then, ten kebeles (the smallest administrative units) were selected from the 32 rural kebeles in the district. After the kebeles had been identified, the households were selected by systematic sampling method using existing list of all households as a sampling frame. Intervals (Kth)) for selecting households were determined by dividing the number of households with the sample size allocated for each kebele. After determining the Kth interval, the first household was selected randomly. The next households were identified systematically onwards by adding cumulatively Kth intervals to the first selected household .Data were collected by means of a pretested, standardized questionnaire and observation checklist. Data analysis was carried out using SPSS version 16.
Results
Of the 608 households, 355 (58.4%) had pit latrines and only 220 (62.0%) were functional (providing services during data collection). One hundred eighty seven (52.7%) had been constructed two or more years prior to the time of the study and 202 (56.9%) latrines required maintenance. The availability of latrines was twice higher in households with an income of 5000 or more Ethiopian Birr (1USD = 17.5 Ethiopian Birr) per year (adjusted odds ratio [AOR], 1.55; 95% confidence interval [CI], 1.06–2.27) than those who hand an income less than 5000 Birr per year; the availability of latrines was twofold higher in households visited by health professional at least three times a month (AOR, 2.29; 95% CI, 1.33–3.93) than those that received no visits. The latrine coverage was about two times higher in households that were less than 30 minutes walk from a health institution (AOR, 1.57; 95% CI, 1.11–2.22) than households that were over 30 minutes walk. The latrine coverage was lower in households located in distant areas (AOR, 0.53; 95% CI, 0.36-0.77) than in households closer to the city.
Conclusions
Latrine coverage in District of Bahir Dar Zuria was far from the national target of 100%. The availability of latrines was affected by income level, frequency of visits by health workers, walking time from local health institutions, and distance from Bahir Dar. Therefore, it is recommended that the frequency of supportive visits be increased and that special attention be given to households in inaccessible areas.
Public health practitioners increasingly agree that it is not enough to provide people with water and sanitation hardware. Numerous approaches are used to tackle the "software" which means to ensure behavior change necessary to come along with the sanitation hardware. A review of these approaches reveals several shortcomings, most importantly that they do not provide behavioral change interventions which correspond to psychological factors to be changed. This article presents a sound psychological model, which postulates that for the formation of new habitual behavior, five blocks of factors must be positive with regard to the new behavior: risk factors, attitudinal factors, normative factors, ability factors, and self-regulation factors. Standardized tools for measuring the factors in face-to-face interviews are presented, and behavioral interventions are provided for each factor block. A statistical analysis method is presented, which allows the determination of the improvement potential of each factor.
Seventy percent of the rural population in sub-Saharan Africa does not use adequate sanitation facilities. In rural Benin, as much as 95 percent of the population does not use improved sanitation. By analyzing a representative sample of 2000 rural households, this paper explores why households remain without latrines. Our results show that wealth and latrine prices play the most decisive role for sanitation demand and ownership. At current income levels, sanitation coverage will only increase to 50 percent if costs for construction are reduced from currently 50 USD per latrine. Our analysis also suggests that previous sanitation campaigns, which were based on prestige and the allure of a modern lifestyle as motives for latrine construction, have had no success in increasing sanitation coverage. Moreover, improved public health, which is the objective of public policies promoting sanitation, will not be effective at low sanitation coverage rates. Fear at night, especially of animals, and personal harassment, are stated as the most important motivational factors for latrine ownership and the intention to build one. We therefore suggest changing the message of sanitation projects and introduce new low cost technologies into rural markets, otherwise marketing strategies will continue to fail in increasing sanitation demand.
Many studies have reported the effect of water supply, sanitation and hygiene (WASH) in improving health and ultimately alleviating poverty. Current coverage estimates show however that a large proportion of people in the world still do not have access to a simple pit latrine or a source of safe drinking water, and this situation worsens in rural areas. To help end these appalling figures, much effort has gone into the development of policy instruments which support decision-making, i.e. planning, targeting and prioritization. Indices and indicators are increasingly recognised as powerful tools for such purposes. This paper details the theoretical framework and development of a multidimensional, WASH-focused, thematic indicator: the WASH Poverty Index (WASH PI). It describes the methodology in index construction and disseminates achieved results in a variety of forms to promote the utility of the tool for the integrated analysis of WASH and poverty linkages. The article uses Kenya as initial case study to illustrate the application of the index. Overall, WASH PI helps identify priority areas and guide appropriate action and policy-making towards improved service delivery.
Background: The construction of latrine is a relatively simple technology that is used to prevent the spread of infectious diseases. While household access is important, community sanitation coverage is even more important to improve health through the regular use of well-maintained sanitation facilities. Objective: Assessing the impact of latrine utilization on diarrhoeal diseases in the rural community in the district of Hulet Ejju Enessie Woreda, East Gojam. Method: A community based descriptive cross-sectional study was conducted in a randomly selected 824 households that had 90% latrine coverage at the time data collection in 2006. A structured and pre-tested questionnaire complemented with observation was used to collect data. The study area is found in one of the districts of East Gojjam where the health services extension program was actively underway. Trained data collectors and supervisors were involved in the study. Data entry and cleaning was done using EPI INFO 6.04d, while SPSS version 11 was used for data analysis. Results: Most (61%) households with traditional pit latrines had latrine utilization. In a bivaraite analysis, the extent of latrine utilization was significantly associated with presence of primary or secondary school children in the house [AOR: 1.47, 95% CI: (1.04-2.06)], perceived reasons for latrine construction [AOR: 2.89, 95% CI: (1.24-6.72)] and learning from neighborhoods [AOR: 10.07, 95% CI: (1.97-51.56)], ecology of 'Kolla' [AOR: 0.47, 95% CI: (0.29-0.74) and 'Woyna-Dega' [AOR: 0.55, 95% CI: (0.38-0.81), and owning latrines for >2 years [AOR: 2.13, 95% CI: (1.57-2.89)]. The occurrence of childhood diarrhoea was not statistically associated with the extent of latrine utilization [AOR: 0.63, 95% CI: (0.22-1.81)]; however, only owning latrines for >2 years remained significant in a multivariate analysis [AOR: 0.28, 95% CI: (0.12-0.66)]. Conclusion: Utilization of latrine facilities was common among the majority of households. The duration of having latrines had impacted the occurrence of childhood diarrhea. [Ethiop. J. Health Dev. 2010;24(2);110-118] Introduction Over 50 different infections are potentially transmitted from an infected person to a healthy one by various routes involving excreta (2). The use of sanitation facilities is known to interrupt the transmission of faeco-oral related disease (2-4). The construction of traditional pit latrine is relatively a simple technology that is available to control the spread of diarrhea that is prevalent in developing nations (5). However, 2.4 billion people, 40% of the total world population, lack improved sanitation and 80% of these people live in rural areas of the developing world (5-8). In the WHO African Region, a total of 631 million people, (40%), had no access to any kind of improved sanitation facilities in 2000 (9). This figure is about the same (36%) in 2002 for Sub-Saharan African nations (10). A very recent publication of WHO/UNICEF indicated Africa is lagging much to attain MDG goals in sanitation, that aims to achieve improving a coverage of 38% (in 2006) to a level of 66% (in 2015) (11).
The proportional odds model for ordinal logistic regression provides a useful extension of the binary logistic model to situations where the response variable takes on values in a set of ordered categories. The model may be represented by a series of logistic regressions for dependent binary variables, with common regression parameters reflecting the proportional odds assumption. Key to the valid application of the model is the assessment of the proportionality assumption. An approach is described arising from comparisons of the separate (correlated) fits to the binary logistic models underlying the overall model. Based on asymptotic distributional results, formal goodness-of-fit measures are constructed to supplement informal comparisons of the different fits. A number of proposals, including application of bootstrap simulation, are discussed and illustrated with a data example.
Definitions and aspects of the concept of access to medical care are reviewed and integrated into a framework that views health policy as designed to affect characteristics of the health care delivery system and of the population at risk in order to bring about changes in the utilization of health care services and in the satisfaction of consumers with those services. Indicators are suggested for the measurement of the various relevant aspects of access, with the system and population descriptors seen as process indicators and utilization and satisfaction as outcome indicators in a theoretical model of the access concept.
Over the past 35 years medical care resources in the United States have become increasingly concentrated in medical centers and university hospitals of large urban areas. This trend has left inhabitants of rural areas increasingly relatively deprived of access to health care resources. More importantly, this relative deprivation of access to medical resources has been a key factor explaining ruralite's deprivation in the utilization of those resources.Although policy makers have been aware of the evolving structural pattern of the industry for some time, to date they appear unwilling and/or unable to fundamentally alter its continued growth and development. This review describes various forces influencing this developmental pattern at both the individual and the system (macro) level. It further discusses how government health policy, the characteristics of the health delivery system and the characteristics of the U.S. people transactionally relate to affect access to and utilization of health care resources.
Access is an important concept in health policy and health services research, yet it is one which has not been defined or employed precisely. To some authors "access" refers to entry into or use of the health care system, while to others it characterizes factors influencing entry or use. The purpose of this article is to propose a taxonomic definition of "access." Access is presented here as a general concept that summarizes a set of more specific dimensions describing the fit between the patient and the health care system. The specific dimensions are availability, accessibility, accommodation, affordability and acceptability. Using interview data on patient satisfaction, the discriminant validity of these dimensions is investigated. Results provide strong support for the view that differentiation does exist among the five areas and that the measures do relate to the phenomena with which they are identified.
- Abate Bekele
- Mesele Abrha
- Zinau Gebrezgi
Abate Bekele, Mesele Abrha, Zinau Gebrezgi, & Dejen Yemane (2018).
Prevalence and associated factors of active trachoma among children aged 1-9 years in rural communities of Gonji Kolella district
- Adane Nigusie
- Resom Berhe
- Molla Gedefaw
Adane Nigusie, Resom Berhe, & Molla Gedefaw (2015). Prevalence and
associated factors of active trachoma among children aged 1-9 years in rural
communities of Gonji Kolella district, West Gojjam Zone, North West
Ethiopia. BMC Research Notes, 8(1). https://doi10.1186/s13104-015-1529-6
The integrated behavioral model for water, sanitation, and hygiene: a systematic review of behavioral models and a framework for designing and evaluating behaviour change interventions in infrastructurerestricted settings
- R Dreibelbis
- P Winch
- E Leontsini
- K Hulland
- P Ram
- L Unicomb
- S Luby
Dreibelbis, R., Winch, P., Leontsini, E., Hulland, K., Ram, P., Unicomb, L., &
Luby, S. (2013). The integrated behavioral model for water, sanitation, and
hygiene: a systematic review of behavioral models and a framework for
designing and evaluating behaviour change interventions in infrastructurerestricted settings. BMC Public Health, 13(1). https://doi10.1186/1471-2458-13-1015
The human right to water: The importance of domestic and productive water rights
- R Hall
- B Van Koppen
- E Van Houweling
Hall, R., Van Koppen, B., & Van Houweling, E. (2013). The human right to water:
The importance of domestic and productive water rights. Science and
Engineering Ethics, 20(4), 849-868. https://doi10.1007/s11948-013-9499-3
Determining sample size: Sampling the evidence of Extension Program Impact (PEOD-5). Program Evaluation and Organizational Development, Institute of Food and Agricultural Sciences
- G Israel
Israel, G. (1992). Determining sample size: Sampling the evidence of Extension
Program Impact (PEOD-5). Program Evaluation and Organizational
Development, Institute of Food and Agricultural Sciences, University of
Florida. Retrieved from: https://edis.ifas.ufl.edu/publication/PD005
Now we feel like respected adults": Positive change in gender roles and relations in a Timor-Leste WASH program (ACFID Research in Development Series
- D Kilsby
Kilsby, D. (2012). "Now we feel like respected adults": Positive change in gender
roles and relations in a Timor-Leste WASH program (ACFID Research in
Development Series, no. 6). https://iwda.org.au/resource/now-we-feel-like
Kiros Fenta, Abraham Aregay, Asfawosen Aregay, Ataklti Gebretsadik, & Nega
Mamo (2020). Latrine ownership and its determinants in rural villages of Tigray,
Northern Ethiopia: Community-based cross-sectional study. Journal of
environmental and public health.
https://doi.org/10.1155/2020/2123652
Determinants of latrine use behavior: The psychosocial proxies of individual-level defecation practices in rural Coastal Ecuador
- V Lopez
- V Berrocal
- A Corozo
- P Ram
- J Trostle
- J Eisenberg
Lopez, V., Berrocal, V., Corozo A., Ram, P., Trostle, J., & Eisenberg, J. (2019).
Determinants of latrine use behavior: The psychosocial proxies of
individual-level defecation practices in rural Coastal Ecuador. The American
Journal of Tropical Medicine and Hygiene, 100(3), 733-741.
https://doi10.4269/ajtmh.18-0144
A knowledge, attitudes and practices study on water
- M C Montoute
- A Cashman
Montoute, M. C., & Cashman, A. (2015). A knowledge, attitudes and practices
study on water, sanitation and hygiene in Anse La Raye village, Saint Lucia.
(CERMES Technical Report No78).
Equity of access to health care: Outlining the foundations for action
- A Oliver
- E Mossialos
Oliver, A., & Mossialos, E. (2004). Equity of access to health care: Outlining the
foundations for action. Journal of Epidemiol Community Health. 58, 655-658. https://doi10.1136/jech.2003.017731
Determinants of open defecation in the Wa municipality of Ghana: Empirical findings highlighting sociocultural and economic dynamics among households
- I Osumanu
- E Kosoe
- F Ategeeng
Osumanu, I., Kosoe, E., & Ategeeng, F. (2019). Determinants of open defecation
in the Wa municipality of Ghana: Empirical findings highlighting
sociocultural and economic dynamics among households. Journal of
Environmental and Public Health, 1-10. https://doi10.1155/2019/3075840
Ending Open defecation in rural Tanzania: Which factors facilitate latrine adoption?
- S Sara
- J Graham
Sara, S., & Graham, J. (2014). Ending Open defecation in rural Tanzania: Which
factors facilitate latrine adoption? International Journal of Environmental
Research and Public Health, 11(9). https://doi10.3390/ijerph110909854
Women, water, sanitation and hygiene : The gender tool box
- Sida
SIDA. (2015). Women, water, sanitation and hygiene : The gender tool box. SIDA
https://www.sida.se/English/publications/159436/
Introduction: Gender and Water, Sanitation and Hygiene
- C Sweetman
- L Medland
Sweetman, C., & Medland, L. (2017). Introduction: Gender and Water, Sanitation
and Hygiene. Gender & Development, 25(2), 153-166.
https://doi10.1080/13552074.2017.1349867
Assessment of land use land cover dynamics and soil erosion estimation for sustainable management of land resources: A case study in Gozamin Woreda
- Teshome Tsegaw
Teshome Tsegaw (2007). Assessment of land use land cover dynamics and soil
erosion estimation for sustainable management of land resources: A case
study in Gozamin Woreda, Amhara Region, Northern Central
Ethiopia (Doctoral dissertation, Msc thesis of GIS and Remote Sensing).
Department of Earth Science, Addis Ababa University.
Creating demand for sanitation and hygiene through community health clubs: A cost-effective intervention in two districts in Zimbabwe
- J Waterkeyn
- S Cairncross
Waterkeyn, J., & Cairncross, S. (2005). Creating demand for sanitation and
hygiene through community health clubs: A cost-effective intervention in
two districts in Zimbabwe. Social Science & Medicine, 61(9), 1958-1970.
https://doi10.1016/j.socscimed.2005.04.012
Drinking-water fact sheet
World Health Organization (2016, November 30). Drinking-water fact sheet. News
and Press Release.
https://reliefweb.int/report/world/drinking-water-fact-sheet-reviewednovember-2016
Guidelines for healthy housing
- Who Regional Office For Europe
- R Ranson
WHO Regional Office for Europe, & Ranson, R., P. ( 1988). Guidelines for healthy
housing. https://apps.who.int/iris/handle/10665/191555