Impact of Community-Led Total Sanitation and Hygiene on Prevalence of Diarrheal Disease and Associated Factors among Under-Five Children: A Comparative Cross-Sectional Study in Selected Woredas of Gamo Gofa Zone, Southern Ethiopia

Abstract

Background. Diarrheal diseases are still one of the major causes of morbidity in under-five children in sub-Saharan Africa. In Ethiopia, diarrhea is responsible for 9% of all deaths and is the major cause of under-five mortality. Objective. To assess the impact of community-led total sanitation and hygiene on the prevalence of diarrheal disease and factors associated among under-five children in Gamo Gofa Zone. Methods. Community-based comparative cross-sectional study design was used to compare the impact of community-led total sanitation and hygiene intervention on under-five diarrheal disease. Multistage sampling method was employed. The data were collected by using pretested structured questionnaires. Data quality was ensured by daily supervision completeness and consistency. The data were coded, entered, and cleaned by using Epi Info version 7 and were analyzed by using SPSS version 20. Bivariate and multivariable analyses were carried out by using binary logistic regression. Significance was declared by using p value of <0.05 and AOR with 95% confidence intervals. Results. The response rate of this study was 93.3%. The overall diarrhea prevalence was 27.5% (CI = (24.06, 30.97)) which was 18.9% (CI = (14.94, 23.2)) in implemented and 36.2%. (CI = (30.41, 41.59)) in nonimplemented woredas. Children whose age was between 12 and 23 months (AOR = 1.6) and greater than 24 months (AOR = 5), availability of handwashing facilities (AOR = 4), disposal of waste in open field (AOR = 9.7), unimproved source of drinking water (AOR = 6.5), using only water for handwashing (AOR = 6), children who started complementary feeding less than 6 months (AOR = 5.6) and greater than 6 months (AOR = 5.2), and utensils used to feed children such as bottle (AOR = 3.9) were the factors positively associated with diarrhea. Conclusion. The overall prevalence of under-five diarrhea was 27.5%. The prevalence was low in CLTSH woredas as compared with non-CLTSH woredas. The study showed that handwashing facility, using only water for handwashing, open refuse disposal, and unimproved source of drinking water among under-five had a statistically significant association with diarrhea occurrence in CLTSH nonimplemented areas. Integrated efforts are needed from the Ministry of Health together with the WASH Project in improving drinking water, handwashing facilities, and solid waste disposal practices.

Individual- and Community-Level Risk Factors Associated with Childhood Diarrhea in Ethiopia: A Multilevel Analysis of 2016 Ethiopia Demographic and Health Survey

“…Children aged 36-59 months were 3.17 times more affected by diarrhea than children age less than 12 months. This is consistent with other studies conducted in Amhara region, Gamo Gofa Zone, Sidama Zone, Ethiopia [ 4 , 7 , 29 ], Tanzania [ 31 ], and northern Uganda [ 14 ]. A higher percentage of diarrhea cases have occurred among the highest birth order.…”

“…Children who had ever been breastfed had less likely to experience diarrhea as compared to children who had never breasted. This finding had conformity with a study done in Gamo Gofa Zone, Southern Ethiopia [ 29 ], Bahir Dar city, Northwest, Ethiopia [ 5 ], Medebay Zana district, northwest Ethiopia [ 13 ], and Ethiopia [ 32 ], which showed that children who were partially or not breastfed had a high risk of diarrhea death than exclusively breastfed children. This is because breastfeeding helps to protect child health by preventing contracting contagious diseases including diarrhea.…”

“…Children who did not have a latrine facility were more likely to experience diarrhea than children with a latrine facility. This finding is supported by a study done in Gamo Gofa Zone, Southern Ethiopia [ 29 ], Jamma district, Northeast Ethiopia [ 16 ], Akaki Kality subcity of Addis Ababa, Ethiopia [ 35 ], and North Gondar Zone, Northwest Ethiopia [ 9 , 20 ], which indicated that children who lived in a household with latrine facility and who defecated in the latrine had lower diarrhea morbidity rate. This may be due that latrine availability reduces fecal environmental pollution and thus decreases the risk of mechanical vectors entering diarrhea-causing organisms to minimize diarrheal disease.…”

“…The prevalence of diarrhea in Ethiopia was 12% (95% CI: 11.39, 12.63). This result is lower than 29.1% in Pader District, northern Uganda [ 14 ], 29.9% in Farta District, Northern Ethiopia [ 4 ], and 27.5% in Gamo Gofa Zone, Southern Ethiopia [ 29 ], though it is higher than 11.9% in Tanzania [ 30 ] and 4.4% in Malaysia [ 21 ]. This may be due to the variation in the sample size of the study, sociodemographic characteristics of the respondents, study period, latrine coverage and utilization, and access to clean drinking water.…”

Preprocessing alternatives for compositional data related to water, sanitation and hygiene

“…r = number of positive variables in the balance V s = number of negative variables in the balance V g m (−) = geometric mean of variables However, to illustrate the behavior of the models in the transformed data, a type of balance is carried out, consistent with the usual form of analysis in the WASH sector. For example, global monitoring is based on the classification of access to improved and unimproved water and sanitation services, which are subsequently subdivided into service categories (WHO/UNICEF, 2017; Turman-Bryant et al, 2018); likewise, both inequalities in access to water and sanitation (Yang et al, 2013;Bain et al, 2014;Anthonj et al, 2020b;Chitonge et al, 2020) as well as studies of access to WASH and its relation to health (Prüss-Ustün et al, 2014;Freeman et al, 2017;Ashole Alto et al, 2020;Hasan and Alam, 2020;Patel et al, 2020) imply in one way or another the classification of improved and unimproved services. Therefore, the order of the balances (Egozcue and Pawlowsky-Glahn, 2005) is defined under this criterion (see Fig.…”