Access to drinking safe water and its associated factors among households in East Africa: a mixed effect analysis using 12 East African countries recent national health survey.

More than half of the population in Sub-Saharan Africa (SSA) faces limited access to safe drinking water. Unimproved water sources can pose risks to the health of entire households, particularly women and children. Despite the fact that East African countries have some of the poorest drinking water infrastructures globally, there is a lack of published data on this issue. Consequently, the objective of this study was to examine access to safe drinking water and its determinants among households in East Africa, utilizing recent nationally representative data. This study analyzed data from recent demographic and health surveys conducted in 12 East African nations between 2011 and 2022. Data were gathered from 204,275 households. A stratified two-stage cluster sampling method was employed, with enumeration areas serving as the main sampling units and households serving as the secondary sampling units. Binary and multiple multilevel logistic regression were used to examine the relevant factors associated with the use of different sources of drinking water in the region. In binary regression and multiple regression, P values of ≤ 0.2 and < 0.05, respectively, were used to determine the statistical significance of variables in the final model. Approximately 72.62% (95% CI = 72.43, 72.83) of households have utilized improved sources of drinking water. Household heads aged 25-35 years (AOR = 1.09, 95% CI = 1.04, 1.14), 36-45 years (AOR = 1.09, 95% CI = 1.04, 1.14), and > 45 years (AOR = 1.08, 95% CI = 1.04, 1.14), those with secondary/higher education (AOR = 1.24, 95% CI = 1.20-1.29), and individuals in wealth index categories of poorest (AOR = 0.17, 95% CI = 0.16, 0.18), poorer (AOR = 0.21, 95% CI = 0.19, 0.22), middle (AOR = 0.25, 95% CI = 0.24, 0.27), and richer (AOR = 0.36, 95% CI = 0.34, 0.38) were associated with improved sources of drinking water. Additionally, female household leaders (AOR = 1.23, 95% CI = 1.20, 1.26), > 30 min of time taken to access the water source (AOR = 2.00, 95% CI = 1.95, 2.05), improved toilet facilities (AOR = 2.25, 95% CI = 2.19, 2.31), rural residence (AOR = 0.43, 95% CI = 0.42, 0.45), high community wealth (AOR = 1.31, 95% CI = 1.13-1.51), community media exposure (AOR = 1.32, 95% CI = 1.15, 1.51) were associated with improved sources of drinking water, respectively. Approximately three-quarters of the population in East Africa has access to improved drinking water, although the quality of water in the region is still considered poor. It is important for relevant organizations to collaborate in order to improve the quality of drinking water, with special attention given to high-risk groups such as communities with high poverty and low literacy rates, poor households, and rural residents. Strengthening women's empowerment and increasing mass media exposure can also play a crucial role in accelerating the adoption of improved drinking water sources in East Africa.

Terefe B ，Jembere MM ，Assimamaw NT 《-》

Iodized household salt utilization and associated factors among households in East Africa: a multilevel modelling analysis using recent national health surveys.

Iodine deficiency disorders (IDDs) are a significant global public health issue that affects the physical and mental development of every age group, with children and nursing mothers being the most vulnerable. Approximately 50 million of approximately 2 billion people with iodine deficiency (ID) globally exhibit clinical symptoms. Identifying iodine levels using various techniques is important when considering treatment choices. Screening programs and early ID diagnostics are crucial for the follow-up of pregnant women, especially in iodine-deficient nations. There have been calls for universal salt iodization programs, but only approximately 71% of people have access to them. The problem is more common in developing nations; however, there is a shortage of literature on the individual-, family-, and community-level factors influencing iodized salt use in East Africa. This study aimed to investigate individual- and community-level factors of household iodized salt usage in East Africa. Using Stata 17, this study used the most recent demographic and health survey datasets from twelve East African countries. The survey included a weighted sample of 154,980 households. To assess factors related to iodized salt use in the region, bivariable and multivariable multilevel logistic regressions were used. P values less than or equal to 0.2, and < 0.05 were used in the binary regression, and to deem variables statistically significant in the final model respectively. About 87.73% (95% CI = 87.56,87.89) households have utilized iodized household salt. Secondary and above education (AOR = 1.23, 95% CI = 1.17-1.30), household heads with ages of 25-35 years, 36-45 years (AOR = 1.20, 95% CI = 1.12,1.28), 36-45 years (AOR = 1.16, 95% CI = 1.09,1.24), and more than 45 years (AOR = 1.18, 95% CI = 1.11,1.25), lower and middle wealth (AOR = 0.89, 95% CI = 0.76,0.89) and (AOR = 0.97, 95% CI = 0.81,0.93), media exposure (AOR = 1.10, 95% CI = 1.07-1.14), female household leaders (AOR = 1.08, 95% CI = 1.04-1.12), access to improved drinking water and better toilet facility (AOR = 2.26, 95% CI = 2.18-2.35) and (AOR = 1.50, 95% CI = 1.44,1.56), larger than five family members (AOR = 0.96, 95% CI = 0.93-0.99), high community level wealth (AOR = 1.54, 95% CI = 1.27-1.87), and low community education(AOR = 0.40, 95% CI = 0.33,0.49) were statistically associated with utilization of iodized household salt in East Africa respectively. In East Africa, household salt iodization is moderately good. To expand the use of iodized salt in the region, access to improved drinking water and toilet facilities, participating family leaders, using the opportunity of family planning services, media sources, and the improvement of the community's socioeconomic level are all needed.

Terefe B ，Jembere MM ，Assimamaw NT 《-》

Unimproved source of drinking water and its associated factors: a spatial and multilevel analysis of Ethiopian demographic and health survey.

Drinking water quality has been a major public health concern in lower and middle income countries where access to improved water supplies is limited. Ethiopia is thought to have one of the worst drinking water infrastructures in the world. This study aimed to assess the spatial variation and determinants of using unimproved sources of drinking water in Ethiopia using recent nationally representative data. A population-based cross-sectional study was employed with the recent EDHS data of 2019. A total of 8663 households were sampled using a stratified two-stage cluster sampling method. Kuldorff's SaTScan version 9.6 software was used to generate spatial scan statistics. ArcGIS version 10.7 software was used to visualize the spatial patterns of unimproved drinking water sources. A multilevel multivariable mixed-effect logistic regression was used to identify factors associated with the use of an unimproved drinking water source. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of using an unimproved source of drinking water. Around 31% (95% CI: 30%, 32%) of the population in Ethiopia uses unimproved sources of drinking water with significant spatial variation across the country. Households aged 41-60 [AOR = 0.69; 95%CI; 0.53, 0.89] as compared to the households aged 10-25, households having middle wealth index [AOR = 0.48; 95%CI; 0.40, 0.59], and households having a rich wealth index [AOR = 0.31; 95%CI; 0.25, 0.39] as compared to the poor households, living in high community literacy level [AOR = 0.36; 95%CI; 0.16, 0.80], living in high-level community poverty [AOR = 3.03; 95%CI; 1.32, 6.98], rural residence [AOR = 7.88; 95%CI; 2.74, 22.67] were significant predictors of use of unimproved source of drinking water. Hot spot areas of use of unimproved drinking water sources were observed in Amhara, Afar, and Somalia regions and some parts of SNNPR and Oromia regions in Ethiopia. The primary clusters were found in Ethiopia's Somalia and Oromia regions. Around one third of the Ethiopian population utilizes unimproved source of drinking water and it was distributed non-randomly across regions of Ethiopia. The age of the household head, wealth status of the household, residence, community poverty level, and community literacy level were found to be significantly associated with utilizing unimproved drinking water source. State authorities, non-governmental organizations and local health administrators should work to improve the quality of drinking water particularly for high risk groups such as communities living in high poverty and low literacy, poor households, rural residents, and hot spot areas to decrease the adverse consequences of using unimproved drinking water source.

Aragaw FM ，Merid MW ，Tebeje TM ，Erkihun MG ，Tesfaye AH ... -  《BMC PUBLIC HEALTH》

Limited access to improved drinking water, unimproved drinking water, and toilet facilities among households in Ethiopia: Spatial and mixed effect analysis.

Belay DG ，Andualem Z 《PLoS One》

Limited handwashing facility and associated factors in sub-Saharan Africa: pooled prevalence and multilevel analysis of 29 sub-Saharan Africa countries from demographic health survey data.

Handwashing is fundamentally an inexpensive means of reducing the spread of communicable diseases. In developing countries, many people die due to infectious diseases that could be prevented by proper hand hygiene. The recent coronavirus (COVID-19) pandemic is a threat to people who are living in resource-limited countries including sub-Saharan Africa (SSA). Effective hand hygiene requires sufficient water from reliable sources, preferably accessible on premises, and access to handwashing facility (water and or soap) that enable hygiene behaviors. Therefore, this study aims to determine the prevalence of limited handwashing facility and its associated factors in sub-Saharan Africa. Data from the Demographic and Health Surveys (DHS) were used, which have been conducted in 29 sub-Saharan African countries since January 1, 2010. A two-stage stratified random cluster sampling strategy was used to collect the data. This study comprised a total of 237,983 weighted samples. The mixed effect logistic regression model with a cluster-level random intercept was fitted. Meta-analysis and sub-group analysis were performed to establish the pooled prevalence. The pooled prevalence of limited handwashing facility was found to be 66.16% (95% CI; 59.67%-72.65%). Based on the final model, household head with age group between 35 and 60 [AOR = 0.89, 95% CI; 0.86-0.91], households with mobile type of hand washing facility [AOR = 1.73, 95% CI; 1.70-1.77], unimproved sanitation facility [AOR = 1.58, 95% CI; 1.55-1.62], water access more than 30 min round trip [AOR = 1.16, 95% CI; 1.13-1.19], urban residential area [AOR = 2.08, 95% CI; 2.04-2.13], low media exposure [AOR = 1.47, 95% CI; 1.31-1.66], low educational level [AOR = 1.30, 95% CI; 1.14-1.48], low income level [AOR = 2.41, 95% CI; 2.33-2.49] as well as lower middle-income level [AOR = 2.10, 95% CI; 2.14-2.17] and households who had more than three children [AOR = 1.25, 95% CI; 1.20-1.31] were associated with having limited handwashing facility. The pooled coverage of limited handwashing facility was high in sub-Saharan Africa. Raising awareness of the community and promoting access to handwashing materials particularly in poorer and rural areas will reduce its coverage.

Endalew M ，Belay DG ，Tsega NT ，Aragaw FM ，Gashaw M ，Asratie MH ... -  《-》