PREVALENCE OF UNSAFE HOUSEHOLD DRINKING WATER HANDLING PRACTICES AND ASSOCIATED FACTORS IN HARORESSA KEBELLE,DILLA TOWN

ASSESSMENT OF THE PREVALENCE OF UNSAFE HOUSEHOLD DRINKING WATER HANDLING PRACTICES AND ASSOCIATED FACTORS IN HARORESSA KEBELLE,DILLA TOWN,SNNPR,ETHIOPIA ,IN 2023 G.C .

1. COLLEGE OF HEALTH SCIENCE AND MEDICINE DEPARTMENT OF PUBLIC HEALTH ASSESSMENT OF THE PREVALENCE OF UNSAFE HOUSEHOLD DRINKING WATER HANDLING PRACTICES AND ASSOCIATED FACTORS IN HARORESSA KEBELLE, DILLA TOWN,SNNPR,ETHIOPIA ,IN 2023 G.C . Dilla,ethiopia November, 2023 12/1/2023 1 By : AMANUEL ASHENAFI

2. OUTLINE OF PRESENTATION INTRODUCTION SIGNIFICAN CE OF THE STUDY OBJECTIVE S METHODOLOGY RESULT DISSCUSION CONCLUSION RECOMMENDATION ACKNOWLEDGEMENT REFERENCE 12/1/2023 2

3. INTRODUCTION Water handling refers to various steps taken by housheolds in securing water from source to consumption which include how water is collected,transported,stored,and eventually used( WHO,2010 ). Safe household drinking water handling and sanitation situation in Ethiopia is very poor; most of the population does not have awareness to safe handling and sanitation .( Ministry of health,Ethiopia,2005). The current status of water borne diseases because of unsafe water handling and treatment in Ethiopia (52.4%) is very low and far from WHO’s recommendation at the national level (90%) . ( WHO ,progress on sanitation and drinking water,2015 ) 12/1/2023 3

4. Cont.. Ethiopia suffers from one of the lowest levels of access to water ,handling and sanitation in the world, where only 81% of urban and 11% of rural population have access to improved water source and the country lags far behind in achieving MDG−7 . ( WHO ,progress on sanitation and drinking water,2015 ) Worldwide low quality of drinking water and lack of good handling practices and sanitation have resulted in diseases, causing 42,000 deaths every week and over 90% of them occur to children under the age of (WHO/UNICEF,2019) . 12/1/2023 4

5. Statement of the problem In 2020,more than 40% of the global population did not practice safe drinking water household handling practices. (WHO,2020) In Africa only 39% of the population practice safe drinking water household handling. (UNICEF progress on sanitation,2020) Only 18% of households in sub saharan and only 7% of housheolds in Ethipoia appropriately handle their drinking water effectively . (Demographic and Health survey,2017) 12/1/2023 5

6. Cont.. More than 2.2 million people die each year from diarrheal disease globally globally( WHO and R.F.I.T,2008 ). Most cases of the diarrheal disease can be linked with a lack of adequate water handling practices. In Ethiopia, 60% of current disease burden is attributed to poor household water handling system.15% of total deaths from diarrhea mainly among children under five resulting into some 250,000 children deaths each year ( Sobsey,2002 ). 12/1/2023 6

7. Significance of the study to assess drinking water household handling practices in Haroressa kebelle, Dilla town and it will try to fill the gaps by assessing factors and pointing out the problems . The information obtained from this study could be useful for recommending changes in the work environment, increase level of knowledge towards household drinking water handling practices of the community. this study will help decision makers and health minister workers as a cornerstone to find best options,arrangements and to put correct decisions and further utilized as a reference for researchers. 12/1/2023 7

8. CONCEPTUAL FRAME WORK       SOCIO-DEMOGRAPHIC FACTORS Age sex educational status Occupation Month-income Marital status Religion Place of residence   behavioral& ENVIROMENTAL Factors Lack awareness Knowledge&attitude Lack of motivation type of storage materials. accessibility of clean water source.   Safe household water handling C HAPTERREE: O FIGURE 1: Conceptual framework of factors associated with drinking water household handling practices adobted by reviewing different literatures . 12/1/2023 8

9. OBJECTIVE OF THE STUDY General Objective To assess the prevalence of Unsafe household drin king water handling practice , and associated factors in haroressa kebele,dilla town,southern Ethiopia,2023. S pecific objectives To assess the prevalence of Un safe household drinking water handling practice in haroressa kebele,dilla town,southern Ethiopia,2023. To identify factors associated with drinking water household handling practice in haroressa kebele,dilla town,southern Ethiopia,2023 . 12/1/2023 9

10. Research Methodology Study area and setting .The study w as conducted in haroressa kebele,dilla town, Gedeo zone which is in the southern part of Ethiopia 20 07 population&house housing census,total population of Dilla town is around 59,150 but the 2021 estimation is 151,682 the kebele has tota l household of 6977. In this kebebele there is 1 health center,3health extension,3primary&1secondary school,religious institutions. 12/1/2023 10

11. Cont.. Study Period Study was conducted from Aug 10 to Sep 10, 2023 G.C Study design A community-based cross-sectional study design w as used to assess drinking water household handling practices among households in haroressa kebele. Source population All households(6977) of haroresa kebele w as used as source population. 12/1/2023 11

12. Study population randomly selected households who lived in Haroressa kebele,dilla town,southern Ethiopia. Study Unit Head of the selected households or representative of household 12/1/2023 12

13. ELIGIBILITY CRITERIA Inclusion Criteria Households resident for more than 6 months and respondent age above18 years old were included . Head of households w ere interviewed with the assumption of getting correct response from them. Exclusive criteria . Households who had farming area and paying tax to kebele, but living outside study area was excluded in the study 12/1/2023 13

14. SAMPLE SIZE DETERMINATION The sample size of the study was designed by using a single proportion formula by considering 95% confidence interval and standard error was 5%.There was previous study done in Assela town,Arsizone,Oromia region,2022, its proportion of respondents who had unsafe water handling practices was 55%. the following assumption was drawn:proportion populatino was 55%,Margin of error(E) 5%,A confidence level of 95% Where :- the critical value was 1.96 at 95 % confidence interval , n= sample size , The p=the proportion of population possessing the character of interest d=degree of precision=0.05 (allowed probability of error) 12/1/2023 14

15. T he sample size will be :- n = ( Za/2) ^2 p (1-p ) /d^2 n= (1.96×1.96)(0.55%)(1-0.55%) =374 (0.05×0.05) Adding non respondent rate 10%, Therefore the sample size was 411 households were participated in the study from selected kebeles by using simple random sampling technique particularly lottery method was applied to give equal chance among the respondents. 12/1/2023 15

16. Sampling techniques A systematic sampling method was used to conduct the households,The sample size will be decided to be n.The sampling fraction will be: N/n Hence,the sample interval will :K The sample size is 4 11 so the sampling fraction is 6977/4 11 =17,which is the sample interval. Simple random sampling Methood(lottery method)will be used to select the first households to include in this study from the list of 1--17 households. 12/1/2023 16

17. Study Variable Dependent variables . Prevalence of un safe drinking water household handling In dependent variables Socio demographic Age,Income Educational status number of children household size Ethnicity Environmental Related factors type of water source accessibility to drinking water distance to water source Behavioral related .knowledge towards safe water handling .Method of water collection&storage&treatment . 12/1/2023 17

18. OPERATIONAL DEFINITION Water handling refers to various steps taken by housheolds in securing water from source to consumption which include how water is collected,transported,stored,and eventually used . (Melese D.,2019) Safe water handling practices: households who were able to answered above the mean the practice questions were measured as safe water handling practice. (Melese D.,2019) Poor water handling practice : households who answered below the mean of the practice questions were measured as poor practice. (Melese D.,2019). 12/1/2023 18

19. DATA COLLECTION PROCEDURES A structured questionnaire w as used ,this Questionnaire is translated to local language. pre-test using 5% of the sample size w as conducted at Sessa kebele,dilla town through a face to face interview. The data was collected f rom the selected household in Haroressa kebelle With a structured questionnaire, through a face to face interview. 12/1/2023 19

20. DATA QUALITY CONTROL The quality of data w as assured by properly designing the questionnaire, proper training and coding of the questionnaire. The data collection tool w as prepared in English, then translated into the Amharic language, and then back-translated to English to ensure consistency and sentence appropriateness .Translators was used for those talking only Gedeoffa language The quality and reliability of data w as assured by pre-test of 5 %( 21 ) of total sample size. Every day, questionnaires was reviewed and checked for completeness by data collector and supervisor in the next morning before data collection. 12/1/2023 20

21. DATA PROCESSING AND ANALYSIS The collected data w as entered, cleaned, edited and checked using KoboCollect electronic app and exported into SPSS version 24 for data processing and analysis. The data analysis w as performed using appropriate descriptive and inferential statistical tests . Binary logistic regression model w as used to identify factors associated with drinking water household handling practices. In bi-variable logistic regression those variables with p-value<0.25 were the candidate for multi-variable logistic regression(P-value<0.05) The degree of associations was interpreted using crude odds ratio (COR) and adjusted odds ratio (AOR) with their 95% confidence interval (CI) w as u sed and P value <0.05 w as taken as significant. 12/1/2023 21

22. ETHICAL CONSIDERATION Before starting this study Ethical clearance was o btained from Dilla University Ethical Board. The investigator w as discuss with concerned bodies in the study area and their agreement w as obtained by formal letter after the objectives and purposes of the study were re plained . The privacy of the respondent w as a ssured. The participation was voluntary base. data collectors respect the community culture, custom and other value ,norms and benefits during the data collection periods. 12/1/2023 22

23. RESULT 12/1/2023 23

24. 6.1 Households profile(sociodemographic characteristics) .Of the total respondents 64.8% of them are females And 35% are male.majority (63.3%) of the respondents are at the age group of 31--45. fig:level of education of the household head of haroressa kebele 12/1/2023 24

25. Table1-socio demographic characteristics of respondents of households in haroressa kebele,dilla town,Gedeo zone,southern region,Ethiopia,2023 12/1/2023 25 Variable Category Frequency Percent 1.sex Male female 142 261 35% 64.8% 2.Age 19--30 31--45 46&above 90 255 58 23.3% 63.3% 14.4% 3.religion Protestant orthodox Muslim Catholic 231 113 54 5 57.3% 28% 13.4% 1.2% 4.Ethnicity Gedeo Oromo Amhara Silte gurage Wolayta other 180 58 55 44 27 22 17 44.7% 14.4% 13.6% 10.9% 7% 5.45% 4.22%

26. Cont.. 12/1/2023 26 5.Marital status Married Single Widowed divorce 317 40 24 22 78.6% 9.9% 5.96% 5.45% 6.Monthly income <2500 2500--3000 3000--4000 4000--5000 >5000 148 57 122 56 20 36.7% 14.17% 30.27% 13.9% 5% 7.Family size <or=4 >or=5 337 66 83.6% 16.4% 8.Occupation Private worker Gov't employe Labourer Housewife student other 260 52 51 31 6 3 64.5% 12.9% 12.66% 7.7% 1.48% 0.74%

27. 6.2 Environmental and behavioral related factors 6.2.1 drinking water accessibility(Source) in this study almost all house holds have access to ddrinking water from different types of water sources.about 91.5%(369) house holds get >40 liter per day Fig3-pie chart of place of they get water source 12/1/2023 27

28. Table 2.accessibility of drinking water in haroressa kebele ,dilla town,2023 12/1/2023 28 Variable Category Frequency Percent Access to drinking water Yes No 403 100% 0% Amount of water >40L/day 20--40L/day 369 34 91.5% 8.4% Time travel to fetch water <10min 10--30min >30min 68 64 62 35% 32.9% 31.9 Distance trave to fetch water 0--500m 501--1000m 1001--3000m >3000m 64 55 41 34 33% 28.35% 21.1% 17.5% Means of water transport By carrying by donkey 167 27 86% 14%

29. 6.2.2 drinking water collection and storage practices most of the respondents 348(86.3%) had four and above containers in their home and 48.4% respondents use different water storage container Only 13(3.2%)of the households had water tank;likewise,329(81.6%) of the households used closed container during data collection . In addition 289(71.7%) of households stored water for three and above days 12/1/2023 29

30. Fig4.material used to fetch water 12/1/2023 30

31. 6.2.3Post collection drinking water handling Nearly three-fourth of the respondents 288 (71.5%) were used separated containers for storing water to drink and other purposes.Likewise, more than three-fourth of respondents 314 (77.9%) covered the storage containers during data collection time . Moreover, less than one third of the respondents 128 (31.8%) were clean the container every day. 12/1/2023 proposal defence 31

32. 6.2.4Knowledge of House Holds Towards Water Handling Practice Less than half of respondents 180 (44.7%) had knowledge about water handling practice. Of these participants the main source of knowledge about safe water handling practice sixty-two percent 112 (62.2%) were accounted self-experiences. about 53.3% had information about water treatment 107 (26.6%), 64 (15.9%), 33 (8.2%) & 11 (2.7%) were responded that boiling, bleaching/chlorination, water filter and Strain it through a cloth method respectively. 12/1/2023 32

33. 6.3The Prevalence of safe water handling practice Of the total of households participated in this study more than half 53.3% had unsafe water handling practice at the corresponding 95% confidence interval was (48.45, 58.24), 12/1/2023 33

34. Fig.prevalence of unsafe drinking water household handling practice 12/1/2023 34

35. 6.4 Factors Influencing Water Handling Practice The result of multivariate analysis showed that factors associated with water handling practice were computed. Their P value were less than 0. 5,so they were candidates for multivariate analysis.but after controlling for the effects of confounding factors, SEVEN variables were strongly associated with drinking water handling practice.Those were:- . level of education .monthly income . educated about safe water handling .family size .frequency of water collection in a day .knowing water treatment . methods to draw water with 12/1/2023 35

36. Cont.. They were significantly associated with water handling practice with a p value < 0.05. so the odds of performing unsafe water handling practice among respondents those who were unable to read and writ e with([AOR=3.341,95%CI: (1.536,7.267)]. The odds of performing unsafe water handling practice among respondents who had average monthly income below 2500 with ([AOR=0.291,95%CI: (0.100,0.848)].the odds of performing unsafe water handling practice among respondents who had family size below and equal to four is ([ AOR= 0.782 ,95%CI: (0.437,1.401) 12/1/2023 36

37. Cont... On the other hand, respondents who were not educated and didn’t know about safe water handling were ([AOR=1.721, 95%CI: (1.103, 2.681]).Likewise, respondents who were didn’t know about water treatment were ([AOR=1.588,95%CI:(1.015,2.485) Those who collect water more than three times a day have [AOR=3.049,95%CI:(1.476,6.299). Yet again, respondent’s members who draw water from their container by dipping method were with ([AOR=1.840,95%CI:(1.111,3.046) 12/1/2023 37

38. Table.bivariable&multivariable logistic regression analysis of factors associated with water handling practice in haroresa kebele,dilla town,2023(N=403) Variable Practice Level of education unable to read&write Unsafe Safe AOR (CI =95%) COR (CI 95%) P-VALUE 62 42 3.341(1.536,7.267) 2.812(1.457,5.427) 0. 002 Monthly income <2500   75 73 0.291(0.100,0.848) 0.685(0.265,1.773) 0.024 Educated about safe water handling No     123   100 1.721(1.103,2.681)   2.176(1.455,3.255) 0.017 12/1/2023 38

39. 12/1/2023 39   Variable Practice Family size <or=4 Unsafe Safe AOR (CI =95%) COR (CI 95%) P-VALUE 157 180 0.782(0.437,1.401) 1.015(1.599,1.723) .409 Frequency of water collect/day More than 3x a day   40 30 3.049(1.476,6.299) (2.429(1.254,4.702) 0.003 Know about water treatment No     101 87 1.588(1.015,2.485)   1.708(1.150,2.536) 0.043 Method of draw water Dipping   66 43 1.840(1.111,3.046) 2.023(1.281,3.196) 0.018

40. Discussion About 53.3% of the households had unsafe practice of water handling,this finding is consistent with the studies conducted in kollabida town,northern region of Ethiopia,51% [Admassu . M ,2021 ] and dire dawa 55% [ Ethiopian Standards (ES), 2001 ] . but it was lower than the study Conducted in farta district in sidama region,73.5%.The observed difference could be because of geographical variation as well as difference in socio-demographic and study period among study groups. 12/1/2023 40

41. Cont.. The odds of performing unsafe water handling practice among respondents who had average monthly income below 2500and between 2500-3000 were 70.9 % and 70.7% more likely practice unsafe water handling compared to 5000 and above Ethiopian birr (ETB) monthly income household’s respectively which had([AOR=0.291,95%CI:(0.100,0.848) . The finding agrees with study conducted in Kolladiba Town, Ethiopia and others worlds [ Admassu . M ,2021 ] . The possible justification might be those who had monthly income ≥5000 ETB might have good education status, experience and knowledge towards safe water handling practice. 12/1/2023 41

42. Cont.. Correspondingly, level of educational also showed statistical significant association with outcome variable. The odds of performing unsafe water handling practice among respondents those who were unable to read with ([AOR=3.341,95%CI:(1.536,7.267) and write 3.3 times more likely unsafe water handling practice compared to those who had certificate and above. The result is supported by study conducted in Sidama Zone and others sites [ Ethiopian Standards (ES), 2001 ] . The possible explanation could be level of education of the community have significant relationship with household water handling practice and respondents who have high level of education have good water handling practice. 12/1/2023 proposal defence 42

43. Cont... On the other hand, respondents who were not educated and didn’t know about safe water handling with ([AOR=1.721,95%CI:(1.103,2.681) were 1.7 more likely practiced unsafe water handling compared to more educated classes .( Sobisey . M , 2008) ) . Even if in this consequence it needs more investigation to know the other reason, probably might be explained that the respondents whose educated by community health workers door to door, got information on household water handling practice could be exercised safe household water handling practice. 12/1/2023 43

44. Cont.. The likelihood of performing unsafe water handling practice respondents who collected water more than three times per day with ([AOR=3.049,95%CI:(1.476,6.299)were practicing above 3 times more likely to have unsafe water handling practice than those who collect Water once per day , supported with several researches were investigated nationally .( Sobisey . M , 2008) This is because of the lack of water reliability results a water scarcity that had overwhelming effect on the domestic water consumption. In Ethiopia 15L of safe water per person per day within a 1.5 km rural dwelling radius from the point of source. 12/1/2023 44

45. Cont... Likewise, respondents who were didn’t know about water treatment were about 1.6 times more likely practiced unsafe water handling compared to households who had information about water treatment(AOR=1.721,95%:(1.103,2.681) . Because of that the studies stated as the respondents who use at level of household treating water at point of use, they can be reduced the risk of diarrheal disease by 30% to 40%. This is in line with survey and research conducted nationally in Ethiopia . ( Asamnew M,2021) 12/1/2023 proposal defence 45

46. Cont.. Yet again, respondent’s members who draw water from their container by dipping method were 1.8 more likely practicing unsafe water handling as computed to those households draw by pouring method(A0R=1.840,95%:(1.111,3.046). The result is supported with studies those investigated different period nationally and globally ( WHO and R.f.l.T , C , 2008) On the other hand using of a clean and special utensil for pouring water made that safe method to draw water from containers. Water fetch by pouring properly proved a significant reduction of the concentrations of fecal coli whereas, dipping practice increased the risk of contamination by unclean cups and through hand contact. 12/1/2023 46

47. Cont... The analyzed data finding indicate that, 53.3% practiced treating drinking water at home. The reason why 46.6% didn’t practicing can be because of they are using treated water at source and they expect untreated water or unimproved ones in this study is free from risk of disease causing microbial or contaminations. Home water treatment practiced by households of study area is Boiling, Filtration and Chlorination/Wuhagar being 107(26.6%), 11(2.7%) and 33(8.2%) respectively. 12/1/2023 47

48. Cont... This finding agree with suggestion given by CDC [ CDC Ethiopis,2019 ] boiling is easy to practice, mostly the households have the required material to do so and there is water boiling practice for other purposes like for coffee, washing heavily soiled utensils. Getting chlorine is costly and available only in the urban market where most of the residents visit market rarely but some people may complain discomfort from change in taste and odor following the utilization of chlorine (UNICEF Ethiopia,2017) that might contribute for less utilization compared to boiling.. Females and literates are more likely to practice small scale water treatment at household level compared to their counterparts and illiterates respectively. (UNDP for health,2018) 12/1/2023 48

49. CONCLUSION In conclusion of this study strongly indicated there is high prevalence of unsafe household water handling practice compared with other areas and previous studies. Level of education, monthly income, know about safe water handling, frequency of water collected per day, knowing watertreatment and methods with draw water from container were factors associated with increase the odds of water handling practice among households. 12/1/2023 49

50. Recommendation Haroressa health center :-health d strength health education for the community about the effect of unsafe water handling and its consequences . households : should reform post water collection handlings,frequency of water collection in a day& apply safe handling practices that will tell by the concerned body. Government sectors and NGO : working in collaboration to implement an intervention program focusing on the community to practice safe water handling practices . Finally Awareness programs through rigorous, frequent and effective implementation of well-designed health education programs with the full and active participation of zone health bureau , organizations working on safe water programs and different partners at the community level . 12/1/2023 50

51. Strengths of the study The key strengths of the study were the design which is community based and involvement of adequate sample size. Being a community-based study help to detect the true prevalence and factors, and helps to generalize the finding. Using WHO based standard questionnaire It was tried to cover the different sociodemograpy ,environmental and behavioral factors that were supposed to determine practice and prevalence of safe water handling. Limitation of the study .Because of the nature of cross sectional study it is difficult to know the cause and effect relationship of the study. 12/1/2023 51

52. REFERENCES 1. WHO . (2013). Households water treatment and save storage. Western pacific region Geneva: WHO . 2. (UNDP), U. N. (2012). The Millennium Development Goals Report. New York: United Nations Development Programme . 3. WHO. (2006). water, Sanitation and Hygiene links to health . 4. S, A. (2014). United Nations Millennium Development Goals (UNMDP). 5. WHO:. (2004). Guidelines for drinking water quality 3rd ed. . Geneva: World Health Organization. 6. WHO. (2015). Progress on sanitation and drinking water-2015 update MDG assessment. WHO. 7. WHO and R.f.l.T , C. (2008). WHO report on the gobal tobacco epidemic. 2008 the MPOEWR package. World health organization . 8. Asamnew . A. (2004). water supply lecture note for environmental health science students . 9. Sobisey , M. e. (2008). Point of use household drinking water filtration: a practical, a practical, effective solution for providing sustained access to safe drinking water in the developing world. In Point of use household drinking water filtration (pp. 4261-4267). Environmental science and techinology 2008, 42(12 ). 12/1/2023 52

53. ACKNOWLEDGEMENT First and for most i am grateful to my Almighty God for his miraculous and unexplainable protection and support. my greatest depth of gratitude is owed to my Advisor Ms. Tsion. M for her guidance during my research work. My appreciation goes dilla University college of health and medicine and all kebele administrative for their legal support. my special thank extends to all study participants representing Household heads for their providing the appropriate information that is constrictive for my assessment. 12/1/2023 53

54. THE END!! 12/1/2023 54