Ethiopia Household Water Treatment Evaluation Among Antiretroviral Treatment Clients and Matched Community Members in 2008 Pubblico
Young, Anjelica (Spring 2018)
Abstract
Background: In Ethiopia, the prevalence rate of adult HIV is approximately 1.5%, and the burden of opportunistic infections are high. People living with HIV experience higher levels of morbidity and mortality from opportunistic infections related to enteric disease. One major intervention to prevent opportunistic enteric infections in people living with HIV is the use of safe water systems that include chlorination of water. The international community, through PEPFAR, is also combatting these enteric infections by providing HIV basic care packages that include a water treatment system. However, it is not clear how HIV patients use water treatment systems provided in these basic care packages.
Project Goals: The four research questions of this analysis center on whether people formally enrolled in antiretroviral therapy (ART) or pre-ART groups 1) have higher rates of self-reported water treatment, 2) have higher rates of Wuha Agar (a chlorine-based water treatment system found in Ethiopia) in their household, and 3) have higher rates of detectable free chlorine residual in their household drinking water compared to matched community members?
Methods: 795 formally enrolled ART clients and 795 age-matched community members were recruited from twenty healthcare facilities in Ethiopia. Original data was collected in December 2008 by the Centers for Disease Control and Prevention (CDC). In this secondary analysis, survey data assessed population demographics, water sources and treatment, latrine coverage, diarrhea rates, and water treatment knowledge. Bivariate analysis and logistic regression modeling were implemented to determine treatment of water, presence of Wuha Agar (chlorinated water treatment solution) and chlorine detection within household drinking water.
Results: Overall, the ART clients were more likely to self-report treatment of water than matched community members (aOR 3.391, 95% CI 2.637, 4.363, p<.0001). They were also more likely to have Wuha Agar in their household (aOR 8.147, 95% CI 4.996, 13.283, p<.0001), and had higher frequency of chlorine detection in the household drinking water (aOR 10.735, 95% CI 4.560, 25.270, p<.0001). ART clients were also more likely to have no reported income (p<.0001) and less education (p=0.0031).
Conclusions: The provision of a basic care package for people living with HIV, which includes a water treatment system, lowers the barriers to access and may increase the quality of life of those affected by HIV/AIDS and their family members. ART clients with access to water treatment systems were more likely to self-report treatment of water, have the chlorine solution present at their household, and have their drinking water test positive for chlorine residual.
Table of Contents
Chapter 1: Introduction……………………........…………………………………….....8
Purpose Statement……………………………………………………………….10
Chapter 2: Review of Literature…………………………………………………....…..12
Enteric Disease in HIV Patients ...……………………………………………....12
Impact of Improved WASH on People Living with HIV/AIDS ….….…………12
WASH in Basic Care Packages………………..………………………………...14
HIV and Poverty…………………………………………………………………16
Chapter 3: Materials and Methods……………………………………………………...17
Chapter 4: Results………………………………………………………………………22
Chapter 5: Discussion and Recommendations………………………………………….35
Chapter 6: Limitations and Conclusions………………………………………………..41
References……………………………………………………………………………….44
Appendix………………………………………………………………………………...46
About this Master's Thesis
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