Maternal Social and Behavioral Factors Associated with the Household WASH Environment in Rural Ethiopia Open Access

Abstract

INTRODUCTION: In rural Ethiopia, the two-week prevalence of diarrhea in children under five is 13%, and 44.4% of children are stunted, indicating high rates of child illnesses often associated with inadequate drinking water, poor sanitation, and improper hand hygiene (WASH). Because women are the primary caretakers of the home and children in sub-Saharan Africa, we investigated associations of maternal social and behavioral factors with whether a household prioritizes improved WASH in rural Ethiopia.

METHODS: We conducted a secondary analysis of cross-sectional data from the CARE Ethiopia's 2014 Nutrition at the Center (N@C) Baseline Survey. Study participants included women of reproductive age (15-49 years) who had given birth in the previous 36 months and lived in the Amhara district of Ethiopia (N=2,132). A six-variable WASH index was dichotomized to represent poor and good household WASH environments, and seven maternal factors were included in a multivariable logistic regression model that controlled for socioeconomic status, district of residence, and maternal age. The six WASH variables were then each included as the dependent variable in multivariable logistic regression models with each of the seven maternal factors, for a total of 7 final models.

RESULTS: Six maternal social and behavioral factors were statistically significantly associated with a good household WASH environment: participation in women's empowerment groups [OR(95%CI) = 2.59 (2.09, 3.21)], participation in household decision-making [OR(95%CI) = 1.98 (1.45, 2.69)], women who do not accept hitting [OR(95%CI) = 1.59 (1.28, 1.98)], moderate/high social capital [OR(95%CI) = 1.52 (1.23, 1.88)], maternal literacy [OR(95%CI) = 1.43 (1.15, 1.78)], and antenatal care attendance [OR(95%CI) = 1.30 (1.04, 1.63)]. In the additional adjusted multivariable models, each of the six individual WASH variables were found to be associated with a variety of maternal social and behavioral factors.

CONCLUSION: These findings indicate that maternal social factors, behaviors, and empowerment status may be associated with the household WASH environment, and suggest that interventions designed to address maternal empowerment and education could lead to improved WASH outcomes in rural Ethiopia.

Table of Contents

Chapter I: Literature Review……………………1

Chapter II: Manuscript…………………………..21

Introduction.………………………………………22

Methods…………………………………………….25

Results………………………………………………32

Discussion………………………………………….36

Tables……………………………………………….44

Chapter III: Public Health Implications…………48

References…………………………………………49

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	mobility antenatal care diarrhea maternal literacy social capital gender violence WASH Ethiopia environmental enteropathy women's empowerment household decision-making stunting
Committee Chair / Thesis Advisor	Leon, Juan, Emory University
Committee Members	Ogden, Stephanie, CARE, USA
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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