Household Water, Sanitation and Hygiene (WASH) Conditions and Newborn Care Practices in the Amhara Region of Ethiopia: A Descriptive Study Open Access
Johnson, Nafissa (Spring 2021)
Abstract
Background: Access to a safely managed water supply and improved sanitation facilities in households is essential to ensure health. Within sub-Saharan Africa, Ethiopia has the lowest coverage of improved water and sanitation services. Household WASH conditions are likely to impact newborn care practices and survival. There is a need to understand WASH conditions for newborns in urban and rural households and the impact on health outcomes. Understanding WASH conditions and behaviors could support the development of evidence-based WASH and newborn care interventions in Amhara, Ethiopia.
Methods: This study of a cohort of 586 newborns examined the results of a baseline survey, a household WASH survey conducted 7 days post-discharge, and lab-confirmed neonatal sepsis diagnosis. Descriptive statistics were conducted to summarize data. Univariate logistic regression was used to examine factors associated with any neonatal sepsis, early- and late-onset sepsis. Logistic regression was used to investigate factors associated with improved sanitation facility ownership and improved drinking water source access.
Results: 86.6% of respondents reported having access to a sanitation facility in their household. However, most respondents had access to an unimproved pit latrine (78.9%). Handwashing facilities were absent in 42.4% of households. 64.1% of urban households reported having access to a safely managed drinking water source, while 9.3% of rural households had access to a limited/basic drinking water source. Increased odds of any sepsis diagnosis (early- or late-onset sepsis) were associated with not washing hands before breastfeeding, household water storage method and cleaning frequency, and not washing the newborn. Covariates such as water storage cleaning frequency, water treatment frequency, age at first bath, bathing frequency, diaper type, material used to dry cord, and cord care counseling were associated with one or more sepsis outcome variables.
Conclusion: Our results indicated that respondents generally incorporated safe WASH and newborn care practices into their household routine. However, there is a need to strengthen good newborn care practices after leaving the health facility. Given the low access to improved toilet and hand hygiene facilities, it is essential to focus on improving household sanitation and hygiene infrastructure in Amhara communities.
Table of Contents
CHAPTER 1: INTRODUCTION 1
SIGNIFICANCE OF STUDY 3
CHAPTER 2: REVIEW OF THE LITERATURE 5
INTRODUCTION 5
CURRENT STATUS OF WASH 6
Water and Sanitation Access in Sub-Saharan Africa 6
DRINKING WATER INFRASTRUCTURE IN ETHIOPIA 7
URBAN AND RURAL HOUSEHOLD WASH CHARACTERISTICS IN ETHIOPIA 8
Drinking Water Sources, Storage, and Household Treatment 8
SANITATION COVERAGE 10
ADVANCES AND CHALLENGES TO INCREASING SANITATION COVERAGE AND DRINKING WATER INFRASTRUCTURE IN HOUSEHOLDS 11
WASH KNOWLEDGE, ATTITUDES, AND PRACTICES IN ETHIOPIA 13
DEMOGRAPHIC AND SOCIO-ECONOMIC CHARACTERISTICS IN ETHIOPIA 15
AMHARA REGION OF ETHIOPIA 17
NEWBORN CARE PRACTICES FOR URBAN AND RURAL HOUSEHOLDS IN ETHIOPIA 17
Cord Care Practices 17
BREASTFEEDING PRACTICES 20
HANDWASHING AND CHILD FECES DISPOSAL PRACTICES 21
COMMUNITY-BASED NEWBORN CARE PROGRAM IN ETHIOPIA 23
SEPSIS AMONG NEONATES IN ETHIOPIA AND ASSOCIATION WITH WASH 24
CHAPTER 3: METHODS AND RESULTS 26
OVERVIEW OF METHODS 26
RESULTS 31
CHAPTER 4: DISCUSSION 69
CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS 73
REFERENCES 75
APPENDIX A: BASELINE SURVEY 81
APPENDIX B: WASH HOUSEHOLD SURVEY 85
APPENDIX C: LOGISTIC REGRESSION -IMPROVED TOILET OWNERSHIP IN STUDY HOUSEHOLDS OUTPUT 89
APPENDIX D: LOGISTIC REGRESSION- SAFELY MANAGED DRINKING WATER SOURCE IN STUDY HOUSEHOLDS 90
APPENDIX E : LOGISTIC REGRESSION SEPSIS OUTPUT 91
APPENDIX F LOGISTIC REGRESSION EARLY-ONSET SEPSIS OUTPUT 94
APPENDIX G: LOGISTIC REGRESSION LATE-ONSET SEPSIS OUTPUT 97
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