A total of 360 respondents were enrolled in the study and females were predominant respondents (75.3%). Almost all (98.9%) of the respondents were Muslim in religion and Tigre in ethnicity. About 41.4% of the respondents were illiterate and 26.7% reached primary level of education. Most of the households (87.8%) own latrine and children (64.7%) usually collect water from the water source. Most of the study participants were aged between 21 to 40 years’ (58.9%) and 41 to 60 years (34.7%).
Majority of the households had one to two children and owns one to two living rooms in their house and more than half (59.4%) of the community had a household size of 4 to 7 individuals. As there is no piped tap water to the households, 63.1% of the households have access to water provided by municipality (public tap) in less than one kilometer away, while 25.3% travel a distance of 1-2 kilometers, and 11.7% travel more than 3 kilometers for water access. (Table: 1)
Table: 1 Socio-demographic characteristics of respondents
Categories
|
Frequency (N)
|
Percent (%)
|
Administrative area
|
01
|
62
|
17.2
|
02
|
30
|
8.3
|
03
|
90
|
25.0
|
04
|
88
|
24.4
|
05
|
30
|
8.3
|
06
|
60
|
16.7
|
Sex
|
Male
|
89
|
24.7
|
Female
|
271
|
75.3
|
Religion
|
Muslim
|
356
|
98.9
|
Christian
|
4
|
1.1
|
Ethnicity
|
Tigre
|
356
|
98.9
|
Tigrigna
|
3
|
0.8
|
Saho
|
1
|
0.3
|
Marital status
|
Married
|
354
|
98.3
|
Single
|
6
|
1.7
|
Level of education
|
Illiterate
|
149
|
41.4
|
Primary
|
96
|
26.7
|
Junior
|
74
|
20.6
|
Secondary & above
|
41
|
11.4
|
Age of respondent (years)
|
<21
|
10
|
2.8
|
21-40
|
212
|
58.9
|
41-60
|
125
|
34.7
|
above 60
|
13
|
3.6
|
Number of children in house
|
1-2
|
178
|
82.8
|
3 and above
|
37
|
17.2
|
Number of rooms in the house
|
1-2
|
299
|
83.1
|
3 and above
|
61
|
16.9
|
Household size
|
1-3
|
62
|
17.2
|
4-7
|
214
|
59.4
|
8 and above
|
84
|
23.3
|
House with Tap water
|
Yes
|
1
|
0.3
|
No
|
359
|
99.7
|
House with latrine
|
Yes
|
316
|
87.8
|
No
|
44
|
12.2
|
Who collects water
|
Mother
|
93
|
25.8
|
Father
|
33
|
9.2
|
Boys
|
94
|
26.1
|
Girls
|
139
|
38.6
|
Distance to municipality (km)
|
< 1km
|
227
|
63.1
|
1-2km
|
91
|
25.3
|
3km and above
|
42
|
11.7
|
Total
|
360
|
100.0
|
Knowledge of respondents on sanitation and hygiene
The community had good level of knowledge on most of the questions regarding sanitation and hygiene. Almost all (98.6%) reported that diarrhea can be prevented and 38.1% answered that water which looked clean by their naked eye was clean and free of bacteria. Majority of the respondents (91.7%) affirmed that defecation in toilet could help prevent diarrhea and regular hand washing is very important (99.7%). (Table: 2)
Table: 2 Response of study participants on the knowledge questions
Variables
|
Yes
|
No
|
Don’t know
|
N
|
%
|
N
|
%
|
N
|
%
|
Diarrhea can be prevented
|
355
|
98.6
|
5
|
1.4
|
0
|
0.0
|
Contaminated water can be a source of infection
|
356
|
98.9
|
3
|
0.8
|
1
|
0.3
|
Water looks clean by naked eye is clean and free of bacteria
|
137
|
38.1
|
206
|
57.2
|
17
|
4.7
|
Defecation in toilet could help prevent diarrhea
|
330
|
91.7
|
27
|
7.5
|
3
|
0.8
|
Did you generally think that diarrhea is a serious illness
|
348
|
96.7
|
12
|
3.3
|
0
|
0.0
|
Does the household think that diarrhea can be prevented
|
351
|
97.5
|
7
|
1.9
|
2
|
0.6
|
Diarrhea is related to the quality of drinking water
|
336
|
93.3
|
15
|
4.2
|
9
|
2.5
|
Do you believe that diarrhea is related to hygiene practice
|
358
|
99.4
|
2
|
0.6
|
0
|
0.0
|
Do you think that the use of a toilet is very important
|
357
|
99.2
|
3
|
0.8
|
0
|
0.0
|
Do you think that regular hand washing is very important
|
359
|
99.7
|
1
|
0.3
|
0
|
0.0
|
Do you think waste collection and disposal is important
|
357
|
99.2
|
2
|
0.6
|
1
|
0.3
|
Total
|
360 (100.0)
|
Knowledge and Practice of the community on sanitation, hygiene and water use
The results showed that 88.6% of the communities in the city have some form of toilet in their compound. The commonly used types of toilets are direct pit (44.4%) and pit latrine with slab (38.6%) and from those who didn’t own toilets, 14.4% would rather use neighbors toilet than openly defecate. One tenth (9.7%) of the toilets were not functional and the main reason was that construction was not finished. Burying was the common (76.9%) method of liquid waste disposal in the community. Even though 97.5% of the study participants were comfortable with their current sanitation situation, 51.1% had reported constraints to improve their sanitation in the community. Among the commonly mentioned constraints to improve their sanitation were shortage of material (32.8%), financial constrains (32.2%) and no space (15.6%). The study participants reported that the positive aspects of using toilet are improved hygiene (90%) and improved health (85%). Almost all (99.4%) of the study participants used water for cleansing after defecation and half of them (49.2%) reported that they had never practiced open defecation in their community.
According to the family heads, two thirds of the household members wash their hand more than 5 times per day, and 32.8% wash 1-4 times per day as needed. And overwhelmingly, 93.1% of them claimed to use water and soap when washing hands. However, during the observation session of the study there was no soap visible at toilets in 76.5% of households. And 20.8% of mothers’ hands were not clean during observation. Only 52.2% of all households washed their hands after defecating, while 72.5% washed before preparing food, 96.7% before eating, 89.2% after eating, 24.2% after cleaning babies’ bottom, 25.3% after returning from work and 41.1% after handling waste. According to observation, the food was covered in 88.9% of the household. Almost all of the community had a good level of comprehensive knowledge (99.4%) and comprehensive good practice of 93.9%. only 6.1% of the study participants had poor practice on sanitation, hygiene and water treatment options and the association of these entities with diarrhea. (Table: 3)
Table: 3.1 knowledge and Practice of the community on sanitation and hygiene
Responses
|
Frequency (N)
|
Percent (%)
|
Do you have toilet on the compound
|
Yes
|
319
|
88.6
|
No
|
41
|
11.4
|
What kind of toilet do you have?
|
direct pit
|
160
|
44.4
|
Pit latrine with slab
|
139
|
38.6
|
Ventilated improved toilet
|
30
|
8.3
|
If you don’t own toilet, where do you dispose human waste?
|
In the field
|
16
|
4.4
|
Use neighbor’s toilet
|
52
|
14.4
|
How do you dispose your liquid waste
|
Use as compost
|
14
|
3.9
|
Burying
|
277
|
76.9
|
Digging of new pit
|
141
|
39.2
|
If you don’t own toilet, are you willing to build household toilet
|
Yes
|
68
|
18.9
|
No
|
7
|
1.9
|
Do you share the toilets with other households
|
Yes
|
48
|
13.3
|
No
|
312
|
86.7
|
Are all toilets functional at the moment
|
Yes, all functional
|
317
|
88.1
|
No functional toilet
|
35
|
9.7
|
Why are toilets not functional
|
Construction not finished
|
32
|
8.9
|
Other technical problems
|
11
|
3.2
|
Are you confortable with your current sanitation situation
|
Very confortable
|
182
|
50.6
|
Confortable
|
169
|
46.9
|
Uncomfortable
|
8
|
2.2
|
Are there constraints to improve your sanitation
|
Yes
|
184
|
51.1
|
No
|
175
|
48.6
|
What are the main difficulties for improving sanitation
|
Financial constraints
|
116
|
32.2
|
No space
|
56
|
15.6
|
No material available
|
118
|
32.8
|
No laborers available
|
44
|
12.2
|
No support/assistance
|
19
|
5.3
|
Lack of know-how
|
51
|
14.2
|
What are the positive aspects of using own toilet
|
Improved health
|
306
|
85.0
|
More privacy
|
275
|
76.4
|
Improved hygiene
|
324
|
90.0
|
Improved social status
|
99
|
27.5
|
Improved safety
|
87
|
24.2
|
Where do you and your household members usually defecate when at home
|
In own toilet
|
315
|
87.5
|
In neighbor's toilet
|
36
|
10.0
|
Open defecation
|
5
|
1.4
|
What do you use for cleaning after defecation
|
Water
|
358
|
99.4
|
Toilet paper
|
2
|
0.6
|
Is open defecation practiced by you or other household members
|
Often
|
15
|
4.2
|
Sometimes
|
52
|
14.4
|
Seldom
|
116
|
32.2
|
Never
|
177
|
49.2
|
Total
|
360
|
100.0
|
Table: 3.2 Hand washing, comprehensive knowledge and practice of respondents
Variables
|
Frequency (%)
|
Percent (%)
|
How often do your household members wash their hands
|
5 times of more a day
|
241
|
66.9
|
1-4 times a day
|
119
|
33.1
|
When do your household members wash their hands
|
Before preparing food
|
261
|
72.5
|
Before eating
|
348
|
96.7
|
After eating
|
321
|
89.2
|
After defecation
|
188
|
52.2
|
After cleaning baby
|
87
|
24.2
|
When returning from work
|
91
|
25.3
|
After handling waste
|
148
|
41.1
|
What do your household members use for hand washing
|
Water only
|
25
|
7.0
|
Water and soap
|
335
|
93.1
|
Comprehensive knowledge
|
Good knowledge
|
358
|
99.4
|
Poor knowledge
|
2
|
0.6
|
Comprehensive practice
|
Good practice
|
338
|
93.9
|
Poor practice
|
22
|
6.1
|
Total
|
360
|
100.0
|
Household water use practice and prevalence of diarrhea
The community’s main sources of drinking water are well (61.7%), truck water supply (18.6%), and public tap (16.9%). The households were asked whether they treat the fetched water regularly and three quarters (76.9%) of the household confirmed that they treat their water at home, and the most common methods used was straining against cloth (48.9%), boiling (38.6%) and adding chlorine (31.7%). The common reasons mentioned for not treating water are lack of knowledge and materials. Sustainability of water access and amount is alarming as 45.6% households sometimes suffer shortages water for drinking. And still the family members drink unsafe and untreated water (72.5%) when either in the field or away from home, and 24.4% when they are in a hurry.
Two third of the study participants were satisfied with the amount and quality of water they received. The main reasons for dissatisfaction mentioned are bad taste (10%), water turbidity (7.5%) and poor quality (3.3%). More than half (60.3%) of the households own water storage tank and they are cleaned it using water and OMO (detergent) on weekly (69.4%) and monthly (22.2%) basis for most of households.
The self-reported prevalence of diarrhea during the last six months in the community was 12.5% and 9.4% in less than five years children. And 4.4% of respondents reported of diarrheal illness in their household in the past two weeks of the study. In this 6 month period 57.7% of the total diarrhea toll in the households was in children of 5 years and younger. (Table: 4)
Table: 4 Household water use attitude, practice and prevalence of diarrhea
Variables
|
Frequency (N)
|
Percent (%)
|
Do you treat your drinking water regularly
|
Yes
|
277
|
76.9
|
No
|
79
|
21.9
|
Don’t know
|
4
|
1.1
|
Do you have a water storage tank
|
Yes
|
217
|
60.3
|
No
|
143
|
39.7
|
Household not get enough water for drinking?
|
Yes
|
164
|
45.6
|
No
|
195
|
54.2
|
Don’t know
|
1
|
0.3
|
Have you drunk unclean water in your home?
|
Yes
|
30
|
8.3
|
No
|
315
|
87.5
|
Don’t know
|
12
|
3.3
|
Any family suffer from diarrhea in the last 6 months
|
Yes
|
45
|
12.5
|
No
|
314
|
87.2
|
Don’t know
|
1
|
0.3
|
In last 6 months, family <5 years had diarrhea?
|
Yes
|
26
|
9.4
|
No
|
252
|
70.0
|
Reasons for not using household water treatment
|
No knowledge
|
30
|
8.3
|
No material
|
24
|
6.7
|
Don't know
|
13
|
3.6
|
How satisfied are you with the amount of water you receive?
|
Satisfied
|
235
|
65.3
|
Neutral
|
78
|
21.7
|
Dissatisfied
|
47
|
13.1
|
How satisfied are you with the water quality
|
Satisfied
|
243
|
67.5
|
Acceptable
|
78
|
21.7
|
Dissatisfied
|
39
|
10.9
|
If dissatisfied or very dissatisfied, reasons
|
Bad taste
|
36
|
10.0
|
Poor quality
|
12
|
3.3
|
Water turbidity
|
27
|
7.5
|
How often do you wash the storage containers used for drinking water?
|
Daily
|
22
|
6.1
|
Weekly
|
250
|
69.4
|
Monthly
|
80
|
22.2
|
How do you wash the storage containers used for drinking water?
|
Water only
|
29
|
8.1
|
Water & Clorox
|
11
|
3.1
|
Water and OMO
|
306
|
85.0
|
Respondent drank unfiltered water when
|
In the field
|
138
|
38.3
|
In a hurry to drink
|
88
|
24.4
|
Away from village
|
123
|
34.2
|
The main sources of drinking water for members of your household
|
Public tap
|
61
|
16.9
|
Well
|
222
|
61.7
|
Tanker
|
84
|
23.3
|
Others
|
103
|
28.6
|
How do you treat your drinking water
|
Strain by cloth
|
176
|
48.9
|
Add Chlorine
|
114
|
31.7
|
Boiling
|
139
|
38.6
|
Others
|
21
|
5.9
|
Practical observation by investigators
The latrines were checked for functionality during the spot observation by trained investigators and 88.9% were deemed functional and the latrine pit hole was left open during the observation period in almost all households (98.7%). During the investigators visit, presence of soap in the toilet was seen in only 23.5% of the households. The investigators also approved that the mother’s hand was clean in 79.2% and food was covered in 88.6% during their visit. Garbage container (disposal system) was present only in 45.8% of the households. And, in 4.7% of households’, feces were observed around the household. (Table: 5)
Table: 5 spot observation by investigators
Variables
|
Frequency (N)
|
Percent (%)
|
presence of latrine
|
Yes
|
322
|
89.4
|
No
|
38
|
10.6
|
Functional toilets
|
Yes
|
320
|
88.9
|
No
|
29
|
8.1
|
Pit covered
|
Yes
|
4
|
1.1
|
No
|
337
|
93.6
|
Containment system full
|
Yes
|
14
|
3.9
|
No
|
324
|
90.0
|
Presence of soap in toilet at time of visit
|
Yes
|
80
|
23.5
|
No
|
261
|
76.5
|
Mother's hands are clean
|
Yes
|
285
|
79.2
|
No
|
75
|
20.8
|
View food is covered
|
Yes
|
319
|
88.6
|
No
|
40
|
11.1
|
Garbage pit present
|
Yes
|
165
|
45.8
|
No
|
195
|
54.2
|
Garbage present inside home
|
Yes
|
18
|
5.0
|
No
|
342
|
95.0
|
Feces observed in living area
|
Yes
|
17
|
4.7
|
No
|
343
|
95.3
|
Association of comprehensive knowledge and practice with their background
Participants aged 41-60 years had lower knowledge compared to the other age groups and these who were illiterate were having lower level of knowledge and practice when compared with the other respondents. Study participants with distance to municipality water source greater than three kilometers were having poor practice on sanitation, hygiene and water use compared to these with one-kilometer distance to the municipality water source. (Table: 6)
Table: 6 Association of comprehensive knowledge and practice with their background
Variables
|
Comprehensive knowledge
|
Comprehensive practice
|
Good N(%)
|
Poor N(%)
|
P value
|
Good N (%)
|
Poor N(%)
|
P value
|
Age (years)
|
<20
|
10(100.0)
|
0(0.0)
|
0.286
|
9(90.0)
|
1(10.0)
|
0.172
|
21-40
|
212(100.0)
|
0(0.0)
|
204(96.2)
|
8(3.8)
|
41-60
|
123(98.4)
|
2(1.6)
|
113(90.4)
|
12(9.6)
|
>=60
|
13(100.0)
|
0(0.0)
|
12(92.3)
|
1(7.7)
|
Gender
|
Male
|
89(100.0)
|
0(0.0)
|
0.416
|
83(93.3)
|
6(6.7)
|
0.775
|
Female
|
269(99.3)
|
2(0.7)
|
255(94.1)
|
16(5.9)
|
Religion
|
Muslim
|
354(99.4)
|
2(0.6)
|
0.881
|
335(94.1)
|
21(5.9)
|
0.113
|
Christian
|
4(100.0)
|
0(0.0)
|
3(75.0)
|
1(25.0)
|
Ethnicity
|
Tigre
|
354(99.4)
|
2(0.6)
|
0.989
|
334(93.8)
|
22(6.2)
|
0.877
|
Saho
|
1(100.0)
|
0(0.0)
|
1(100.0)
|
0(0.0)
|
Tigrigna
|
3(100.0)
|
0(0.0)
|
3(100.0)
|
0(0.0)
|
Marital status
|
Married
|
352(99.4)
|
2(0.6)
|
0.854
|
332((93.8)
|
22(6.2)
|
0.529
|
Single
|
6(100.0)
|
0(0.0)
|
6(100.0)
|
0(0.0)
|
Level of education
|
Illiterate
|
147(98.7)
|
2(1.3)
|
0.416
|
139(93.3)
|
10(6.7)
|
0.488
|
Primary
|
96(100.0)
|
0(0.0)
|
88(91.7)
|
8(8.3)
|
Junior
|
74(100.0)
|
0(0.0
|
71(95.9)
|
3(4.1)
|
Sec&above
|
41(100.0)
|
0(0.0)
|
40(97.6)
|
1(2.4)
|
Distance to municipality water source
|
<1km
|
225(99.1)
|
2(0.9)
|
0.555
|
217(95.6)
|
10(4.4)
|
0.009
|
1-2km
|
91(100.0)
|
0(0.0)
|
86(94.5)
|
5(5.5)
|
>=3km
|
42(100.0)
|
0(0.0)
|
35(83.3)
|
7(16.7)
|
Number of rooms in the house
|
1
|
156(100.0)
|
0(0.0)
|
0.217
|
145(92.9)
|
11(7.1)
|
0.278
|
2
|
141(98.6)
|
2(1.4)
|
133(93.0)
|
10(7.0)
|
3 & above
|
61(100.0)
|
0(0.0)
|
60(98.4)
|
1(1.6)
|
Household size
|
1-3
|
62(100.0)
|
0(0.0)
|
0.504
|
58(93.5)
|
4(6.5)
|
0.253
|
4-7
|
212(99.1)
|
2(0.9)
|
198(92.5)
|
16(7.5)
|
8 & above
|
84(100.0)
|
0(0.0)
|
82(97.6)
|
2(2.4)
|
Total
|
358(99.4)
|
2(0.6)
|
|
338(93.9)
|
22(6.1)
|
|
Association of administrative areas to different background of study participants
Study participants from administrative area of one and three have the highest good practice compared to the other administrative areas and the lowest practice on sanitation and hygiene was reported in administrative area of two, (p=0.001). The highest and lowest prevalence of diarrhea in the last six months in the city was reported in administrative area of three and one respectively. Even though most of the study participants had less than two-kilometer distance from their home to municipality water source; all study participants from administrative area of two where having greater than three kilometer distance from their home to municipality water source (p<0.001). Majority of the respondents in administrative area of four and five were practicing hand washing of greater than five times a day compared to the other administrative areas (p<0.001). The level comprehensive practice, prevalence of diarrhea, distance to municipality water source and hand washing practice of the participants showed significant association the administrative area in the city. (Table: 7)
Table: 7 Association of administrative kebabi to different background of study participants
Variables
|
Administrative Area
|
Total
|
P value
|
01
|
02
|
03
|
04
|
05
|
06
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
Comprehensive knowledge of respondents
|
Good
|
61(98.4)
|
30(100.0)
|
90(100.0)
|
87(98.9)
|
30(100.0)
|
60(100.0)
|
358(99.4)
|
0.705
|
Poor
|
1(1.6)
|
0(0.0)
|
0(0.0)
|
1(1.1)
|
0(0.0)
|
0(0.0)
|
2(0.6)
|
Comprehensive practice of respondents
|
Good
|
61(98.4)
|
23(76.7)
|
88(97.8)
|
84(95.5)
|
28(93.3)
|
54(90.0)
|
338(93.9)
|
0.001
|
Poor
|
1(1.6)
|
7(23.3)
|
2(2.2)
|
4(4.5)
|
2(6.7)
|
6(10.0)
|
22(6.1)
|
Did any member of your household suffer from diarrhea in the last six months
|
Yes
|
4(6.5)
|
5(16.7)
|
22(24.4)
|
8(9.1)
|
2(6.7)
|
4(6.7)
|
45(12.5)
|
0.021
|
No
|
58(93.5)
|
25(83.3)
|
68(75.6)
|
79(89.8)
|
28(93.3)
|
56(93.3)
|
314(87.2)
|
Don’t know
|
0(0.0)
|
0(0.0)
|
0(0.0)
|
1(1.1)
|
0(0.0)
|
0(0.0)
|
1(0.3)
|
House with latrine
|
Yes
|
57(18.0)
|
25(7.9)
|
78(24.7)
|
79(25.0)
|
25(7.9)
|
52(16.5)
|
316(100.0)
|
0.761
|
No
|
5(11.4)
|
5(11.4)
|
12(27.3)
|
9(20.5)
|
5(11.4)
|
8(18.2)
|
44(100.0)
|
Distance from your home to municipality water source
|
<1 km
|
54(23.8)
|
0(0.0)
|
70(30.8)
|
61(26.9)
|
0(0.0)
|
42(18.5)
|
227(100.0)
|
0.001
|
1-2km
|
8(8.8)
|
0(0.0)
|
20(22.0)
|
26(28.6)
|
30(33.0)
|
7(7.7)
|
91(100.0)
|
>=3km
|
0(0.0)
|
30(71.4)
|
0(0.0)
|
1(2.4)
|
0(0.0)
|
11(26.2)
|
42(100.0)
|
How often do your household members wash their hands in a day?
|
< 5 times
|
32(27.1)
|
11(9.3)
|
38(32.2)
|
1(0.8)
|
7(5.9)
|
29(24.6)
|
118(100.0)
|
0.001
|
>=5 times
|
30(12.4)
|
19(7.9)
|
52(21.5)
|
87(36.0)
|
23(9.5)
|
31(12.8)
|
242(100.0)
|