Access to and challenges in water, sanitation, and hygiene in healthcare facilities during the early phase of the COVID-19 pandemic in Ethiopia: A mixed-methods evaluation.

BACKGROUND: Inadequate water, sanitation, and hygiene (WASH) in healthcare facilities (HCFs) have an impact on the transmission of infectious diseases, including COVID-19 pandemic. But, there is limited data on the status of WASH facilities in the healthcare settings of Ethiopia. Therefore, this study aimed to assess WASH facilities and related challenges in the HCFs of Northeastern Ethiopia during the early phase of COVID-19 pandemic. METHODS: An institution-based cross-sectional study was conducted from July to August 2020. About 70 HCFs were selected using a simple random sampling technique. We used a mixed approach of qualitative and quantitative study. The quantitative data were collected by an interviewer-administered structured questionnaire and observational checklist, whereas the qualitative data were collected using a key-informant interview from the head of HCFs, janitors, and WASH coordinator of the HCFs. The quantitative data were entered in EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for data cleaning and analysis. The quantitative data on access to WASH facilities was reported using WHO ladder guidelines, which include no access, limited access, and basic access, whereas the qualitative data on challenges to WASH facilities were triangulated with the quantitative result. RESULTS: From the survey of 70 HCFs, three-fourths 53 (75.7%) were clinics, 12 (17.2%) were health centers, and 5 (7.1%) were hospitals. Most (88.6%) of the HCFs had basic access to water supply. The absence of a specific budget for WASH facilities, non-functional water pipes, the absence of water-quality monitoring systems, and frequent water interruptions were the major problems with water supply, which occurred primarily in clinics and health centers. Due to the absence of separate latrine designated for disabled people, none of the HCFs possessed basic sanitary facilities. Half (51.5%) of the HCFs had limited access to sanitation facilities. The major problems were the absence of separate latrines for healthcare workers and clients, as well as female and male staffs, an unbalanced number of functional latrines for the number of clients, non-functional latrines, poor cleanliness and misuse of the latrine. Less than a quarter of the HCFs 15 (21.4%) had basic access to handwashing facilities, while half 35 (50%) of the HCFs did not. The lack of functional handwashing facilities at expected sites and misuse of the facilities around the latrine, including theft of supplies by visitors, were the two most serious problems with hygiene facilities. CONCLUSION: Despite the fact that the majority of HCFs had basic access to water, there were problems in their sanitation and handwashing facilities. The lack of physical infrastructure, poor quality of facilities, lack of separate budget to maintain WASH facilities, and inappropriate utilization of WASH facilities were the main problems in HCFs. Further investigation should be done to assess the enabling factors and constraints for the provision, use, and maintenance of WASH infrastructure at HCFs.

COVID-19 infection prevention practices among a sample of food handlers of food and drink establishments in Ethiopia.

BACKGROUND: Cases of coronavirus disease (COVID-19) are increasing at an alarming rate throughout the world, including Ethiopia. Food handlers in food and drink establishments are at high risk of exposure to the virus due to their many daily contacts with customers. Since there is a paucity of evidence about infection prevention practices and associated factors among this high-risk group in Ethiopia including in Dessie City and Kombolcha Town, this study was designed to address this gap. METHOD: An institution-based cross-sectional study was conducted among 422 food handlers in Dessie City and Kombolcha Town food and drink establishments in July and August 2020. The study participants were selected using a simple random sampling technique. Data were collected by trained data collectors using a pretested structured questionnaire and an on-the-spot observational checklist. Data were entered into EpiData version 4.6 and exported to STATA version 14.0 for data cleaning and analysis. Data were analyzed using bivariable and multivariable logistic regression model at 95% confidence interval (CI). From the bivariable analysis, variables with a p-value <0.25 were retained into multivariable analysis. Finally, variables that had a p-value <0.05 were declared as factors significantly associated with good infection prevention practices of COVID-19 among food handlers. MAIN FINDINGS: The overall rate of good practice in infection prevention among food handlers was 43.9% (95% CI: 39.2-48.4%). Among the total 401 food handlers, 79.8% had good knowledge and 58.4% had a favorable attitude about COVID-19 infection prevention. Factors significantly associated with good COVID-19 infection prevention practices were: educational status of college or above (AOR = 1.97; 95% CI: 1.32-3.75), food handling work experience greater than five years (AOR = 2.55; 95% CI: 1.43-5.77), availability of written guidelines within the food and drink establishment (AOR = 2.68; 95% CI: 1.52-4.75), and taking training about infection prevention (AOR = 3.26; 95% CI: 1.61-6.61). CONCLUSION: Our findings showed that around one-third of food handlers had good infection prevention practices. Thus, to reduce COVID-19 transmission, integrated work is urgently needed to further improve food handlers' good practices, knowledge and attitude about infection prevention through providing health education, training and by making written infection prevention guidelines available in food and drink establishments.

Facemask wearing to prevent COVID-19 transmission and associated factors among taxi drivers in Dessie City and Kombolcha Town, Ethiopia.

BACKGROUND: The World Health Organization (WHO) has pointed out that urban taxi drivers and their passengers are at higher risk of transmitting coronavirus disease 19 (COVID-19) due to frequent contact among many people. Facemask wearing is one of the preventive measures recommended to control the transmission of the virus. A lack of evidence of the proportion of facemask wearing among taxi drivers and associated factors in Ethiopia, including Dessie City and Kombolcha Town, hinders the design of targeted interventions to advocate for facemask use. This study was designed to address this gap. METHODS: A cross-sectional study was conducted among 417 taxi drivers in Dessie City and Kombolcha Town from July to August, 2020. The study participants were selected using a simple random sampling technique after proportionally allocating the sample size from the total number of taxi drivers working in Dessie City and Kombolcha Town. The data were collected by trained data collectors using a structured questionnaire and an on-the-spot observational checklist. The collected data were checked, coded and entered to EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for data cleaning and analysis. Bivariate (Crude Odds Ratio [COR]) and multivariable (Adjusted Odds Ratio [AOR]) logistic regression analyses were employed using 95% CI (confidence interval). From bivariate logistic regression analysis, variables with p-value < 0.250 were retained into multivariable logistic regression analysis. Then, from the multivariable analysis, variables with p-value < 0.050 were declared as factors significantly associated with facemask wearing among taxi drivers in Dessie City and Kombolcha Town. MAIN FINDINGS: The proportion of taxi drivers who wore a facemask was 54.68% [95%CI: 50.10-59.7%]. The majority (58.3%) of drivers were using cloth facemasks, followed by N95 facemasks (24.5%) and surgical facemasks (17.3%). Out of the total 417 taxi drivers, more than two-thirds (69.8%) of them had a good knowledge about COVID-19 and 67.6% of taxi drivers had a positive attitude towards taking precautions against transmission of COVID-19. Three-fourths (74.1%) of the taxi drivers believed that wearing a facemask could prevent COVID-19. More than half (52.5%) felt discomfort when wearing a facemask. Almost three-fourths (72.2%) of taxi drivers felt that the presence of local government pressure helped them to wear a facemask. We found that marital status [AOR = 3.14, 95%CI: 1.97-5.01], fear of the disease [AOR = 2.1, 95%CI: 1.28-3.47], belief in the effectiveness of a facemask [AOR = 5.6, 95%CI: 3.1-10.16] and feeling government pressure [AOR = 3.6, 95%CI: 2.16-6.13] were factors significantly associated with wearing a facemask. CONCLUSION: We found that the proportion of facemask wearers among taxi drivers was relatively low in Dessie City and Kombolcha Town. In order to increase that number, government bodies should work aggressively to encourage more taxi drivers to wear a facemask. We also recommend that government and non-government organizations work very closely together to implement strategies that promote facemask use, including increasing the availability of inexpensive facemasks, and monitoring and controlling facemask use.