Magnitude and associated factors of occupational hazard exposures among sanitary workers: Propose RASM model for risk mitigation for the public hospitals, eastern Ethiopia.

BACKGROUND: Hospital sanitation workers (SWs) are exposed to numerous occupational hazards due to workplace conditions such as unsafe and unhygienic working environment in the hospitals. Therefore, knowing magnitude, types and source of occupational hazard exposures with their determinants are very significant for further mitigations. METHODS: Hospital based cross-sectional study design was conducted in public hospitals, eastern Ethiopia from 1st May to August 30th, 2023. 809 SWs participated. Data was entered into Epi Data Version 3.1 and Stata 17MP version used for analysis. Descriptive analysis was applied to describe the data. While, multilevel logistic regression was explored to determine the association between outcome and independents among at individual level (model 1), at hospitals (model 2) and combination of the two (model 3). The crude odds ratio (COR) and adjusted odds ratio (AOR) for models 2 and 3 were reported. Variables with an AOR with a 95% confidence interval (CI) at a p-value < 0.05 were reported. RESULT: Out of 809 SWs, 729 (90.11%) responded. The overall magnitude of self-reported occupational hazard exposures among SWs was 63.65% (95% CI 0.60-0.67). Of this, biological, chemical, and ergonomic hazards accounted for 82.44%, 74.76%, and 70.92%, respectively. The multilevel logistic regression shows that having social recognition (AOR: 0.37, 95% CI 0.14, 0.91), neutral attitude (AOR: 0.48, 95% CI 0.17, 1.41) as compared to negative attitude. The model also found that SWs those supervised could reduce the likelihood of occupational hazard exposures by 50% times (AOR: 0.50, 95% CI 0.18, 1.38) as compared to non-supervised SWs. The final model predicted the variation of occupational hazard exposures among sanitary workers from the hospitals to hospitals was 26.59%. CONCLUSIONS: The concluded that hospital sanitary workers are facing biological, chemical, ergonomic, physical, psychological, mechanical, and electrical hazards. This study's findings predicted that dissatisfied with their environment, working more than 8 hr per a day,  a negative attitude towards workplace risks and inadequate supervision may serve as contributing factors for the likelihood of occupational hazard exposures among these groups. Thus, the study suggested that hospitals could reduce these hazard risks if they implement the Risk Assessment and Safety Management (RASM) model, which includes multi-modal strategies, indicators and tripartite philosophy.

Open defecation practice among households with latrines in rural communities of Ararso District, Somali Region, Eastern Ethiopia.

Background: Open defecation contributes to the spread of different feco-oral diseases. Therefore, access to a latrine is strongly recommended, as it considerably reduces the risks. Even though provision of latrine facilities alone does not guarantee the desired health benefits, they should be integrated with behavior change. In Ethiopia, efforts have been made to increase the coverage of latrine facilities. However, evidence on how consistently households use it is limited. Most prior studies focused on latrine utilization among households, and limited evidence is available about open defecation practices among households with latrines and associated factors. Thus, this study is critical for developing effective intervention approaches to prevent open defecation among households with latrines. Objective: The aim of this study was to assess the open defecation practice and associated factors among households with latrines in rural communities of Ararso District, Somali Region, Eastern Ethiopia, 2023. Method: A community-based, cross-sectional study design was employed among households with latrines in the district. A total of 632 households latrines were selected using a systematic sampling technique. Data were collected using a structured questionnaire and an observational checklist. The questionnaire was designed in KoboTool box, Humanitarian Response software, and the data were collected using the Kobo Collect version 2023.2.4 mobile application. The data were downloaded from the server in the Microsoft Excel format for data cleaning before being exported to STATA version 14 for analysis. Bivariate and multivariable analyses were employed to investigate the relationship between outcome and independent variables. Odd ratios with 95% confidence intervals were utilized to assess the association between the outcome and the predictor variables. A P-value of <0.05 was used as the threshold point for statistical significance. Result: In this study, the prevalence of open defecation practice among households with latrines was 32.4% (95% CI: 28.1, 35.9). Sex of the household (AOR = 1.60, 95% CI: 1.06, 2.4), educational status (AOR = 2.40, 95% CI: 1.08, 5.53), family size (AOR = 1.62, 95% CI: 1.22, 2.78), the presence of under-5-year-old children in the house (AOR = 1.84, 95% CI: 1.19, 2.75), the need for latrine maintenance (AOR = 2.37.95% CI: 1.62, 3.48), current status of the latrine (AOR = 2.37, 95% CI: 1.62, 3.48), and latrine cleanness status (being unclean) (AOR = 1.91, 95% CI: 1.29, 2.81) were significantly associated with open defecation practice among households with latrine. Conclusion: The study concluded that open defecation was significantly practiced by households with latrines. This revealed that the presence of a latrine alone was insufficient to considerably reduce open defecation. To alleviate this problem, the government and health workers, in collaboration with the health bureau, should promote frequent sanitation and hygiene education in the communities.

Field-based methods for measuring greenhouse gases emissions from on-site sanitation systems: A systematic review of published literature.

On-site sanitation systems (OSS) are a source of greenhouse gas (GHG) emissions. Although efforts have been made recently to measure and quantify emissions from septic tanks using various field-based methods, the vast majority of published literature reporting GHG emissions from OSS units (e.g., pits and tanks) is based on non-empirical evidence. This systematic review presents an overview and limitations of field-based methods used for the quantification of GHG emissions from OSS. Papers published in English were searched in three databases: Google Scholar, PubMed, and Directory of Articles and Journals. Peer-reviewed papers that reported field-based methods applied to containment units in OSS were included in this study. Only eight out of 2085 papers met the inclusion criteria with septic tanks as the sole technology reported and were thus, considered for the review. Most of the studies have been conducted in middle- and high-income countries. Field-based measurements of GHGs are conducted using a flux chamber (FC) and the most commonly used FC methods are (a) the modified simple static FC, (b) automated static FC, and (c) floating FC. Data reported in published studies do not provide sufficient information on the calibration and validation of the results from the FCs used. The complex FC designs, laborious fieldwork operations, and reliance on expensive, specialist equipment, suggest that such methods may not be suitable in Low and Middle-Income countries (LMICs), where resources and access to laboratory facilities are limited. Also, the complexity of pits and tank typology in LMICs (i.e., unstandardised designs and sizes) may be a challenge to the use of FCs with fixed dimensions and set operational conditions. The variation in the quantification methods and resulting emission rates among the studies indicates that gaps prevail in the use of existing methods. Therefore, there is still a need for a simple field-based, easily adaptable FC method with adequate calibration and validation that can help in reliably quantifying the emissions from different OSS in any LMICs.

Cloth sharing with a scabies case considerably explains human scabies among children in a low socioeconomic rural community of Ethiopia.

BACKGROUND: In 2020, scabies were integrated into the WHO roadmap for neglected tropical diseases, aimed at ending the negligence to realize the SDGs. Ethiopia has also introduced scabies as a notifiable disease in drought-prone localities since 2015. Many of the previous studies employed study designs that might be subject to bias. Moreover, there is no scientific evidence about scabies in this area. Hence, this study aimed to determine the prevalence and associated factors of scabies among children aged below 15 years in rural Ethiopia. METHODS: A community-based cross-sectional study was carried out among 942 children in rural kebeles of Lay Gayent District from March through May 15, 2021. A two-stage sampling technique was applied. Data on sociodemographics, housing, water supply and sanitation, children's personal hygiene, and caregivers' knowledge about scabies were collected by a structured questionnaire. Data quality was maintained through pretesting, training of data collectors and supervisors, and supervision. An adjusted binary logistic regression was modelled to identify factors associated with scabies. The Hosmer-Lemeshow goodness-of-fit test was run to check the model fitness. RESULTS: The prevalence of scabies was 21.5% (95% CI 19.0-24.3). Maternal illiteracy (adjusted odds ratio (AOR) = 1.61; 95% CI 1.07-2.43); low household wealth (AOR = 2.04; 95% CI 1.25-3.33); unimproved water source (AOR = 1.58; 95% CI 1.05-2.40); not cleaning a house daily (AOR = 2.43; 95% CI 1.63-3.62); not trimming nails (AOR = 2.21; 95% CI 1.50-3.25); cloth sharing with a scabies case (AOR = 11.77; 95% CI 6.94-19.97); and low caregiver knowledge about scabies (AOR = 2.44; 95% CI 1.64-3.63) were factors associated with scabies. CONCLUSIONS: Scabies remains a significant public health issue among children aged below 15 years in the district. Maternal illiteracy, low household wealth, unimproved water source, not cleaning a house daily, not trimming nails, cloth sharing with a scabies case, and low caregiver knowledge about scabies were factors associated with scabies. Community-wide interventions with prime emphasis on improving maternal education and caregivers' knowledge about scabies, upgrading household wealth, ensuring a safe water supply, providing healthy housing, and ensuring adequate personal hygiene are warranted.

Menstrual hygiene management and associated factors among adolescent school girls in gursum district, Eastern Ethiopia: Institution-based a cross-sectional study.

BACKGROUND: In 2017 WHO reported that due to a lack of menstrual hygiene management (MHM) facilities, high costs, and ignorance, 2.3 billion girls and women worldwide do not manage their menstruation properly. This leads to the use of other options, such as old clothes or other unhygienic materials, which may make them a risk group for infections and other health consequences. Despite the significant role of appropriate menstrual hygiene practices, it is still a missed opportunity to address the hygienic practice of menstruation among girls in many low-and middle-income countries, including Ethiopia. OBJECTIVE: Primarily, this study was aimed at investigating menstrual hygiene management (MHM) practice and determinant factors among young adolescent school girls in eastern Ethiopia, Gursum District 2021. METHOD: An institutional-based cross-sectional survey was conducted among adolescent school girls in Gursum, Eastern Ethiopia, in 2021. 577 girls participated in this study and a multi-stage sampling procedure was employed so as to select a fair and representative sample of female students who experienced menarche. After controlling for confounding variables, binary logistic regression was fitted to identify factors affecting MHM among adolescent girls. RESULT: This study revealed that 58.41% of adolescent school girls practice unsafe MHM practices. It was also reported that 193(33.45%) of the girls use reusable sanitary pads. Of those, 182(31.5%) of them keep the pads in hidden places as it is a shame to be seen Seventy-six (13.17%) of the respondents had experienced vaginal infections during menarche. Having knowledge about menstruation prior to experiencing menstruation [AOR 0.28 CI: (0.1476132, 0.5613692)], being over 15 years old [AOR 1.56, CI: (1.020577, 2.387646)], living in rural areas [AOR 1.23 CI: (1.1563013, 1.3562546)], and having infection around their vagina during menarche [AOR 4.6 CI: (2.633405, 8. 273,883)] were significant determinants of MHM practice. CONCLUSION: The majority of the adolescent girls who participated in this study practice unsafe MHM practices. Results suggest that school health education focusing on improving the hygienic practices of adolescent girls during menstruation should be provided.

Sero-prevalence of hepatitis viral infections among sanitary workers across worldwide: a systematic review and meta-analysis.

BACKGROUND: Sanitation or sanitary workers are exposed to hepatitis virus infections because of filthy and dangerous working conditions. The current global systematic review and meta-analysis aimed to estimate the pooled sero-prevalence of occupationally associated hepatitis virus infection among them. METHODS: Preferred Reporting Items for Systematic Reviews (PRISMA), and Population, Intervention, Comparison, Outcome and study design (PICOS) were used for flow diagram, and review questions, respectively. Four databases other methods were used published articles from 2000 to 2022. Boolean logic (AND, OR), MeSH, and keywords were used: (Occupation *OR Job *OR Work) AND (Hepatitis A *OR Hepatitis B virus *OR Hepatitis C virus *OR Hepatitis E virus) AND (Solid waste collectors [SWCs] *OR Street sweepers [SS] *OR Sewage workers [STWs] *OR health care facilities cleaners [HCFCs)) AND (Countries). Stata MP/17 software was used for pooled prevalence analysis, meta-regression analysis (Hedges) at a 95% confidence interval (CI:95%). RESULTS: A total of 182 studies were identified studies, a total of 28 studies were included from twelve countries. Of these, from developed (n = 7) and developing countries (n = 5). From total a of 9049 sanitary workers, 5951(66%), 2280 (25%) and 818 (9%) were STWs, SWCs and SS, respectively. Globally, the pooled sero-prevalence of occupational-related hepatitis viral infections among sanitary workers was 38.06% (95% CI: 30-0.46.12). Of this, it was 42.96% (95% CI: 32.63-53.29) and 29.81% (95% CI: 17.59-42.02) for high-income and low-income countries, respectively. Meanwhile, by sub-analysis, the highest pooled sero-prevalence of hepatitis viral infections by categories, type and year were 47.66% (95%CI: 37.42-57.90), 48.45% (95% CI: 37.95-58.96), and 48.30% (95% CI: 36.13-60.47) for SWTs, HAV, and 2000 to 2010 year, respectively. CONCLUSION: The consistency of the evidence suggests that sanitation workers, particularly sewage workers, are susceptible to occupationally acquired hepatitis regardless of their working conditions, necessitating significant changes to occupational health and safety regulations from governmental policies and other initiatives to reduce risks among sanitary workers.

Association of drinking water and environmental sanitation with diarrhea among under-five children: Evidence from Kersa demographic and health surveillance site, eastern Ethiopia.

Background: Diarrhea remains one of the leading causes of mortality and morbidity, despite the global progression of eradicating the burden of diarrhea-related morbidity and mortality in the past two decades. In Sub-Saharan African (SSA) countries, there is inadequate supply and sanitation of safe water. However, there is a lack of literature that estimates the impact of drinking water and sanitation service on childhood diarrhea in Kersa Demographic and Health Surveillance. Therefore, the current study aimed to assess the prevalence and effect of water supply and environmental sanitation on diarrhea among under-five children from 2017 to 2021 in Kersa Demographic and Health Surveillance, Eastern Ethiopia. Method: A prospective cohort study design was implemented among 6,261 children from the Kersa Health Demographic Surveillance System (HDSS), Eastern Ethiopia, from 1 January 2016 to 31 December 2021. STATA statistical software was used to extract data from the datasets. The binary logistic regression was used to identify the impact of water supply and environmental sanitation on diarrhea by controlling important confounders. The adjusted odds ratio (AOR) with a 95% confidence interval measures this association. Result: The current study showed that among 6,261 under-five children, 41.75% of them had developed active diarrhea during the follow-up time. The final model depicted that having media exposure of 22% [AOR - 0.78 CI: (0.61, 0.98)], a protected tube well source of drinking water of 50% [AOR - 1.50, CI: (1.32, 1.71)], unprotected tube well source of drinking water of 66% [AOR - 1.66 CI: (1.27, 2.18)], having toilet facility of 13% [AOR - 0.87 CI: (0.78, 0.97)], and accessibility of source of water [AOR - 1.17 CI: (1.05, 1.30)] showed a significant association with diarrhea among under-five children. Conclusion: The prevalence of diarrhea is found to be high in the Kersa District. The main predictors of diarrhea under five were a lack of latrines, an unimproved source of drinking water, and a distance from access to drinking water. The study setting should focus on increasing the adequacy of safe drinking water and sanitation.

Hand hygiene compliance and associated factor among nurses working in public hospitals of Hararghe zones, Oromia region, eastern Ethiopia.

Background: Healthcare workers are in constant contact with a wide variety of materials and surfaces, including waste, body fluids, mucous membranes, food, their own bodies, and the skin of patients. As a result, their hands are colonized by different groups of pathogens. Hand hygiene of healthcare workers is recognized to be the main factor in reducing healthcare-associated infections. Therefore, this study aimed to assess hand hygiene adherence and related factors among nurses working in public hospitals in eastern Ethiopia. Methods: An institutional based cross-sectional study was conducted in Hospital, Hararghe zone, Eastern Ethiopia from July 1 to 30, 2021. A total of 451 study participants were randomly selected, after the proportional allocation of study participants to each selected hospital. The data was collected using self-administered questionnaire and observation checklist. SPSS version 26 was used to analyze the data. Bivariable and multivariable analysis were employed to assess the association between outcome and independent variables. Finally, a p-value of < 0.05 was used as a cutoff point for statistical significance. Results: Out of 436 eligible nurses, the overall hand hygiene compliance was 37.4% [95% CI (0.33, 0.42)]. The overall compliance among those working in medical, surgical, OR ward, OPD, Gynecology/obstetrics, emergency ward, Intensive care units, Pediatrics, and other wards/departments was 46.8, 44.8, 35.7, 28.2, 20.7, 45.1, 23.1, 40.5, and 29.4%, respectively. The mean knowledge score was 21.6% (SD: 2.08). Furthermore, there was a statistically significant association between hand hygiene compliance and gender, work experience, training in hand hygiene, availability of running water, and knowledge of hand hygiene. Conclusion: The current study found overall compliance with hand hygiene accounted for 34.7%. Therefore, an exemplary worker may initiate others to do so, and strong managerial and leadership commitment may also help the workers stick to the rules and regulations to follow the multimodal hand hygiene practice as per WHO recommendation.

Urban Households' Willingness to Pay to Improve Municipal Solid Waste Collection Services and Associated Factors: A Double-Bounded Contingent Valuation Study in Harar City, Ethiopia.

Municipal solid waste collection (MSWC) service financing is a challenge for governments in developing countries, with little or no contribution from the service users. In most Ethiopian cities, residents do not pay for MSWC. This study aims to estimate households' willingness to pay (WTP) for improved municipal solid waste collection service in Harar city. A cross-sectional study was conducted among 331 households employing the contingent valuation method with a double-bounded dichotomous choice format. The hypothetical program works to collect solid waste twice a week, house-to-house, and safely dispose of it to reduce environmental and health impacts. The Tobit regression model was used to account for the determinants of households' WTP. Findings showed that 89% (95% CI: 85.4, 92.5) of households were WTP for the improved waste collection program, with an average yearly amount of US$12. The Tobit model shows that being married (ß = 6.9, 95% CI: 1.2, 13.7), having a monthly household income of >8000 ETB (ß = 31.9, 95% CI: 22.1, 41.7), attending education about MSWM (ß = 11.8, 95% CI: 5.6, 18.1), having temporary storage at household level (ß = 15.3, 95% CI: 9.5, 21.2), and recycling practices (ß = 5.5, 95% CI: 1.2, 10.8) positively influenced the WTP. Interventions like providing educational programs about waste handling and recycling and providing or encouraging households to have temporary storage at the household level are needed to enhance users' WTP. The policy implication of the finding is that community contribution through service fees could be a strategy for sustainable financing.

Hand washing practice among public primary school children and associated factors in Harar town, eastern Ethiopia: An institution-based cross-sectional study.

Background: Hand washing with soap and water reduces the risk of diarrheal episode by 28-48% and acute respiratory infection by 20-50%. However, there is limited evidence on hand washing practices among students in Eastern Ethiopia, particularly in Harari town. Therefore, this study aimed to determine hand washing practice among primary school students and associated factors in Harar town, Eastern Ethiopia. Methods: An institution-based cross-sectional study was applied among 670 students in Harar town from June 1 to 30, 2021. A multi-stage sampling was employed; 6 out of 20 schools were selected through simple random sampling, while eligible children from each school was selected by probability proportional to size sampling method. Data were collected using a pre-tested questionnaire with a face-to-face interview technique and via observation. The data were analyzed using SPSS software version 23. Binary and mult-variable analysis were used to determine the association between factors and outcome variable. Finally, a p-value of < 0.05 was considered to declare a statistically significant association. Results: A total of 670 participants were included in the study, of which 248 (37.0%) had washed their hands [95% CI: 33.3-40.06]. Being in grade 8 Adjusted Odd Ratio[AOR = 4.9; 95% Confidence Interval (CI): 2.28-10.52], living in an urban area [AOR = 3.49; 95% CI: 1.29-9.40], having role models (parents [AOR = 4.41; 95% CI: 1.79-10.86], teachers [AOR = 3.69; 95% CI: 1.39-8.81], and health professionals [AOR = 3.17, 95% CI: 1.17-8.63]), availability of hand washing facility [AOR = 3.62; 95% CI: 1.57-8.34], access to soap and water [AOR = 2.89; 95% CI: 1.39-5.98] and being membership of water sanitation and hygiene (WASH) club [AOR = 2.39; 95% CI: 1.41-4.03] were found to be significantly associated with hand washing practice. Conclusions: The current study found that nearly a third of students practiced proper hand washing. Hand washing practice was influenced by students' grade level, residence, referents (role models for hand washing), presence of a hand washing facility, access to water and soap, and membership of WASH club. Therefore, the finding revealed that there is a need to improve hand-washing practices in schools by concerned agencies.

Rabies prevention and control practices and associated factors among dog owners in Chiro, West Hararghe, Ethiopia.

Background: Rabies is among the most deadly and fatal diseases of all human diseases, once clinical symptoms appear. In developing countries, including Ethiopia, rabies prevention and control practices is not adequate. The study aimed to assess knowledge, attitude, and practices toward rabies prevention and control and identified factors associated with prevention and control practices. Methods: A community-based cross-sectional study was conducted from July 30 to August 30, 2021. A total of 326 dog-owner households were selected from the total number of 6500 dog-owner households using a simple random sampling method. Pretested and structured questionnaire were used to collect the data. The sections of the questionnaire includes socio-demographic, knowledge, attitude, and practice toward rabies prevention practices, and health and personal-related characteristics of the participants. The data was analyzed using SPSS version 24. Bivariate and multivariable logistic regression were used to determine the association variables. Finally, a p-value of less than 0.05 was considered as a cut-off point for statistical significance. Results: Of 326 households involved in the study, 52.8% of the participants were found to have poor rabies prevention and control practices. More than half (52.1%) of the respondents had good knowledge of rabies prevention and control practices, and 49.1% had a positive attitude. Only 28.2% of the respondents reported a history of dog bites. Factors associated with good rabies prevention and control practices were; having good knowledge of human rabies virus [(Adjusted Odd Ratio (AOR) = 2.41 (95% CI: 2.25-4.83)], having good attitude on prevention and control [AOR = 2.06 (95% CI: 1.95-3.82)], having only one dog per household [AOR = 2.46 (95% CI: 1.25-4.83)], availability of vet clinic within 30 min distance from residents [AOR = 9.32 (95% CI: 4.19-20.70)], and getting health information from Mass media [AOR = 3.68(95% CI: 1.74-7.77)] or Health workers [AOR = 3.16 (95% CI: 1.60-6.23)]. Conclusions: More than half (52.1%) of the participants had poor rabies prevention and control practices. Improving rabies prevention and control practices through improving the knowledge and attitude of the community is important to protect public health.

Healthcare Workers' Compliance With Standard Precautions and Associated Factors in Bahir Dar Town, Ethiopia.

Background: According to the literature analysis, the majority of the studies focused primarily on public health institutions. Although assessing the compliance of healthcare workers in private and public institutions would give comprehensive evidence on existing problems and appropriate prevention method, as a result, research on adherence to standard precautions are still required. Rely on existing research, to the best of the investigator's knowledge, compliance with standard precautions in hospitals of Bahir Dar town has not been assessed. Therefore, this study will contribute to narrowing these gaps and determining the scope of problems with standard precautions. Methods: An institution-based cross-sectional study design was conducted among 442 healthcare workers working in hospitals from June 10 to 30, 2021. A stratified random sampling technique was employed to select the study participants. Pre-tested and structured questionnaires and an observational checklist were used to collect the required data. The data were entered into EpiData and analyzed using SPSS version 22. Bivariate and multivariable analyses were used to assess the association between independent and outcome variables. Odd ratios at 95% CI were used to measure the strength of the association between the outcome and explanatory variables. Finally, a P-value of <.05 was considered as a cut-off point for statistical significance. Results: Of the 442 healthcare workers who participated in the study, 41% were compliant with standard precautions. Furthermore, 68.1% and 51.8% of the respondents had good knowledge and a positive attitude toward infection prevention, respectively. Consistent water supply availability (AOR = 1.92 and 95% CI = 1.63, 6.27), and access to infection prevention guidelines (AOR = 1.73 and 95% CI = 1.08, 2.77), and availability of personal protective equipment (AOR = 2.32 and 95% CI = 1.35, 3.98) were some of the factors significantly associated with health care workers' compliance. Conclusions: The current study found that only about two-fifths of the healthcare workers complied with standard precautions. The study suggests that there is a significant risk of developing an infection. Therefore, the concerned organizations; Bahir Dar Zonal Health Office, and respective sectors including Amhara Regional Health Office and the Federal Ministry of Health must take appropriate measures to improve the implementation of safety practices.

Global Occupational Exposure to Blood and Body Fluids among Healthcare Workers: Systematic Review and Meta-Analysis.

Background: Occupational exposure to blood and body fluids has become a serious public health problem for healthcare workers and is a major risk for the transmission of various infections such as human immune-deficiency virus, hepatitis B virus, and hepatitis C virus. This systematic review and meta-analysis aims to determine the career time and previous one-year global pooled prevalence of occupational exposure to blood and body fluids among healthcare workers. Methods: For the review, the articles published in English were searched using the electronic databases (SCOPUS/Science Direct, PubMed, Web of Science, Google Scholar, CINAHL, MEDLINE, Cochrane Library, DOAJ, and MedNar) with a combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings (MeSH), and keywords. A quality assessment was conducted to determine the relevance of the articles using JBI critical appraisal tools. Furthermore, several steps of assessment and evaluation were taken to select and analyze the relevant articles. Results: Of the 3912 articles identified through the electronic database search, 33 that met the inclusion criteria were included in the final analysis. The current study found that the global pooled prevalence of blood and body fluids among healthcare workers during career time and in the previous one year accounted for 56.6% (95% CI: 47.3, 65.4) and 39.0% (95% CI: 32.7, 45.7), respectively. Based on subgroup analysis by publication year, survey year, and World Health Organization regions, the highest prevalence of blood and body fluid exposure in the last 12 months was observed among articles published between 2004 and 2008 (66.3%), conducted between 2003 and 2008 (66.6%), and conducted in the Southeast Asia Region (46.9%). The highest career time prevalence was 60.6%, 71.0%, and 68.4% for articles published between 2015 and 2020, conducted between 2015 and 2019, and reported in the African region, respectively. Conclusion: The current study revealed a high prevalence of occupational exposure to blood and body fluids among healthcare workers and suggests the need to improve occupational health and safety services in healthcare systems globally.

Water, Sanitation, and Hygiene Service Ladders and Childhood Diarrhea in Haramaya Demographic and Health Surveillance Site, Eastern Ethiopia.

Background: The WHO/UNICEF Joint Monitoring Program (JMP) service ladders are worldwide indicators for monitoring drinking water, sanitation, and hygiene elements of the sustainable development goal targets. However, evidence on how the prevalence of childhood diarrhea looks across the service ladders is limited. This study aimed to assess the relationship between WASH service ladders and the prevalence of childhood diarrhea in Haramaya Demographic and Health Surveillance site, Eastern Ethiopia. Methods: A cross-sectional study using a structured questionnaire, observational checklist, and water quality analysis was conducted on 535 households with children under 5 years of age. Poisson regression with a robust error variance estimator was used to investigate the relationship between dependent and independent variables. Results: The prevalence of diarrhea among under-five children in the surveillance site was 24.8% (95% CI: 22.3-27.6). The regression model revealed that water and sanitation service ladders were associated with childhood diarrhea. Childhood diarrhea was found to be 73% (APR = 0.27; 95% CI: 0.12-0.57) less common in families with a basic water service ladder than in households with a surface water service ladder. In addition, children in households with basic sanitation services had 83% (APR = 0.17; 95% CI: 0.05-0.56) lower diarrhea prevalence than children in households where open defecation was practiced. Conclusion: The present study found that childhood diarrhea differed considerably among WASH service levels and continues to be a serious health problem at the surveillance site. This study also shows that much work is needed to improve WASH services.

Trends and Associated Factors of Under-five Mortality Based on 2008-2016 Data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia.

Background: Of the 6.2 million estimated deaths of children under 15 years of age globally, the death toll of children under 5 years of age accounted for 5.3 million. In Ethiopia, even though significant progress has been made, facility-based research shows that the mortality rate of children under 5 is still high. In the country, particularly in the eastern part, evidence on trends in under-five mortality and associated factors from population-based longitudinal data is limited. Objective: The objective of the study was to assess under-five mortality focusing on the trends and associated factors based on 2008-2016 data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia. The method: The study was based on 9 years of surveillance data. The surveillance site was founded in 2007 with the aim of producing community-based health and demographic data in the eastern Ethiopia. Data were collected from the surveillance site and analyzed with STATA version 15 (for factor analysis) and/or Statistical Package for Social Sciences (SPSS) version 26 (for trend analysis) and Microsoft (MS) Excel software. The autoregressive integrated moving average (ARIMA) model and Mann-Kendall were used to analyze mortality trends. Multi-level logistic regression was used to assess the associated factors. Result: There were a total of 18 759 newborns in the surveillance sites, of which 1602 died of children under 5 years of age, and the total mortality rate for children under 5 years of age was 85 per 1000 live births. Trend analysis shows that the mortality rate of children under 5 has been steadily declining during the study period. Multi-level logistic regression shows that the variance of the random component model related to the intercept term is statistically significant, which means that there is a change in the mortality rate of children under 5 between the survey years, which is explained by the random intercept term. Antenatal care visits by mothers (AOR = .61, 95% CI = .49, .74), primary education (AOR = .58, 95% CI = .49, .68), normal birth weight (AOR = .78, 95% CI = .64, .95), and having 2 or fewer total births (AOR = .37, 95% CI = .22, .37) were all associated with child death. Conclusion: Despite the downward trend, the mortality rate of children under 5 years old at the surveillance sites is high. Effective intervention measures should be implemented.

Households with unimproved water sources in Ethiopia: spatial variation and point-of-use treatment based on 2016 Demographic and Health Survey.

BACKGROUND: Improved water sources are not equally available in all geographical regions. Populations dependent on unsafe water sources are recommended to treat their water at point-of-use using adequate methods to reduce associated health problems. In Ethiopia, the spatial distribution of households using unimproved water sources have been incomplete or ignored in most of the studies. Moreover, evidence on the point-of-use water treatment practice of households dependent on such water sources is scarce. Therefore, the current study is intended to analyze the spatial distribution of unimproved water sources by wealth quintiles at country level and point-of-use treatment (POU) practices using nationally representative data. METHOD: The data of 2016 Ethiopian Demographic and Health Survey (EDHS) conducted on 16650 households from 643 clusters were used for the analysis. For spatial analysis, the raw and spatially smoothed coverage data was joined to the geographic coordinates based on EDHS cluster identification code. Global spatial autocorrelation was performed to analyze whether the pattern of unimproved water coverage is clustered, dispersed, or random across the study areas. Once a positive global autocorrelation was confirmed, a local spatial autocorrelation analysis was applied to detect local clusters. The POU water treatment is analyzed based on reported use of either boiling, chlorine (bleach), filtration, or solar disinfection (SODIS). RESULTS: There were 5005 households using unimproved water sources for drinking purposes. Spatial variation of unimproved water coverage was observed with high coverage observed at Amhara, Afar, Southern Nations Nationalities and People and Somalia regions. Disparity in unimproved water coverage between wealth quintiles was also observed. The reported point-of-use water treatment practice among these households is only 6.24%. The odds of POU water treatment among household heads with higher education status is 2.5 times higher (95% CI = 1.43-4.36) compared to those who did not attend education. CONCLUSION: An apparent clustering trend with high unimproved water coverage was observed between regions and among wealth quintiles hence indicates priority areas for future resource allocation and the need for regional and national policies to address the issue. Promoting households to treat water prior to drinking is essential to reduce health problems.

Place of food cooking is associated with acute respiratory infection among under-five children in Ethiopia: multilevel analysis of 2005-2016 Ethiopian Demographic Health Survey data.

BACKGROUND: Globally, acute respiratory infections are among the leading causes of under-five child mortality, especially in lower-income countries; it is associated with indoor exposure to toxic pollutants from solid biomass fuel. In Ethiopia, 90% of the population utilizes solid biomass fuel; respiratory illness is a leading health problem. However, there is a paucity of nationally representative data on the association of household cooking place and respiratory infections. Besides, evidence on the variability in the infection based on the data collected at different times is limited. Therefore, this study is intended to assess the association of food cooking place with acute respiratory infections and the variability in households and surveys. METHODS: The current analysis is based on the Ethiopian Demographic and Health Survey data collected in 2005, 2011, and 2016 and obtained via online registration. The association of food cooking place with acute respiratory infection was assessed using multilevel modeling after categorizing all factors into child level and survey level, controlling them in a full model. The analyses accounted for a complex survey design using a Stata command "svy." RESULT: A total of 30,895 under-five children were included in this study, of which 3677 (11.9%) children had an acute respiratory infection, with 12.7% in 2005, 11.9% in 2011, and 11.1% in 2016. The risk of having an infection in under-five children in households that cooked food outdoors was 44% lower (AOR = 0.56, 95% CI = 0.40, 0.75) compared to those households that cooked the food inside the house. There was a statistically significant difference among the children among surveys to have an acute respiratory infection. CONCLUSION: The risk of having children with acute respiratory infection is lower in the households of cooking food outdoor compared to indoor. The infection difference in different surveys suggests progress in the practices in either food cooking places or the fuel types used that minimize food cooking places location or the fuel types used that minimizes the risk. But, the infection is still high; therefore, measures promoting indoor cooking in a well-ventilated environment with alternative energy sources should take place.

Chemical exposure in garage workers and related health risks on the biochemical levels: A comparative study in Harar town, eastern Ethiopia.

OBJECTIVES: Occupational exposure to chemicals causes a wide range of biological effects depending on the level and duration of exposure. The current study is intended to determine the differences in biochemical levels among garage workers compared with occupationally nonexposed participants in Harar town, eastern Ethiopia. METHODS: A comparative cross-sectional study was conducted in Harar town, eastern Ethiopia. Thirty (30) garage workers were selected and compared with 30 age- and sex-matched control group of teachers and students. Demographic and occupational data were collected using a structured questionnaire by trained data collector. Biochemical levels were measured by automated clinical chemistry analyzer (Autolab 18, Boehringer-Mannheim Diagnostics, the United States). Data were analyzed using STATA Version 13. RESULTS: All of the included garage workers were male. A statistically significant increase were found in alanine aminotransferase (35.60 ± 7.93 vs 19.17 ± 0.91 U/L; P value = 0.0440), aspartate aminotransferase (47.23 ± 4.89 vs 27.03 ± 1.13 U/L; P value = 0.0002), total protein (85.83 ± 1.16 vs 76.40 ± 0.86 g/l; P value < 0.0001), uric acid (7.34 ± 0.29 vs 5.19 ± 0.21 mg/dl; P value < 0.0001), glucose (85.13 ± 3.92 vs 75.60 ± 2.40 mg/dl; P value = 0.0425); total cholesterol (199.40 ± 13.11 vs 140.37 ± 3.81 mg/dl; P value = 0.0001) and triglyceride (143.40 ± 5.79 vs 110.60 ± 8.98 mg/dl; P value = 0.0033) in garage workers compared with control group. On the contrary, a statistically significant decrease were found in albumin (39.37 ± 1.78 vs 46.37 ± 0.56 g/l; P value = 0.0004) and urea (21.63 ± 1.04 vs 27.60 ± 1.69 mg/dl; P value = 0.0039) among garage workers compared with the control group. CONCLUSION: Our finding indicates that working in the garage changes most of the biochemical levels. Therefore, appropriate and effective safety measures need to be implemented to prevent possible chemical exposure during routine work.

Consistent point-of-use water chlorination among households using unimproved water sources and treatment preference in Eastern Ethiopia.

A consistent and correct use of water treatment options is fundamental for health gain from point-of-use water chlorination. In Ethiopia, empirical evidence about the consistent use and preference for by end users is scarce. The current study is intended to explore these issues using Waterguard and Bishan Gari in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia. Data were collected every 2 week for 4 months and analyzed using mixed effects logistic regression. Of 377 households, 31% consistently used Waterguard and Bishan Gari in all the study waves. Product use over time within a household varied based on the perception about the products and the type of products each household received. From the exit assessment, 56% of households stated a preference for Waterguard significantly different from 5.6% of households that stated a preference for Bishan Gari. An intervention for consistent use beyond their availability and accessibility to end users is needed.

Appropriate household water treatment methods in Ethiopia: household use and associated factors based on 2005, 2011, and 2016 EDHS data.

BACKGROUND: Diarrheal disease attributable to water and sanitation can be prevented using point-of-use water treatment. In Ethiopia, a small number of households treat water at point-of-use with appropriate methods. However, evidence on factors associated with household use of these treatment methods is scarce. Therefore, this study is intended to explore the household use of appropriate point-of-use water treatment and associated factors in Ethiopia. METHODS: The data of 2005, 2011, and 2016 Ethiopian demographic and health surveys were used for analysis. Households reportedly treating water with bleach, boiling, filtration, and solar disinfection in each survey are considered as treating with appropriate treatment methods. Household water treatment with these treatment methods and factors associated was assessed using bivariate and multivariable regression. In addition, a region level difference in the treatment use was assessed by using multilevel modeling. RESULTS: The number of households that reported treating water with appropriate water treatment methods was 3.0%, 8.2%, and 6.5% respectively in 2005, 2011, and 2016. Household heads with higher education had 5.99 (95% CI = 3.48, 10.33), 3.61 (95% CI = 2.56, 5.07), and 3.43 (95% CI = 2.19, 6.37) times higher odds of using the treatment methods respectively in 2005, 2011, and 2016 compared to household heads who had no education. There was a significantly high number of households that used appropriate water treatment methods in 2011 (AOR = 2.78, 95% CI = 2.16, 3.57) and 2016 (AOR = 2.18, 95% CI = 1.64, 3.89) compared to 2005 data. In pooled data analysis, the reported use of the treatment methods is associated with household head education, residency, drinking water sources, and owning radio and television. From a multilevel modeling, within-region variation is higher than between-region variations in the use of treatment methods in each survey. CONCLUSIONS: Below 10% of households reportedly treating water at point-of-use in each survey attributable to different factors. Designing intervention strategies for wide-scale use of treatment methods at the country level is fundamental.