Heavy metals in Ethiopian drinking water and public health risks: Insights from nationwide and regional analysis.

The ambitious sustainable development goal (SDG) 6 of the United Nations, which aims to achieve universal access to safe water and sanitation by 2030, remains elusive for many developing countries like Ethiopia. This is often due to a multitude of intricate factors, including the escalating degradation of water quality. Here, we present a comprehensive nationwide and regional analysis of heavy metal pollution in drinking water sources and the associated human health risks in Ethiopia based on a dataset of 11 heavy metal concentrations (n = 975) collated from available studies. Results indicate significant variations in heavy metal pollution in drinking water sources in Ethiopia, with 44 % of the total concentration exceeding maximum permissible limits. The mean concentrations were ranked as follows: Pb (1.92 mg/L) > Zn (1.25 mg/L) > Fe (0.56 mg/L) > Mn (0.43 mg/L) > Cu (0.40 mg/L) > Co (0.30 mg/L) > As (0.12 mg/L) > Ni (0.12 mg/L) > Cr (0.10 mg/L) > Cd (0.06 mg/L) > Hg (0.04 mg/L). We found that children are more vulnerable to non-carcinogenic health risks than adults, with the highest hazard quotient (HQ) exceedances of up to a factor of 1823 and 762, respectively. Furthermore, a Monte Carlo-based probabilistic risk assessment highlighted significant concerns regarding co-exposure to multiple heavy metals. The measured concentrations, ingestion rates, and exposure frequencies were identified as sensitive parameters. Overall, a higher risk was attributed to Pb and As, with river drinking water sources and the Tigray region requiring immediate mitigation measures. In conclusion, the findings emphasize the urgent need to test and purify water before consumption and to implement effective public health interventions. Furthermore, a multifaceted approach including regular monitoring, source protection, and proper waste management is recommended to expedite the achievement of SDGs and promote water sustainability in resource-limited Ethiopia and sub-Saharan Africa.

Organochlorine pesticides in Ethiopian waters: Implications for environmental and human health.

Despite the global ban on organochlorine pesticides (OCPs) since the 1970s, their use continues in many developing countries, including Ethiopia, primarily due to the lack of viable alternatives and weak regulations. Nonetheless, the extent of contamination and the resulting environmental and health consequences in these countries remain inadequately understood. To address these knowledge gaps, we conducted a comprehensive analysis of reported concentrations (n=398) of OCPs (n=30) in distinct yet interconnected water matrices: water, sediment, and biota in Ethiopia. Our analysis revealed a notable geographical bias, with higher concentrations found in sediments (0.074-1161.2 µg/kg), followed by biota (0.024-1003 µg/kg) and water (0.001-1.85 µg/L). Moreover, DDTs, endosulfan, and hexachlorohexenes (HCHs) were among the most frequently detected OCPs in higher concentrations in Ethiopian waters. The DDT metabolite p,p'-DDE was commonly observed across all three matrices, with concentrations in water birds reaching levels up to 57 and 143,286 times higher than those found in sediment and water, respectively. The findings showed a substantial potential for DDTs and endosulfan to accumulate and biomagnify in Ethiopian waters. Furthermore, it was revealed that the consumption of fish contaminated with DDTs posed both non-carcinogenic and carcinogenic risks while drinking water did not pose significant risks in this regard. Importantly, the issue of OCPs in Ethiopia assumes even greater significance as their concentrations were found to be eight times higher than those of currently used pesticides (CUPs) in Ethiopian waters. Consequently, given the ongoing concerns about OCPs in Ethiopia, there is a need for ongoing monitoring, implementation of sustainable mitigation measures, and strengthening of OCP management systems in the country, as well as in other developing countries with similar settings and practices.

Current and future burden of Ross River virus infection attributable to increasing temperature in Australia: a population-based study.

Background: Ross River virus (RRV), Australia's most notifiable vector-borne disease transmitted through mosquito bites, has seen increased transmission due to rising temperatures. Quantifying the burden of RRV infection attributable to increasing temperatures (both current and future) is pivotal to inform prevention strategies in the context of climate change. Methods: As RRV-related deaths are rare in Australia, we utilised years lived with disability (YLDs) associated with RRV infection data from the Australian Institute of Health and Welfare (AIHW) Burden of Disease database between 2003 and 2018. We obtained relative risks per 1 °C temperature increase in RRV infection from a previous meta-analysis. Exposure distributions for each Köppen-Geiger climate zone were calculated separately and compared with the theoretical-minimum-risk exposure distribution to calculate RRV burden attributable to increasing temperatures during the baseline period (2003-2018), and projected future burdens for the 2030s and 2050s under two greenhouse gas emission scenarios (Representative Concentration Pathways, RCP 4.5 and RCP 8.5), two adaptation scenarios, and different population growth series. Findings: During the baseline period (2003-2018), increasing mean temperatures contributed to 35.8 (±0.5) YLDs (19.1%) of the observed RRV burden in Australia. The mean temperature attributable RRV burden varied across climate zones and jurisdictions. Under both RCP scenarios, the projected RRV burden is estimated to increase in the future despite adaptation scenarios. By the 2050s, without adaptation, the RRV burden could reach 45.8 YLDs under RCP4.5 and 51.1 YLDs under RCP8.5. Implementing a 10% adaptation strategy could reduce RRV burden to 41.8 and 46.4 YLDs, respectively. Interpretation: These findings provide scientific evidence for informing policy decisions and guiding resource allocation for mitigating the future RRV burden. The current findings underscore the need to develop location-specific adaptation strategies for climate-sensitive disease control and prevention. Funding: Australian Research Council Discovery Program.

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.

Effects of high temperatures and heatwaves on dengue fever: a systematic review and meta-analysis.

BACKGROUND: Studies have shown that dengue virus transmission increases in association with ambient temperature. We performed a systematic review and meta-analysis to assess the effect of both high temperatures and heatwave events on dengue transmission in different climate zones globally. METHODS: A systematic literature search was conducted in PubMed, Scopus, Embase, and Web of Science from January 1990 to September 20, 2022. We included peer reviewed original observational studies using ecological time series, case crossover, or case series study designs reporting the association of high temperatures and heatwave with dengue and comparing risks over different exposures or time periods. Studies classified as case reports, clinical trials, non-human studies, conference abstracts, editorials, reviews, books, posters, commentaries; and studies that examined only seasonal effects were excluded. Effect estimates were extracted from published literature. A random effects meta-analysis was performed to pool the relative risks (RRs) of dengue infection per 1 °C increase in temperature, and further subgroup analyses were also conducted. The quality and strength of evidence were evaluated following the Navigation Guide systematic review methodology framework. The review protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). FINDINGS: The study selection process yielded 6367 studies. A total of 106 studies covering more than four million dengue cases fulfilled the inclusion criteria; of these, 54 studies were eligible for meta-analysis. The overall pooled estimate showed a 13% increase in risk of dengue infection (RR = 1.13; 95% confidence interval (CI): 1.11-1.16, I2 = 98.0%) for each 1 °C increase in high temperatures. Subgroup analyses by climate zones suggested greater effects of temperature in tropical monsoon climate zone (RR = 1.29, 95% CI: 1.11-1.51) and humid subtropical climate zone (RR = 1.20, 95% CI: 1.15-1.25). Heatwave events showed association with an increased risk of dengue infection (RR = 1.08; 95% CI: 0.95-1.23, I2 = 88.9%), despite a wide confidence interval. The overall strength of evidence was found to be "sufficient" for high temperatures but "limited" for heatwaves. Our results showed that high temperatures increased the risk of dengue infection, albeit with varying risks across climate zones and different levels of national income. INTERPRETATION: High temperatures increased the relative risk of dengue infection. Future studies on the association between temperature and dengue infection should consider local and regional climate, socio-demographic and environmental characteristics to explore vulnerability at local and regional levels for tailored prevention. FUNDING: Australian Research Council Discovery Program.

Associations between temperature and Ross river virus infection: A systematic review and meta-analysis of epidemiological evidence.

Ross River virus (RRV) infection is one of the emerging and prevalent arboviral diseases in Australia and the Pacific Islands. Although many studies have been conducted to establish the relationship between temperature and RRV infection, there has been no comprehensive review of the association so far. In this study, we performed a systematic review and meta-analysis to assess the effect of temperature on RRV transmission. We searched PubMed, Scopus, Embase, and Web of Science with additional lateral searches from references. The quality and strength of evidence from the included studies were evaluated following the Navigation Guide framework. We have qualitatively synthesized the evidence and conducted a meta-analysis to pool the relative risks (RRs) of RRV infection per 1 °C increase in temperature. Subgroup analyses were performed by climate zones, temperature metrics, and lag periods. A total of 17 studies met the inclusion criteria, of which six were included in the meta-analysis The meta-analysis revealed that the overall RR for the association between temperature and the risk of RRV infection was 1.09 (95% confidence interval (CI): 1.02, 1.17). Subgroup analyses by climate zones showed an increase in RRV infection per 1 °C increase in temperature in humid subtropical and cold semi-arid climate zones. The overall quality of evidence was "moderate" and we rated the strength of evidence to be "limited", warranting additional evidence to reduce uncertainty. The results showed that the risk of RRV infection is positively associated with temperature. However, the risk varies across different climate zones, temperature metrics and lag periods. These findings indicate that future studies on the association between temperature and RRV infection should consider local and regional climate, socio-demographic, and environmental factors to explore vulnerability at local and regional levels.

Landfill Site Selection Using GIS Based Multicriteria Evaluation Technique in Harar City, Eastern Ethiopia.

Solid waste disposal is one of the challenging components in integrated solid waste management. Particularly the problem is prominent in cities with rapid population growth and waste generation. Harar, a capital city of Harari regional state located in the eastern part of Ethiopia, covers an area of 19.5 km2 and has a total population of 270 000. Despite the fastest population growth of the city, it doesn't have a landfill site to accommodate the waste generated and open dumping is in full practice. As an integral part of a solid waste management plan, the construction of a landfill has been suggested by the city municipality. However, the multi-dimensional and conflicting aspect of landfill sitting, which involves environmental, social, technical, and economic considerations, challenges the location of a suitable landfill site. In the current study, we have applied geographic information system (GIS) and analytical hierarchy process (AHP) multi-criteria decision analysis to select a landfill site through minimizing conflicting interests. Environmental and socio-economic factors including well water, distance from residence, land use and land cover, elevation, slope, and wind direction were weighted to develop a suitability index for landfill siting. Experts' opinion was obtained to rank the aforementioned factors. The required landfill size was determined based on population growth, waste generation rate, and waste volume/year. Accordingly, the suitability index resulted in 3% of the area as highly suitable, and the rest 0.29%, 14.18%, 52.75%, and 29.8% classified as unsuitable, least suitable, moderately suitable, and suitable, respectively. Considering the future trend of waste generation, 16 ha of land located in the eastern part of the city was selected as a candidate landfill site with all the required suitability. The results of this study can be used as an input for decision making in siting landfill for Harar city.

Environmental Health Services and Professionals Level of Engagement in Different Sectors in Eastern Ethiopia: A Mixed Methods Study Design.

INTRODUCTION: Environmental health (EH) services have a long history in Ethiopia, but data on environmental health services quality and the magnitude of environmental health professionals' engagement has never been addressed. This study was conducted to assess the quality of environmental health services in different sectors and professionals' level of engagement in Eastern Ethiopia. METHODS: Institution based cross-sectional mixed study design was implemented. A cluster sampling technique was employed to select 83 participants. Data were collected using a pretested questionnaire and an interview guide. Descriptive, bivariate, multivariate, and thematic analysis was carried out. RESULTS: Professionals' performance in most services were reported to be average or low. Only 19.5% of participants responded as having good satisfaction in their job. The multiple logistic regression analysis showed factors associated with selected environmental health services. The odds of identifying environmental problems was associated with profession (adjusted odds ratio (AOR): 4.1; 95% confidence interval (CI): 1.3-7.6) and level of education (AOR: 3.1; 95%CI: 0.9-5.9). The factors contributing to introducing innovative solutions to EH problems were type of institution (AOR: 3.1, 95%CI = 1.6-9.3), profession (AOR: 3.4, 95%CI = 1.1-12.2), and level of support and emphasis offered (OR: 5.6, 95% CI = 2.2-11.9). Level of job satisfaction was also associated with the above-mentioned independent variables. CONCLUSION: The current study showed low level of professionals' engagement and factors associated with the quality of environmental health services in different sectors. Therefore, Ethiopian Federal Ministry of Health and other concerned ministries, agencies, and authorities should intervene accordingly to improve the service and level of professionals' engagement.

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.