Assessment of Water handling and Sanitation practices among Rural communities of Farta Woreda, Northwest Ethiopia

Worldwide, 663 million people do not have access to improved drinking water supplies and 2.5 billion people lack access to improved sanitation including one billion who practice open defecation. Eighty-eight percent of deaths from diarrheal diseases are attributable to unsafe water, inadequate sanitation, and insufficient hygiene practices. Objective: To assess water handling and sanitation practice among rural communities of Farta woreda,North west Ethiopia. Methods: A community based cross-sectional study design was conducted in Farta Woreda from March 5 to 20, 2015. A total of 834 households were proportionally allocated to 10 kebeles of the Woreda and selected by systematic random sampling Technique.Data was collected using a pretested structured questionnaire. Descriptive analysis was performed to obtain the frequency distribution of the variables. Results: The majority of respondents water source were unprotected spring 313 (37.5%) followed by protected spring 206(24.7%). In addition to this, most households 382 (92.5%) had covered their stored water. Most of the respondents practiced pouring method to withdraw water from the stored container. Majority 738 (88.5%) of households had access to water within a time of 30 minutes or less. House hold water treatment was not common in the study area, only 23 (2.8%) households practiced. About four hundred seventy eight (57.3%) households had latrine facility, of which 263 (55%) was open pit latrine. In addition of those households having latrine only 102(21.3%) of households had hand washing facility. Conclusions: This study revealed that most of the respondents had poor water handling and sanitation practice. Thus, this study underscores that there should be great attention.


Introduction
Access to safe water alone does not reduce diarrheal diseases significantly. Even if the source is safe, water become faecally contaminated during collection, transportation, storage and drawing in the home. Water and sanitation are among the most important determinants of public health and an adequate supply of clean water is one of the most basic human needs and one that must be met [7]. Sanitation practices have a major effect on community and household water issues. In most rural communities, the use of on-site sanitation is a common tradition, which is not hygienic for health. As a result of this, there is a growing concern that the wide spread use of on-site sanitation systems will cause sub-surface migration of contaminants, ultimately resulting in disease transmission and environmental degradation. Surface waters such as rivers and ponds undergo such degradation as they are subject to biological and chemical contamination [9]. practicing open defecation [15]. Approximately eighty-eight per cent of cases of diarrhea worldwide are attributable to unsafe water, inadequate sanitation or insufficient hygiene. The constitute the socio risk factors of waterborne infectious diseases.
In addition to water sources, water collection, water storage in appropriate vessel and point-of-use treatment have been shown to greatly reduce diarrhoea generally and cholera specifically [3,4].
Ethiopia has the lowest water supply and sanitation coverage. According to data from WHO and UNICEF estimated in 2008 only 38% of total population had access for improved water supply (98% for urban areas and 26% for rural areas), 12% had access for improved sanitation (29% in urban areas, 8% in rural areas) [17].
People living in rural communities are the population sector most affected by hydro-transmissible infectious pathogen agents. Therefore, controlling of water quality is one of the essential issues of drinking water management [11,14]. There for the objective of this study was to assess water handling and sanitation practice among rural community.

Study area
The study was conducted in Farta Woreda which is one of the 12 Woredas found in South Gonder zone, Amhara regional

Study Design
A community based cross-sectional study was conducted using interviewer-administered questionnaire from March 5 to 20, 2015.

Source Population
All households found in rural kebeles of Farta Woreda

Study Population
Selected households found in 10 rural kebeles of Farta Woreda

Inclusion and Exclusion Criteria
Respondents lived at least for 6 month in the study area were included and respondents who were critically ill and other mental problems that prevents to get the required information were excluded from the study

Study Variables
Household water handling and Sanitation practice, age, education, occupation and marital status of the respondent, family size, type, ownership and availability of latrine, hand washing facility of latrine, water source, distance from house to water source, daily water consumption, ways of refuse disposal, types of floor and roof construction material and number of rooms, Latrine utilization, hand washing practice were variables included in the study.

Sample Size Determination
The total sample size included in the study was calculated by using Epi Info window version 3.5.3 statistical software manufactured by Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia (USA). A single population proportion formula used by considering 95% confidence level, Proportion of households covered their storage container from previous study was 52%(0.52),margin of error 5%, design effect of 2 and 10% non response rate give the total sample of 834 HHs.

Sampling Procedures
Multi-stage sampling technique was used .Ten rural The interviewers physically observed the condition of house hold water handling practices and utilization of sanitation facilities.
The supervisors were fully responsible to lead and handle the whole session of data collection process along with the principal investigator.

Data Quality Management and Analysis
Two days training of data collectors and supervisors on sampling procedures, techniques of interviews and data collection process was performed. In addition the data collectors and supervisors were participated in pre-testing of the questionnaire for its understandability by 5% of sample size in another kebele with the same level in every aspects of basic infrastructure and socio-demographic characteristics in the study area which were not included in the study and the result of the pretest was used to correct some unclear ideas and statements. During data collection the supervisors and principal investigator had closely followed the day-to-day data collection process and ensure completeness and consistency of questionnaire administered each day. After data collection the collected information was rechecked for its completeness and consistency by the supervisors and principal investigators before transferring in to computer software. Non over lapping numerical code was given for each question and the coded data was entered and cleaned into Epi Info soft ware

Ethical consideration
Permission letter was written to South Gonder zone and Farta Woreda administrators from Addis Ababa University Ethiopian Institute of Water Resource. The Woreda administrators wrote permission letter for study kebeles before the study started. Then informed verbal consent was obtained from the respondents after the necessary explanation about the purpose, benefits and risks of the study and also their right on decision of participating in the study. The assurance of confidentiality was performed by omitting name of the study participants from the questionnaire, by telling the safety of the place where the questionnaire to be stored after data collection and also the analysis is not for individual it is for groups.

Operational definitions
Improved water sources: includes Piped water into dwelling, Piped water to yard/plot, Tube well or borehole, Public standpipes, protected dug wells, protected springs and Rainwater.
"Improved" source is one that is likely to provide "safe" water [16].
Proper hand washing facility: household having functional hand washing facility with water in the container and moisture under the container.
High contamination risk in household water handling practices: is the sanitary risk score of 8-10 from the total 12 questions which is used to measure household water handling practice [6].

Medium contamination risk in household water handling
practices: is the sanitary risk score of 5-7 from the total 12 questions which is used to measure household water handling practice [6].

Low contamination risk in household water handling
practices: is the sanitary risk score of 2-4 from the total 12 questions which is used to measure household water handling practice [6]. Proper refuse disposals a way of disposal which included, burning, burying in a pit or storing in a container and disposing in designed site.

Water source and Household water handling practice
The major source of water supply for the study household were Unprotected spring 313 (37.5%) followed by protected spring 206(24.7%) and contributes 449 (53.8%) improved water supply access of study households. This is consistent with a study conducted in rural Dire Dawa communities, Ethiopia [2].The majority of households 738 (88.5%) required less than 30 minutes to fetch drinking water and the mean per capita daily water consumption of the households was 10.2 (±4.4) liters. Of the total 834 households, 121 (14.5%),146 (17.5%) and 567(68%) households were at high,medium and low contamination risk in household water handling practices respectively.

Water handling practice related to Water collection
Adult women 639 (76.6%) followed by 160 (19.2%) female child (under 15 years) were responsible for the collection of water for domestic use. The study revealed that the most 789(94.6%) commonly preferred type of water collection container was Jerrican. This finding is in agreement with similar study done in Dire Dawa rural communities and Kolladiba Town [12,5]. From the total respondents, the majority 579 (64.4%) and 743 (89.1%) were clean their container and wash their hands before collection of water respectively. In addition, majority 793 (95.1%) of the respondents were cover the collection container during transportation.

Water Handling Practice Related to Household Water Storage
Four hundred ninety five (59.4%) of the households used Jerrican followed by clay pot 180 (21.6) to store water at household and About 338 (40.5%) of the respondents used separate containers to store water for drinking purposes. This is used in many African countries storing water using Jerrican (CDC, 2010). Similarly majority 753(90.3%) of the households covered the storage containers during data collection time but the sanitation near to the storage containers was poor and only 148(17.7%) drinking water storage containers kept as WHO recommendation (40 cm above the floor ) [6]. Pouring method for drawing water from storage containers was used commonly by 609 (73%) of the respondents and separate cane for taking drinking water from the storage container used by 331(39.7%) respondents. After use, drinking utensils were mostly kept on table by 399(47.8%) followed by floor 290(34.8%) respondents. This finding is in line with a study done in Bahirdar city and Adama town [13,8].
Eight hundred twenty one (98.4%) respondents wash water storage container before storing water, of which 528(63.3%) washed every day followed by 251 (30.1%) every other day and the majority 554 (66.4%) of households stored water for one day . Treating water was not common in the study area, only 23 (2.8%) households practiced water treatment method of which around 12 households used leach/chlorine to treat drinking water (Table 3).This is finding is similar with a study done in sidama zone,southern Ethiopia [1].

Conclusion
The present study revealed that the water handling practice of the community was very poor, which showed that supply of safe water alone cannot guarantee that the water in the household for drinking purpose is safe as well. Sanitation practice in rural household is still very far from the recommended level. So efforts will be required to increase awareness regarding the components of household water handling and sanitation practice.