Assessment of Water, Sanitation and Hygiene Status of Households in Welenchiti Town, Boset Woreda, East Shoa Zone, Ethiopia

Ethiopia has made tremendous progress toward universal water, sanitation and hygiene access in the past decade, but still significant challenges remains unaddressed which varies from place to place. This study aimed to assess the status of Water supply, sanitation and hygiene of households in the town. A cross sectional study was conducted. The study subjects were randomly selected 423 households by systematic random sampling. Data were collected through interview and observation checklist. Concerning average consumption of water by households, majority 312 (74.00%) of them got less than 20 liters per capita per day. The study also revealed that, only 126 (33.60%) respondents washed their hands after defecation with soap and water. Majority of households, 294 (69.70%) disposed their solid wastes in open dump outside the yard. Those households who got water supply less than 20 liters per person per day (AOR=2.51, 95% CI=1.07-5.87, P=0.03), no hand washing practices after defecation (AOR=2.60, 95% CI=1.10-6.14, P=0.03) were more likely to have diarrhea in last two weeks. Based on the key indicators addressed in this study, access to water, sanitation and hygiene is lower than that of required standard. Health-workers and local authorities must pay special emphasis to improve these conditions.


Introduction
The significance of hygiene and sanitation is recognized in the United Nations' Millennium Development Goals. However, it remains one of the biggest development challenges in all developing countries [1]. It is common for many international organizations to use access to safe drinking water and hygienic sanitation facilities as a measure for progress in the fight against poverty, disease, and death. It is also considered to be a human right, not a privilege, for every man, woman, and child to have access to these services. Even though progress has been made in the last decade to provide safe drinking water and sanitation to people throughout the world, there are still billions of people that lack access to these services every day [2].
Although urban sanitation figures generally greater than rural access, it is widely known that the poor, unplanned, densely populated areas are badly underserved. This density therefore poses a greater risk of contamination than thinly populated rural areas. Limited sanitation options and high demand are compounded by poverty and limited space, creating a major challenge, particularly to vulnerable groups such as the very young, the elderly and people suffering from diseases that lower their resistance. Poorly controlled waste also means daily exposure to an unpleasant environment [3].
To achieve the targets, action must start now. Households, communities, local and national governments, civil society, and private companies all need to work together. Key areas of action that could create impact are as follows: making political commitments; creating legislation and regulations to support improvement in access and quality of sanitation and hygiene services; bringing together more resources, having stronger institutions and better trained people; culturally sensitive and appropriate hygiene education; right choice of technology that are cost-effective and environment-friendly; giving attention to gender and equity; supporting small-scale entrepreneurs; monitoring progress; and making information flow [2,3]. Therefore targeting hygiene and sanitation is vital for improving the health of the population at large.
The United Nations estimates that 2.5 billion people were still without improved sanitation in 2010 and around 1.1 billion practice open defecation throughout the world. The World Health Organization also estimates that, worldwide, there are 884 million people without access to a safe water supply. An even greater number, 1100 million people, do not have access to latrines or other forms of improved sanitation. Globally, Diarrhea alone kills 4,000 children every daycausing more child deaths than HIV/AIDS, malaria and measles combined [1].
Several studies in Africa documented that over half the population in Africa use an improved or shared sanitation facility; but one in four practices open defecation [2]. Similarly in sub-Saharan Africa, 45% of the populations use either shared or unimproved facilities, and an estimated 25% practice open defecation [3].
Ethiopia like many other countries in Sub-Saharan Africa has low levels of water, sanitation and hygiene facilities and practices. The national coverage figures for access to safe rural water supply within 1.5km are quoted to be 41% and access to safe urban water supply within 0.5 km to be 78%. Sanitation coverage is quoted to be 18% in rural areas and 57% in urban areas [4]. It has been reported that 60% of overall diseases is related to poor sanitation and hygiene in Ethiopia [5]. A diarrheal disease represents more than 75% of outpatient cases in Ethiopia and contributes to malnutrition. There is also a high prevalence of worm infestations (causing anemia). This, in turn, impacts on school attendance and level of education attained [6]. This is actually contributed due to poor sanitation practices such as open defecation, a low level of hygiene practices, and improper waste disposal. In general more than 80% of communicable diseases in Ethiopia are believed to be preventable using environmental health interventions, so targeting hygiene and sanitation is vital for improving the health of the population at large [7].
Among the main problems which are responsible for this situation are: lack of priority given to the sector, lack of financial resources, lack of sustainability of water supply and sanitation services, poor hygiene behaviors, and inadequate sanitation in public places including hospitals, health centers and schools. Providing access to sufficient quantities of safe water, the provision of facilities for a sanitary disposal of excreta, and introducing sound hygiene behaviors are of capital importance to reduce the burden of disease caused by these risk factors [8].
Lack of provisions to proper WASH facilities can hinder the development of a country. This may be a challenge to achieve Millennium Development Goal. Provision of adequate WASH facilities is not only a socioeconomic and developmental issue, but also an issue of self-respect, human dignity and public health [8,9].
The increased magnitude of water, sanitation and hygiene problems in urban settings of the country demands community-based studies that will facilitate a better understanding of the issues and influence policy and decision-making at the community, town, and regional state and national level. Therefore, this study aimed to assess Water supply, sanitation and hygiene status of households in Welenchiti Town, Bosetworeda, East Shoa Zone, Ethiopia.

Study Design and Setting
A cross-sectional study design was used to assess Water supply, sanitation and hygiene status of households. The study was carried out in the Welenchiti town, Oromia region state, Ethiopia. The town is located 25 km from Adama town, along the road from Addis Ababa to Dire Dawa. The study population was all households in Welenchiti town. The study units were randomly selected households from the two kebeles. The study period was from March 2015 to August 2015.

Sampling Methods
To select a fairly representative sample of households, the sample size was distributed proportionally to each of the two kebeles based on the number of households they have. After assigning a number to each houses, each sample was selected by systematic random sampling at an interval of 13 (5323 households divide by 423 total sample size). In case of absenteeism the next number was included in the study.

Sample Size Determination
The sample size was determined using the single population proportion formula.
Where n = Sample size of households. P = Proportion of households using improved water and sanitation. No previous similar study was carried out in the area and to get maximum sample size P was taken as 50% (P=0.5). d = Degree of accuracy required (sampling error) is 5% that is, d = 0.05. Z = Standard score for 95% confidence level is 1.96. Additional 10 % for non-response rates were taken. Substituting the above values (1), the calculated sample size for the study was 423 households.

Inclusion and Exclusion Criteria
Inclusion sampling criteria for this study was being a household living in a registered housing unit of Welenchit in Welenchiti Town, Boset Woreda, East Shoa Zone, Ethiopia town. Exclusion sampling criteria for the study were being institutions (such as offices, hotels, etc.) and households that were not registered in the kebeles of the town.

Ethical Considerations
The ethical approval and clearance was obtained from Adama Hospital Medical College, Institutional Ethics Review Committee. Then at all levels, officials were contacted and permission was secured. All the study participants were informed about the purpose of the study and verbal consent of all study subjects were obtained before data collection. Participants also informed that they have full right to discontinue or refuse to participate in the study. To ensure confidentiality, the name of interviewee was not written on the questionnaire. Besides, the interview was made in a place where it was conducive to the study participants, in their compound. Each respondent was assured that the information provided by them was confidential and used only for the purpose of research. Moreover, there was no risk or harm that was anticipated from participation of the study.

Data Collection Techniques
Data were collected using structured, pretested, interviewer-administered questionnaire through house to house and observational check list. Questionnaires were translated in to local language. In order to identify the clarity of questions, pre-testing of the instrument was done. During the pre-testing discussion was held with the interviewers and households on the problems they encountered to collect data. Correction was incorporated in the final questionnaire. Five health professionals were recruited as data collectors. Two health professionals were selected as supervisors. Training was given for both the supervisors and the data collectors for one day before the pretest and for a day after the pretest. The training includes the objectives of the study, method of data collection, checking completeness of questionnaire and the way approaching to the households.

Data Processing and Analysis
After the data were collected and the responses coded, the data was entered into a computer and analyzed using SPSS version 20. In the analysis process, frequency distribution of variables was worked out in order to describe them. To ascertain the association between dependent and independent variables, adjusted odds ratio with 95% confidence interval will be calculated at 5% significance level. Regarding occupation of respondents half of them, 211 (50.00) were housewife. Majority, 330 (78.19) of the households, family size were in the range of less than five persons (Table 1).  From a total of 422 households assessed for presence of excreta disposal systems, majority 375 (88.90%) reported that they have latrine or toilet facilities; while 47 (11.10%) were without latrine. From those households who had latrine, 342 (91.20%) were traditional pit latrines. The main reasons for not having larine are lack of space (59.60%) and costly to construct (40.40%) ( Table 3). Fortify five (10.70%) of the households had diarrhea in the last two weeks (Table 4).  Table 5 below indicates the association between latrine availability, adequate water supply and hand washing practices after defecation with diarrhea in the last two weeks. Those households who had no latrine availability (AOR=2.92, 95% CI=1.37-6.22, P=0.01), water supply less than 20 liters per person per day (AOR=2.51, 95% CI=1.07-5.87, P=0.03), no hand washing practices after defecation (AOR=2.60, 95% CI=1.10-6.14, P=0.03) were more likely to have diarrhea in last two weeks.

Discussions
Increasing access to improved drinking water is one of the sustainable developmental goals (SDGs). The study indicated that the proportion (34.40%) of households reported having piped water on their premises was lower when compared to EDHS 2011 report (48.40%) and other urban areas in Ethiopia [7,9]. The average water consumption of people in this study area was (74% of households got less than 20 liters per capita per day) lower than the WHO guidelines, which state that the per capita water consumption should be at least 20 liters per day [3,4]. The reasons may be Scarcity or inadequate water supply sources and walking distances might explain lesser amount of water consumption per capita per day. Diarrhea disease was a health problem in the study area. Households who got less than 20 liters of water per person per day had diarrhea almost two times more than households who got greater than 20 liters of water per person per day (AOR=2.51, 95% CI=1.07-5.87, P=0.03).
Washing of hand with soap after visiting toilet (or after defecation) has a paramount importance in decreasing of diarrheal and other parasitic diseases [9,10]. The study showed only 30% of the households with latrines washed their hands after defecation. The result was much lower than the growth and transformation plan or health sector transformation plan of Ethiopia (77%) which will be achieved in next five year (2020G.C.)This poor hand washing practices after toilet is significantly associated with diarrheal diseases (AOR=3.26, 95%, CI=1.35-7.91, P=0.03).
Many researchers have underlined the relationship between public health and improper solid waste management [5,8]. This study indicated that majority (69.70%) of the households disposed their solid wastes in open dump outside the yard. This leads to a polluted environment and sources of communicable diseases. This finding is similar with a study done in Ambo town, Oromia region, Ethiopia 2011, where majority, (63.68 %,) of the households disposed their solid wastes in open fields [11,12].

Limitations of the Study
The households that were included in the study were from only one town (Welenchit) and other towns in oromia were not incorporated in this study. Research results therefore are limited to this particular town and cannot be generalized to other towns in Oromia. The study was limited to the problems related to domestic environmental sanitation condition at household level and did not include data collection from the local institutions such as: the municipality, the town's health facilities, and other.

Conclusions and Recommendations
This study revealed that majority of the household's water supply was inadequate. The average water consumption of people in the town was lower than the WHO guidelines. Low proportion of the household's washed their hands after defecation. Majority of the household's proportions disposed solid wastes in open dump outside the yard. Therefore, this study recommends the following actions in order to alleviate the problems of WASH in Welenchiti town: Additional water supply source should be provided to supply adequate and continues water to the community. Increasing community based health education on hand washing practices after defecation is essential by strengthening Health Extension Workers. Increasing awareness and practices of safe solid waste disposal methods by the households and preparation of solid waste disposal site by the town municipal. Continues follow-up and supervision of all stake holders to implement community based national hygiene and sanitation strategy plan of 2015. Further research is needed including institutions.