The effect of improved water and sanitation on diarrhea: Evidence from pooled Ethiopia Demographic and Health Surveys – A multilevel mixed-effects analysis

Abstract Background: In Ethiopia, diarrhoea is the leading cause of illness and hospital admissions among children, and the persistence of diarrheal epidemics in urban and rural areas warrants an exploration of the impact of WASH facilities over recent years. Objective: The study aimed to assess the effect of improved water sources and sanitation on the occurrence of diarrhea in Ethiopia, while controlling for household and child-related factors and accounting for higher-level variables. Methods: A total of 42,282 study subjects were pooled from the four rounds of the Ethiopian Demographic and Health Survey. A multilevel mixed-effects logistic regression model was run to identify the effect of water and sanitation on diarrhea, after adjusting for higher-level and confounding factors. SPSS version 24 was used for data management, while Stata version 15.1 was used for descriptive and multilevel analysis. Results: An improved water source was strongly associated with the occurrence of diarrhea in the final model, (AOR 95% CI: 1.02-1.2), while improved sanitation had a marginal association, (AOR 95% CI: 0.87-1.20). The interaction between improved water sources and improved sanitation has maintained the relevance of improved water sources, but not for improved sanitation, on diarrhea. Conclusions and recommendations: Improved water source was a strong predictor of diarrhea. Improved water sources and improved sanitation are both required to get the maximum benefit of reducing diarrhea among children. [Ethiop. J. Health Dev. 2020; 34(4):268-276] Key words: Diarrhea, improved water source, improved sanitation, interaction, effect, Demographic and Health Surve

Health Effects of Environmental Exposures, Occupational Hazards and Climate Change in Ethiopia: Synthesis of Situational Analysis, Needs Assessment and the Way Forward

Background: The burden of diseases caused by environmental and occupational health hazards and the effects of global climate change are of growing concerns in Ethiopia. However, no adequate information seems to be available on the current situation. This means there is a critical gap in research, policy framework and implementation in the country.Objective: The purpose of this paper was to synthesize evidence from a systematic situational analysis and needs assessment to help establish a hub for research and training on three major themes and their related policy frameworks: air pollution and health, occupational health and safety and climate change and health.Methods: The methods used in this work include a systematic review of secondary data from peer-reviewed literature, thesis reports from academia, government and national statistical reports. Limited primary data based on key informant interviews held with major stakeholders were also used as sources of data.Findings: Exposures to high levels of indoor and outdoor air pollutants were found to be major sources of public health challenges. Lack of occupational safety and health due to agricultural activities and exposure to industries was found to be substantial. Worse is the growing fear that climate change will pose increasingly significant multidimensional challenges to the environment and public health. Across all three areas of focus, there was a paucity of information on local scientific evidence. There is also very limited trained skilled manpower and physical infrastructure to monitor the environment and enforce regulatory guidelines. Research, policy frameworks and regulatory mechanisms were among the cross-cutting issues that needed urgent attention.Conclusions: Critical gaps were observed in research and training across the three themes. Also, there is a limitation in implementing the link between policy and related regulations in the environment and health.

The Magnitude of Occupational Injury and Associated Factors among Factory Workers in Ethiopia; The case of Mugher Cement Factory

Back Ground: Throughout the world, occupational exposure to cement dust and noise continue to cause serious public health hazard and one of the leading causes of disability and disease among workers. Objectives: The study investigated the prevalence and associated factors of occupational injuries(injuries that occur at a person's workplace which can include exposure to chemicals or other  substances) among cement factory workers in Mugher. Methodology: The sampling frame was obtained from Mugher cement factory. An institution based cross sectional study was conducted using stratified random sampling. The data was collected, edited, entered in to a computer using Epi Info version 3.5.0 then exported to SPSS version 21 and cleaned. Bivariate analysis & multivariate analysis was done. All employees who were directly engaged in the production process within the study period & had been working for at least one year in the selected factory irrespective of gender were included Results: The prevalence of occupational injury in one year was 10.4%. In addition, 1356 working days were lost as a result of 52 work related injuries. Thirty seven (71.2%) employees were hospitalized, accounting for 51.4% hospitalization for more than 24 hours, 18(34.6%) were absent from work for 15-30 days. The significant contributing factor for occupational injuries was job category. Workers in the cement production were 74.7% less likely to experience occupational injury than workers in the clinker production [AOR= 0.25, C.I : (0.100-0.639)]. Conclusion and Recommendation: Most of the world's work - related deaths, injuries and illnesses are preventable. The prevalence of occupational injury was high. Preventive measures like provision of adequate and quality safety materials timely and work place supervision should get focus

Prevalence of occupational injury and associated factors among workers in large-scale metal manufacturing factories in Addis Ababa, Ethiopia

Background: Worldwide work related injuries are becoming serious public health problems. However, very limited attempts have been made to assess the prevalence and factors associated with work-related injuries in Ethiopia.Objectives: The aim of this study was to assess the prevalence of occupational injury and associated factors among workers in large-scale metal manufacturing factories in Addis Ababa, Ethiopia.Methods: An institutional-based cross-sectional study was carried out among 588 metal workers in Addis Ababa, Ethiopia. Five metal factories were involved in the study. Data were collected using structured questionnaires, clinical data reviews and an observational checklist. Descriptive and multivariable analyses were done to describe the study population and identify risk factors associated with injury using an odds ratio with a 95%confidence interval (CI).Results: The prevalence of occupational injury among workers in the metal factories was 291 (49.9%) [95%CI: 45.8-53.9] per year. Among those injured respondents, 149 (51%) were not wearing personal protective equipment (PPE) at the time of injury. The use of PPE[adjusted odds ratio (AOR)=4.84; 95%CI: 2.93-8.01], attending primary school only [AOR=5.64; 95%CI: 3.05-10.43] and having 11 to 20 years’ work experience [AOR=7.878; 95%CI: 2.60-23.90], were major predictors of work-related injury after adjusting for confounding factors. There were 18 recorded incidents resulting in major disabilities in one factory during the study period.Conclusions: The prevalence of occupational injury among metal workers was high. The use of PPE, attending primary school and those who had 11 to 20 years work experience were major predictors of work related injury. There is a need of provide an adequate supply of PPE for all metal workers and to ensure that they use it. [Ethiop.J. Health Dev. 2019; 33(2):94-101]Key words: Work related injury, health and safety, factory workers, occupation, personal protective equipment utilizatio

Inhalation Exposures to Particulate Matter and Carbon Monoxide during Ethiopian Coffee Ceremonies in Addis Ababa: A Pilot Study

The unique Ethiopian cultural tradition of the coffee ceremony increases inhalation exposures to combustion byproducts. This pilot study evaluated exposures to particulate matter and carbon monoxide in ten Addis Ababa homes during coffee ceremonies. For coffee preparers the geometric mean (57 μg/m3) and median (72 μg/m3) contributions to an increase in a 24-hour time-weighted average exposure were above World Health Organization (WHO) guidelines. At 40% of the study sites the contribution to the 24-hour average exposure was greater than twice the WHO guideline. Similar exposure increases existed for ceremony participants. Particulate matter concentrations may be related to the use of incense during the ceremony. In nearly all homes the WHO guideline for a 60-minute exposure to carbon monoxide was exceeded. Finding control measures to reduce these exposures will be challenging due to the deeply engrained nature of this cultural practice and the lack of availability of alternative fuels

Review of Policy, Regulatory, and Organizational Frameworks of Environment and Health in Ethiopia

Background: Ethiopia produced its Environmental Health Situational Analysis and Needs Assessment (SANA) report in 2010 as part of the global endeavor to characterize and underscore the importance of connecting health and environment. The assessment methods used in SANA 2010 were updated, replicated and used in this SABNA. with a focus on air pollution, occupational safety and health, and climate change.Objectives: The purpose of the review was to examine national policies and identify gaps in regulations and organizational arrangements that determine Ethiopia’s ability to mitigate and eventually prevent the health impacts of air pollution, occupational hazards, and climate change.Methods: The national policy and regulatory documents were reviewed. Literature was identified through electronic searches. Hard copies of past reports and policies were reviewed whenever necessary. A semi-structured guideline was used to conduct in-depth interviews aimed at identifying gaps and needs.Results: The Constitution of Ethiopia has policy provisions related to air pollution, occupational safety and health (OSH), and climate change and health. Proclamation No. 300/2002 on Environmental Pollution Control specifies ambient air quality standards and allowable emissions. However, there were no documents that outlined the national or regional strategies that the ministries and agencies could adopt to translate existing policies, legal provisions, or guidelines for air pollution into practical programs. In the same way, a national OSH policy was lacking at the time this review was made on how occupational safety and health should be handled nationally or at lower governing levels as required by the International Occupation Safety and Health and Working Environment Convention No. 155/1981. Ethiopia is a signatory of this Convention.Conclusions and Recommendations: The results of the situational analysis indicate that there are cross-cutting gaps in the various sectors. Among these, addressing the critical shortage of skilled personnel is an urgent priority. Most stakeholders face acute shortages of professionals and poor retention mechanisms. It is therefore important toa) design interventions that focus on capacity building in, for example, aligning curricula with specific needs of ministries, andb) equip professionals with the necessary technical skills.In addition, the results indicate that policies and regulations exist in theory, but in practice, there are inadequate implementation strategies to encourage adherence and enforcement of the regulations and policies

Respiratory health among hand pickers in primary coffee processing factories of Ethiopia

Objective: The aim of this study was to assess chronic respiratory symptoms and lung function among female hand pickers. Methods: A total of 374 hand pickers exposed to coffee dust and 175 female controls from water bottling factories were included. The symptoms were assessed using a standardized questionnaire. Personal total dust exposure and lung function tests were performed. Results: Hand pickers experienced a higher dust exposure, displayed a higher prevalence ratio for cough [prevalence ratio (PR) = 3.0, 95% confidence interval (95% CI): 1.4 to 6.2] and work-related shortness of breath (PR = 2.5, 95% CI: 1.1 to 5.6), and had a lower FEF25–75 than controls. Hand pickers without tables had a significantly higher prevalence ratio of cough with sputum (PR = 3.9, 95% CI: 1.6 to 9.5) and lower forced vital capacity, forced expiratory volume in 1 second, and mean forced expiratory flow between 25% and 75% of the FVC than hand pickers with tables. Conclusion: Hand pickers show a range of adverse symptoms and lung function impairments that warrant efforts to improve working conditions.publishedVersio

Bacterial contamination of coffee and personal exposure to inhalable dust and endotoxin in primary coffee processing factories in Ethiopia

Introduction and objective: Endotoxins from gram-negative bacteria might be released when the coffee cherries are processed and may cause respiratory health problems among workers in the coffee industry. The relationship between bacterial contamination and occupational exposure to endotoxin levels has not been thoroughly explored previously in primary coffee processing factories in Ethiopia, or elsewhere. The aim of this study was to characterize the level of personal endotoxin exposure and its relations with bacterial contamination of coffee cherries in such factories in Ethiopia. Material and methods: A cross-sectional study was conducted from March 2020 – February 2021 in 9 primary coffee processing factories in 3 regions in Ethiopia. A total of 180 personal air samples were collected to analyze workers’ exposure to inhalable dust and endotoxin. Correlation tests were performed to assess the relationship between total bacteria and endotoxin levels and between inhalable dust and endotoxin levels. Results: The geometric mean (GM) of personal inhalable dust exposure among machine room workers and hand pickers were 9.58 mg/m3 and 2.56 mg/m3, respectively. The overall GM of endotoxin exposure among machine room workers and hand pickers were 10,198 EU/m3 and 780 EU/m3, respectively. Gram-negative bacteria were found in all 54 coffee samples. The correlation between inhalable dust and endotoxin exposure was significant (r=0.80; P <0.01). Conclusions: About 92% of the samples from hand pickers and all samples from machine room workers exceeded the occupational exposure limit of 90 EU/m3 recommended by the Dutch Expert Committee on Occupational Standards. Prevention and control of bacterial contamination of the coffee in primary coffee processing are suggested to reduce endotoxin exposure that might cause respiratory health problems among coffee workers.publishedVersio

Review of Climate Change and Health in Ethiopia: Status and Gap Analysis

Background: This review assessed Ethiopia’s existing situation on issues related to the environment, climate change and health, and identifies gaps and needs that can be addressed through research, training, and capacity building.Methods: The research was conducted through a comprehensive review of available secondary data and interviewing key informants in various national organizations involved in climate change adaptation and mitigation activities.Results: Climate change-related health problems, such as mortality and morbidity due to floods and heat waves, vector-borne diseases, water-borne diseases, meningitis, and air pollution-related respiratory diseases are increasing in Ethiopia. Sensitive systems such as agriculture, health, and water have been affected, and the effects of climate change will continue to magnify without the right adaptation and mitigation measures. Currently, research on climate change and health is not adequately developed in Ethiopia. Research and other activities appear to be fragmented and uncoordinated. As a result, very few spatially detailed and methodologically consistent studies have been made to assess the impact of climate in the country. There has often been a lack of sufficient collaboration among organizations on the planning and execution of climate change and health activities, and the lack of trained professionals who can perform climate change and health-related research activities at various levels.Conclusion: Firstly, there is a lack of organized structure in the various organizations. Secondly, there is inadequate level of inter-sectoral collaboration and poor coordination and communication among different stakeholders. Thirdly, there are no reliable policy guidelines and programs among organizations, agencies and offices that target climate change and health. Fourth, the existing policies fail to consider the gender and community-related dimensions of climate change. Fifth, the monitoring and evaluation efforts exerted on climate change and health activities are not strong enough to address the climate change and health issues in the country

Registered health problems and demographic profile of integrated textile factory workers in Ethiopia: a cross-sectional study

Background Textile and garment factories are growing in low and middle-income countries as worldwide demand for inexpensive clothing increases each year. These integrated textile and garment production factories are often built-in areas with few workplaces and environmental regulations, and employees can be regularly exposed to workplace hazards with little regulatory oversight. Consequently, workers’ health may be significantly affected due to long term exposure to hazards. This study describes registered health problems and their association to work-related and personal factors among workers in integrated textile factories in Ethiopia. Methods Institution-based cross-sectional study design was employed for this analysis. A one-year recording of worker’s clinical diagnoses (between March 2016 and February 2017) was gathered from the factory clinics of three integrated textile factories. Clinical diagnosis data was obtained as factory workers visited the clinics if feeling unwell. Sociodemographic characteristics and work-related information were obtained from the factory’s human resource departments. The sociodemographic and clinical diagnosis statuses of 7992 workers were analyzed. The association between the registered diagnoses and workplace factors (work in textile production, garment production and support process) and personal factors (age, sex and educational status) were studied using logistic regression analysis. Results The average employee age and years of service were 40 years and 11 years respectively. 60% of workers were females, comprising of 4778 women. 66% of all workers (5276) had 27,320 clinical diagnoses. In total, this caused 16,993 absent working days due to sick leave. Respiratory diseases (34%) and musculoskeletal disorders (29%) were the most prevalent diagnoses, while bodily injuries were the cause of most work absences. Work department, sex and educational status are variables that were most significantly associated with higher prevalence of disease groups. Conclusions About two-thirds of the integrated textile factory workers were diagnosed with different types of disease. The textile and garment production department workers were affected at a greater rate than the support process workers, indicating that some diseases may be related to workplace exposure. Further study should investigate rare chronic diseases such as cancer, heart diseases, renal diseases and diabetes.publishedVersio