Water quality in Ethiopia: learning from data Kate Shields, A.J. - - PowerPoint PPT Presentation

Water quality in Ethiopia: learning from data

Kate Shields, A.J. Karon, Elizabeth Christenson, Argaw Ambelu, Kaida Liang, Jamie Bartram

Outline

Background & Intro Methods Results Using the data

Background & Intro Methods Results Using the Data

Background: Existing evidence

• 7 water quality studies measuring E. coli or thermotolerant

coliforms conducted in Ethiopia since 2004.

– 5 studies had low study design quality overall – 2 studies found to be of high quality,

• 1 focused on piped water in urban areas
• 1 was 2004-2005 Rapid Assessment of Drinking-Water Quality (RADWQ)

study by WHO and UNICEF

– 56% of samples unsafe (156 containers – both rural and urban)

• 3 studies had comparisons of household stored water

(HSW) quality versus source water quality.

Background & Intro Methods Results Using the Data

Background: SDG service ladders

Water

Safely managed

A basic drinking water source which is located on premises, available when needed and free

• f faecal and priority chemical contamination

Basic

Piped water, boreholes or tubewells, protected dug wells, protected springs and rainwater provided collection time is no more than 30 minutes for a roundtrip including queuing

Unimproved

Drinking water from unprotected dug wells, unprotected springs, carts with small tank/drum, tanker trucks or basic sources with a total collection time of more than 30 minutes for a roundtrip including queuing

Surface water

River, dam, lake, pond, stream, canal or irrigation channel

Sanitation

Safely managed

A basic sanitation facility which is not shared with other households and where excreta are safely disposed in situ

• r treated off-site

Basic

Flush/pour flush to piped sewer system, septic tank or pit latrine, ventilated improved pit latrine, composting toilet

• r pit latrine with a slab not shared with other households

Shared

Sanitation facilities of an otherwise acceptable type shared between two or more households

Unimproved

Pit latrines without a slab or platform, hanging latrines and bucket latrines

Open defecation

Human faeces disposed of in fields, forest, bushes, open bodies of water, beaches or other open spaces or disposed of with solid waste

Hygiene

Basic

Hand washing facility with soap and water in the household

Unimproved

Handwashing facility without soap or water

No facility

No handwashing facility

Background & Intro Methods Results Using the Data

Background: SDG service ladders

Water

Safely managed

A basic drinking water source which is located on premises, available when needed and free

• f faecal and priority chemical contamination

Basic

Piped water, boreholes or tubewells, protected dug wells, protected springs and rainwater provided collection time is no more than 30 minutes for a roundtrip including queuing

Unimproved

Drinking water from unprotected dug wells, unprotected springs, carts with small tank/drum, tanker trucks or basic sources with a total collection time of more than 30 minutes for a roundtrip including queuing

Surface water

River, dam, lake, pond, stream, canal or irrigation channel

Sanitation

Safely managed

A basic sanitation facility which is not shared with other households and where excreta are safely disposed in situ

• r treated off-site

Basic

Flush/pour flush to piped sewer system, septic tank or pit latrine, ventilated improved pit latrine, composting toilet

• r pit latrine with a slab not shared with other households

Shared

Sanitation facilities of an otherwise acceptable type shared between two or more households

Unimproved

Pit latrines without a slab or platform, hanging latrines and bucket latrines

Open defecation

Human faeces disposed of in fields, forest, bushes, open bodies of water, beaches or other open spaces or disposed of with solid waste

Hygiene

Basic

Hand washing facility with soap and water in the household

Unimproved

Handwashing facility without soap or water

No facility

No handwashing facility

Safely managed

A basic drinking water source which is located on premises, available when needed and free

• f faecal and priority chemical

contamination

Background & Intro Methods Results Using the Data

Background and Motivation

• Millennium Water Alliance

– Active in Ethiopia since 2004 – Works through member organizations

• 2014 endline/baseline indicated water quality challenges
• Wanted to better understand water quality to improve

programming

• Particular interest in household stored water quality

Background & Intro Methods Results Using the Data

METHODS

Background & Intro Methods Results Using the Data

Design: Sampling plan

All MWA program areas from 2011-2017. Stratified by completed projects (2011-2014) and new projects (2014-2017). 44 kebeles selected at random from each stratum. Up to 4 gots selected at random from each kebele. 6 households selected at random per got. All community water sources selected per got.

Background & Intro Methods Results Using the Data

Design: Study tools

• Community survey
• Water point survey (WaSH MEL field kit)

– Arsenic – Fluoride – pH – Conductivity – E. coli

• Household survey

– E. coli

• Sanitation facility survey

Background & Intro Methods Results Using the Data

Surveys collected by region

Household Village Water source Amhara 908 149 235 Benishangul 129 21 32 Oromia 549 87 84 SNNPR 351 55 73 Total 1937 316 425

Background & Intro Methods Results Using the Data

Map of surveyed villages

Background & Intro Methods Results Using the Data

DESCRIPTIVE STATISTICS

National

Background & Intro Methods Results Using the Data

Water source

147 163 55 150 112 127 203 41 187 125 10 20 30 40 50 60 70 80 90 100 Managed by WaSH committee Functional on day of survey In the past year, water system been broken down for more than

• ne day

Water is avaliable from source at all times Water is available from this source at all hours of the day Percentage of water sources Completed projects New projects

Background & Intro Methods Results Using the Data

Water source: Quality

55 52 46 32 28 8 13 16 6 6 7 9 5 9 30 26 32 54 67 10 20 30 40 50 60 70 80 90 100 Public tap/standpipe (60) Borehole with manual pump (149) Protected spring (37) Unprotected spring (69) Surface water (18) Percentage of Sources Source type Conformity (<1 CFU/100 mL) Low risk (1-10 CFU/100 mL) Intermediate risk (11-100 CFU/100mL) High risk (>100 CFU/100 mL)

Background & Intro Methods Results Using the Data

Household: Water access

4 13 209 334 1 10 109 127 1 1 7 1 141 390 9 35 69 182 109 5 10 15 20 25 30 35 40 45 50 Piped water into dwelling Piped water to yard/plot Public tap/standpipe Borehole with manual pump Protected dug well Unprotected dug well Protected spring Unprotected spring Pay another person/buy filled containers Cart with small tank/drum Surface water Percentage of households Completed projects New projects

Background & Intro Methods Results Using the Data

Household: Water treatment and storage

16 616 468 4 50 43 36 879 386 9 42 14 10 20 30 40 50 60 70 80 90 100 Household practices water treatment Storage container has lid Storage container has a narrow opening Storage cotainer has a tap or spigot Storage container is above reach of animals Storage container is clean Percentage of households Completed projects New projects

Background & Intro Methods Results Using the Data

Household: Stored water quality

9 12 6 6 2 15 12 11 7 10 23 17 13 11 6 54 60 71 76 83 10 20 30 40 50 60 70 80 90 100 Public tap/standpipe (351) Borehole with manual pump (709) Protected spring (168) Unprotected spring (335) Surface water (121) Percentage of Households Source type Conformity (<1 CFU/100 mL) Low risk (1-10 CFU/100 mL) Intermediate risk (11-100 CFU/100mL) High risk (>100 CFU/100 mL)

Background & Intro Methods Results Using the Data

Sanitation: Latrine usage

Background & Intro Methods Results Using the Data

Hygiene: Handwashing times

552 106 586 645 109 2 2 5 13 3 7 587 97 606 790 101 4 4 10 10 27 3 9 17 20 40 60 80 100 after defecation after changing a baby before preparing food before eating before feeding a child in the afternoon when hands are dirty after eating in evening in morning before going outside the home before prayer after work, cleaning, dealing with animals, farming Percentage of households reporting handwashing time Completed projects New projects

Background & Intro Methods Results Using the Data

REGRESSION ANALYSIS

National

Background & Intro Methods Results Using the Data

Regression analysis: Source water safety

Safe source water

No human excreta within 10m OR: 2.5 (1.0-5.9) External support available OR: 1.7 (1.0-2.8)

Background & Intro Methods Results Using the Data

Regression analysis: Source water safety

Contrast Odds Ratio 95% Confidence Interval P-value* Source type: piped vs unimproved 2.1 (0.8 - 5.2) 0.2882 Source type: other improved vs unimproved 1.6 (0.7 - 3.3) Human excreta within 10m of source: no vs yes 2.5 (1.0 - 5.9) 0.0358 Fencing around source: yes vs no 1.4 (0.8 - 2.4) 0.2218 External support available: yes vs no 1.7 (1.0 - 2.8) 0.0431 Sampling: 2011-2014 vs 2014-2017 0.8 (0.5 - 1.3) 0.2942

*Based on a Type III test of significance which allows for testing of the p-value for a categorical variable overall rather than for each comparison.

Background & Intro Methods Results Using the Data

Regression analysis: HSW safety

Safe HSW

Safe source water OR: 1.9 (1.0-3.5) How water is removed from container OR: 2.2 (1.2-4.2)

Funds saved for repair/ replacement of source OR: 2.1 (1.1-3.9)

Region Distance to source (decrease by 100m) OR: 1.1 (1.0-1.2)

Background & Intro Methods Results Using the Data

Regression: HSW safety

Contrast Odds Ratio 95% Confidence Interval P-value*

Household sanitation type: pit latrine with slab vs. no facility 0.8 (0.4 - 1.7) 0.7243 Household sanitation type: pit latrine without slab/open pit vs. no facility 0.8 (0.4 - 1.5) No open defecation witnessed by household member in past two weeks 1.3 (0.9 - 2.0) 0.1621 Household does not have livestock 1.7 (0.9 - 3.0) 0.1270 Fixed location for handwashing 1 (0.4 - 2.4) 0.9994 Distance to source: decrease by 100m 1.1 (1.0 - 1.2) 0.0078 Water source safe 1.9 (1.0 - 3.5) 0.0465 HWT with bleach 6.5 (1.0 - 43.7) 0.1298 Storage container has narrow opening 1.3 (0.7 - 2.4) 0.3389 Removing water from container: Nothing used [water directly poured or dispensed through spigot] vs. utensil used [ladle, bucket, cup, bowl, jar, can] 2.2 (1.2 - 4.2) 0.0043 WaSH committee/community has funds saved for repairing/replacing water source[s] 2.1 (1.1 - 3.9) 0.0222 Region: Oromia vs. Amhara 2.3 (1.0 - 5.0) 0.0194 Region: SNNPR vs. Amhara 0.9 (0.3 - 2.9) Region: Benishangul vs. Amhara 3.2 (1.3 - 7.8) Sampling: 2011-2014 vs 2014-2017 0.8 (0.4 - 1.6) 0.5424

*Based on a Type III test of significance which allows for testing of the p-value for a categorical variable overall rather than for each comparison.

Background & Intro Methods Results Using the Data

Limitations of the study

• Logistical challenges of data collection
• Water quality testing is for one point in time only
• Recall bias (especially for functionality)
• Courtesy bias (especially for handwashing)
• Results generalizable to MWA program areas, care should

be taken when applying results to other areas of Ethiopia

Background & Intro Methods Results Using the Data

USING THE DATA

Background & Intro Methods Results Using the Data

Zone reports

Background & Intro Methods Results Using the Data

Stakeholder presentations

Background & Intro Methods Results Using the Data

Improvement plans

Background & Intro Methods Results Using the Data

Acknowledgements

• MWA and member organizations

– Melkamu Jaleta – Mussie Tezazu – Yisehak Leta

• Mike Fisher
• Enumerators and drivers
• Study participants

QUESTIONS?

SUPPLEMENTARY SLIDES

Got characteristics

Number of water sources per village Reported population of village Completed New Completed New Range 0-11 0-4 20-3000 15-4500 Mean 1.3 1.3 299 297

Health: Diarrhea

Socioeconomic status: Mobile phone

• wnership

Water source: Functionality

1 38 67 3 1 23 20 5 4 25 11 1 2 24 88 1 4 19 51 15 1 4 14 10 20 30 40 50 60 70 80 90 100 110 Number of sources Yes No Yes No Functionality: completed projects Functionality: new projects

Water source: Sanitary inspection

215 112 188 166 57 112 68 31 41 90 129 70 23 17 65 90 76 78 184 104 174 160 85 125 100 55 72 108 146 90 56 48 64 73 66 60 10 20 30 40 50 60 70 80 90 100 No latrine within 10m of source Nearest latrine not on higher ground than source No human excreta on the ground within 10m of source No sewer or gutter receiving sewage within 10m of source No other obvious source of pollution within 10m of source No ponding of stagnant water within 2m of cement floor Source has a drainage channel Drainage channel not broken, cracked, or in need of cleaning Drainage channel is not filled with stagnant water Fencing around source is adequate to keep animals out Source has a cement floor No visible cracks on the cement floor No signs of leaks in the mains pipes feeding this system No pipes exposed within 10 m of source No cracks in the walls of the source Walls of concrete pad extend below ground at all points Above-ground hardware not loose at base Base of the water point is adequately sealed Percent of water sources Completed projects New projects

107 84 28 54 56 70 87 85 87 31 24 99 61 26 61 47 85 73 75 86 27 50 20 40 60 80 100 WaSH committee Someone is responsible for reparing the community's water facilities when they break down People who maintain the facility have received training Community able to get spare parts and materials Maintinance person posesses all necessary tools Community maintenance person/team camee the last time they were called Someone outside the community that can be called if a water facility is broken down or has a problem People pay to fetch water Committee/community has money saved for repairing/replacing facility Percent of villages Completed projects Active committee Committee not active No committee New projects Active committee Committee not active No committee

Household: Water quantity

Household: Distance to water

Sanitation

618 667 587 492 732 561 10 20 30 40 50 60 70 80 90 100 At least one person in the household defecates in a latrine (at least some of the time) No excreta present in house or yard No one seen openly defecating in past two weeks Percentage of households Completed projects New projects

Sanitation: Facility inspection

93.9 6.5 83.1 82.8 59.3 68.9 6.3 72.2 89.5 95.8 8.5 87.4 81.5 65.7 56.6 12.4 48.2 84.8 10 20 30 40 50 60 70 80 90 100 Signs of recent use Accessible to disabled people Inside of facility not soiled with feces No evidence of feces on the ground within 10m of facility No unpleasant or offensive smell within the facility which could discourage its use No cracking or damage to the toilet pedestal or squat-slab Pit covered Cover slab completely sealed Pit or septic tank not full, overflowing or allowing wastes to leak

• nto the ground

Percentage of sanitation facilities Completed projects New projects

Hygiene

24 192 29 33 829 277 41 300 32 227 34 36 944 261 28 376 10 20 30 40 50 60 70 80 90 100 Fixed location for handwashing Soap present Ash present No cleanser present Water used to wash hands Soap used to wash hands Ash used to wash hands Rubbing motion used when washing hands Percentage of households Completed projects New projects

Hygiene: Promotion

20 40 60 80 100 120 Someone in community who is responsible for promoting hygiene besides the health extension workers Hygiene promotion activities

Within the last two weeks Within the last month Within the last year Over a year ago None Within the last two weeks Within the last month Within the last year Over a year ago None