Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 12;79(Suppl 1):S53-S62.
doi: 10.1093/cid/ciae274.

Dissecting Water, Sanitation, and Hygiene (WaSH) to Assess Risk Factors for Cholera in Shashemene, Oromia Region, Ethiopia

Dejene Hailu  1   2 , Yeonji Jeon  1 , Abel Gedefaw  1   3 , Jong-Hoon Kim  4 , Ramzi Mraidi  4 , Tomas Getahun  5 , Ondari D Mogeni  1 , Edlawit Mesfin Getachew  5 , Geun Hyeog Jang  4 , David Mukasa  4 , Gi Deok Pak  4 , Deok Ryun Kim  4 , Samuyel Ayele Abebe  6 , Biruk Yeshitela  7 , Moti Edosa  8 , Yeshambel Worku Demlie  8 , Se Eun Park  1   9 , Mekonnen Teferi  5
Affiliations

Dissecting Water, Sanitation, and Hygiene (WaSH) to Assess Risk Factors for Cholera in Shashemene, Oromia Region, Ethiopia

Dejene Hailu et al. Clin Infect Dis. .

Abstract

Background: Cholera outbreaks have afflicted Ethiopia, with nearly 100 000 cases and 1030 deaths reported from 2015 to 2023, emphasizing the critical need to understand water, sanitation, and hygiene (WaSH) risk factors.

Methods: We conducted a cross-sectional household (HH) survey among 870 HHs in Shashemene Town and Shashemene Woreda, alongside extracting retrospective cholera case data from the Ethiopian Public Health Institute database. Relationships between WaSH and sociodemographic/economic-levels of HHs were examined. WaSH status and cholera attack rates (ARs) were described at kebele-level using geospatial mapping, and their association was statistically analyzed.

Results: Access to basic drinking water, sanitation, and hygiene facilities was limited, with 67.5% (95% confidence interval, 64.4-70.6), 73.4% (70.3-76.3), and 30.3% (27.3-33.3) of HHs having access, respectively. Better WaSH practices were associated with urban residence (adjusted odds ratio, 1.7, [95% confidence interval, 1.1-2.7]), higher educational levels (2.7 [1.2-5.8]), and wealth (2.5 [1.6-4.0]). The association between cholera ARs and at least basic WaSH status was not statistically significant (multiple R2 = 0.13; P = .36), although localized effects were suggested for sanitation (Moran I = 0.22; P = .024).

Conclusions: Addressing gaps in WaSH access and hygiene practices is crucial for reducing cholera risk. Further analyses with meaningful covariates and increased sample sizes are necessary to understand the association between cholera AR and specific WaSH components.

Keywords: Cholera; Ethiopia; WaSH risk factors; basic WaSH; hygiene practice.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Estimated association between mean cholera attack rate (AR) from 2016 to 2020 and water, sanitation, and hygiene (WaSH) status in study kebeles in Shashemene Town and Shashemene Woreda. The association is shown for three components of WaSH with “at least basic” status: drinking water source, sanitation, and hygiene. Each line represents LOESS (locally estimated scatterplot smoothing) estimates of association between mean cholera AR and status of respective WaSH components, with nonparametric 95% confidence intervals (gray shaded areas). Each dot represents the surveyed kebele. The x-axis represents the proportion of households with “at least basic” WaSH status by kebele, and the y-axis, mean cholera AR.
See this image and copyright information in PMC

References

    1. World Health Organization . WHO global water, sanitation and hygiene annual report 2018. 18 September 2019. Available at: https://www.who.int/publications-detail-redirect/WHO-CED-PHE-WSH-19.147. Accessed 5 December 2023.
    1. Ohwo O, Agusomu TD. Assessment of water, sanitation and hygiene services in sub-Saharan Africa. Eur Sci J ESJ 2018; 14:308.
    1. World Health Organization . Compendium of WHO and other UN guidance on health and environment. 3 September 2021. Available at: https://www.who.int/publications-detail-redirect/WHO-HEP-ECH-EHD-21.02. Accessed 5 December 2023.
    1. GBD 2016 Diarrhoeal Disease Collaborators . Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018; 18:1211–28. - PMC - PubMed
    1. Demlie YW, Gedefaw A, Jeon Y, et al. Retrospective analysis of cholera/acute watery diarrhea outbreaks in Ethiopia from 2001 to 2023: incidence, case fatality rate, and seasonal and multiyear epidemic patterns. Clin Infect Dis 2024; 79(S1):S8–19. - PMC - PubMed

Publication types