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      Households access to improved drinking water sources and toilet facilities in Ethiopia: a multilevel analysis based on 2016 Ethiopian Demographic and Health Survey

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          Abstract

          Objective

          This study aimed to assess households access to improved drinking water sources and sanitation facilities and their associated factors in Ethiopia.

          Design

          Cross-sectional study.

          Setting

          Ethiopia.

          Participants

          Household heads.

          Primary outcomes

          Access to improved drinking water sources and toilet facilities.

          Methods

          We conducted an in-depth secondary data analysis of 2016 Ethiopian Demographic and Health Survey. Data from a total of 16 650 households and 645 clusters were included in the analysis. The households were selected using a stratified two-stage cluster sampling technique. Multilevel binary logistic regression analyses were performed to identify factors associated with access to an improved drinking water source and toilet facilities. Adjusted OR with a 95% CI was reported with p value <0.05 was used to declare a significant association between the covariates and the outcome variables.

          Results

          The proportions of households’ access to improved sources of drinking water and toilet facilities were 69.94% (95% CI: 69.23% to 70.63%) and 25.36% (95% CI: 24.69% to 26.03%), respectively. Households headed by women and households with a better wealth index were positively associated with access to improved drinking water sources. Whereas rural households, ≥30 min round trip to obtain drinking water and region were factors negatively associated with households access to improved drinking water sources. A higher probability of having access to improved toilet facilities: households with heads who had attained higher education, households having better access to improved sources of drinking water and households with better wealth index. While the following households were less likely to have access to improved toilet facilities: households with heads were widowed, households with four to six members, rural households and region.

          Conclusion

          The study found that the proportions of households’ access to improved drinking water sources and toilet facilities in Ethiopia were relatively low, which demands the need to tailor strategies to increase the coverage of access to improved drinking water sources and toilet facilities.

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          Most cited references31

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          Bayesian measures of model complexity and fit

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            A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena.

            In social epidemiology, it is easy to compute and interpret measures of variation in multilevel linear regression, but technical difficulties exist in the case of logistic regression. The aim of this study was to present measures of variation appropriate for the logistic case in a didactic rather than a mathematical way. Data were used from the health survey conducted in 2000 in the county of Scania, Sweden, that comprised 10 723 persons aged 18-80 years living in 60 areas. Conducting multilevel logistic regression different techniques were applied to investigate whether the individual propensity to consult private physicians was statistically dependent on the area of residence (that is, intraclass correlation (ICC), median odds ratio (MOR)), the 80% interval odds ratio (IOR-80), and the sorting out index). The MOR provided more interpretable information than the ICC on the relevance of the residential area for understanding the individual propensity of consulting private physicians. The MOR showed that the unexplained heterogeneity between areas was of greater relevance than the individual variables considered in the analysis (age, sex, and education) for understanding the individual propensity of visiting private physicians. Residing in a high education area increased the probability of visiting a private physician. However, the IOR showed that the unexplained variability between areas did not allow to clearly distinguishing low from high propensity areas with the area educational level. The sorting out index was equal to 82%. Measures of variation in logistic regression should be promoted in social epidemiological and public health research as efficient means of quantifying the importance of the context of residence for understanding disparities in health and health related behaviour.
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              Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries

              Background To develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and middle-income countries. Methods For each of the analysed diseases, exposure levels with both sufficient global exposure data for 2016 and a matching exposure-response relationship were combined into population-attributable fractions. Attributable deaths and disability-adjusted life years (DALYs) were estimated for each disease and, for most of the diseases, by country, age and sex group separately for inadequate water, sanitation and hygiene behaviours and for the cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Findings An estimated 829,000 WASH-attributable deaths and 49.8 million DALYs occurred from diarrhoeal diseases in 2016, equivalent to 60% of all diarrhoeal deaths. In children under 5 years, 297,000 WASH-attributable diarrhoea deaths occurred, representing 5.3% of all deaths in this age group. If the global disease burden from different diseases and several counterfactual exposure distributions was combined it would amount to 1.6 million deaths, representing 2.8% of all deaths, and 104.6 million DALYs in 2016. Conclusions Despite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children. These estimates contribute to global monitoring such as for the Sustainable Development Goal indicator on mortality from inadequate WASH.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2021
                18 March 2021
                : 11
                : 3
                : e042071
                Affiliations
                [1 ]departmentDepartment of Environmental and Occupational Health and Safety , College of Medicine and Health Sciences, University of Gondar , P. O. Box 196, Gondar, Ethiopia
                [2 ]departmentDepartment of Women’s and Family Health , School of Midwifery, College of Medicine and Health Sciences, University of Gondar , P. O. Box 196, Gondar, Ethiopia
                [3 ]departmentDepartment of Epidemiology and Biostatistics , Institute of Public Health, College of Medicine and Health Sciences, University of Gondar , P. O. Box 196 Gondar, Ethiopia
                [4 ]departmentDepartment of Human Physiology , School of Medicine, College of Medicine and Health Sciences, University of Gondar , P. O. Box 196 Gondar, Ethiopia
                [5 ]departmentDepartment of Medical Microbiology , School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar , Gondar, Ethiopia
                Author notes
                [Correspondence to ] Mr Zewudu Andualem; Zewuduandualem12@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-4731-1696
                http://orcid.org/0000-0001-5506-8705
                http://orcid.org/0000-0002-2397-5930
                http://orcid.org/0000-0003-4587-7925
                Article
                bmjopen-2020-042071
                10.1136/bmjopen-2020-042071
                7978246
                33737423
                62505933-d998-4867-acc8-97dc49e73af0
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 30 July 2020
                : 26 February 2021
                : 01 March 2021
                Categories
                Public Health
                1506
                1724
                Original research
                Custom metadata
                unlocked

                Medicine
                public health,preventive medicine,health policy
                Medicine
                public health, preventive medicine, health policy

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