MWA WQ study presentation 10-7-2016 [Read-Only] · Microsoft PowerPoint - MWA WQ study presentation 10-7-2016 [Read-Only] 10/11/2016 7:53:37 AM

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


Data

Background: Existing evidence

• 7 water quality studies measuring E. coli or thermotolerantcoliforms 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.


Data

Background: SDG service laddersWater

Safely managedA basic drinking water source which is located on premises, available when needed and free of faecal and priority chemical contamination

BasicPiped 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 waterRiver, dam, lake, pond, stream, canal or irrigation channel

Sanitation

Safely managedA basic sanitation facility which is not shared with other households and where excreta are safely disposed in situ or treated off-site

Basic

Flush/pour flush to piped sewer system, septic tank or pit

latrine, ventilated improved pit latrine, composting toilet or pit latrine with a slab not shared with other households

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

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

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

Hygiene

BasicHand washing facility with soap and water in the household

UnimprovedHandwashing facility without soap or water

No facilityNo handwashing facility


Data

Background: SDG service laddersWater


BasicPiped 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 waterRiver, dam, lake, pond, stream, canal or irrigation channel

Sanitation

Safely managedA basic sanitation facility which is not shared with other households and where excreta are safely disposed in situ or treated off-site

Basic

Flush/pour flush to piped sewer system, septic tank or pit

latrine, ventilated improved pit latrine, composting toilet or pit latrine with a slab not shared with other households

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

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

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

Hygiene

BasicHand washing facility with soap and water in the household

UnimprovedHandwashing facility without soap or water

No facilityNo handwashing facility



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


Data

METHODS


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.


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


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


Data

Map of surveyed villages


Data

DESCRIPTIVE STATISTICSNational


Data

Water source

147

163

55

150

112

127

203

41

187

125

0 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 thanone 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


Data

Water source: Quality

5552

46

3228

813 16

6 67 9 5 9 0

3026

32

54

67

0

10

20

30

40

50

60

70

80

90

100

Public tap/standpipe(60)

Borehole with manualpump (149)

Protected spring (37) Unprotected spring (69) Surface water (18)

Perc

enta

ge o

f Sou

rces

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)


Data

Household: Water access

4

13

209

334

1

10

109

127

1

1

7

0

1

141

390

9

35

69

182

0

0

109

0 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 householdsCompleted projects

New projects


Data

Household: Water treatment and storage

16

616

468

4

50

43

36

879

386

9

42

14

0 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



Data

Household: Stored water quality

9 12 6 6 215

12 11 7 10

2317

13 11 6

5460

7176

83

0

10

20

30

40

50

60

70

80

90

100

Public tap/standpipe(351)

Borehole with manualpump (709)

Protected spring (168) Unprotected spring(335)

Surface water (121)

Perc

enta

ge o

f Hou

seho

lds

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)


Data

Sanitation: Latrine usage


Data

Hygiene: Handwashing times

552

106

586

645

109

2

2

5

0

13

0

3

7

587

97

606

790

101

4

4

10

10

27

3

9

17

0 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 timeCompleted projects

New projects


Data

REGRESSION ANALYSISNational


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)


Data

Regression analysis: Source water safety

ContrastOdds 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.


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)


Data

Regression: HSW safety

Contrast Odds Ratio95% 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.


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


Data

USING THE DATA


Data

Zone reports


Data

Stakeholder presentations


Data

Improvement plans


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 ownership

Water source: Functionality

1

38

67

3 123 20 5

4

25

11

1

224

88

1 4 19

51

15 1

4

14

0

10

20

30

40

50

60

70

80

90

100

110

Num

ber

of s

ourc

es

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

0 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 sourcesCompleted 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

0 20 40 60 80 100

WaSH committee

Someone is responsible for reparing the community's waterfacilities 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 theywere called

Someone outside the community that can be called if a waterfacility is broken down or has a problem

People pay to fetch water

Committee/community has money saved for repairing/replacingfacility

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

0 10 20 30 40 50 60 70 80 90 100

At least one person in the household defecates in a latrine (at leastsome of the time)

No excreta present in house or yard

No one seen openly defecating in past two weeks



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

0 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 coulddiscourage 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 leakonto the ground

Percentage of sanitation facilitiesCompleted projects New projects

Hygiene

24

192

29

33

829

277

41

300

32

227

34

36

944

261

28

376

0 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



Hygiene: Promotion0 20 40 60 80 100 120

Someone in community who is responsible for promoting hygienebesides 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

Documents

MWA WQ study presentation 10-7-2016 [Read-Only] · Microsoft PowerPoint - MWA WQ study presentation 10-7-2016 [Read-Only] 10/11/2016 7:53:37 AM