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Geographical variation and factors associated with unsafe child stool disposal in Ethiopia: A spatial and multilevel analysis.
PLoS One. 2021; 16(4):e0250814.Plos

Abstract

BACKGROUND

Unsafe disposal of children's stool makes children susceptible to fecal-oral diseases and children remain vulnerable till the stools of all children are disposed of safely. There is a paucity of data on spatial distribution and factors associated with unsafe child stool disposal in Ethiopia. Previous estimates, however, do not include information regarding individual and community-level factors associated with unsafe child stool disposal. Hence, the current study aimed (i) to explore the spatial distribution and (ii) to identify factors associated with unsafe child stool disposal in Ethiopia.

METHODS

A secondary data analysis was conducted using the recent 2016 Ethiopian demographic and health survey data. A total of 4145 children aged 0-23 months with their mother were included in this analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of unsafe child stool disposal. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant spatial clusters. A multilevel multivariable logistic regression model was fitted to identify factors associated with unsafe child stool disposal.

RESULTS

Unsafe child stool disposal was spatially clustered in Ethiopia (Moran's Index = 0.211, p-value< 0.0001), and significant spatial SaTScan clusters of areas with a high rate of unsafe child stool disposal were detected. The most likely primary SaTScan cluster was detected in Tigray, Amhara, Afar (north), and Benishangul-Gumuz (north) regions (LLR: 41.62, p<0.0001). Unsafe child stool disposal is more prevalent among households that had unimproved toilet facility (AOR = 1.54, 95%CI: 1.17-2.02) and those with high community poorer level (AOR: 1.74, 95%CI: 1.23-2.46). Higher prevalence of unsafe child stool disposal was also found in households with poor wealth quintiles. Children belong to agrarian regions (AOR: 0.62, 95%CI 0.42-0.91), children 6-11 months of age (AOR: 0.65, 95%CI: 0.52-0.83), 12-17 months of age (AOR: 0.68, 95%CI: 0.54-0.86), and 18-23 months of age (AOR: 0.58, 95%CI: 0.45-0.75) had lower odds of unsafe child stool disposal.

CONCLUSIONS

Unsafe child stool disposal was spatially clustered. Higher odds of unsafe child stool disposal were found in households with high community poverty level, poor, unimproved toilet facility, and with the youngest children. Hence, the health authorities could tailor effective child stool management programs to mitigate the inequalities identified in this study. It is also better to consider child stool management intervention in existing sanitation activities considering the identified factors.

Authors+Show Affiliations

Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia.Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.Department of Surgery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.Department of Surgery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.Department of Pediatrics, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.Department of Public Health, Wachemo University, Hosaena, Ethiopia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33914836

Citation

Sahiledengle, Biniyam, et al. "Geographical Variation and Factors Associated With Unsafe Child Stool Disposal in Ethiopia: a Spatial and Multilevel Analysis." PloS One, vol. 16, no. 4, 2021, pp. e0250814.
Sahiledengle B, Teferu Z, Tekalegn Y, et al. Geographical variation and factors associated with unsafe child stool disposal in Ethiopia: A spatial and multilevel analysis. PLoS One. 2021;16(4):e0250814.
Sahiledengle, B., Teferu, Z., Tekalegn, Y., Awoke, T., Zenbaba, D., Bekele, K., Tesemma, A., Seyoum, F., & Woldeyohannes, D. (2021). Geographical variation and factors associated with unsafe child stool disposal in Ethiopia: A spatial and multilevel analysis. PloS One, 16(4), e0250814. https://doi.org/10.1371/journal.pone.0250814
Sahiledengle B, et al. Geographical Variation and Factors Associated With Unsafe Child Stool Disposal in Ethiopia: a Spatial and Multilevel Analysis. PLoS One. 2021;16(4):e0250814. PubMed PMID: 33914836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Geographical variation and factors associated with unsafe child stool disposal in Ethiopia: A spatial and multilevel analysis. AU - Sahiledengle,Biniyam, AU - Teferu,Zinash, AU - Tekalegn,Yohannes, AU - Awoke,Tadesse, AU - Zenbaba,Demisu, AU - Bekele,Kebebe, AU - Tesemma,Abdi, AU - Seyoum,Fikadu, AU - Woldeyohannes,Demelash, Y1 - 2021/04/29/ PY - 2020/08/03/received PY - 2021/04/14/accepted PY - 2021/4/29/entrez PY - 2021/4/30/pubmed PY - 2021/10/1/medline SP - e0250814 EP - e0250814 JF - PloS one JO - PLoS One VL - 16 IS - 4 N2 - BACKGROUND: Unsafe disposal of children's stool makes children susceptible to fecal-oral diseases and children remain vulnerable till the stools of all children are disposed of safely. There is a paucity of data on spatial distribution and factors associated with unsafe child stool disposal in Ethiopia. Previous estimates, however, do not include information regarding individual and community-level factors associated with unsafe child stool disposal. Hence, the current study aimed (i) to explore the spatial distribution and (ii) to identify factors associated with unsafe child stool disposal in Ethiopia. METHODS: A secondary data analysis was conducted using the recent 2016 Ethiopian demographic and health survey data. A total of 4145 children aged 0-23 months with their mother were included in this analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of unsafe child stool disposal. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant spatial clusters. A multilevel multivariable logistic regression model was fitted to identify factors associated with unsafe child stool disposal. RESULTS: Unsafe child stool disposal was spatially clustered in Ethiopia (Moran's Index = 0.211, p-value< 0.0001), and significant spatial SaTScan clusters of areas with a high rate of unsafe child stool disposal were detected. The most likely primary SaTScan cluster was detected in Tigray, Amhara, Afar (north), and Benishangul-Gumuz (north) regions (LLR: 41.62, p<0.0001). Unsafe child stool disposal is more prevalent among households that had unimproved toilet facility (AOR = 1.54, 95%CI: 1.17-2.02) and those with high community poorer level (AOR: 1.74, 95%CI: 1.23-2.46). Higher prevalence of unsafe child stool disposal was also found in households with poor wealth quintiles. Children belong to agrarian regions (AOR: 0.62, 95%CI 0.42-0.91), children 6-11 months of age (AOR: 0.65, 95%CI: 0.52-0.83), 12-17 months of age (AOR: 0.68, 95%CI: 0.54-0.86), and 18-23 months of age (AOR: 0.58, 95%CI: 0.45-0.75) had lower odds of unsafe child stool disposal. CONCLUSIONS: Unsafe child stool disposal was spatially clustered. Higher odds of unsafe child stool disposal were found in households with high community poverty level, poor, unimproved toilet facility, and with the youngest children. Hence, the health authorities could tailor effective child stool management programs to mitigate the inequalities identified in this study. It is also better to consider child stool management intervention in existing sanitation activities considering the identified factors. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/33914836/Geographical_variation_and_factors_associated_with_unsafe_child_stool_disposal_in_Ethiopia:_A_spatial_and_multilevel_analysis_ DB - PRIME DP - Unbound Medicine ER -