Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.5
,
No
.2
,
Jun
e
2
016
, pp
. 13
7
~ 1
41
I
S
SN
: 225
2-8
8
0
6
1
37
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Inves
t
igations
of
Latrine Coverage and
As
sociat
ed Factors
Among Debretabor Town, Amhara
Region North West Ethiopia
Yilka
l
T
a
fere
1
, Mirkuzie Wo
ldie
2
, He
nok
Assefa
3
1
Department of public
health
,
D
e
breta
bore Univ
ersity
, Debre Tabor, Ethiopia
2
De
pa
rt
me
nt
of
He
a
l
t
h
Se
rvi
c
e
s
Ma
na
ge
me
nt
, Jimma
Uni
v
e
r
si
ty
, Ji
mma
,
E
t
hi
opi
a
3
Department of Epidemiolog
y
and
Biostati
stic
s,
Jimma
Unive
r
s
ity,
Jim
m
a
, E
t
hio
p
ia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Dec 15, 2015
Rev
i
sed
Feb
16
, 20
16
Accepted Apr 29, 2016
Studies in a nu
mber of countries have
shown
that wher
ever
inappropraite
waste disposal
morbidity
and
morta
lity
rates
are h
i
gh. Altho
ugh latrine
coverag
e
is
an i
m
portant indi
ca
t
o
r for m
eas
uring
s
u
cces
s
of th
e h
eal
th s
e
rvi
c
e
program
; data o
n
latrin
e covera
ge scarce in th
e
stud
y
are
a
. To
investigat
e
latrin
e cov
e
rage and associated
fact
orsinamong
households of Debretabor
town, Amhara region,
Ethiop
ia. A co
mmunity
based cross sectional stu
d
y
was conducted in Debretabor to
wn fro
m
September 1-30, 2013. A total o
f
422 households were included
in the
stud
y
using sy
stematic sampling
techn
i
que. Data
were co
llected u
s
ing
structur
ed questionnaire an
d
analy
z
ed
using SPSS version 16.0. Degree of
associatio
n between independent and
dependen
t
variables was a
ssessed with a 95% confidence lev
e
l
and p-valu
e
less than 0.05 w
a
s used to dete
ct
statisti
cal sign
if
ican
ce
. In this stud
y. Nine
t
y
three poin
t
five percent of hou
seholds
have latrine. Graduated
as model
fam
i
l
y
was pred
ictor for ava
ilab
ilit
y of la
trine (
AOR= 3.18,). Incom
e
and
house ownership were
also fou
nd to b
e
pr
ed
ictors for availability
of
latrine
(AOR=3.70), (
AOR=8.46), r
e
spectively
.
Education
a
l status of
respondents
was found to be predictors for availab
ility
of latrine (AOR= 2.6
5
). Latr
ine
coverag
e
was relativ
el
y
lower fro
m
the national target of 100%, still there ar
e
households that
use open defication. Ed
u
cational status, house o
w
ner shipe,
income and
graduated
as model family
wer
e
m
a
in f
actors
affe
c
ting l
a
trin
e
availability
.
Imp
r
oving so
cio economic status of households, provision of
continuous advice and technical s
upport
at househ
old level on the
availability
of latrine ar
e r
e
commended.
Keyword:
Ed
ucat
i
onal
st
at
us
Ethiopia
Health
serv
ice
p
r
og
ram
Latrin
e cov
e
rag
e
St
ruct
ure
d
que
st
i
o
n
n
ai
re
Copyright ©
201
6 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Yilk
al Tafere,
Depa
rt
m
e
nt
of
Pu
bl
i
c
Heal
t
h
,
Debretabo
r
e Un
iv
ersity,
D
e
br
e Tabo
r,
Eth
i
op
ia.
Em
a
il: y
ilk
al2
0
07@yaho
o.com
1.
INTRODUCTION
C
r
eat
i
ng p
r
op
er wast
e m
a
nagem
e
nt
pract
i
ces i
s
an essent
i
a
l
part
for i
m
prove
d h
u
m
a
n heal
t
h
.
I
n
Et
hi
o
p
i
a
wast
e
m
a
nagem
e
nt
pract
i
ces co
ve
rage rem
a
i
n
lo
w (6
0
%
) ev
en su
b
s
tan
tial efforts is
m
a
d
e
b
y
th
e
g
o
v
e
r
n
m
e
n
t
. In
g
e
n
e
r
a
l, san
itatio
n
r
e
lated
health
r
i
sk
s ar
e
co
mm
o
n
p
r
o
b
l
e
m
s [
1
] A
c
co
rd
ing
to
st
u
d
y
o
n
444
H
H
s
of
K
e
rsa
w
o
r
e
d
a
, Et
h
i
opia, show
ed th
at
on
ly 15
6 (36
.
4%)
H
H
s
r
e
po
r
t
ed
th
at t
h
ey
h
a
v
e
latr
in
e [2
].
Et
hi
o
p
i
a
n
po
p
u
l
a
t
i
on
has p
o
o
r
heal
t
h
st
at
u
s
, l
o
w i
n
com
e
and e
d
ucat
i
on
l
e
vel
especi
al
l
y
am
ong t
h
e
wo
m
e
n
,
in
ad
eq
u
a
te access t
o
san
ita
tio
n
facilities co
n
t
ribu
te to th
e
bu
rd
en ill h
ealth
.
Th
e
h
ealth
ch
allen
g
e
s
facing
Et
h
i
op
ia are sub
s
tan
t
i
a
l. Matern
al m
o
rtality ratio
in Eth
i
op
ia is
(MMR) 67
6
/
1
0
0
,
0
0
0
liv
e
b
i
rth
s
. Th
i
s
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
13
7 – 1
4
1
13
8
in
d
i
cates th
at
need
for exp
a
n
s
i
o
n of
p
r
im
ary
h
ealth
care
faci
lities in
o
r
d
e
r
to
attain
un
iv
ersal h
ealth
co
v
e
rag
e
[3]
.
Urba
n environments are m
o
re likely to see large
di
ffe
re
nc
es i
n
soci
oec
o
nom
i
c
st
at
us.
I
n
Et
hi
opi
a as
el
sewhe
r
e i
n
d
e
vel
o
pi
n
g
co
u
n
t
r
i
e
s, u
r
ba
n d
w
el
l
e
rs oft
e
n l
ack basi
c sani
t
a
t
i
on. Lac
k
of
basi
c i
n
fra
st
r
u
c
t
ure can
exacerbate rates
of
infectious disease [4],[5].
Im
p
r
o
p
e
r ex
creta d
i
spo
s
al are prin
cip
a
l
determin
an
ts for bo
th
m
o
rb
i
d
ity an
d
m
o
rtality. It is
esti
m
a
ted
th
at
m
o
re than
five m
i
llion pe
ople
die each
year fr
om
diseases related t
o
ina
p
propriate waste
di
sp
osal
[
6
]
.
M
o
re
ove
r,
88
% of
di
arr
h
eal
di
seases are a
t
t
r
i
but
ed t
o
p
o
o
r sa
ni
t
a
t
i
on [
7
]
.
In
th
e 48
co
un
tries
desi
g
n
at
ed
as
t
h
e
l
east
devel
o
ped
by
t
h
e Uni
t
ed
Nat
i
o
ns
, 1
i
n
4 peo
p
l
e
prac
t
i
ce
ope
n defec
a
t
i
on [8]
.
In
de
vel
o
pi
n
g
co
unt
ri
es
wa
st
e
m
a
nagem
e
nt
o
f
t
e
n em
erges as
a p
r
ob
l
e
m
t
h
at
enda
nge
rs
h
u
m
a
n
h
ealth
. To
m
a
k
e
m
a
tters wo
rse, waste m
a
n
a
ge
m
e
n
t
u
s
u
a
lly h
a
s a low
p
r
iority o
n
th
e po
litical p
r
og
ram
o
f
such
co
un
tries, as they are strugg
lin
g
with
o
t
h
e
r i
m
p
o
r
tan
t
i
ssue
s
[9].
A m
a
ssive diseas
e
burden is a
ssociat
ed wit
h
d
e
ficien
t san
itatio
n
an
d is largely p
r
ev
en
tab
l
e
with
prov
en
, co
st-effectiv
e interv
en
tio
n
s
[10].
In
t
h
e l
a
st
fe
w
y
ears i
n
m
a
ny
areas
o
f
Et
hi
o
p
i
a
u
r
ban
p
o
p
u
l
at
i
on
gr
owt
h
i
s
i
n
cre
a
si
n
g
.
U
r
ba
n a
r
eas
are am
ong the
worst in
waste
m
a
nagem
e
nt because of this
health relate
d
problem
s
are rising. M
u
ch of these
wastes,
which lead to
high
rates of
diseas
e and deat
h, a
r
e caused
by l
ack
of a
d
e
qua
te excreta
dis
pos
al
facilities. As
p
opu
latio
n in
crease, th
e situatio
n
will
grow worse
and
th
e
n
eed fo
r
safe and
affo
rd
ab
l
e
san
itatio
n
techn
o
l
o
g
y
at
HHs lev
e
l will b
e
m
o
re critical
. Alth
oug
h urb
a
n
san
itatio
n
facilit
y fig
u
res
gen
e
rally
are m
o
re t
h
an ru
ral
,
i
t
i
s
wi
del
y
kno
wn t
h
at
t
h
e po
or,
un
pl
anne
d,
den
s
el
y
po
pul
at
ed a
r
e
a
s are un
der
s
e
r
ve
d.
Thi
s
de
nsi
t
y
t
h
eref
ore
p
o
ses
a g
r
eat
ri
s
k
of
cont
am
i
n
at
i
on.
Li
m
i
t
e
d sani
t
a
t
i
on
o
p
t
i
ons
a
n
d
hi
gh
dem
a
nd a
r
e
com
pounde
d
by poverty and limited sp
ace, creating a m
a
jor c
h
allenge
unm
et
waste disposal
needs
of t
h
e
ur
ba
n
po
or
w
h
o
reso
rt
t
o
hi
gh
-ri
s
k
e
x
cret
a
di
spo
s
al
p
r
act
i
ces [
5
]
,
[
11]
.
In m
o
st
o
f
de
v
e
l
opi
n
g
c
o
unt
ri
es i
n
cl
u
d
i
n
g Et
hi
o
p
i
a
wast
e m
a
nagem
e
nt
p
r
a
c
t
i
ces are p
o
o
r.
Sani
t
a
t
i
o
n
C
ove
rage i
n
E
t
hi
opi
a rem
a
i
n
l
o
w (
6
0
%
) e
v
en c
o
nsi
d
e
r
a
b
l
e
eff
o
rt
s i
s
m
a
de by
t
h
e g
ove
r
n
m
e
nt
, sani
t
a
t
i
o
n
related
h
ealth
risk
s are co
mmo
n
pro
b
l
em
s it
is and
asso
ci
ated
with
low
san
itatio
n
cov
e
rag
e
[1
].
Altho
u
g
h
the
go
ve
rnm
e
nt
o
f
Et
hi
o
p
i
a
t
r
i
e
s
t
o
s
o
l
v
e
ur
ba
n
heal
t
h
p
r
o
b
l
e
m
s
t
h
r
o
u
g
h
Ur
ba
n
Heal
t
h
Ext
e
nsi
o
n
Pac
k
age
UHE
P; the
r
e
are iss
u
es in
waste m
a
nage
ment practices
th
at aff
ect
u
r
b
a
n pop
u
l
ation
,
on
ly 14
% ur
b
a
n
population
has
acces to a
n
improved toilet [12].
A st
u
d
y
con
ducted
in th
e
District o
f
Bah
i
r
Dar Zu
ria shows t
h
at av
ailab
ility o
f
latrines was twice
h
i
gh
er
in
HH
s w
ith
an
in
come o
f
50
00
or
m
o
r
e
Eth
i
op
i
a
n
Bir
r
p
e
r
year
[1
3
]
.
A
n
o
t
her
stud
y in
SN
NPR;
in
d
i
cate th
at
77
%
HHs rep
o
rted
th
at
d
i
scu
s
sio
n
was m
a
d
e
with
HEWs
o
n
latrin
e
u
tili
zatio
n
[14
]
. A stu
d
y
d
o
n
e
i
n
Duk
e
m
,
Eth
i
o
p
i
a, 20
11
sho
w
s th
a 55
%
o
f
HHs
h
a
d latrin
e.
Av
ailab
ility o
f
l
a
trin
was sign
i
f
ican
tly
associ
at
ed wi
t
h
h
ous
e ow
ner
s
hi
p (
p
<0
.0
5)
[
1
5]
.
In Et
hiopia, even though progre
ss
was m
a
de in re
duci
ng
child m
o
rtality from
123
deaths of
unde
r
fi
ve y
ears
of c
h
i
l
d
re
n pe
r
1,
0
00 l
i
v
e
bi
rt
h
s
i
n
2
0
05
[1
6]
t
o
88
deat
hs
per
1,
00
0 l
i
v
e bi
rt
hs i
n
20
1
1
[
3
]
,
chi
l
d
r
e
n
in
th
e cou
n
t
ry
still su
ffer from d
i
arrh
eal d
i
seases. Acco
rd
i
n
g
to
Et
h
i
op
ian
d
e
m
o
g
r
aph
i
c an
d
h
ealt
h
surv
ey, th
e
t
w
o wee
k
pre
v
al
ence
o
f
di
ar
r
h
eal
di
sease
s
was 13
%
am
on
g un
de
r
fi
ve
c
h
i
l
d
ren
[
3
]
.
To
im
p
r
o
v
e
san
itatio
n
thr
ough
ou
t Eth
i
o
p
i
a,
th
e N
a
tion
a
l San
itatio
n
Str
a
t
e
g
y
estab
lish
e
s th
e go
al o
f
1
0
0
%
latrin
e co
v
e
rag
e
[17
]
.
Th
e con
s
tru
c
tio
n of
san
ita
tion
facilities is un
d
e
rway in all p
a
rts
o
f
th
e co
un
try
since the introduction of the
HEP
by
the
m
i
nistry of
health. Because of
growi
ng c
once
r
ns of im
prope
r e
x
creta
d
i
spo
s
al related
h
ealth
risk
s fro
m
th
e to
wn
s
o
f
th
e co
un
try,
it is essen
tial
t
o
p
e
rfo
r
m
co
mm
u
n
ity
b
a
sed
stu
d
i
es
th
at will sup
p
o
r
t
b
e
tter
u
nderstand
ing
o
f
th
e prob
lem
s
. Based
o
n
t
h
ese con
t
ex
ts, t
h
e p
r
esen
t st
u
dy was
co
ndu
cted
with
reg
a
rd
to
Inv
e
stig
ation
s
of
latrin
e co
v
e
rag
e
and
id
en
tified
th
e fact
ors that affect latrine
cove
ra
ge
am
on
g ho
use
h
ol
ds o
f
D
e
b
r
et
ab
or
t
o
wn
, No
rt
h
w
est
Et
hi
o
p
i
a
.
2.
R
E
SEARC
H M
ETHOD
C
o
m
m
uni
t
y
based cr
oss-
sect
i
onal
st
u
d
y
wa
s con
duct
e
d i
n
Debre t
a
b
o
r
t
o
w
n
, N
o
rt
h
West
Et
hi
opi
a
f
r
o
m
Sep
t
e
m
b
e
r
1-
30
/201
3.
D
e
br
e tabo
r
t
o
wn
is lo
cated
665
K
m
s aw
ay f
r
o
m
A
d
d
i
s Ab
ab
a, cap
ital o
f
Eth
i
op
ia. Study Po
pu
latio
n
w
a
s selected
HH
s fou
n
d
in
Deb
r
etab
or
tow
n
d
u
r
i
ng
th
e st
ud
y p
e
r
i
od
. Indiv
i
d
u
a
l
ho
use
h
ol
d
hea
d
s
t
h
at
l
i
v
e
s
i
n
t
h
e t
o
w
n
fo
r at
l
east
6
m
ont
hs a
n
d
abo
v
e
d
u
ri
ng
t
h
e st
udy
peri
o
d
was
in
clu
d
e
d
.
Av
ai
lab
ility o
f
latrin
e
was
d
e
p
e
nden
t
v
a
riab
le.
Marital statu
s
,
Edu
catio
n
a
l
statu
s
, Relig
i
o
n, Fam
i
ly
size, Mo
n
t
h
l
y
f
a
mily
in
co
me o
f
r
e
spond
en
ts to
U
H
EP, gr
adu
a
ted
as a
m
o
d
e
l f
a
mil
y
w
e
r
e
in
dep
e
nd
en
t
vari
a
b
l
e
s.
Sam
p
l
e
si
ze was cal
cul
a
t
e
d
u
s
i
ng si
ngl
e
p
o
p
u
l
a
t
i
on
pr
o
p
o
r
t
i
on
fo
rm
ul
a. B
y
t
a
ki
ng t
h
e
pr
o
p
o
r
t
i
o
n
of
wast
e di
sp
osal
co
vera
ge
of h
o
u
se
hol
d
s
, 5
3
.
3
%, f
r
o
m
ot
her st
u
d
i
e
s [1
5]
. C
o
nfi
d
e
n
ce i
n
t
e
r
v
al
at
95
%
an
d settin
g alph
a at
5
%
,
4
2
2
to
tal o
f
sam
p
le size was calculated
.
Th
e sam
p
le size
was al
lo
cated
p
r
op
ort
i
o
n
a
l
to the size of households in each ke
bele
(the s
m
a
llest administrative unit in
Ethiopia
)
. The
num
b
er of
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Invest
i
g
at
i
o
ns
of
L
a
t
r
i
n
e C
o
v
e
ra
ge
an
d A
s
s
o
ci
at
ed
F
a
ct
or
s Am
o
n
g
De
br
et
ab
or
Tow
n
,
..
.. (
Y
i
l
k
al
T
a
f
e
r
e
)
13
9
house
h
olds
wa
s taken
from
each ke
be
le a
d
ministrative office. T
h
e first
house
h
old
was
selected by l
o
ttery
m
e
t
hod a
n
d t
h
e su
bse
que
nt
h
ous
eh
ol
ds
we
r
e
sel
ect
ed
usi
n
g sy
st
em
ati
c
sam
p
li
ng t
e
c
hni
q
u
e.
Data were co
llected
u
s
ing
a stru
ctured
q
u
e
st
io
nn
ai
re ado
p
t
ed
fro
m
rev
i
ewing
literatures. Eigh
t
d
a
ta
col
l
ect
ors a
nd
one s
u
per
v
i
s
o
r
were rec
r
ui
t
e
d
and fa
ce t
o
fa
ce i
n
t
e
rvi
e
w
w
a
s t
h
e t
echni
qu
e of dat
a
c
o
l
l
ect
i
on.
Data co
llecti
o
n
to
o
l
s were in
itial
l
y
p
r
ep
ared
in
Eng
lish
and
were tran
slated
in
to
Am
h
a
ric (lo
cal
l
a
ng
uage
) a
n
d
agai
n
re
-t
ra
nsl
a
t
e
d
back
t
o
En
gl
i
s
h.
To
assu
re q
u
ality,
d
a
ta co
l
l
ecto
r
s an
d
their su
p
e
rv
iso
r
were train
e
d
for two
d
a
ys and p
r
etestin
g
o
f
th
e in
strumen
t
was co
n
d
u
c
ted
b
e
fo
re th
e actu
a
l
d
a
ta co
llectio
n. Th
e d
a
ta were en
tered
in
t
o
EPI In
fo
versi
on
3.
1 and exported to
SPSS ve
rsion 16.
0
statistical softwa
re
for its analysis. Both biva
ria
t
e and
m
u
ltivariable analyses
we
re done.
All
vari
ables
with a
p-val
u
e <
0
.25
in t
h
e
biva
riate analysis
we
re
furth
e
r fit to
m
u
l
tiv
ariab
l
e lo
g
i
stic regressio
n
s
fo
r b
e
tt
er p
r
ed
iction
o
f
d
e
term
in
an
ts. Crud
e an
d
ad
ju
sted
o
d
d
s
ratio
with
95
% con
f
i
d
en
ce in
terv
als were co
m
p
u
t
ed
. P-v
a
lu
e less th
an
0
.
05
was tak
e
n
as statisticall
y
si
gni
fi
ca
nt
.
The st
udy
w
a
s et
hi
cal
l
y
app
r
ove
d by
researc
h
ethical committee
review
b
o
a
r
d
o
f
J
i
m
m
a
Un
i
v
ersity. B
e
fore co
mm
en
cin
g
d
a
ta co
llectio
n
leg
a
l
p
e
rmissio
n
with
l
e
tter o
f
sup
port was ob
tain
ed fro
m
Debre Tabo
r t
o
wn
h
ealth
o
ffice. All th
e st
ud
y p
a
rticip
an
ts w
e
r
e
inf
o
r
m
e
d
ab
ou
t th
e pu
rp
o
s
e of
t
h
e stud
y and
th
eir ri
gh
t to
refu
se.
Inform
e
d
co
nsen
t
was ob
tain
ed
fro
m ev
ery respo
nden
t
. St
rict con
f
id
en
tiality was also
main
tain
ed
thro
ugh
co
d
i
n
g
of qu
estion
n
a
ire
an
on
ym
o
u
s
ly.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
A t
o
t
a
l
of
42
2
ho
use
hol
ds sa
m
p
l
e
d i
n
t
h
e tow
n
an
d
41
4
of t
h
em
have
part
i
c
i
p
at
ed i
n
t
h
i
s
st
udy
.
From
t
o
t
a
l
st
udy
su
bject
s
w
e
re 3
37
(8
1.
4
%
) fem
a
l
e
s. The m
ean age
was 3
5
.
9
9 wi
t
h
±
9
.
23y
ea
r st
anda
r
d
devi
at
i
o
n. M
a
jo
ri
t
y
of res
p
on
de
nt
s 2
81
(6
7.
9%
)
w
e
re
m
a
r
r
i
ed
, and 1
5
8
(3
8.2%) w
e
r
e
hou
sew
i
v
e
s
respect
i
v
el
y
.
T
h
e m
ean fam
i
ly
si
ze of
t
h
e
h
ous
eh
ol
ds
was
3.
6
2
. R
e
gar
d
i
n
g
t
h
e et
hni
ci
t
y
40
1
(9
6.
9%
)
of
t
h
e
resp
o
nde
nt
w
e
re Am
hara a
n
d
m
a
jori
t
y
o
f
t
h
e resp
o
nde
nt
s
37
3
(9
0.
1%
) w
e
re O
r
t
h
od
o
x
b
y
rel
i
g
i
o
n
.
M
o
r
e
t
h
an
t
h
ree f
o
rt
h o
f
h
ous
eh
ol
ds
31
4
(7
5.
8%
) were
pri
v
at
el
y
owne
d. A
b
out
t
h
ree
hu
n
d
re
d t
w
e
n
t
y
si
x (7
8.
7%)
of t
h
e
resp
o
nde
nt
s
at
t
e
nde
d fo
rm
al
educat
i
o
n
an
d onl
y
l
e
ss
t
h
a
n
hal
f
,
1
7
9
(4
3.
2
%
) ho
use
h
ol
ds
we
re gra
d
uat
e
d
as
a
m
odel
fam
i
l
y
. As Ta
bl
e
1,
f
r
o
m
t
h
e t
o
t
a
l
4
1
4
h
o
u
se
hol
ds,
3
8
7
(
93
.5%
)
HHs
do
ha
ve
l
a
t
r
i
n
e, am
ong
t
h
es
e
35
3
(
9
1
.
2
%
)
of
t
h
em
have
p
r
i
v
at
e
l
a
t
r
i
n
e w
h
i
l
e
t
h
e rest
3
4
(
8
.
8
%
)
of
t
h
e
l
a
t
r
i
n
es we
re share
d
.
Am
ong
t
h
e
house
h
olds who did
not
ha
ve their own toile
t 21 (77.
8%
) of them used open field
to de
fecate. Regardi
ng the
typ
e
o
f
latrin
e 3
5
0
(90
.
4
%
) were p
it latrin
e, 24
(6
.2
%) v
e
n
tilated
im
p
r
ov
ed
p
it
latri
n
e, 13
(3
.4
%) water
carriag
e.
Ou
t
of th
e to
tal hou
seh
o
l
d
to
ilets,
34
7 (89
.
7
%
) to
ilets were fun
c
tio
n
a
l
du
ri
n
g
v
i
sit.
Table
1.
Availability of latrine am
ong the
re
sponde
n
ts in
Debreta
b
or to
wn, Am
hara Re
gion,
North
W
e
st
of
Eth
i
op
ia, Sep
t
em
b
e
r
2
013
Fr
equency Per
cent
(
%
)
Availability of toilet
facility Yes
387
93.5
No 27
6.
5
Do y
ou shar
e
y
our
pr
ivate toilet with
other
househol
ds
Yes
34
8.
8
No 353
91.
2
T
o
tal 387
100.
0
T
h
e status of latr
ine dur
ing the visit
Functional
347
89.
7
Not functional
40
10.
3
T
o
tal 387
100.
0
Reasons for
not ha
ving pr
ivate latr
ine
Lack of
adequate space
Yes
4
14.8
No 23
85.
2
T
o
tal 27
100
L
a
nd unsuitable to
constr
uct latr
ine
Yes
1
3.
7
No 26
96.
3
T
o
tal 27
100
Financial pr
oblem
Yes
15
55.
6
No 12
44.
4
T
o
tal 27
100
T
h
e house is r
e
nted
Yes
12
44.
4
No 15
55.
6
T
o
tal 27
100
I
f
y
our
HHs
do not have pr
ivate latr
ine,
where do y
ou
usually
use
?
Open field
21
77.
8
Shar
e neighbor
toilet
6
22.
2
T
o
tal 27
100.
0
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
13
7 – 1
4
1
14
0
3.
1.
Fa
cto
r
s a
s
so
ci
a
t
ed with
av
a
i
la
bility
o
f
latrine
Du
ri
n
g
t
h
e bi
vari
at
e anal
y
s
i
s
, h
ouse
o
w
ne
rshi
p, i
n
c
o
m
e
, educat
i
o
nal
s
t
at
us, bei
n
g
g
r
ad
uat
e
d as
m
o
d
e
l family
were t
h
e
v
a
riab
les th
at
was
fo
und
to
b
e
si
gn
ifican
tly associated
with
availab
ility o
f
latrin
e at
si
gni
fi
ca
nce l
e
vel
o
f
p-
val
u
e
≤
0.
25
.
Al
l
t
h
e vari
a
b
l
e
s whi
c
h sh
o
w
si
gni
fi
ca
nt
associ
at
i
on
du
ri
n
g
t
h
e bi
vari
at
e
anal
y
s
i
s
were
ent
e
red t
o
m
u
lt
i
v
ari
a
bl
e anany
s
i
s
,
ho
use
ow
ners
hi
p
,
i
n
com
e
, educat
i
o
nal
st
at
us, bei
n
g g
r
ad
uat
e
d as
m
odel
fam
i
l
y
sho
w
si
gni
fi
ca
nt
ass
o
ci
at
i
on
at
p
-
v
a
l
u
e <
0.
05
.
Ed
ucat
i
onal
st
at
us
also sh
ows sign
ifican
t asso
ciatio
n wit
h
av
ailab
ility o
f
latrin
e Respo
n
d
e
n
t
s
who
atten
d
e
d an
y l
e
v
e
l of
ed
u
cat
io
n
w
e
r
e
about 2
.
6
5
tim
es
mo
re lik
ely to
hav
e
latrin
e t
h
an
tho
s
e
who
do
no
t
at
t
e
nded
(A
OR
= 2.6
5
;
95
% C
I
= 1.
06
, 6.
6
3
).
In t
h
i
s
st
udy
,
R
e
spo
n
d
ent
s
w
ho
had t
h
ei
r
o
w
n
ho
use we
re
8.4
6
m
o
re l
i
k
el
y
t
o
have
l
a
t
r
i
n
e t
h
an t
h
ose
w
h
o r
e
nt
t
h
e
h
o
u
s
e (
AOR
=
8
.
46;
9
5
%
C
I
=
3
.
3
6
,
21
.3
3)
.
Sim
i
l
a
rl
y
respo
nde
nt
s
wh
o
ha
d a
n
i
n
c
o
m
e
of
1
2
0
1
or m
o
re
Et
h.B
i
rr
pe
r m
ont
h
were
3.
7
0
m
o
re l
i
k
el
y
to
h
a
v
e
latr
in
e
th
an
respon
d
e
nts w
ith
or
less th
an
12
00
Eth
Bir
r
p
e
r
m
o
n
t
h (
A
O
R
=3.70
;
95
% CI
=1
.1
7, 11
.7
1).
H
o
u
s
eh
o
l
d
s
wh
o
gr
adu
a
ted as m
o
d
e
l f
a
mily
o
n
H
E
P
w
e
r
e
3
.
1
8
m
o
r
e
lik
ely to
h
a
v
e
latr
in
e th
an
r
e
spond
en
ts
wh
o wer
e
not
gra
d
uat
e
d
as
m
odel
fam
i
ly
on HEP (
AOR
,
3
.
18;
9
5
%
C
I
= 1
.
1
6
, 8.
6
7
)
,
as T
a
bl
e
2
.
Tab
l
e
2
.
Asso
ciatio
n
of so
ci
od
em
o
g
r
ap
h
i
c an
d o
t
h
e
r ch
arac
teristics o
f
resp
ond
en
ts with
latrin
e av
ailab
i
lity in
D
e
br
etabo
r
tow
n
, A
m
h
a
r
a
, N
o
r
t
h W
a
st Eth
i
op
ia,
Sep
201
3
Variables
Availability of latrine
COR (95% CI)
AOR (95% CI)
Yes (%
)
No (%)
Ow
ner ship of th
e
house
Private
307(
97.
8)
7(
2.
2)
10.
96(
4.
48,
26.
8
4
)
8.
46(
3.
36,
21.
33)
*
*
Rent fr
o
m
pr
ivate
80(
80.
0)
20(
20.
0)
1
Monthly inco
m
e
(ETB)
<=1200
186(
89.
0)
23(
11.
0)
1
>=1201
201(
98.
0)
4(
2.
0)
6.
21(
2.
11,
18.
30)
3.
70(
1.
17,
11.
71)
*
Educational statu
s
Never
attended sch
ool
76(
86.
4)
12(
13.
6)
1
Attended so
m
e
sch
ool
311(
95.
4)
15(
4.
6)
3.
27(
1.
47,
7.
28)
2.
65(
1.
06,
6.
63)
*
Being
graduat
e
d as m
o
del f
a
m
i
ly
Yes
173(
96.
7%)
6(
3.
4%)
2.
81(
1.
12,
7.
17)
3.
18(
1.
16,
8.
67)
*
No
214(
91.
1%)
21(
8.
9%)
1
1
3.
2.
Discusio
n
Th
is stud
y was co
nd
ucted
to in
v
e
stig
ate availab
ility
o
f
lat
r
in
e and
asso
ciated
facto
r
s in Deb
r
etabor
t
o
w
n
, Am
hara,
Nort
h
W
e
st
Et
hi
opi
a. T
h
e fi
ndi
ng
s of t
h
i
s
st
udy
sh
ow
ed t
h
at
93
.5%
of t
h
e HH
s ha
d l
a
t
r
i
n
es
.
Thi
s
res
u
l
t
i
s
a
l
m
o
st
sim
i
l
a
r wi
t
h
a st
u
d
y
d
one i
n
Dam
boy
wo
reda
, S
N
NPR
,
a
n
d D
u
k
e
m
t
o
wn,
Et
hi
opi
a
20
1
1
th
at, 9
3
.8% and
91
.3
% HHs h
a
d
latrin
e faci
lity
resp
ectiv
el
y
[1
4
]
, [1
5
]
. Th
is si
m
i
larity
mig
h
t
b
e
in
b
o
t
h
of
th
e stu
d
y
areas th
e p
r
esence o
f
h
ealth
ex
tensio
n
work
ers mig
h
t
co
n
t
ri
b
u
te fo
r th
e av
ail
a
b
ility o
f
latrin
e .Ou
t
of
t
h
ose
w
h
o
di
d
n
o
t
ha
ve
t
h
ei
r
o
w
n
l
a
t
r
i
n
es,
a
b
o
u
t
77
.8
%
of
t
h
e
m
were usi
n
g
ope
n
de
fecat
i
o
n.
Thi
s
in
d
i
cates a
n
e
ed
to su
stain
a
b
l
e and
m
u
ltistrateg
y pro
m
o
tio
n.
Th
e
effect o
f
oth
e
r facto
r
s
on
av
ailab
ility
o
f
latr
in
e was assessed
.
Ho
use ow
n
e
rsh
i
p
was
sig
n
i
fican
tly
asso
ciated
with
av
ailab
ility
o
f
latri
n
e. Resp
ond
en
ts
wh
o h
a
d
th
eir own h
o
u
s
e were
8.4
6
ti
m
e
s
m
o
re
lik
ely
h
a
v
i
n
g
latrin
e
.Th
i
s find
ing
is in
lin
e with
th
e
find
ing
s
of a stu
d
y
don
e in
Da
m
b
o
y
a
Wo
red
a
, Duk
e
m
to
wn
and
Kersa
[2]
,
[
1
4
-
1
5
]
.
Thi
s
si
m
i
l
a
ri
t
y
m
i
ght
be i
n
bot
h st
ud
y
areas si
nce r
e
sp
on
de
nt
s ha
d t
h
ei
r o
w
n h
ous
e i
t
m
i
ght
be sui
t
a
bl
e t
o
co
nst
r
uc
t
l
a
t
r
i
n
e by
arr
a
ngi
ng t
h
ei
r p
r
em
i
s
es.So t
h
at
peo
p
l
e
can
out
wei
g
h t
h
e be
ne
fi
t
s
of
av
ailab
ility o
f
latrin
e an
d
th
ey can
k
eep
th
e su
rrou
nd
i
n
g
s
clean
co
nsid
erin
g
th
at th
ey are liv
in
g
p
e
rm
a
n
en
tly
in the a
r
ea.
Edu
catio
n
a
l st
atu
s
o
f
th
e
resp
ond
en
ts
was also
foun
d
to
be an
i
m
p
o
r
tan
t
p
r
ed
icto
r fo
r av
ailab
ility o
f
latrin
e. Th
is co
u
l
d
b
e
du
e t
o
edu
catio
n lead
s t
o
i
n
creas
e awa
r
ene
ss t
o
bring
be
havi
oral cha
n
ge a
bout the
b
e
n
e
fit of av
ailab
ility o
f
latrine.
Fin
d
i
n
g
s fro
m
th
is stu
d
y
sho
w
ed
th
at in
co
m
e
o
f
th
e resp
ond
en
ts was fou
n
d
to
h
a
ve statistica
lly
sig
n
i
fican
t
asso
ciatio
n
with
av
ailab
ility o
f
latrin
e Tho
s
e respo
n
d
e
n
t
s who
h
a
d
an
i
n
come o
f
12
01
and
m
o
re
Eth
.
Birr p
e
r mo
n
t
h
were
3
.
7
0
m
o
re lik
ely to h
a
v
e
latrin
e t
h
an
resp
ond
ents with
or less
th
an
1
200
Eth
Birr .
Th
is
repo
rt is co
n
s
isten
t
with th
e st
u
d
y
do
n
e
in
Zu
riya
[13
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Invest
i
g
at
i
o
ns
of
L
a
t
r
i
n
e C
o
v
e
ra
ge
an
d A
s
s
o
ci
at
ed
F
a
ct
or
s Am
o
n
g
De
br
et
ab
or
Tow
n
,
..
.. (
Y
i
l
k
al
T
a
f
e
r
e
)
14
1
4.
CO
NCL
USI
O
N
In t
h
i
s
st
udy
even t
h
o
u
gh t
h
ere
was a
h
i
ghe
r pe
rcent
a
ge o
f
l
a
t
r
i
n
e
cove
ra
ge i
n
t
h
e st
u
d
i
e
d
ho
use
h
ol
ds
’ 1
0
0
% l
a
t
r
i
n
e c
o
v
e
rage
was n
o
t
achi
e
ve
d d
u
r
i
n
g t
h
e t
i
m
e of d
a
t
a
col
l
ect
i
on.
The fi
ndi
ngs
o
f
t
h
i
s
st
udy
have i
m
po
rt
ant
i
m
pl
i
c
at
i
on f
o
r
i
m
provi
ng a
v
ai
l
a
bi
l
i
t
y
o
f
latrin
e.
Health
p
l
ann
e
rs n
e
ed
to
u
n
d
e
rstand
p
o
s
sib
l
e d
e
termin
an
t facto
r
s at th
e h
o
u
seho
ld
lev
e
l wh
ic
h
affects av
ailab
ility o
f
latri
n
e. Ed
u
cation
a
l statu
s
,
ho
use o
w
ners
h
i
p, i
n
com
e
, gr
aduat
e
d as
m
odel
fam
i
l
i
e
s on
UHEP
were factors that affe
ct th
e av
ailab
i
l
ity o
f
latrin
e.
ACKNOWLE
DGE
M
ENTS
We wo
ul
d l
i
k
e t
o
expre
ss our g
r
at
e
f
ul
heart
f
el
t
app
r
eci
at
i
on
t
o
Debre t
a
bo
r To
wn
Adm
i
ni
st
rat
o
rs
, dat
a
col
l
ect
ors a
nd s
u
per
v
i
s
o
r
s o
f
t
h
e
st
udy
f
o
r t
h
ei
r
coo
p
erat
i
o
n
and s
u
pp
ort
,
g
i
vi
ng
u
n
reserv
ed
time and
fo
llow up
fro
m
th
e b
e
g
i
nn
ing
till com
p
le
tio
n
o
f
t
h
is research .Ou
r
ackno
wled
ge
m
e
n
t
also
ex
tend
s to stud
y p
a
rticipan
ts
wh
o
were inv
o
l
v
e
d i
n
th
is stud
y.
REFERE
NC
ES
[1]
FMOH, “Co
mmunity
led sani
tation and h
y
giene (CLTSH) verification a
nd
certif
i
cation proto
c
ol,” Addis Ababa
Ethiopia, 2012.
[2]
Bizatu M.
& Negga B., “Community
ba
sed assessment on house
hold management
of waste and
h
y
giene pr
actices
i
n
Ke
rsa Wore
da,
Ea
st
e
r
n E
t
hi
opia
,
”
Ethiop. J. Health Dev,
vol/issue: 24(2)
, pp
. 10
4-109, 2008
.
[3]
Centra
l Statisti
c
a
l Agenc
y
[Eth
i
opia]
and ICF Interna
ti
onal, “Ethiopia Demographic
and Health
Survey
,” Addis
Ababa, Eth
i
opia
and Calverton
,
Mar
y
land, USA: Cent
r
a
l Statistical Agen
cy
and I
C
F International, 2012
.
[4]
“Urban Versus
Rural Health,
”
Available from: URL: h
ttp://www.
uniteforsight.org/gl
obal-health-uni
versity
/
urban-
rural-he
alth
.
[5]
FMOH, “Urban health ex
tension
pack
ag
e implementation
gu
ide line,” 2009.
[6]
J.
K.
Tumwine
,
et al
, “Diarrhea and effects of diffe
rent water
sources, sanitation a
nd h
y
giene behavior in East
Africa,
”
Trop M
e
d Int Health,
WHO,
vol/issue: 7
(
9), pp
. 750-756
, 2007.
[7]
World Health
Or
ganization
,
“WHO Facts
and
figu
res: Water, sanitation
and
h
y
gien
e links to
health
,” 2004.
[8]
WHO/UNICEF, “Progress on drinki
ng
water and sanitation,”
201
2.
[9]
H. B. N. Yongs
i,
et
al.
,
“
E
nvi
ro
nm
ental San
ita
ti
on and H
eal
th
Risks in Trop
ic
al Urban
Set
ting
s
: Case Stud
y
o
f
Household Refu
se and Dia
rrh
ea in Yaoundé Cameroon,”
International
Journal
of Human and Social S
c
ien
ces
,
2008.
[10]
Bartram J. & Cairncross
S., “H
y
g
iene, San
itation
,
and
Water:
For
gotten
Foundatio
ns of Health,”
PLoS Med
, 2010.
[11]
F. Kebede,
et al.
, “Lectur
e
notes for Environmental Health
Students, H
u
man a
nd Other Liquid Was
t
e
Management,” J
i
mma
University, 2002
.
[12]
USID/Ethiopia,
“End of project
Evalu
a
tion
for
u
r
ban health
ex
tensi
on program A
p
ril,” 2012
.
[13]
Awoke W. & M
u
che S., “A cros
s section
a
l stud
y: latrin
e cov
e
rag
e
and
associ
ated
factors
am
ong ru
ral
com
m
unities
in th
e Distri
ct
of
Bahi
r
Dar
Zuria, Ethiopia,”
BM
C Public H
e
alth
,
vol. 13, pp. 99,
2013.
[14]
Korm
a S
., “
A
s
s
es
s
m
ent of the exten
t
of im
plem
entati
on
and affecting
factors of envir
onmental health
extension
p
ackages at house ho
ld
lev
e
l
in
Dambo
y
a Woreda, K
e
mbata
Z
one, S
NNP Region,” 2
011.
[15]
Mohammed A., “Assessing environmental
san
itation in
urban setting of
Duke
m Town, Ethiopia, University
O
f
South Africa,” 2
011.
[16]
Central Statistical Agency
[
E
thiopi
a]
and ORC
Macro, “EDHS 2005,” Addi
s Ababa, Ethiopia and Calverto
n
,
Mar
y
land, USA: Centr
a
l Statistic
al Agen
cy
and O
RC Macro, 2006
,
[17]
Ministr
y
of Health, “National H
y
giene and
Sa
nitation Str
a
teg
y
,” Addis Ababa
Eth
i
opia, 2005.
Evaluation Warning : The document was created with Spire.PDF for Python.