Prediction of Low Community Sanitation Coverage Using Environmental and Sociodemographic Factors in Amhara Region, Ethiopia

• Type of Material: Article
• Authors: William E. Oswald, Emory University; Aisha E.P. Stewart, The Carter Center, Atlanta; William Flanders, Emory University; Michael Kramer, Emory University; Tekola Endeshaw, The Carter Center, Addis Ababa; Mulat Zerihun, The Carter Center, Addis Ababa; Birhanu Melaku, The Carter Center, Addis Ababa; Eshetu Sata, The Carter Center, Addis Ababa; Demelash Gessesse, The Carter Center, Addis Ababa; Tesfaye Teferi, The Carter Center, Addis Ababa; Zerihun Tadesse, The Carter Center, Addis Ababa; Birhan Guadie, Amhara Regional Health Bureau; Jonathan D. King, The Carter Center, Atlanta; Paul Emerson, Emory University; Elizabeth K. Callahan, The Carter Center, Atlanta; Christine Moe, Emory University; Thomas Clasen, Emory University
• Language: English
• Date: 2016-09-01
• Publisher: American Society of Tropical Medicine and Hygiene
• Publication Version: Final Published Version
• Copyright Statement: © 2016 by The American Society of Tropical Medicine and Hygiene.
• Final Published Version (URL): http://dx.doi.org/10.4269/ajtmh.15-0895
• Title of Journal or Parent Work: American Journal of Tropical Medicine and Hygiene
• ISSN: 0002-9637
• Volume: 95
• Issue: 3
• Start Page: 709
• End Page: 719
• Grant/Funding Information: This study was supported by the Lions-Carter Center Sight-First Initiative and was made possible by the generous support of the American people through the U.S. Agency for International Development (USAID) and the ENVISION project led by RTI International in partnership with The Carter Center.; William Oswald was supported by the Emory University Laney Graduate School, ARCS Foundation Atlanta, and the Global 2000 program of The Carter Center.
• Keywords: Tropical Medicine; DEMAND; Public, Environmental & Occupational Health; HEALTH EXTENSION PROGRAM; MODEL; Science & Technology; INTERVENTIONS; Life Sciences & Biomedicine; AREAS; BENIN; LATRINES
• Research Categories: Health Sciences, General; Health Sciences, Public Health

Abstract

This study developed and validated a model for predicting the probability that communities in Amhara Region, Ethiopia, have low sanitation coverage, based on environmental and sociodemographic conditions. Community sanitation coverage was measured between 2011 and 2014 through trachoma control program evaluation surveys. Information on environmental and sociodemographic conditions was obtained from available data sources and linked with community data using a geographic information system. Logistic regression was used to identify predictors of low community sanitation coverage ( < 20% versus ≥ 20%). The selected model was geographically and temporally validated. Modelpredicted probabilities of low community sanitation coverage were mapped. Among 1,502 communities, 344 (22.90%) had coverage below 20%. The selected model included measures for high topsoil gravel content, an indicator for low-lying land, population density, altitude, and rainfall and had reasonable predictive discrimination (area under the curve = 0.75, 95% confidence interval = 0.72, 0.78). Measures of soil stability were strongly associated with low community sanitation coverage, controlling for community wealth, and other factors. A model using available environmental and sociodemographic data predicted low community sanitation coverage for areas across Amhara Region with fair discrimination. This approach could assist sanitation programs and trachoma control programs, scaling up or in hyperendemic areas, to target vulnerable areas with additional activities or alternate technologies.