Introduction

Globally, diarrhoea alone kills more children compared to malaria and tuberculosis together
(Odi 2006). Also, research indicates that more than half of acute illnesses are attributable to
water, sanitation and hygiene-related across all age groups.

In developing countries, the problem is complicated due to urban and peri-urban populations
that expanding rapidly, with limited resource to provide basic infrastructure in Urban areas.
“According to the World Resources Institute (WRI), urban populations in the developing
world are growing at 3.5 per cent per year, compared to a less than 1 per cent growth rates in
developed world cities. UN-Habitat reported that a staggering 95 per cent of the expected
global population growth is expected over the next 2 decades by cities in the developing
world.

World Health Organization (W.H.O) defines sanitation as group of methods to collect human
excreta and urine as well as community waste waters in a hygienic way, where human and
community health is not altered. Sanitation methods aim to decrease spreading of diseases by
adequate waste water excreta and other waste treatment, proper handling of water and food,
by restricting the occurrence of causes of diseases. The world has now realized the benefits of
parallel improvement of sanitation facilities with water supply and envisaged an ambitious
but must be met project under the Millennium Development Goals (MDGs).

The terms of reference demands to assess sanitation and recommends improvements; this is
quite a commendable move due to the fact that improvements only in water supply do not
result in improvements public health situation. The importance of safe drinking water and
basic sanitation to the preservation of human health, particularly among children, cannot be
overstated. Water related diseases are the most common cause of illness and death among the
poor of developing countries. The burden of waterborne diseases is paramount in the globe.
About 4% of the global burden of diseases is attributable to water, sanitation and hygiene
(Prüss, 2002).

The situation in Ethiopia is similar to other developing country, as it is characterized by rabid

urbanization throughout the country, accordingly necessitating improved urban
infrastructures like liquid waste management facilities as municipal urban-infrastructures that
are used to safely dispose of waste generated by day-to-day activities of city residents. These
generated wastes also vary from easily decomposable to non-biodegradable inorganic wastes.
Mismanagement of both wastes result in serious environmental, economic and social
problems. In most of the cities in the country Liquid waste management is very poor and very
much below the standards as compared to other countries.

Thus, Sanitation is a system to increase and maintain healthy life and environment. Though,
this is an undeniable fact, not enough attention has been given to sanitation especially in
developing countries; according to WHO and UNICEF, millions of children suffer from
malnutrition, low school attendance rates, and economic losses due to diarrheal disease that
are preventable by adequate sanitation. Human excreta increase intestinal parasite, which
affects 1.5 billion people around the world (W.H.O, 1998).

Werabe is a town in south-central Ethiopia. Official sources locate this town in the Silte Zone
of the Southern Nations, Nationalities and Peoples Region (SNNPR), although it is reported
that at a referendum in 2000 the Silt'e people unanimously voted to form their own Zone,
Silt'e, which includes Werabe. The town has a latitude and longitude of 8°1′N 38°20′E /
8.017°N 38.333°E with an elevation of 2,113 meters (6,932 ft.) above sea level.

According to the SNNPR's Bureau of Finance and Economic Development, as of 2003

Werabe amenities include digital telephone access, postal service, and 24-hour electrical
service. Werabe has nearly 91602 people Capital of silte zone Near to lakes with best sand
used for construction of buildings in central Ethiopia.

Werabe town water supply, sanitation and hygiene promotion project aims to improve the
health situation of 91602 people of the urban people in the worabe town silite zone SNNPR.
The project will address these key needs which form the basis of all development through
participatory, inclusive and effective means to bring about the following life changing project
purposes: The safe water supply coverage of worabe town is 59%, but the coverage is
different from one kebele to an other kebele. Because of these fuge, datie wezir, albazer and
alkeso kebeles community are elapsed time to fetch water for women and girls reduced from
1-2 hours to 30 minutes after project implementation, the project area population with
access to and use of sanitation facilities increased by 5.2 %, worabe town.
 Objectives the project
 General Objectives
The overall objective is to contribute sustainable health improvements amongst 91,602 water
users and 64.5% of this figure is expected to be addressed by hygiene and sanitation
education in the town of those mentioned of the town. Through this action significant change
will be expected in the life of communities WASH related diseases.

By improving access to clean water sources and improved sanitation facilities waterborne
diseases will decrease greatly, in particular women and children will benefit to a greater
extent.

 Specific objective

 To assess safe water supply schemes and ensuring management chain from source to
end users;
 To Facilitating the construction and proper use of improved sanitation facilities,
focusing in the town
 To Promotion of improved hygiene practices and behaviour change;

Problem Identification
The overall water supply provision coverage, reported by the werabe administrative town
water, sanitation and hygiene sector, is low of the population with having access to sanitation
facilities, with kebeles that are newly interred in to the werabe administrative areas being less
well served than the urban areas (werabe kebele 01 and werabe kebele 02).

The existing situation for most of kebeles that are newly interred in to the werabe
administrative population and in particular the proposed beneficiaries of this action is a
combination of:

 Distant and unreliable water sources

 Water which is contaminated at source by human and animal excreta

 Environmental pollution because of lack of sanitation facilities

 Poor knowledge of the links between water and poor hygiene practices

Consequently, women and children spend up to 1 –2 hours per day fetching contaminated
water that is inadequate in quantity to allow good hygiene to be practised. In many schools,
children take alternate mornings off classes to collect water for the school, thus missing 25%
of their education, as well as collecting water for the household after school. Since much time
is wasted in water hauling, physical injury follows from this load carrying such as back
injuries, hernia & miscarriages. Furthermore the whole population and especially children
suffer from ill health, water- and excreta-related diseases such as parasitic worms, diarrhoea,
skin and eye diseases.

In order to improve this situation people must get sufficient water of better quality from well-
developed and improved water supply systems closer to their homes such that they can
practice good hygiene, including safe excreta disposal, hand washing and home cleanliness.
However, at present communities are not able to bring about the changes required without
external assistance due to the low awareness and educational levels, particularly in relation to
the need for improved hygiene and sanitation practices, as well as the high initial cost of
installing water supply schemes which are unaffordable at community level.

To sum up, the major existing problems for the poor water and hygiene sanitation situation all
over the town and particularly in the selected areas are a combination of:

 Poor hygiene practices and thus being vulnerable to water, sanitation and hygiene related
diseases

 Lack of sustainable access to adequate safe water supply

 Poor access to appropriate sanitation facilities

Methodology
Study area
The study was carried out in the werabe town, silte zone, SNNPR state, Ethiopia. The town is
located 172 km from Addis Abeba. The study population was all households in werabe town .
the study units were selected from all kebeles in the town.

Sampling methods
To select a fairly representative sample of households, the sample size was distributed
proportionally to each of all kebeles based on the number of households they have. After
assigning a number of each house, each sample was selected by simple random sampling
from 11 kebeles we select only 05 kebeles, if there were more than one client in the
household, preferably the female was selected to provide information since they have main
responsibility in water and sanitation. For those unable to communicate immediate care giver
were asked, from each kebele select 10 Households for getting answer for the prepared
questioner.
Therefore, the poor urban people usually experience a negative impact
on the health and livelihood of the community. As it is seen in the
community interviews and reports from the sector the main
components of the existing water and sanitation problems of
developing countries like Ethiopia are as mentioned below.
1. Capacity Building
In each site WASH committees established and the desired training
usually conducted in collaboration with the sector office in the town.
This training mainly focuses on hygiene and sanitation, sustainable
scheme management and operation of the system.
In addition to this, basic health education training is provided for all
age groups continuously with the help of teaching aids/materials in
different participatory ways. This means for example, to hold group
discussions and teaching, using posters and slides at formal meetings,
schools, house to house visit and established traditional associations
like Eder and others social gatherings or events, to enable community
members to gain a thorough understanding of the importance of safe
water, personal hygiene and environmental sanitation, as well as the
necessary skills to employ these practices in daily life.
8. Implementation Strategy
The central implementation strategy of the project is working with the
local government, communities and households. The approach then is
direct community management of WASH activities through
elected/appointed committees or other groups which logically leads to
delegated management by trained members of the community.
Emphasis will be given on hygiene promotion and sanitation towards
bringing real behavioural change.
Feasibility study, construction design and assessments will be
conducted in consultation with community and woreda stakeholder.
 Initial request for support – Requests come direct from the
community via the Government offices. As the community initiate
the relationship with EKHC IWSP all subsequent interaction seeks to
build on this ownership. Initial discussion with community to
establish preliminary plans for schemes and expectations for
community contribution are facilitated through existing community
leadership. Working through the established authority structure
continues until the community mobilisation and education teams enter
the community one week prior to the start of installing the
infrastructure.
 Establishment of CBOs – The CBOs comprise the WASH
committee, SCs and CLTS/PHAST groups. If the Local Government
allows and the community agree, the IWSP will work with an existing
CBO in the community. This has the advantage of already having
authority, legitimacy and trust within the community and with the
Government. If it is not possible to work with an established CBO
then a community election process is undertaken where by the
community democratically elect a WASH committee, SCs and
CLTS/PHAST groups. The government is then expected to grant this
legal status. SC role and capacity building – For each scheme two
caretakers are elected by the community. Their role is to support the
daily operation and maintenance of the water facilities. The
maintenance training teams work alongside the community training
teams to ensure that the SCs have the skills and equipment to carry
out regular maintenance and minor repair work. The SC report to the
WASH committee/Woreda Water Office and receive remuneration for
the work they undertake from user fees collected. WASH Committee
role and capacity building – The WASH Committee is ultimately
responsible for all software and hardware aspects of the scheme.
Having gone through the CLTS/PHAST intensive training the
members then work with the community training team to follow up on
the CLTS/PHAST groups work. District Government role and
capacity building – The WaSH staff are involved in the capacity
building of each CBO in their locality. This builds the capacity of the
WaSH staff to be able to provide external support to the scheme and
builds relationships with the community that will provide ongoing
support and accountability. In order to support major periodic
maintenance requirements the WaSH staff are trained by the
maintenance training teams and equipped with the necessary
equipment. The WaSH departments' carry out an evaluation of each
scheme with the IWSP staff, the scheme is formally handed over to
the community at this point. Project organization and management:
the EKHCDP coordinates and oversees the overall operation of the
project whereas the IWSP will facilitate the implementation of
activities.
9. Community Involvement and Contribution
Community demand, involvement, contribution and ownership are the
key features of the intervention which ensures sustainability of the
WASH facilities and services in all aspects. Such contributions are
expected and would be measured on concrete terms as described in
the following ways where consent agreement will also be made
during the implementation process.
The contributions include:
 Information provision in all aspects of the process including
guiding and data stipulation
 Time allocation for hygiene and sanitation promotion and training
 Road construction for the accessibility of construction materials,
machines, vehicles…
 Venue and store provision for operation
 Provision of local materials: stone, sand, wood, if available…
 Unskilled labour provision: excavation and backfilling pipeline
trench work, loading and unloading of materials and tools…
 Protecting water sources, fencing schemes, planting indigenous
trees around water shed catchments….
 Election of representatives for the management of scheme through
50% women involvement in decision making positions of the WASH
committees. Households should cooperate with the WASHcoms.
 Financial contributions for scheme operation and maintenance as
well as future cost recovery. Through Woreda and Keble facilitation
as appropriate each household will pay for the water they use.

10. Project Activities

Table2. Project activities

Main activities
1. Mobilisation of communities to establish CBOs, WASH
committees, SC… to help install, manage schemes. 2. Train
community members ( CLTS group members ) on water, hygiene and
sanitation -1 group comprising of 15-20 households) 3. Train and
build capacity of WASH committee members, Kebele officials, and
health extension workers in CLTS and water management. 4. Train
SC and water technicians to operate, maintain, manage and sustain
schemes. 5. Train and build capacity of district WaSH dept. staff (2
from each office: water, health, education and agriculture) on the
support of software and hardware aspects of scheme management. 5.
Follow up and monitoring of CBO capacity development and scheme
impact. 6. Construct medium size gravity scheme/motorised pump
scheme, Extension of water supply systems from existing systems and
protected springs; 7. Conducting water quality test for each water
source; 8. Monitoring and evaluation of progress and impact:
11

11. Reporting, Monitoring and Evaluation

At programme level key results (improved health and sustainable

water supply) will be monitored. However, monitoring health trends
is difficult, instead it is often more practical to measure service
coverage, use of facilities and hygiene behaviours. It is generally
agreed that if certain key behaviours occur at the individual and
household/community level then it is reasonable to assume that health
benefits will follow.
Since the following four essential household practices are keys to
reduction in morbidity and mortality: monitoring and evaluation will
also focus in these areas;

1. Proper hand washing practices with soap (local alternatives) at

critical times: before & after meal, after latrine use and after
defecating children. 2. Safe excreta disposal and appropriate
utilization of latrines. 3. Practice of safe drinking water management
in the household (from source to mouth) 4. Practice food hygiene in
the households

Sanitation and hygiene programme will directly influence the first two
of these behaviours and the next two indirectly. Monitoring and
Evaluation will focus on these key behavioural change indicators, on
selection of easy to measure inputs, what is happening in the ground
and the primary results.

The main approach for monitoring and evaluation is setting up a

frame work where all the stakeholders participate in the process i.e.
participatory monitoring and evaluation, PME. Periodic reporting on
monthly, quarterly, biannual and annual basis will be conducted based
on the progress monitoring result.

12. Phase-out Strategy and Sustainability

EKHCDP is well aware of the importance of achieving sustainable

projects and thus only withdraws from the project area once a sense of
ownership and proper management of schemes are developed and
assured by the community and the respective water committees,
namely WASH committee, CLTS groups and SC's. Accordingly, the
established and well-trained water committees have the responsibility
to run the system in cooperation with the wereda water office. The
scheme care takers and water technicians are responsible for operation
and maintenance of the scheme as they will be provided with
sufficient training and tools. Apart from this the woreda water office
is also responsible for the overall monitoring of the management and
maintenance of the schemes at higher level. Regarding the software
part, particularly personal hygiene and sanitation is going to be
facilitated mostly by the local community workers (LCWs) using the
established CLTS groups, in cooperation with HEW, the woreda
health office and government structures. Once the capacity and
management structure of the schemes is in place EKHCDP/IWSP will
hand over the project out puts to the communities and local
government which leads to terminal evaluation before exit.p

Area Overview

Ethiopia is one of the least developed countries in the World which is

found in the horn of Africa. It is the second populous country in
Africa; 73.9 million people of which 84.6% live in rural (2007
National census). The country is characterized by diversified agro
ecology and known in the continent as a tower of water and roof of
Africa. The nation has known in traditional farming system (crop
production, livestock rearing, fishery, forest and horticulture
production system etc). However the nation is characterized by lack
alternative income sources, high population pressure, low social and
economic service and improper utilization of natural resources like
land and water.

The Amhara National Regional State (ANRS) is one of the Regions of

the Federal Democratic Republic of Ethiopia. Geographically it is
located between 90 29’ - 140 0’ North latitude and 360 20’– 400 20’
East longitude coordinates. The total area of the Region is estimated
to be 170,152 km2 which constitutes 15% of the country. According to
the 2007 national population census, the region has 17.21 million
people.

Amhara Region is the source of Blue Nile and the region also shares
the Tekeze and Awash basins. The project areas fall in the Abay
basin. The biggest Lake of the country, Lake Tana is also found in
this region. Amhara region is gifted with huge amount of surface and
ground water resources. However, the water resources potential of the
region is still underutilized and the people are not getting the
necessary social and economical benefits out of it. For example the
potable water coverage of the region is not more than 52% (rural 47%
and urban 85%). The sanitation coverage of the region is very low as
compared to potable water supply coverage. The primary health care
service of the region is 94.1%. The gross enrollment ratio of Amhara
region is 99.8%. The literacy level of the region is 37.91 percent
(Development indicators of Amhara region, 2008).

North and South Gondar administrative zones are two zones of the 11
Administrative zones in Amhara National Regional State found in
North West of Ethiopia. North Gondar zone has 23 districts and 3
administrative towns while South Gondar has 12 districts. The current
potable water coverage, primary education and health service
coverage of North Gondar zone is 51.89%, 77.4%and 94.6%
respectively. The project areas (Takussa and Alefa districts) are found
in North Gondar administrative Zone, 858 and 909 km away from
Addis Ababa respectively. It is located in North West of Ethiopia and
100 and 162 km away from Gondar, zonal capital respectively. While
Lay Gayint is found in South Gondar administrative zone 210 km
from North East of Bahir Dar. Both project districts are connected
with all weather gravel road. The district capital of Takusa is Delgi,
located along the shore of Lake Tana, the district capital of Alefa is
Shahura, while Lay Gayint is at Nifas Mewucha.

A Glimmer of Hope/MSDF and WINE for Water and ORDA jointly

launched water supply, sanitation and hygiene promotion projects in
Takusa district during 2009 fiscal year. During this period, 39 water
supply schemes are constructed and serving properly for 18,676
people. And also in Lay Gayint district in 2009 year, 108 water
supply projects and sanitation facilities constructed. Currently, Takusa
and Alefa districts have 31.8%/14.3%, 50%/20.8%, 81%/ 87% and
91%/68.9% potable water coverage, sanitation coverage, primary
education and health service coverage respectively. And due to the
implemented 2009 year charity water projects, lay Gayint district has
reached potable water coverage 56.18% and sanitation coverage
22.4%.The potable water coverage of the districts is very lower as
compared to their respective zones. In fact, the great majority of the
rural population fetches drinking water from unprotected sources
(rivers; springs, Lake Tana, ponds, rain water, developed pit near to
river sand deposited and traditional hand dug wells). These water
sources are not well protected from wild and domestic animals’ and
human beings’ urine and faeces. People’s practice of open defecation
accelerates the contamination of water sources.

Most population of the districts suffered from water borne and water
washed diseases. The extent of acute watery diarrhea epidemic
diseases is more serious in Takusa than Alefa and Lay Gayint
districts. In the year 2007 and 2008, AWD epidemic disease prevailed
in Takusa. After a while the implemented water, sanitation and
hygiene promotion projects of MSDF and WINE for water helped to
reduce the incidence of the disease in the project area till August
2009.

Table 1 Project background information (2009)

S/ Description Takusa Alefa Lay Gayint

N district district
1 No of kebeles in the district 25 25 33
2 District population 157,833 178,251 238,495
3 No of target kebele in the 7 5 2
proposed project
4 Target kebele population 74,139 50,212 19,784
5 Topography
5.1 Rugged (%) 20 30 70
5.2 Mountainous (%) 35 30 15
5.3 Plain % 40 40 10
5.4 Valley (%) 5 5
 6 Agro climate
6.1 Dega 40
6.2 Woina Dega (%) 42 45 45
6.3 Kolla (%) 58 55 7
6.4 Wurich 8
6.5 Average annual rainfall in 950- 950- 600-
mm 1500mm 1500mm 1000mm
7 Development indicators
7.1 Primary education coverage 81 87
(%)
7.2 Health service coverage (%) 91 68.9
7.3 Sanitation coverage (%) 50 20.8 22.4
7.4 Potable water coverage (%) 31.8 14.3 56.18
8 District total area in hectare 190,283 189,285 132,031

Alefa district is covered by volcanic rock and reddish clay soil while
Takusa is alluvial deposit. In these areas, the presence of highly
weathered, fractured, jointed and shear zone, dike and covered by big
natural tree and bushes which help easy infiltration of rain water into
the ground. These structures serve as ground water conduits and
increase ground water storage and transmission capacity of the area.
In the selected project villages, particularly in Alfa district, presence
of high discharge spring water and swampy areas are natural
phenomenon. In addition to ground water, Lake Tana, perennial and
intermittent rivers help the target people in using sand pit water
during dry season for domestic purposes. Lay Gayint district has also
rich in surface springs.

Need for Improved Sanitation

Several studies had shown that improvements in water supply system
alone do not guarantee improvements in public health and safety.
Improvement in sanitation has proved to be more effective as stated
above than mare water supply projects. To this end, several
comparisons and benefits of improved sanitation in parallel with
water supply is the way forward these days.

Impacts of Improved Water Supply, Sanitation, and Hygiene

on morbidity and mortality for six common diseases: evidence from
144 studies (after Esrey et.l 1991) Source: Water Supply and
sanitation Programming Guide: Water Supply and sanitation
Collaborative Council and World Health Organization, [Link]
8.3 Sanitation in Ethiopia
The situation in Ethiopia is similar to other developing country, as it
is characterized by rabid urbanization throughout the country,
accordingly necessitating improved urban infrastructures like liquid
waste management facilities as municipal urban-infrastructures that
are used to safely dispose of waste generated by day-to-day activities
of city residents. These generated wastes also vary from easily
decomposable to non-biodegradable inorganic wastes.
Mismanagement of both wastes result in serious environmental,
economic and social problems. In most of the cities in the country
Liquid waste management is very poor and very much below the
standards as compared to other countries.
In Ethiopia like other developing countries, the tremendous growth of
the country’s urban centres over the last two decades has
overwhelmed the capacity of town/cities to provide public services.
As unwavering migration and elevated birth rates have pushed
population levels skyward, municipal governments have found
themselves unable to meet the basic needs of residents. Living
conditions become increasingly unhealthy as governments fail to
provide the services and infrastructure necessary to insure the
adequate management of solid and liquid waste, the removal of
garbage, and the provision of clean water.

Substandard Municipal Sanitation Services manifested by:

 Inadequate solid waste management, including household and
industrial refuse and sewage—specifically insufficient construction
and poor maintenance of latrine systems,
 Inadequate used-water management, including poor drainage,
removal, and treatment and
 Popular misconceptions and unawareness with regard to
appropriate hygiene practices in a health-hostile urban environment.
Generally, urban sanitation is under the responsibility of ministries in
charge of the environment, public health, housing, water, while
ministries of health and education are respectively in charge of rural
and school sanitation. If coordination mechanisms and clear
leadership were in place in most towns/cities, this institutional
fragmentation would not have been a bottleneck to the development
of the sector.
The environmental policy of the Federal Democratic Republic of
Ethiopia’s overall policy goal is summarized in terms of the
improvement and enhancement of the health and quality of life of all
Ethiopians, and the promotion of sustainable social and economic
development through the adoption of sound environmental
management principles. The policy is fully integrated and compatible
with the overall long-term economic development strategy of the
country and has the broad aim of rectifying previous policy failures
and deficiencies that, in the past, have led to serious environmental
Ministry of Water Resource
The general policies of FDRE, MOWR, and Ethiopian Water
Resource Management Policy 1999 are:
 Recognize that water supply and sanitation services are inseparable
and integrate the same at all levels through sustainable and coherent
framework.
 Promote the “User Pays” principle for urban water supply and
sanitation services.
 Promote as far as possible that the development as well as the
operation and maintenance of water supply and sanitation systems are
carried out at decentralized and appropriate body.
 Ensure efficient and sustainable management of water supply and
sanitation system by avoiding fragmented management on one hand
and at the same time by avoiding over-centralization of management.
 Create conducive situations for the participation of all stakeholders
in integrated water supply and sanitation activities and legalize the
same.
 Develop national standards, guidelines and procedures on the
different aspects of urban water supply and sanitation.
 Work in partnership with all concerned for water supply, drainage
and wastewater master plans in major urban areas and prepare water
supply and sanitation strategies in rural and other urban centers.
 Ensure that water supply and sanitation financing is based on
established set of criteria that incorporate the relevant factors.
METHODOLOGY
STUDY DESIGN
A cross-sectional study design was used to assess water ,sanitation
and hygiene states of households. The study was carried out in the
werabe town, silte zone, SNNPR state, Ethiopia. The town is located
172 km from Addis Abeba . The study population was all households
in werabe town . the study units were selected from all kebeles in the
town .
Sampling methods
To select a fairly representative sample of households, the sample size
was distributed proportionally to each of all kebeles based on the
number of households they have. After assigning a number of each
houses, each sample was selected by simple random sampling from
11 kebeles we select only 05 kebeles, If there were more than one
client in the household, preferably the female was selected to provide
information since they have main responsibility in water and
sanitation. For those unable to communicate immediate care giver
were asked, from each kebele select 10 Households for getting
answer for the prepared questioner .
METHODS OF DATA COLLECTION
Data were collected by the group member of this assignment .
The overall data collection was coordinated by the principal
investigator. The two principal data collection methods used in this
study were; 1. Household interview A structured and pre-tested
questionnaire adapted from WHO/UNICEF core questions on
drinking water and sanitation for household surveys was posed in face
to face for home-based care client in the household.
2. Observation 28 Data on covering of water storage vessels, water
container volume, presence of soap in the house, availability of hand
washing facility, water and detergent near latrines, cleanliness of
latrines, availability of pamphlets on hygiene were collected using
check list. VARIABLES Sets of variables used in this study were:-
Independent variables: - Socio-demographic and economic variable
like house ownership, income, educational status, sex of head of
house hold. Dependent variables: - outcome variables such as
availability of improved water sources, improved sanitation, hand
washing facilities and hygiene practices. DATA QUALITY Quality
of data was assured through the following methods; • Using
standardized adapted questionnaire (25) • The data collection tool was
pre-tested with data collectors & supervisors and necessary correction
was made after the pre-test to reach a common understanding prior to
the study. • Data collectors and supervisors were trained on objective
of the study, sources of bias, observation and interview techniques. •
Questionnaire was checked for completeness on daily basis by
immediate supervisors. • Each questionnaire was manually cleaned up
for completeness, missed values and inconsistent of responses. • The
data was entered by trained data entry clerk and ten percent of the
entered data was checked by the principal investigator for its
correctness. • Frequencies and cross tabulations were used to check
missed values and variables. Errors identified were corrected after
revising the original questionnaire. 29
DATA ANALYSIS All responses to the survey questionnaires were
coded against the original English version and entered using EPI-6
software. The final data file was exported into SPSS 11.0 statistical
package for analysis. Recoding and re-categorizing was made for
selected relevant variables. Cross tabulations were made to calculate
crude odds ratios, p-values and X2 for descriptive (univariate,
bivariate and multivariate) analysis. The data was presented using
tables, percentages, graphs and mean values.
I. Socio-demographic and economic data dug

1 House owner ship Private -----1 Rented from kebele -------

2 Rented from private -------
3 Others, specify --------
2 Sex of client Male--------- 1 Female ------2
3 Head of household Male------1 Female ------2 Daughter/son ------3
Other, specify -------99
4 Respondent’s family status Father ---------1 Mother ------- 2
Daughter/son ---3 Other, specify ---99
5 Respondent’s marital status Single/never married-----1
Married----------------2 Divorced-------------3 Separated----------4
Widowed--------5
6 Respondent’s age in year _________________
7 Respondent’s educational status ______________________
8 Household family size ______________________ 5
9 Respondent’s religion Orthodox------------1 Muslim -------------- 2
Catholic -------------3 Protestant ------------4 Others, specify ____99
10 Respondent’s occupation House wife -----------1 Merchant -----2
Government employee-----3 Private/NGO employee ---4 Daily
laborer---------5 Other, specify -------
11 Respondent’s monthly income in birr ________________

II. Water supplies

12 What is the principal source of drinking water for members of your
household {check one}:- Piped water into dwelling ---1 Piped water
to yard/plot ---- 2 Public tab/standpipe --------- 3 Protected dug well
----------- 4 Protected spring -------------- 5 Unprotected dug well
------- 6 Unprotected spring ---------- 7 Rain water collection --------8
Cart with small tank/jerican-- 9 Surface water ----------- ---- 10
13 How long does it take to go there, get water and come back{In
minutes} ____________________
14 Who usually goes to these sources to fetch the water for your
household? Adult women------------1 Adult man --------------- 2
Female child {under 15 years} 3 Male child {under 15 years )--- 4 60
Care giver ------------------ 5 Others, specify -------------
15 Yesterday, how much water did you fetch for household domestic
use? Number of container ----------1 Don’t know---------88
16 Container volume in liter {Check by observation}
__________________
17 Total amount of water fetched daily (Number of container
multiplied by volume of container) ____________________
18 What is the primary vessel{s} you use for storing water? {Observe
the vessel/s) Plastic bucket container --- 1 Jerican ------------------------
2 Clay Jars ---------------------- 3 Metal containers -------------- 4 Other,
specify-----------------
19 Does the container covered? (Observe the container ) Yes-----------
1 No------------2
20 If container does not have narrow neck, how do you get water
from the drinking water container? Pouring ----------------1 dipping
---------------- 2 Container has a spigot -------3 Both pouring & dipping
---- 4 Other, specify ----------------
21 Do you treat your water in any way to make it safer to drink?
Yes---------1 No ----------2 I don’t know----
22 What do you usually do to the water to make it safer to drink?
Boil------------1 Add Agar -----2 Filter it through a cloth ------- 3 Use a
water filter ------------ 4 Solar disinfection -------------5 Let it stand
and settle--------- 6 Other, specify -----------------
23 If do not practice any home treatment Lack of money ----------1 61
method, why? Lack of knowledge ------ 2 Lack of treatment
mechanisms 3 Other, specify --------------
III. Sanitation
24 Does this household have a latrine? Yes ------------1 No -----------2
25 What kind of toilet facility do members of your household usually
use? Flush/pour flush -------------1 Ventilated improved pit latrine – 2
Pit latrine with slab ------------- 3 Pit latrine without slab/wood ---- 4
Public latrine -------------------5 Communal latrine --------------- 6
26 If flush/pour flush, where does the flush goes to? Piped sewer
system ------------ 1 Septic tank ---------------------- 2 Pit latrine
------------------------ 3 River/elsewhere ---------------- 4 Unknown
place -----5
27 Do you share this facility with other households? Yes
-------------------1 No --------------------2
28 If yes, How many households share this toilet facility? How many
people use it? _____________________
29 State the current condition of the latrine? ( Observe carefully)
Fecal matter found in squat------1 Flies found in the latrine --------- 2
Smells --------------------------- 3 It is clean ---------------------------4
30 Do hand washing facility available in/by latrine facility? (Observe)
Yes-----------------1 No ------------------ 2
31 Is there water? ( observe by turning on tap and check container if
water is available) Yes -------1 No---------2
32 Is there soap or detergent or ash near the hand washing place?
(observe) Yes --------1 No --------- 2
33 Do you have under 5 children? Yes -------------1 No -------------2
34 What was done to dispose of the stool of the youngest child? Child
used toilet/latrine -----------1 Thrown into garbage ---------- 2 Buried
------------------------- 3 Left in the open -------------- 4 Other, specify
------------------
35 If they do not have toilet facility, what is the reason? Lack of
money--------1 Lack of space ------ 2 Lack of permission for
construction -3 The house is rented -------- 4 Others, specify -----------
IV. Hygiene practice and prevalence of diarrhea
36 Do you have a bar of soap for hand washing in your house hold
today? Yes -------------1 No -------------2
37 Have you used soap for washing during the past 24 hours? Yes
--------------- 1 No ---------------2
38 If you used soap during the last 24 hours, what did you used it for
(Circle all the replies) Washing clothes --------1 Washing my body---2
Washing my children’s body --3 Washing my children’s hand ---4
Washing my hands ------5 Other, specify -------------------
39 If for washing hands is mentioned, probe what was the occasion,
but do not read the answer {circle all that apply} Washing hands after
defecating -1 Washing hands after cleaning child - 2 Washing hands
before feeding children 3 Washing hands before preparing food--4
Washing hands before eating ------5 Washing hands after eating----6
Other, specify --------------
40 When is important to wash hands? {circle all replies} Before
preparing food or cooking -1 Before eating ------------------------- 2
Before feeding children -------------3 After defecating -------------------
4 After cleaning children’s faces ---- 5 After eating food
-------------------6 Other, specify--------------
41 Have you participated in any hygiene promotion meetings? Yes
-------- 1 No --------- 2 I do not remember ---------88 Skip-45 Skip-45
42 If you participated can you mention the topics covered?(list the
topics covered) _____________________________
_____________________________
43 Are there any pamphlets/visual aids in this house depicting
hygiene promotion? Yes -----------------1 No -------------------2 Skip-44
If yes, please ask them to see and record what they cover?
____________________________ ___________________________
45 Did you have diarrhea in the past two weeks? Yes -----------------1
No --------------------- 2
46 What is the duration of diarrhea? __________________ days
47 Did the diarrhea have blood? Yes ------------ 1 No ------------- 2
48 Where did you take bath? I have shower in my house --------------1
I used neighbor’s shower --------- 2 I have bath ---------------------------
3 I used public bath ------------------- 4 I used bucket -------------------5
49 How often did you take shower? Every day----------------1 As
needed -------------- 2 Every week ------------ 3 Every two week -------
4 Other, specify ----------------------