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ObjectiveTo determine the associations of WHO/UNICEF Joint Monitoring Program Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia.DesignA community-based cross-sectional study.SettingBishoftu town, Ethiopia, January–February 2022.ParticipantsA total of 1807 mothers with at least one child under 5 years were included. Sociodemographic and WASH variables were collected using a structured questionnaire. 378 drinking water samples were collected.OutcomeThe response variable was diarrhoeal disease among children under 5 years.ResultsThe 2-week prevalence of diarrhoeal disease among children under 5 years was 14.8%. Illiteracy (adjusted OR 3.15; 95% CI 1.54 to 6.47), occupation (0.35; 0.20 to 0.62), mother’s age (1.63; 1.15 to 2.31), family size (2.38; 1.68 to 3.39), wealth index (5.91; 3.01 to 11.59), residence type (1.98; 1.35 to 2.90), sex of the child (1.62; 1.17 to 2.24), child’s age (3.52; 2.51 to 4.93), breastfeeding status (2.83; 1.74 to 4.59), food storage practice (3.49; 1.74 to 8.26), unimproved drinking water source (8.16; 1.69 to 39.46), limited drinking water service (4.68; 1.47 to 14.95), open defecation practice (5.17; 1.95 to 13.70), unimproved sanitation service (2.74; 1.60 to 4.67), limited sanitation service (1.71; 1.10 to 2.65), no hygiene service (3.43; 1.91 to 6.16) and limited hygiene service (2.13; 1.17 to 3.86) were significantly associated with diarrhoeal disease.ConclusionIn this study, diarrhoea among children is a significant health issue. Child’s age, drinking water service, residence type and hygiene service were the largest contributors with respect to the prevalence of diarrhoeal disease. This investigation provides information that could help to inform interventions to reduce childhood diarrhoea. The findings suggest that state authorities should initiate robust WASH strategies to achieve the Sustainable Development Goal 3 agenda.

Background and Aims Access to safe drinking water, sanitation, and hygiene is a fundamental human right and essential to control infectious diseases. However, many countries, including Ethiopia, do not have adequate data to report on basic water, sanitation, and hygiene (WASH) services. Although contaminated drinking water spreads diseases like cholera, diarrhea, typhoid, and dysentery, studies on drinking water contamination risk levels in households are limited in Ethiopia. Therefore, closing this gap needs investigation. Methods A community‐based cross‐sectional study was conducted. A total of 5350 households were included. A systematic, simple random sampling technique was used to select the participants. The information was gathered through in‐person interviews using a standardized questionnaire. Furthermore, 1070 drinking water samples were collected from household water storage. Results This investigation revealed that 9.8%, 83.9%, and 4.9% of households used limited, basic, and safely managed drinking water services, respectively. Besides, 10.2%, 15.7% and 59.3% of households used safely managed, basic and limited sanitation services, respectively. Yet, 10.6% and 4.2% of households used unimproved sanitation facilities and open defecation practices. Also, 40.5% and 19.4% of households used limited and basic hygiene services. On the other hand, 40.1% of households lacked functional handwashing facilities. In this study, 12.1%, 26.3%, and 42% of households’ drinking water samples were positive for Escherichia coli, fecal coliforms, and total coliforms, respectively. Also, 5.1% and 4.5% of households’ drinking water samples had very high and high contamination risk levels for E. coli, respectively. We found that 2.5% and 11.5% of households and water distributors had unacceptable fluoride concentrations, respectively. Conclusion The majority of households in Bishoftu town lack access to safely managed sanitation, drinking water, and basic hygiene services. Many households’ water samples had very high and high health risk levels. Hence, the government and partner organizations should implement water and sanitation safety plans.

AimThis scoping review synthesises the global evidence on tobacco retailers’ attitudes towards selling tobacco, tobacco control (TC) measures and the potential phase out of tobacco sales.MethodsWe searched eight databases covering health, social science and business topics to identify records published between 2000 and 2024. Records were eligible for inclusion if they examined tobacco retailers’ perceptions, attitudes or views on selling tobacco and nicotine products, or opinions on TC measures or ceasing tobacco sales. The review followed the Joanna Briggs Institute (JBI) Scoping Review Methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist for reporting scoping reviews.Results52 studies met the eligibility criteria, with the USA and India contributing the most research. Most retailers demonstrated a strong understanding of existing TC measures, although knowledge varied by country and retailer demographics. Retailers largely opposed TC policies such as taxes, product display bans and standardised tobacco packaging. Despite recognising tobacco as a low-profit product for their business, most studies reported perceived customer attraction and retention as key reasons why retailers continue selling tobacco. 10 studies from high-income countries (Australia, New Zealand and the USA) indicated that stringent TC measures, along with personal ethical considerations, are key factors that motivate discontinuing tobacco sales.ConclusionsThis review found that tobacco retailers typically report negative attitudes about TC regulations. However, regulatory measures, voluntary cessation initiatives and retail education that appeals to ethical values can collectively encourage some individual retailers to cease selling tobacco. Although these alone are unlikely to substantially reduce the number of tobacco retailers. These factors may also inform communication strategies concerning regulated phase-outs of tobacco retailing.

Background Tobacco, one of the risk factors for non-communicable diseases, kills 8 million people each year. Like other sub-Saharan countries, Ethiopia faces the potential challenge of a tobacco epidemic. However, there is no organized data on the prevalence of tobacco use in the country. Therefore, this study aims to determine adult tobacco use in Ethiopia. Methods The study was conducted using the WHO and CDC GATS survey methods. Complex survey analysis was used to obtain prevalence and population estimates with 95% confidence intervals. Bivariate regression analyses were employed to examine factors related to tobacco use. Results The overall tobacco use percentage was 5.0% [95% CI (3.5, 6.9)], of which 65.8% [95% CI (53.4, 76.3)] only smoked tobacco products; 22.5% [95% CI (15.7, 31.2)] used smokeless tobacco only; and 11.8% [95% CI (6.5, 20.4)] used both smoked and smokeless tobacco products. In 2016, more men adults (8.1%) used tobacco than women did (1.8%). Eight out of eleven states have a higher smoking rate than the national average (3.7%). Gender, employment, age, religion, and marital status are closely linked to current tobacco use ( p -value< 0.05). Men adults who are employed, married, and mostly from Muslim society are more likely to use tobacco. Conclusion The prevalence of tobacco use is still low in Ethiopia. However, the percentage of female smokers is increasing, and regional governments such as Afar and Gambella have a relatively high prevalence. This calls for the full implementation of tobacco control laws following the WHO MPOWER packages. A tailored tobacco control intervention targeting women, younger age groups, and regions with a high proportion of tobacco use are recommended.

In the Southern Nations, Nationalities, and Peoples’ Region of Ethiopia, improved water is the main source of water for household purposes. Access to improved water closer to their homes benefits the community in many ways. It improves their health status, saves their time and energy, and improves their productivity in jobs and education they are engaged in. However, due to natural and human activities, improved water sources do not always deliver good quality of water. It can be contaminated by different pathogenic microorganisms and chemicals. The result indicated that 44.7% and 50.9% of the samples were contaminated with Escherichia coli and enterococci respectively, and from the sanitary condition survey, 57.6% of the water sources exhibited from intermediate- to very high-risk level. And the risk priority matrix identifies 95 (27.9%) samples with high risk and 54 (15.9%) of the samples with very high risk. The main risks identified at those unsafe water sources were that the drainage canals were blocked with mud, grass, leaves, and stones; animals drinking the overflow water and grazing in the proximity of water sources and feces such as cow dung were observed; inadequate protection of water sources such as absence of fences and diversion ditches; and stagnant water near the source. The study conducted in the Southern Nations, Nationalities, and Peoples’ Region has clearly indicated that people may be at risk of being exposed to pathogens in half of the improved water sources when used for drinking based on the microbial indicator data or the sanitary inspection risk score. Though no correlation resulted from water quality and sanitary condition of sources, the risk priority matrix did enable prioritization of 54 very high-risk-level water sources for urgent targeted interventions from a total of 340 improved drinking water sources. From this, targeted interventions, improving water management practices, identifying and implementing effective water treatment options, providing sustainable energy sources for the supply of continuous water, and implementing climate resilience water safety planning, are recommended.

Introduction The use of unimproved energy sources is associated with a range of health problems. However, in Ethiopia, studies focused on the utilization of unimproved energy sources and associated factors are limited. Therefore, this study aimed to close this gap. Methods In this community-based cross-sectional study, 5,350 participants were enrolled. Multivariable logistic regression analyses were employed to examine the associations between the utilization of unimproved energy sources and the predictor variables. Additionally, the chi-square test was used to examine the association between households' unimproved energy source utilization and the occurrence of health problems. Results In this study, 45% of households used unimproved energy sources. In the multivariable analysis, households headed by men (adjusted odds ratio [AOR] = 0.76; with 95% confidence interval [CI] 0.66, 0.87), households headed by illiterate heads (AOR = 1.77 with 95% CI 1.47, 2.14), household family size (AOR = 0.79 with 95% CI 0.79, 0.93), households headed with farmers (AOR = 3.33 with 95% CI 2.31, 4.81), households with low income (AOR = 3.41 with 95% CI 2.57, 4.51), rural households (AOR = 7.94 with 95% CI 6.76, 9.32), and households with regular coffee ceremony practices (AOR = 1.17 with 95% CI 1.00, 1.36) were significantly associated with the utilization of unimproved energy sources. Additionally, the results of the chi-square test revealed that households that relied on unimproved energy sources had a 1.5-fold greater risk of developing respiratory illnesses, an 8.5-fold greater risk of developing cataract disease, and a 5.2-fold greater risk of developing trachoma than households that used improved energy sources. Conclusion A significant proportion of households in Bishoftu town still rely on unimproved energy sources for cooking and other household needs. This indicates a substantial challenge in achieving universal access to clean and sustainable energy in the area. Several socioeconomic and demographic factors are associated with the use of unimproved energy sources, including male-headed households, illiteracy of household head, smaller family size, farming occupation, low income, rural residence, and regular coffee ceremony practices. Most importantly, the use of unimproved energy sources is associated with higher risks of respiratory illnesses, cataracts, and trachoma among household members. Therefore, the government should implement targeted interventions to promote the adoption of clean and improved energy sources among vulnerable households such as households headed by farmers, those with illiterate heads, households with low socioeconomic status, households with regular coffee ceremony practices, and those in rural areas. In addition, the local government should develop and implement educational campaigns to raise awareness about the health and environmental risks associated with the use of unimproved energy sources, particularly among households with high-risk factors identified in the study. Highlights ➣ Nearly half of households in Bishoftu use harmful energy sources for cooking. ➣ Utilization of unimproved energy use links to serious health issues like respiratory diseases, Trachoma and cataracts. ➣ Many determinant factors influencing households' utilization of unimproved energy sources were identified. ➣ Targeted education and support are needed to promote clean energy adoption in vulnerable communities.

Access to basic water, sanitation and hygiene services is the most effective mechanism to reduce many infectious diseases. WASH in schools related to better educational outcomes although adequate water, sanitation, and hygiene services were unavailable to millions of school-age children in Ethiopia. Therefore, it is crucial to assess the level of WASH coverage and identify factors affecting access to basic water, sanitation, and hygiene services. A cross-sectional study was carried out among 82 school facilities. A structured questionnaire and an observational checklist were used to gather the data. Water samples were taken from the schools' water storage. Descriptive and multivariable logistic regression analyses were used to analyze the data. In this study, 74.7%, 61. 3% and 37.3% of the schools had access to basic drinking water, sanitation, and hygiene services, respectively. Additionally, 21.3%, 29.4%, and 30.7% of the schools had access to limited drinking water, sanitation, and hygiene services, respectively. However, 4%, 9.3%, and 32% of the schools lacked water, sanitation, and hygiene services, respectively. We discovered that schools with male heads were 7% less likely to have access to basic hygiene services (AOR = 0.07 with 95% CI 0.01–0.5) than those with female directors. In addition, schools with hygiene and environmental health clubs had an 11.8-fold higher access rate to basic hygiene services (AOR = 11.8 with 95% CI 1.35–104) than schools without such clubs. Besides, schools that conduct WASH lessons at least once a week were 8.63 times more likely to use basic hygiene services (AOR = 8.63; 95% CI 1.18–63.22) than schools that did not. This study offers scientific evidence that could be used for sound decisions to fill the school WASH gaps. This is a unique study in determining the level of WASH coverage and identifying factors affecting access to basic hygiene services. The investigation provides some insights into how access to WASH services can be improved at the grassroots level. Federal and regional governments should implement effective interventions that assist schools to attain Sustainable Development Goal 6 by 2030. School administrators and other partner organizations should take proactive measures to enhance and maintain the WASH services.

This study aimed to assess the level of JMP ladders for WASH services. A cross-sectional study was conducted. Forty-four healthcare facilities were enrolled. From each healthcare facility, water samples were collected directly from water storage facilities. In addition to the interview, an observational checklist was used. Descriptive statistics and a chi-square test were conducted to analyze the data. The coverage of advanced and basic drinking water services in healthcare facilities was 4.6 and 70.4%, respectively. However, the healthcare facilities’ access to advanced and basic sanitation services was nil. Similarly, 61.4 and 88.6% of the healthcare facilities had no hygiene and waste disposal services, respectively. While 2.6, 4.5, and 75% of healthcare facilities had advanced, basic, and limited environmental cleaning services, 18.2% lacked environmental cleaning services. Water samples of 15.9, 11.4, and 6.8% of the healthcare facilities were found positive for total coliforms, fecal coliforms, and E. coli, respectively. The WASH services of the healthcare facilities were very low and not on track to achieve the Sustainable Development Goal target. Healthcare facilities could be sources of healthcare-associated infections. Hence, the government and other concerned bodies should take urgent action to improve WASH services.

BackgroundIn 2020, Ethiopia passed a landmark tax proclamation implementing an evidence-based mixed excise system aimed at curbing tobacco use. This study evaluates the impact of the tax increase of more than 600% on both legal and illegal cigarette prices in order to gauge the impact of the tax reform in the presence of a sizeable illicit cigarette market.MethodsData on 1774 cigarette prices were obtained from retailers during Empty Cigarette Pack Surveys in the capital and major regional cities conducted in 2018 and 2022. Packs were categorised as ‘legal’ or ‘illicit’ using criteria from the tobacco control directives. Descriptive and regression analyses were used to study the cigarette price changes during the period of 2018–2022, capturing the impact of the 2020 tax increase.ResultPrices of both legal and illegal cigarettes increased in response to the tax increase. In 2018, the stick prices ranged from ETB0.88 (Ethiopian birr) to ETB5.00 for legal cigarettes while they ranged from ETB0.75 to ETB3.25 for illegal ones. In 2022, a legal stick sold for ETB01.50–ETB2.73 and an illegal stick for ETB1.92–ETB8.00. The average real price of legal and illegal brands increased by 18% and 37%, respectively. The multivariate analysis confirms that prices of illicit cigarettes grew faster compared with the legal ones. By 2022, illicit brands were on average more expensive compared with their legal counterparts. This result is statistically significant at p<0.01.ConclusionThe prices of both legal and illegal cigarettes increased following the 2020 tax increase, with the average real cigarette price increasing by 24%. As a result, the tax increase likely had a positive impact on public health despite a sizeable illicit cigarette market.

Reducing inequalities in all its forms is one of the key principles of the Sustainable Development Goal (SDG). However, the 2030 SDG Agenda has been a real challenge in addressing inequalities in Water, Sanitation, and Hygiene (WASH) services. There is a disparity in the use of WASH services in Ethiopia. Therefore, this study aimed to identify demographic factors affecting the use of Joint Monitoring Program (JMP) ladders for WASH services. In this study, a total of 5350 households were included. Households having heads with vocational education levels were 2.9 times higher in use of basic drinking-water services ((Adjusted Odds Ratio (AOR) = 2.9 with 95% CI 1.6–5.1) than household having heads who could not read and write. Besides, households living in urban areas were 21.7 times more likely to use basic drinking-water services (AOR = 21.7 with 95% CI 16–30) than in rural parts. Further, households with merchants’ heads were 2.1 times higher to use basic sanitation services (AOR = 2.1 with 95% CI 1.5, 3.1) than households with farmers’ heads. Moreover, households having higher monthly income per head were 2.9 times higher in utilizing basic sanitation services (AOR = 2.9 with 95% CI 2.32–3.58) than the poorest households. Similarly, households with female heads were 1.5 times higher in using the JMP ladder for basic hygiene services (AOR = 1.5 with 95% CI 1.24–1.71) than households with male heads. Additionally, respondents who live in urban areas had 2.8 times higher use of basic hygiene services (AOR = 2.8 with 95% CI 2.26–3.54) than those in rural areas. Many demographic factors that influence the use of the JMP ladders for water, sanitation, and hygiene services were identified. The use of surface water, open defecation practice, unimproved sanitation, and no hygiene services were positively associated with illiteracy. The findings suggest that state authorities should initiate firm WASH policies and strategies to achieve the SDG 6 and 10. Additionally, the government should apply effective WASH interventions that consider demographic disparities.