An assessment of the causes of malnutrition in Ethiopia: A ...

estimated 65 percent of the city’s solid waste is collected, leaving the rest mainly to pollute
the immediate environment. Similar situations exist in urban liquid waste management,
although it is worse and sustains ambient water sources pollution. The uncollected waste
maintains the continued breeding of disease vectors and is a source of human discomfort due
to odor and unsightliness. The situation is a lot worse in crowded areas.
Fly breeding is intense in areas where proper waste collection is not performed. Flies,
which feed on filth such as cow dung, are mechanical transmitters of diseases such as diarrhea
and eye infections. Flies alone in Ethiopia are the major contributor to the transmission of
filth-borne diseases such as typhoid fever, dysentery, shigellosis, and many other diarrheal
related diseases. One study found that a reduction of the fly population by 64 percent resulted
in a reduction of 42 percent in clinic visits for diarrhea and an 85 percent reduction in
shigellosis (Cohen et al. 1991). Flies, in the continued presence of poor waste management
and household hygiene practice, make a difference in the outcome of infections that affect the
nutritional status of under-fives.
5.3.4. Knowledge, attitudes and practices towards sanitation
UNICEF, in collaboration with the MOH, conducted studies in 1997 on the
knowledge, attitudes, and practices (KAP) on water supply, environmental sanitation, and
hygiene education in selected woredas that were involved in the Woreda Integrated Basic
Services (WIBS) since 1990. The findings indicate that respondents’ general KAPs were very
poor. More than 60 percent of respondents in most rural woredas did not know that diseases
could be transmitted through human excreta; 30-75 percent of respondents did not know that
diseases are associated with drinking water; and 23 to 87 percent of respondents did not know
any method of treatment for drinking water. These findings confirm the prevailing mass
ignorance and apparent lack of impact of health education programs in the country, programs
that have been active since the establishment of the first Training Institute in Gondar in 1954.
Household water handling practice is another major factor that determines possible
contamination of drinking water. The rural population uses traditional pots (“Insra”) for the
collection and storage of drinking water with an average size of 15-20 liters (Mengistu &
Gebre-Emanuel 1992). The proportion of households that covered their stored water was 57
percent, while the proportion using a poured water collection method was 88 percent in a rural
study on the determinants of diarrhea. The same study indicated that the method of drawing
water from household water containers and its covering status affect the prevalence of
diarrhea. Some NGOs promote water handling in 20-25 liter “Jericans” which have a smaller
mouth as a means of proper storage that avoids the contamination of drinking cups. The
Demographic and Health Survey of Ethiopia in 2000 indicated that the presence of sanitation
management infrastructures, such as safe water and latrine, did not alone make a marked
difference in the prevalence of diarrheal diseases. This is evidence that factors like sanitation
behavior play a decisive role in disease transmission.
5.3.5. Sustainable issues in sanitation development in Ethiopia
Human resource development, the institutional framework in sanitation, and the level
and use of available resources are the major factors that determine the effectiveness of the
provision of environmental services. The traditional health cadres in environmental health, the
sanitarians, have played key roles in the promotion of sanitation in both urban and rural areas
of Ethiopia. However, these trained cadres have grown so slowly to the extent that their effort
have not been sufficiently productive to contribute to the public control of communicable
diseases, such as diarrhea, through the provision of improved water supplies and sanitation.
The Federal Government of Ethiopia now plans to train and utilize environmental health
technicians and Health Extension Package health cadres in order to increase the number of
professionals working on water and sanitation activities.
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