BackgroundStunting reflects a failure to receive adequate nutrition over a long period of time. Stunting is associated with adverse functional consequences including poor cognition, low educational performance, low adult wages, and poor reproductive outcomes. The objective of the study was to investigate spatial variations and factors associated with childhood stunting in Ethiopia.MethodsThis study is a secondary data analysis of the 2011 Ethiopian Demographic and Health Survey (EDHS). A total of 9893 children aged 0–59 months were included in the analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of stunting. A multilevel multivariable logistic regression was used to identify factors associated with stunting.ResultsStatistically significant hotspots of stunting were found in northern parts of the country whereas low hotspots where there was less stunting than expected were found in the central, eastern, and western parts of the country. In the final model of multilevel logistic regression analysis, individual and community level factors accounted for 36.6 % of childhood stunting. Short birth interval [AOR = 1.68; 95%CI: (1.46–1.93)], being male [AOR = 1.20; 95%CI: (1.08–1.33)], and being from a male-headed household [AOR = 1.18; 95 % CI: (1.01–1.38)] were the factors that increased the odds of stunting at the individual level. Children in the age group between 24–35 months were more likely to be stunted than children whose age was less than one year [AOR = 6.61; 95 % CI: (5.17–8.44)]. The odds of stunting among children with severe anemia were higher than children with no anemia [AOR = 3.23; 95%CI: (2.35–4.43)]. Children with mothers who had completed higher education had lower odds of being stunted compared to children whose mothers had no formal education [AOR = 0.42; 95%CI: (0.18–0.94)]. The odds of being stunted were lower among children whose fathers completed higher education [AOR = 0.58; 95%CI: (0.38–0.89)] compared to children whose fathers had no formal education. Children whose mothers who had high a Body Mass Index (BMI) (≥25.0 kg/m2) were less likely to be stunted compared with children whose mothers had a normal BMI (18.5 kg/m2-24.9 kg/m2)[AOR = 0.69; 95%CI: (0.52–0.90)]. Children from the poorest wealth quintile had higher odds of being stunted compared to children from the richest wealth quintiles [AOR = 1.43; 95 % CI: (1.08–1.88)]. Unavailability of improved latrine facilities and living in the northern parts of the country (Tigray, Affar, Amhara and Benishangul-Gumuzregions) were factors associated with higher odds of stunting from the community-level factors.ConclusionStunting in children under five years old is not random in Ethiopia, with hotspots of higher stunting in the northern part of Ethiopia. Both individual and community-level factors were significant determinants of childhood stunting. The regions with high hotspots of child stunting should be targeted with additional resources, and the identified factors should be considered for nutriti...

This research examines the acceptability of solar disinfection of drinking water (SODIS) in a village in Kathmandu Valley, Nepal, using constructs from the Health Belief Model as a framework to identify local understandings of water, sanitation and health issues. There has been no published research on the acceptability of SODIS in household testing in Nepal. Understanding the context of water and water purity in Nepalese villages is essential to identify culturally appropriate interventions to improve the quality of drinking water and health. Forty households from the village census list were randomly selected and the senior woman in each household was asked to participate. Baseline data on water sources and behaviors were collected in March 2002, followed by training in SODIS. Follow-up data were collected in June and July 2002. Only 9% of households routinely adopted SODIS. Participants mentioned the benefit of treating water to reduce stomach ailments, but this did not outweigh the perceived barriers of heavy domestic and agricultural workloads, other cultural barriers, uncertainty about the necessity of treating the water, and lack of knowledge that untreated drinking water causes diarrhea. Strategies for developing safe water systems must include public health education about waterborne diseases, source water protection, and a motivational component to achieve implementation and sustained use. In addition, other options for disinfecting water should be provided, given the women's work constraints and low level of formal education.

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The study examined pH, turbidity and fecal contamination of drinking water from household water storage containers, wells and taps, and the Godawari River, and tested the effectiveness of solar disinfection (SODIS) in reducing levels of fecal contamination from household containers.The research was conducted in 40 households in a village 6 km outside the capital city of Kathmandu, Nepal. Three rounds of data were collected: a baseline in March 2002 followed by training in solar disinfection, and follow-ups in June and July 2002. Untreated drinking water was found to have levels of contamination ranging from 0 to too numerous to count fecal coliform CFU 100 ml 21. Source water was significantly more contaminated than water from the household storage containers. Wells were less contaminated than taps. SODIS reduced the level of contamination under household conditions. Turbidity from taps was above 30 NTU in the rainy season, above the maximum for effective solar disinfection. SODIS was routinely adopted by only 10% of the participating households during the study.

Many health care facilities (HCFs) in developing countries lack adequate infrastructure for handwashing and drinking water, increasing the risk of healthcare-associated infections. Attaining permanent, 24-hour/day piped water access – the long-term goal – is time-consuming and expensive. To address this problem in the short- to medium-term, low-cost portable handwashing water stations (HWSs) and drinking water stations (DWSs) were installed in rural Kenyan HCFs in 2011. Access to HWSs with soap and DWSs with safe water was ascertained at baseline and 1-year follow-up. Cost data were obtained from the program budget and beneficiary data (number of health workers, households, and individuals within HCF catchment areas) from the Ministry of Health. A cost analysis was adjusted for incremental gains from baseline to follow-up in access to improved handwashing and safe DWSs. The cost of improved access to handwashing with soap was $1,527/HCF, $217/health worker, and $0.17/individual, and to safe drinking water was $720/HCF, $103/health worker, and $0.08/individual. The favorable cost of this intervention per beneficiary justifies its use for rapid improvement of handwashing and drinking water access in HCFs during planning and construction of permanent infrastructure.