Access to and challenges in water, sanitation, and hygiene in healthcare facilities during the early phase of the COVID-19 pandemic in Ethiopia: A mixed-methods evaluation

Abstract

Background Inadequate water, sanitation, and hygiene (WASH) in healthcare facilities (HCFs) have an impact on the transmission of infectious diseases, including COVID-19 pandemic. But, there is limited data on the status of WASH facilities in the healthcare settings of Ethiopia. Therefore, this study aimed to assess WASH facilities and related challenges in the HCFs of Northeastern Ethiopia during the early phase of COVID-19 pandemic. Methods An institution-based cross-sectional study was conducted from July to August 2020. About 70 HCFs were selected using a simple random sampling technique. We used a mixed approach of qualitative and quantitative study. The quantitative data were collected by an interviewer-administered structured questionnaire and observational checklist, whereas the qualitative data were collected using a key-informant interview from the head of HCFs, janitors, and WASH coordinator of the HCFs. The quantitative data were entered in EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for data cleaning and analysis. The quantitative data on access to WASH facilities was reported using WHO ladder guidelines, which include no access, limited access, and basic access, whereas the qualitative data on challenges to WASH facilities were triangulated with the quantitative result. Results From the survey of 70 HCFs, three-fourths 53 (75.7%) were clinics, 12 (17.2%) were health centers, and 5 (7.1%) were hospitals. Most (88.6%) of the HCFs had basic access to water supply. The absence of a specific budget for WASH facilities, non-functional water pipes, the absence of water-quality monitoring systems, and frequent water interruptions were the major problems with water supply, which occurred primarily in clinics and health centers. Due to the absence of separate latrine designated for disabled people, none of the HCFs possessed basic sanitary facilities. Half (51.5%) of the HCFs had limited access to sanitation facilities. The major problems were the absence of separate latrines for healthcare workers and clients, as well as female and male staffs, an unbalanced number of functional latrines for the number of clients, non-functional latrines, poor cleanliness and misuse of the latrine. Less than a quarter of the HCFs 15 (21.4%) had basic access to handwashing facilities, while half 35 (50%) of the HCFs did not. The lack of functional handwashing facilities at expected sites and misuse of the facilities around the latrine, including theft of supplies by visitors, were the two most serious problems with hygiene facilities. Conclusion Despite the fact that the majority of HCFs had basic access to water, there were problems in their sanitation and handwashing facilities. The lack of physical infrastructure, poor quality of facilities, lack of separate budget to maintain WASH facilities, and inappropriate utilization of WASH facilities were the main problems in HCFs. Further investigation should be done to assess the enabling factors and constraints for the provision, use, and maintenance of WASH infrastructure at HCFs.

Healthcare Facility Water, Sanitation and Hygiene Service Status and Barriers in Ethiopia: It’s Implication for COVID-19 pandemic and Healthcare Acquired Infection Prevention

“…The basic access to water service (86%) was higher than from national level access (30%) (18), and the worldwide level of basic water service (78%) (6). However, the available basic sanitation service(0%) and basic hand hygiene service (8.1%) in our study were lower than from national level of access 59% and 52% respectively by 2016 (18), and from the study conducted in the north western part of Ethiopia, 21.4% of facility had basic access to hand washing facility (23). The higher level of basic water service access might be attributed to the study area conducted in urban setting, which is the capital city of Ethiopia with better investment to access improved water sources as compared to studies conducted in urban and rural parts of the country.…”

“…In the context of poor healthcare WASH services, adverse events including healthcare acquired infection and risk of AMR significantly affect the healthcare system (23). In our study, built environments of WASH infrastructure was found to be the most commonly cited barrier to WASH services provision in all healthcare facility.…”

“…Similarly mixed method evaluation in part of Ethiopia (23), lack of functional hand hygiene facility and lack of washing materials at the point of care and nearby the toilet was impeding factors indicating that quality of care and patient safety was compromised across all healthcare facility, which makes that the risk of catching with COVID-19, monkey box, Ebola and any else among patients and caregivers are high (32,34).…”

COVID-19 Vaccine Acceptance and Associated Factors Among College Students in Dessie City, Northeastern Ethiopia

“… 9 , 10 Due to their poor health infrastructure and training, African countries are more vulnerable to the spread of disease. 11 Additionally, their inability to quickly receive the vaccination raises the danger of disease spread. 12 Vaccination programs for Africans may be further delayed by vaccine-related expenses and transfer problems until late 2021 or early 2022.…”

Water, sanitation, hygiene practices, health and nutritional status among children before and during the COVID-19 pandemic: longitudinal evidence from remote areas of Dailekh and Achham districts in Nepal

“…Inadequate WASH, malnutrition and infectious diseases are intricately linked [27]. While malnutrition is directly associated with insufficient dietary intake, underlying contributing factors, such as lack of access to safe and adequate WASH, result in recurrent infectious diseases such as intestinal parasites, diarrhea and COVID-19 [28,29]. The intestinal parasites interfere with the digestive process by inhibiting the absorption of nutrients leading to compromised immunity of the host [27].…”