BULE HORA UNIVERSITY COLLEGE OF HEALTH AND

MEDICAL
SCIENCES
DEPARTMENT OF ENVIRONMENTAL HEALTH

Assessment of bacteriological quality of

drinking water from sources to HHs and WASH
practices of consumers of Bule Hora Town,
South Ethiopia
• By Degefa Dhengesu (BSc) PI
• Dagnamyelew Tilahun (BSc. MSc) CI
• Wako Gollicha (Bsc. MPH) CI

November, 2018
Presentation Outline

1. Introduction
 Background
 Statement of the problems
 Significance of the study

2. Objectives
 Ganeral
 Spesifics

3. Methodology
Details

4. Grand total Budget

1.1 Back ground
• Why WASH oriented title?
• Water reduce diarrhoea by 15%
• Sanitation reduce diarrhoea by 36%
• Hygiene HW with soap and water after toilet reduce diarrhoeal by 35%
• WASH can reduce diarrhoea by 65%
• UN SDG6 (2015) envisions universal, sustainable, and equitable access to
6.1 Safe drinking water
6.2 Sanitation and hygiene Components of SDG6
6.3 Water quality by 2030

• Combined WASH intervention is better for

 Maximum health impact
 Other SDG
1.1 Back ground
• Why we assess WASH?
Accurate information about WASH related issues is important
• Woreda (town) leaders
• Decision-makers and
• Stakeholders when making decisions.
Sound, evidence-based information can be used in a variety of
ways, including:
To assess progress towards national and international goals and
targets
To promote increased investments in the sector
To focus attention on needy areas and efficiently allot resources
1.1 Back ground

• Why we concern about WASH?

• HR to WS entitled everyone to PASS
• All Ethiopians access to clean water (FDRE, 1995, A90/1)
• MDG
Improved drinking water sources 88/91%, 56/57%
Improved sanitation facilities 77/68% , 56/28%
• Is improved DW source safe? NO.
• Safe free of pathogens.
• MDG to SDG sustainable access to “safe” drinking-water.
Regular monitoring and
Water safety plans are recommended to ensure DWS. (FDRE
SDG, 2017).
1.1 Back ground
• Minimize DWQ overlook again!!
• The 3 improved sources of DW in urban HHs are
HHs yard or plot (63%)
Public tap/standpipe (13%)
Water piped to a neighbor (12%), (FDRE/DHS, 2016)
• GTP-II /SDG6 based clearly planned to reach
85% (59% ) in rural
75% (58%) in urban
100% (27%) safely managed sanitation services
70% (17%) Hand Washing
70% (17%) living in healthy environments by 2020
1.1 Back ground
• In developing countries, water contamination at
Home storage is an issue than at
Source and
Distribution points
• Different studies show that
Coli form levels were higher in HH water containers than in the
original sources.
Association b/n poor water quality and infectious diarrhea.
• Determinants of Water Quality:- ES 2001 SP
Biological Quality (TC), (TTC/FC), E.coli and others
Physical quality 18 physicochemical parameters
 Chemical quality 24 toxic chemicals (11 pesticides) for
maximum permissible levels and testing methods
1.1 Back ground
• The WHO and Ethiopian DWG require the absence of
E.coli
TTC and
TC in public drinking water
• The WHO recommended in QA/QC
Turbidity
PH
 Chlorine residual to be checked
• If resources permit assessing pathogens presence
Source and drinking water are useful for
Public health risk from drinking water and
Check health based water quality targets.(5)
1.1 Back ground
• Water Quality Monitoring and Surveillance
• Not well addressed in HS (3 sectors)
• Lack of proper budget allocation
• Lack of logistic arrangements
• Conducted on demand bases
• Poorly enforced
• Few human resources
• Inadequate laboratory equipment
• limited availability of reagents
• Poor interaction and exchange of information
1.1 Back ground
These facilities analysis water from
• New water supply schemes to verify
• Only once before the schemes enter into operation
• Response for an emergency epidemics.
• Response to requests of d/t organizations, NGOs etc
• No regular and continuous programs of DWQM
• Customer complaints
• Changes in water-quality
• Community involvement
• No significant involvement of community
• Little awareness creation work (14)
1.1 Back ground
Water quality verification
• Reducing epidemics
• Important for human health
• Verify WQ from the sources to the point of consumption (16).
• Reduction of morbidity and
• Mortality from infectious diarrheal diseases
• Improvements in the quality
• Excreta disposal
• General personal hygiene
• Environmental hygiene (6)
1.2 Statement of the problems

• People drink water contaminated with FIB.

26% globally
14% in Europe
Over 52% in Africa. (17)
• 663 million use unimproved
• Over 50% (sub-Saharan Africa)
• 1/5 in Southern Asia (6).
• Even improved sources are not necessarily safe
• Due to poor WASH each year
 88% of diarrhea cases
 1.5 million deaths (18).
1.2 Statement of the problems
• Microbial water contamination (E.coli, TC, TTC)
14.4 to 87.5% at national level
8.6 to 84.3% in Amhara region
 17 to 87.5% in Oromia region
25 to 85.7% in SNNR region
83.3 in Dire Dawa were positive for indicator organism (19)
• In developing countries
 75% of all industrial waste
 95% of sewage is discharged without any treatment
• In Ethiopia
Improved sanitation, 27% from 20%, MDG
OD is common practices
1.2 Statement of the problems
• Water and soap were absent in
• 43% of urban households and
• 68% of rural households
• Breakdown in water supply safety chain may lead to
• Disease outbreaks.
• Sporadic disease
• There is no regular DWQ monitoring
• There is no study done so far
• At source and
• Points of use and
• SH practices in the Bule Hora Town.
• Therefore, this study is intended to determine bacteriological
quality of drinking water from source to points of use and
1.3. Significance of the study

• Poor WASH practices are associated with high morbidity and

mortality
• Assurance of FIB drinking water quality has been a pillar of
Primary prevention and
Continues to be the foundation for the prevention and control of
waterborne diseases.
• The primary beneficiaries of the study results will be
BHT health offices
BHT water , mineral and energy offices and
BHT administration office
Other GO and NGO
1.3. Significance of the study

• The study findings will help for

Planning of appropriate WASH intervention for the study area.
Integrated intervention of water quality improvements.
Baseline information on WASH for further studies in the future.
Remedial actions to reduce potential sources of contamination
Implementation of multiple barrier system from source to the point
of use
Awareness creation for the users on WASH
Design and implement WASH projects and
Improve safe drinking water supply coverage in Bule Hora Town.
• Thus, this study will be paramount important to identify the degree
of bacteriological drinking water contamination and WASH
practices from source to household level in the town.
Chapter III: Objectives

3.1 General objective

• The general objective of this study is to determine the
bacteriological quality of drinking water and to assess the
sanitation and hygiene practices of users in Bule Hora Town,
South of Ethiopia
3.2 Specific objectives
• To determine the bacteriological quality of drinking water from
sources to point of uses.
• To assess the sanitation facilities of users at HH level
• To assess the hygiene practices of users at HH level
Chapter IV Methodology
• 4.1 Study Area and period
• Study will be conducted in Bule Hora Town, South of Ethiopia, from Jan 3-14/201.
• The main water sources of the town include
• 8 Motorized Boreholes/deep wells
• 7 reservoirs
• 50 public taps and
• 2924 yard/plot taps
• Served population 27,820(5796HH)
• 4.2 Study design
• A cross-sectional quantitative study design will conducted.
• 4.3 Source and study population
• All households
• All drinking water sources
• Distribution points (water points and house hold yard taps),
• Point of use water containers and
• Reservoirs
 Methodology
4.4 Inclusion and exclusion criteria
4.4.1 Inclusion criteria
 BH
 Reservoirs
 Distribution points (WP and HH yard/plot taps)
 Water container at point of use
 Female care giver greater than 15 years old
• 4.4.2 Exclusion criteria
 Non-functional water schemes
 Schemes that are not providing services
 Home lined water taps
 Institutional yard tap and reservoirs.
 Less than three months lived HH will be excluded from the study
• 4.5 Sample size determination
Water samples size from source to HH plot
taps

Types of sample site Unit Total in town Served population Sample size Remarks

Bore hole BH (source) Number 8 30,000 6

WHO DWG

Reservoir (booster and main) Number 7 30,000 6

Public water points Number 50 15,000 3

House hold yard/plot taps HH 2924 15,000 3

Total 18
Water sample size to be collected from HH
storage
Shashamenne
Bahir Dar Maximum sample size

• Therefore, the sample size will be determined as the following

Confidence level 95%
Confidence interval 5%
Population of the town 27,820 (5796HH) CSA (2007)
• Epi info 7 Stat Cal will be used to determine the sample size to
be 358 as the following.
Water sample size to be collected from
HH storage
CIO Prevalence Sample size to be Sample size to be Remarks

interviewed interviewed
In storage

90.5% 129 259 (38) Shashamenne

TC
77.1% B 259 (25) Bahir Dar

42.8% 353 347 (38) Shashamenne

FC/TTC
45.7% B 358 (25) Bahar Dar

33.3 322 324

E.coli (38) Shashamenne

81% 227 347 (25) Bahir Dar

 Total water samples size for bacteriological
quality of drinking from source to house holds

Types of sample site Unit Total in town Sample size Remarks

Bore hole BH (source) Number 8 6

WHO DWG
Reservoir (booster and main) Number 7 6

Public water points Number 50 3

House hold yard/plot taps HH 2924 3

House hold water container in the HH 5796 358 Epi info 7 STATCAL

house with p=0.46

Total 376
4.5.2 Sample size determination for survey of HH SHP
• Confidence level 95%
• Confidence interval 5%
• Population 27,820 (5796HH), CSA, (2007)
• Prevalence of sub primary variables from study conducted in
Welenchiti town (32)
• Epi info 7 Stat Cal will be used to determine the sample size to
be 338 as the following.
Sample size calculation for HH, SH practices survey

Sub primary Prevalence Confidence Confidence Sample size to 5%non- Total Remarks

variables level interval be interviewed respondents

95% 5%

No latrine 11.1% 95% 5% 148 7 155 min

Open dump 69.7% 95% 5% 307 15 322 min

Hand washing 33.3 95% 5% 322 16 338 max

after defecation
 Methodology
• 4.6 Sampling techniques
• RS/sampling frame will be used for water sampling of
 water sources
 reservoirs
public water points
• 338 will be distributed proportionally to 3 kebeles.
K1 =2636 HH(154HH)
K2 =888HH(52HH)
K3 =2272HH(132HH)
• SRS will be used to determine the interval for each kebeles
• If sampling fraction is too large half of the fraction will be
jumped
• Coin tossing will be used to determine the first observation
 Methodology
• 4.7 Data collection procedure
• Data collection for bacteriological water quality analysis:
• Allow water to run for 3 minutes from tap
• Collect sample water with 100ml sterile G/P water and label immediately
• Keep in Cold box
• Transport to laboratory within 6 hours
• Filtered through a sterile MF (0.45μm ) to retain the FIB.
• Sterilized before use and re-sterilized between samples using methanol
• The MF to a Petri dish, contains lauryl sulfate lactose broth.
• The Petri dishes will be labeled with all the necessary information.
• The plates will be incubated at temperature of
 44 ± 0.5 0c for 18-24 hours for E.coli after 24 hours count the number of
CFU/100ml of water
 44–45°C for TTC
 35–37°C within 24–48 hours for TC
 Methodology

• Sanitary Survey:
• On-site inspection
 Bore hole source
 Reservoirs and WHO sanitary inspection checklists
 Public water points
• HH survey
 Structured questionnaire (local language)
 Pre-test
• Data collector (diploma).
• Training will be given for all data collectors and supervisors
• The data will be collected from Jan 3-14/2018 G.C.
 Methodology
• 4.8 Variables
• 4.8.1 Primary variables
• Bacteriological water quality
• TC, TTC and E.coli FIB tests
• 4.8.2 Secondary variables
• Background variables
• Age
• Sex
• Income
• Educational status
• Marital status and
• Occupation
 Methodology
• Water
• PH
• Turbidity
• Residual chlorine
• Types of water sources
• Distances/round trip time of water source from households
• Water storage time
• Water availability
• Water affordability/cost
 Methodology
• Sanitation
• Types of sanitation ladders
• Toilet cleaning practices
• Toilet using practices
• Solid waste management practices
• Liquid waste management practices
• Hygiene practices
• Covering water container
• Washing water container
• Hygienic water dipping/withdrawal
• Home water treatment methods
• Critical time hand washing
 Methodology
• 4.9. Operational definitions
• Water quality compliance with national standards.
• Water quality assessment sanitary inspections and analytical
measurements.
• Safe water handling: safe collection, transportation and keeping water in
clean, narrow necked container with lid and drawing water from storage
containers using pouring mechanism rather than dipping.
• Bacteriological safe water source: no faecal coliform bacteria detected in
any 100ml of water sample.
• Contaminated water: Water which may contain FIB which make it unfit
for human consumption.
• Improved water source: Piped water into dwelling, plot or yard, Public
tap/standpipe, Tube well/borehole, protected dug well, protected spring,
Rainwater collection from safe surface in clean container.
• Multiple barrier system for water source protection: various approaches
that include protection of the entire catchment areas; fencing the immediate
areas, diversion of flood and frequent cleaning near water sources.
 Methodology
4.11 Data analysis
• Completeness
• Correctness Communication and Correction
• Consistency
• Codding
• Recording
• Editing
• Cleaning before analysis
• Double data entry before exporting to SPSS
• Data analysis using SPSS version 20
• Frequencies
• Percentages
• OR with 95 % CI Associations among samples variables
• p-value of <0.05
• Statements, tables and figures.
 Methodology
• 4.12 Ethical considerations
• Ethical clearance will be obtained from
• Concerned BHU
• Ethical review board
• Before the study commences.
• Official letters will be submitted to
BHT WMEO and
Health offices
• Purposes
• Importance
• Informed consent
• Confidentiality
• Voluntary basis
 Methodology
• 4.13. Expected outcome
• Bacteriological water analysis
• WASH practices survey results
• On site sanitary inspection
• 4.14. Dissemination and utilization of results
• The final report will be shared to stakeholders who will
Implement periodic preventive maintenance
Prevent contamination using multiple barrier system
Baseline evidence for designing strategies and
Integrated intervention for consistent water quality improvements
Need of this result
Advocated for those who can implement it,
 Publish the paper in local or international journals
 Methodology
• 4.15. Limitations of the study
• Being cross sectional study
• It will be liable to biases in determining the associations of
variables
• Rainy/wet season contamination is likely high during dry
season.
• If the bacteriological water quality analysis is carried out
during the rainy/wet season, the possibility of water
contamination is increased
• Water source contamination is less likely during dry season.
• This might not represent quality of water sources throughout a
year
Grand total budget required for the whole research works

S/n Description/budget category Unit Total cost

Remarks

1 Personal ETB 37620

2 Refreshment ETB 2880

3 Stationery ETB 5420

4 Transport and laboratory cost ETB 156,400

Grand total ETB 202,320

Contingency ETB 20232

Grand total ETB 222,552

ACKNOWLEDGEMENTS
1. Bule Hora University
 College of Health and Medical sciences
Department of Environmental Health
 Community Service and Research Office
 Internet and library workers
Academic staff of College of Health and Medical Sciences
2. Bule Hora Town
Health office
 Water and mineral office
Administration offices for their cooperation in development of
this proposal