Knowledge, Attitude And Practice Towards Water Supply, Sanitation And Hygiene (Wash) Among Residents In Arsi Nagele Town, South Eastern Ethiopia CURRENT

Background The national water coverage has been in increasing trend. However, unsafe water supply and poor sanitation practice was the major health concern which is causing diseases with considerable morbidity and mortality in Ethiopia. Objective To assess knowledge, attitude and practice of Arsi Nagele town inhabitants on water supply, sanitation and hygiene at household level. Method Community-based cross sectional study design was used at household level in Arsi Nagele town in April, 2019. Data was collected with structured questionnaires through face to face interview. Data was analyzed using SPSS version 20 statistical software. Result Four out of ten (43.8%) respondents know private taps are safe for drinking and domestic use while 116(40.4%) shared taps are safe. Moreover, 31(10.5%) know hand pump are safe and 16(5..3%) know unprotected well are safe for any domestic purpose. The majority of the respondents 260(90.5%) had positive attitude whereas 21 (7.1%) of the respondents negative and 8(2.5%) neutral attitude to the issue that in proper disposal of solid and liquid waste may contribute to the transmission of disease. While 241 (83.9%) of the respondent had positive attitude while 32(10.8%) and 16(5.2%) of the respondents had negative and neutral attitude to the view that human waste disposal is not a problem in that area. Conclusion The majority of respondent 250(87.1%) had good practice in case of cover the water storage container during the time of visit while 39(12.9%) of the respondent had bad practice. This calls urgent action to creat awareness on health education and hygiene household be promoted to influence the resident’s attitude that target personal, household and community hygiene and sanitation.

drinking water has increased from 49% in 1990 to 57% in 2011, while in the same time span the access to improved sanitation has only risen from 28% to 31% though the government of Ethiopia eagerly working on improving the standard of of WASH service for tracking progress towards the 2030 suatainable development goal target (6.1 and 6.2 and 6.3)(WHO/UNICEF-JMP, 2017).
Lack of water supply, sanitation and hygiene is the major cause of morbidity and mortality (Dreibelbis et al., 2013). It is estimated that 10,000 die every day from a range of water and sanitation related illness. The impact of inadequate water and sanitation service falls primarily on the poor and marginalized community (Beyene et al., 2015). Badly served by the formal sector, the poor make their own often inadequate arrangements to meet basic survival needs any fetch water from a long distance or end up paying high prices to water renders for very small quantity of water (UN HABITAT, 2011).
Water supply, sanitation and hygiene situation in Ethiopia is very poor, as most of the population does not have access to safe and adequate water supply, sanitation and hygiene facilities as like most of developing country (GLAAS, 2010). As a result three-fourth of the health problems in Ethiopia is due to communicable diseases attributable to unsafe or inadequate watersupply and improper waste management particularly excreta (Abera et al., 2016). Diarrhoeal diseases caused by improper management of water and sanitation are among the major causes of infant and child morbidity and mortality (WHO/UNICEF, 2015).The combination of safe water supply, sanitation facilities and hygienic practices demonstrated a high potential in contributing to a remarkable decrease in the prevalence of a child and maternal morbidity and mortality (MoWR/EARO/IWMI/ILRI, 2002).
The estimated water service level of Ethiopia in terms of coverage, quantity, quality, and reliability is among the lowest in the world. Sanitation facilities are also in worst condition (FMOH, 2017). Due to unreliability of safe and unaccessbility of safe and sufficient water supply and adequate sanitation facilities the estimated service level could be in much less situation. These combine effect of the poor water supply and sanitation facilities in the country have high impact on the economic development of the country and the living condition of the towns' communities (Health, 2006).
As a result the existing health problem in the country is infectious disease is directly or indirectly caused by poor access to safe water supply and sanitation(Central Statistical Agency (CSA) [Ethiopia] and ICF. 2016, 2016). The per capita of drinking water can not satisfy 50% of the minimum requirements. So, this condition exposed the people to prevent water borne diseases that accounts more than 40% of the communicable disease prevent in the country (MOWR, 2016). The aim of this study is to assess the knowledge,attitude and practice of water supply, sanitation and hygiene (WASH) in household on safe excreta disposal and the water storage container time.

Study Area And Period
The study was conducted at Arsi Nagele town. Arsi Nagele is a town in Southeastern Ethiopia located in the Western Arsi zone in the Oromiaregion on the paved highway north of Shashamane, this town has latitude and longitudeof 7 0 17'54`N to7023'28''N Latitude and38042''E Longitude with on elevation of 2043 meters above sea level (CSA, 2017 Sample size determination and sampling techniques: The sample size for households were determined using Epi info version 7.1, by considering 99% confidence level and marginal error (5%).
The sample size of households were calculated using P = 78% of the study conducted in Northwest Gojam (Beyene et al., 2015). The total sample size was 263 and taking 10% non-response rate the total sample size was 289. Sample households were selected by systematic random sampling method. To ensure homogeneity, a random number was determined to select households by dividing the total number of household by the sample size.

Data collection instruments:
The structured questionnaire was used to collect data through face to face interview by translating English questionnaire to Amharic language and backtranslated to English to ensure consistency and the knowledge, attitude and practices of each respondent in relation to water supply, sanitation, hygiene and its management was asked and supported by observational checklist .

Data quality control:
To know the characteristic of questionnaire acceptance and willingness of respondents a pretest was carried one week before the actual data collection outside of the study area.
Data processing and analysis: Data was analyzed by using SPSS version 20 statistical software package and at the end the result was interpreted and discussed in line with study objectives so conclusion and recommendation was made based on study findings.
Ethical consideration: A formal letter was taken from Hawassa University, College of Medicine and Health Sciences, Institutional Research Review Board. Moreover, prior to contact with the households the purpose of study was discussed with Arsi Nagele town kebeles leaders and the permission for data collection was taken. Each respondent was clearly explained that participation is voluntary and they can decline at any time without any explanation if they wish to do so.

Socio-Demographic Data
The minimum and maximum age of the respondent was 18 and 60 years respectively. The majority, (79%) were in the age group of 18-35 (Table 1).   (Table 3). High number of respondents 229 (79.6%) were knowledgeable on the matter that "sanitation is agroupof method to collect human excreta, urine and community waste in a hygienic way" where as 60 (20.4%) of the respondents had wrong response on the issue. In the case of "environmental sanitation is the control of environmental factors that form links in disease transmission", 249(87.4%) of the respondents gave correct response where as 36 (12.6%) of the respondents gave wrong response to the issue (Fig.1).
The highest number of respondents 253(88.1%) provide positive response while 36 (11.9%) of the respondents had negative response on the environmental sanitation is keeping our environment clean. The majority of the residents 264 (91.9%) were knowledgeable on the matter that dirty place or home attracting flies"where as 25(8.1%) of the respondents had wrong response on the issue (Table 4).    The majority of respondents 267 (93.7% ) believed that hand washing with soap was good and 18(6.3%) were negative attitude to the idea. However, 273 (95.8%) of the respondent had positive attitude and 12(4.2%) negative attitude regarding to poor personal hygienic was cause of diarrheal in the same manner 269(94.4%) and 16(5.6%) of the respondents had positive and negative attitude in the case of good hygiene was preventing from disease ( Table 6).
The result showed that the highest percentage of respondents had positive attitude 280(98.2%) and 9(1.8%) of respondents had negative attitude to the view that not hand washing before meal has health effect. The type of water used while washing your body 199(69.1%), 28(9.5%) and 61(21.4%) of the respondent had using pipe water, spring and well water respectively.The majority of respondents 261 (90.9%) believed that trimming finger nail was good for health and 28(9.1%) were negative attitude to the idea.

Residents practice on water supply, sanitation and hygiene
The majority of respondent 250(87.1%) had good practice in case of cover the water storage container during the time of visit while 39 (12.9%) of the respondent had bad practice.results indicated that most (46.6%) of the respondents treat their drinking water by boiling, while about 33.7% use water filters, 7.8% use sedimentation and the rest 11.9% was no measurement taken.

Discussion
The majority of the respondents 126 (43.8%) know private taps are safe for drinking and domestic use while 116(40.4%) shared taps are safe and also 31(10.5%) know hand pump are safe and 16(5.3%) know unprotected well are safe for any purpose. This result is less than the study done in Sidama zone (Belachew, 2012) and study reports by (Belachew, 2012).
The majority of respondents in the study collect water in small covered containers such as jerrycans 46.3%, buckets 34.5%, barrels 16.4% and 2.8% of residents indicated that they collected water in clay pot. This finding is in line with the study reported by Telmo, (2002) majority of residents collect water in small covered containers such as jerrycans 45.5% and buckets (35.8%). Moreover, 7.6% of residents indicated that they collected water in barrels but they did not specify whether these containers were covered after collection. It should also be noted observation that wide neck containers such as buckets have been associated with increased water contamination in comparison to small neck containers such as jerry cans. This is probably because with wide neck containers there is agreater tendency to insert water drawing devices (such as cups) and a larger surface area is exposed to contaminating agents when uncovered (Unicef, 2012).
High number of respondents 229(79.3%) were knowledgeable on the matter that"sanitation is agroupof method to collect human excreta, urine and community waste in a hygienic way. attitude to the view that human waste disposal is not a problem in that area which less compared the study reported by (Corps, 2008). Arsi Nagele is known for its large church, dedicated to St. Gabriel which is the site of massive twice yearly pilgrimages (on 26 July and 28 December) attended by tens of thousands of orthodox pilgrims. So, a lot of people attended on this festivity whi`ch is probably the cause for high amount of solid and liquid waste which lead to loses its natural beauty, bad odour to the community, health problems on the society and pollution of surface and groundwater (Bandaragoda, 1997 Generally, most of the residents have knowledge and attitude about water supply, sanitation and hygiene but they are not practice what they know. Sanitation improvement is gradual and it may take a long time to notice the impact this may be achieved through creating awareness on the bad impact of poor sanitation to the public health, cooperation among various stakeholders and take responsibility in introducing and implementing rules and laws that are related to environmental protection and sanitation by the government.

Conclusion
Based on this finding it has been evident that the majority of respondents were knowledgeable about water supply, sanitation and hygiene; however it was not adequate as water supply, sanitation and hygiene is one of the basic elements and human right of the health living of human being, and most of the residents were expected to acquire high level of knowledge. Where as asmajority of respondents were not practise what they have known.
Greater part of the respondents had favourable attitude to water supply, sanitation and hygiene but there was some in consistencies on residents attitude. These variations might be due to lack of knowledge and information, or existence of weak social norms in the value system of the community concerning WASH.
Majority of the residents of Arsi Nagele town did not take actions to improve environmental sanitation in their living area. This indicated that they were not as such sacrificing their personal interest for the sake of WASH. This lack of action might be the weakness of the communities and other stakeholders to do different practical activities in group in order to maintain urban environmental sanitation.

Recommendations
Based on the finding of the study the following recommendations were provided: District health office take responsibility for health education and hygiene awareness should be promoted to influence the resident's attitude that target personal, household and community WASH.
Special consideration should be given by city administration to integerate practical engagement of the residents in the community through developing sewerage system, urban beautification and toilet facility.
This will help to create awareness as well as alter the negative attitude and practice related to WASH.
Extension workers should undertake continuous home visit to improve the sanitation of the compound and home.
Government should be motivated community to take part in different community activities; this will help them to have the exposure to value how their role is important and become committed for the improvement of WASH.
The municipality must assign enough budgets to enlarge water services Good governance should be exercised to encourage water supply, sanitation and hygiene through the participation of different stakeholders (government, NGOs and communities) in decision making.