Environmental risk factors associated with community diarrheal disease in Ethiopia

Devin LaPolt, Department of Food Science and Technology, The Ohio State University, Columbus, OH, USA. lapolt.2@osu.edu.
Sage Smith, College of Public Health, The Ohio State University, Columbus, OH, USA.
Lina Gazu, Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia.
Silvia Alonso, Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia.
Amete Mihret Teshale, National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Binyam Moges Azmeraye, The Ohio State Global One Health Initiative Eastern Africa Regional Office, Addis Ababa, Ethiopia.
Galana Mamo Ayana, Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia.
Dessie Abebaw Angaw, Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, School of Public Health, University of Gondar, Gondar, Ethiopia.
Desalegne Degefaw, The Ohio State Global One Health Initiative Eastern Africa Regional Office, Addis Ababa, Ethiopia.
Ariel V. Garsow, Department of Food Science and Technology, Center for Foodborne Illness Research and Prevention, The Ohio State University, Columbus, OH, USA.
Aaron Beczkiewicz, Department of Food Science and Technology, Center for Foodborne Illness Research and Prevention, The Ohio State University, Columbus, OH, USA.
Getnet Yimer, Department of Genetics, Penn Center for Global Genomics & Health Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Michala J. Krakowski, College of Public Health, The Ohio State University, Columbus, OH, USA.
Robert Scharff, Department of Human Sciences, The Ohio State University, Columbus, OH, USA.
Eyasu T. Seyoum, The Ohio State Global One Health Initiative Eastern Africa Regional Office, Addis Ababa, Ethiopia.
Barbara Kowalcyk, Department of Food Science and Technology, The Ohio State University, Columbus, OH, USA.

Document Type

Journal Article

Publication Date

5-27-2025

Journal

BMC public health

Volume

25

Issue

1

DOI

10.1186/s12889-025-23086-4

Keywords

Diarrheal diseases; Environmental health; Ethiopia; WASH

Abstract

BACKGROUND: Diarrhea is a major contributor to mortality in sub-Saharan Africa, where access to improved sanitation and clean water is limited. Identifying factors associated with diarrhea across geographical regions and age groups can inform resource allocation toward water infrastructure, healthcare, and disease mitigation. The objective of this study was to identify environmental risk factors associated with diarrhea in the general population across multiple communities in Ethiopia. METHODS: A prospective cross-sectional study was conducted in three regions in Ethiopia from October 2021-October 2022. REDCAP mobile app was used to collect data during face-to-face interviews using a structured, pretested questionnaire. Descriptive statistics characterized household environmental exposures. Univariate and multivariable logistic regression were used to identify factors associated with diarrhea. RESULTS: A total of 2,436 households participated in the study. Of these, 10.3% of households reported at least one case of diarrhea during the previous four weeks. Household animal ownership varied by site, with Addis Ababa reporting the lowest animal ownership and Harar reporting the highest ownership. Across all sites, pit latrines without covers were the most common sanitation facility. Water piped to yard was the most frequent source of drinking water and most households did not use treated water (boiled/filtered) when handling food. No environmental factors were associated with diarrhea in Addis Ababa. In Gondar, drinking water from unprotected wells was associated with increased odds of diarrhea [COR:4.81(95%CI:2.03,11.43)]. Dry season was associated with decreased odds of diarrhea compared to short [COR:0.42(95%CI:0.24,0.75)] and long rains seasons [COR:0.55(95%CI: 0.34,0.88)]. In Harar, drinking water from communal taps was associated with increased odds of diarrhea [COR:2.02(95%CI:1.32,3.09)]. CONCLUSION: Multiple environmental factors for diarrhea were identified. Given the variation in factors by site, strategies for intervention and management should be community-specific. These factors can be managed through improved water treatment, sanitation practices, and educational programs focused on proper hygiene. Efforts to manage these factors can potentially reduce the burden of diarrheal diseases.

Department

Exercise and Nutrition Sciences

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