Sage Journals: Discover world-class research

Abstract

Globally, a significant percentage of diseases are communicable, with over 60% linked to infections and inadequate hygiene practices at home and in the environment. The gap between knowledge and actual practices further complicates access to improved hygiene. However, there is no study conducted on the knowledge and practices of housing and environmental hygiene. Consequently, this study aimed to assess the knowledge, practices, and factors influencing housing and environmental hygiene among household mothers. A community-based cross-sectional study was conducted from August 20, 2022, to September 15, 2022, involving 634 mothers selected through a two-stage sampling technique. Data were collected using pretested interviewer-administered and observation questionnaires, entered into Epi-Data 4.6, and analyzed with SPSS version 23. Out of 634 study participants, 72.4% had good knowledge and 58.7% had good hygiene practices. Being an urban dweller (AOR: 1.61; 95% CI [1.04, 2.49]), having access to media (AOR: 1.82; 95% CI [1.17, 2.84]), absence of flies in the house (AOR: 1.77; 95% CI [1.08, 2.91]), having a separate room for food preparation (AOR: 1.89; 95% CI [1.13, 3.18]), and preparing food outside the main house in an open space (AOR: 4.72; 95% CI [1.66, 13.56]) were identified as predictors of good hygiene knowledge. Age groups 18 to 26 years (AOR: 6.09; 95% CI [3.04, 12.19]), 27 to 35 years (AOR: 3.43; 95% CI [2.05, 5.74]), and 36 to 44 years (AOR: 2.02; 95% CI [1.20, 3.40]), having private latrines at the household level (AOR: 2.27; 95% CI [1.50, 3.45]), and being urban dwellers (AOR: 2.71; 95% CI [1.79, 4.12]) were predictors of good hygiene practices. Our findings show that household and environmental hygiene knowledge and practices were insufficient. Key factors included age, urban residence, media access, flies in the house, food preparation location, latrine availability, and water access within 30 min. We recommend hygiene training for mothers, with health workers and women’s groups promoting home hygiene. Rural health education should stress latrine use, hygiene facilities near latrines, and separate food preparation areas. Policymakers and healthcare providers should develop targeted interventions to improve maternal and child health.

Keywords

hygiene knowledge practice mothers Ethiopia

Background

According to the World Health Organization, hygiene is the process of cleaning an environment of all sickness factors that may cause health problems and involves all the precautions to be taken to reduce microorganisms (Mahmudiono et al., 2020). Creating hygienic environments is a critical part of breaking the fecal-oral transmission route for many diarrhea and other illnesses (World Health Organization, 2023). Diarrhea and other illnesses, access to safe water and hygiene facilities is a basic human challenge for survival and well-being (World Health Organization, 2023). Using improved hygiene facilities such as clean and safe water in facilities that can effectively prevent human, animal, and insect contact with excreta by using protected pit latrines to flush toilets with a sewerage connection is very important (Mahmudiono et al., 2020). The evidence above suggests that poor hygiene has become a pressing and significant public health issue. In Ethiopia, most household mothers have a greater role in maintaining housekeeping and environmental hygiene than men. Infants and children expose to diarrheal diseases during household women food poor hygienic way preparations (Mengistie & Baraki, 2010). Studies have shown that diarrheal incidence increases when the house and environment are usually introduced as unhygienic handling methods as sources of diarrheal pathogens (Miko et al., 2013; Nath, 2003) and when those who have access to improve household hygiene facilities have great health benefits, ranging from reductions in diarrheal disease, helminth infections, and trachoma to a reduced risk of accidents and enhanced psychosocial well-being (Dhimal et al., 2014). Improper handling of the house and environment at the household level can contribute to different infectious diseases caused by enteric pathogens associated with preventable food-borne bacteria (Wasonga et al., 2014). However, there is a need for primary study to clearly determine the bottleneck problems.

Globally, 2.3 billion people still lack basic hygiene including 670 million with no handwashing facilities at all (JMP, WHO, UNICEF, 2021). Similarly, 1.9 million deaths and 123 million disability-adjusted life years (DALYs) are associated with poor hygiene-related infectious diseases due to inadequate water. The disease burden attributable to inadequate water and hygiene accounts for 4.6% of global DALYs and 3.3% of global deaths (World Health Organization, 2019). A causal link between hand hygiene and the rate of infectious disease illness has also been established. Hand hygiene is any action of hand cleansing, that is, the act of cleaning one’s hands with or without the use of water or another liquid or with the use of soap to remove soil, dirt, and/or microorganisms (World Health Organization, 2017, 2019). In Africa, poor hygiene of houses and their environments is a common problem (Degebasa et al., 2018). In 2020, it is estimated that more than 208 million people in Africa practiced open defecation, 839 million people lacked basic hygiene services, and diarrheal diseases are listed as the top killers of children in developing countries (JMP, WHO, UNICEF, 2021). Significant inequalities persist between and within countries including between urban and rural settings (Hutton & Chase, 2016). In Ethiopia, 20 million people practice open defecation, and 106 million people still lack basic hygiene services (JMP, WHO, UNICEF, 2021). Improving water and hygiene practices at the household level is the most effective intervention measure to prevent and control the burden of diarrhea and other communicable diseases since mothers always prepare food. For instance, proper handwashing with soap, use improved water quality, and proper excreta disposal can reduce diarrheal diseases by 48%, 17%, and 36%, respectively (Cairncross et al., 2010). These factors are important for reducing diarrheal diseases by maintaining housekeeping and compound hygiene, yet there is a high client flow at health facilities for related infectious diseases (Teshome et al., 2023).

Sociodemographic factors such as good educational status and type of house (having a modern house) create favorable conditions for increased knowledge and hygienic practices (Yallew et al., 2012). Environmentally related factors such as the presence of latrines at the household level and hand washing facilities are also associated with an increased status of good knowledge and hygiene practices, whereas open defecation (OD), access to safe disposal of human excreta, awareness of hygienic practices, and use of non contaminated water are associated with an increased status of good knowledge and hygiene practices (Johnson et al., 2015; Yallew et al., 2012). Similarly, knowledge of handwashing and latrine use is also significantly associated with good hygiene practices (Shehmolo et al., 2021).

The substantial benefits of hygiene improvements have been gained from the health extension program, which was designed and implemented by the Ethiopian Ministry of Health (MOH) since 2003 (Assefa et al., 2019). The WASH National Program and the Growth and Transformation Plan (GTP) have been implemented and have played a great role in improving hygiene infrastructure throughout the country (Girma et al., 2024; SWAp AM-S, 2013). Although these programs are implemented in Ethiopia, infectious diseases among children under 5 years of age are prevalent in the study area.

Although knowledge and practices related to hygiene influence household mothers’ hygiene behaviors, this topic remains under-researched (Teshome et al., 2023). In the study area, despite health extension workers’ efforts, diarrheal diseases remain common, according to annual reports from the district health office. This study aimed to assess the knowledge, practices, and associated factors of household and environmental hygiene among mothers in Tegede district, Central Gondar Zone, Amhara Region, Northwest Ethiopia. The findings will support healthcare providers and policymakers in designing targeted interventions to improve maternal and child health.

Methods

Study Design

A community-based cross-sectional study was conducted among household mothers in the Tegedie district from August 20, 2022, to September 15, 2022. The Tegedie district is one district of the Central Gondar Zone and is located in northwestern Ethiopia. It is located 115 km from Gondar town and 295 km from Bahir Dar City. The district consists of one primary hospital, four governmental health centers, and 26 health posts. The district is structured into 21 kebeles (2 urban and 19 rural). According to reports from the Tegedie District Health Office, 100,382 people (53,829 males and 46,553 females) live in the district (Teshome et al., 2023). The presence of latrines at the household level and the water coverage of the district are 14% and 63.8%, respectively. Malaria, diarrhea, intestinal parasites, and upper respiratory tract infections are the main health problems in the general community (Teshome et al., 2023).

Participants

All household mothers who lived for at least 6 months in the district were considered the source population, while all household mothers who lived for at least 6 months in each kebele during the data collection period were considered the study population.

Inclusion and Exclusion Criteria

Inclusion and exclusion criteria were clearly defined to minimize selection bias. All household mothers residing in the study area for at least 6 months during data collection were included. Mothers who were seriously ill or unable to hear were excluded.

Sample Size Determination

The sample size was determined using a single population proportion formula. Accordingly, the formula for sample size determination used was n = (Zα/2)2 × [(p1q1)/(d)2]. The following assumptions were considered: n denotes the sample size, Zα/2 is the reliability coefficient of standard error at the 5% level of significance = 1.96, and p = the status of the level of knowledge toward WASH, based on the 49.2% score from previous research conducted in the Tigray Region, Northern Ethiopia (Berhe et al., 2020). Considering a 10% non response rate and a design effect of 1.5, the final sample size was approximately 634.

The sample size was also calculated using the second objective of associated factors with knowledge and practice of hygiene by considering the following assumptions: two-sided confidence interval = 95%; power = 80%; ratio (unexposed to expose) = 1; design effect (DE) = 1.5; and 10% non response rate (NR; Table 1).

Table 1.

Sample Size Calculation With Associated Factors.

Factors	% Outcome in unexposed	% Outcome in exposed	Odds ratio	Calculated sample size	Sample size + DE + NR	Reference
Hygiene knowledge	40.75%	70%	3.39	102	169	Sahiledengle et al. (2018)
Solid waste collection containers witnessed	53.95%	34.17%	2.26	216	357	Sahiledengle et al. (2018)
Handwashing knowledge	40.76%	23.16	2.28	242	400	Shehmolo et al. (2021)
Knowledge of latrine use	36.68%	22.64%	1.98	358	590	Shehmolo et al. (2021)

More importantly, the sample size obtained by using the single population formula (634) was greater than the sample size calculated by using the second objective (using factors significantly associated with the outcome variable). Therefore, the minimum sample size to represent the source population was 634.

Sampling Technique

A two-stage sampling technique was used. First, 10 kebeles (about half of the 21 kebeles in Tegedie district) were selected by simple random sampling (lottery method). The sample size was proportionally allocated to each kebele based on its population. Mothers were then selected systematically at the household level, with a sampling interval of approximately 14 (K = total mothers ÷ allocated sample), selecting every 14th household (Figure 1).

Figure 1.

Schematics showing the sampling procedure.

Variables and Measurements

The outcome variables of this study were knowledge and practice of household and environmental hygiene. The explanatory variables included sociodemographic factors (age, religion, ethnicity, residence, marital status, family size, occupation, family income, education level, and media access), attitudes, environmental health, and housing-related factors.

The questionnaire was developed by reviewing previous studies (Abdul et al., 2020; Degebasa et al., 2018; Sultana et al., 2016). It was first prepared in English, then translated into Amharic, and back-translated into English by language experts to ensure consistency. Hygienic practices related to housing and environmental hygiene were assessed using a 22-item questionnaire, including observational questions with a scoring scale above three points and some yes/no questions. The mean score of responses was calculated, and participants scoring at or above the mean were classified as having good hygiene practices; those below were considered to have poor hygiene practices (Berhe et al., 2020).

Household mothers’ knowledge of house and environmental hygiene was assessed using 12 related questions for categorical analysis. Participants scoring at or above the mean total score were considered to have good knowledge; otherwise, they were classified as having poor knowledge (Berhe et al., 2020). Attitudes toward housing and environmental hygiene were assessed with 16 questions. Total attitude scores were calculated, then dichotomized as favorable (≥mean) or unfavorable (<mean; Afework et al., 2022).

Data Quality Management

A pretest was conducted with 5% of the sample (32 participants) from outside the study area (Layrmachiho District), and necessary revisions were made based on the results. Data collectors received training on the study’s purpose, procedures, inclusion/exclusion criteria, questionnaire review, interviewing techniques, and data collection methods. Daily supervision was conducted by a master’s-level environmental health professional. Ten BSc health officers and environmental health providers collected data through interviews and direct observation using structured, pretested questionnaires. The principal investigator reviewed each questionnaire daily for completeness before data entry. Participants were informed about the study’s purpose to create a comfortable environment and reduce stress, given the sensitive nature of the topics.

The questionnaire’s content validity was confirmed by experts, and reliability was established using internal consistency (Cronbach’s alpha = 0.75). Multicollinearity was assessed with variance inflation factors (VIF < 1.5). Model fit was confirmed by the Hosmer–Lemeshow test (knowledge p = .422; practice p = .608). To reduce bias, random sampling was used to ensure representativeness, standardized questionnaires ensured uniform data collection, and data collectors were trained to maintain consistency and minimize interviewer bias.

Data Processing and Analysis

The data were checked for completeness, coded, entered into Epi-data 4.6, and then exported to SPSS version 23 for cleaning and further analysis. For each question, the participants were given a score of one point for each correct answer and 0 (zero) points for the incorrect answer about the house and environment hygiene-related questions. The responses were added, and the mean was computed. Descriptive statistics were carried out and are presented with tests, figures, and tabulations.

The associations of each independent variable with the outcome variables were determined using univariable binary logistic regression analysis. Furthermore, variables with a p-value < .25 were included in a multivariable binary logistic regression model to identify the independent predictors with a p-value < .05. A backward stepwise analysis method was used to select variables for multivariable binary logistic regression to control for confounding effects. Most variables were removed via a backward stepwise method. The odds ratio with a 95% confidence interval was used to determine the strength of the association between the predictors and outcome variables.

Results

Sociodemographic Characteristics

Of the overall sample required (n = 634), all participants were included in the study, and the response rate was 100%. The mean age of the study participants was 36.7 years (±9.9 years). Almost all (91.8%) of the study participants were Amhara ethnicity. The majority (62%) of the study participants were currently residing in urban areas. Regarding the educational status of the study participants, only 63 (9.9%) of them were attended secondary school and above. Furthermore, more than half (56.6%) of the study participants did not have access to house or environmental hygiene information (Table 2).

Table 2.

Sociodemographic Characteristics of Mothers in the Tegedie District, Northwest Ethiopia, 2022.

Variables	Frequency	Percent (%)
Age groups
18–26	87	13.7
27–35	234	36.9
36–44	185	29.2
45–70	128	20.2
Ethnicity
Amhara	582	91.8
Tigray	52	8.2
Religion
Orthodox	573	90.4
Muslim	56	8.8
Other	5	0.8
Mothers’ marital status
Current married	479	75.6
Single	155	24.4
Husbands’ education (n = 479)
Unable to read and write	171	35.7
Able to read and write	230	48.0
Primary school	43	9.0
Secondary and above	35	7.3
Mothers’ educational
Unable to read and write	387	61.0
Able to read and write	145	22.9
Primary school	39	6.2
Secondary and above	63	9.9
Mothers’ occupation
Housewife	454	72.1
Civil servant	146	22.9
Merchant	34	5.0
Family size in number
≤4	329	51.9
>4	305	48.1
Residence
Urban	393	62.0
Rural	241	38.0
Access to media
Yes	378	56.6
No	256	40.4
Other: Catholic and protestant

Environment-Related Factors

Three hundred sixty-eight (58%) of the study participants had access to a private latrine. Of these, only 119 (18.8%) of the participants had latrines with handwashing facilities, and only 67 (10.6%) had functional water and soap during the data collection period. Regarding access to a safe water supply, many of the participants (349; 55.0%) received water from piped water sources. This revealed that a greater proportion of mothers (464 (73.2%) had collected water within 30 min. Regarding the individual daily amount of water utilization, 522 (82.3%) of the study participants used 20 liters per capita per day (L/C/D). Regarding the water treatment option, 461 (72.7%) of the participants did not treat the water during utilization. In the case of waste disposal, nearly half of the participants (50.5%) disposed of waste in open fields (Table 3).

Table 3.

Frequency Distribution of Housing and Environmental Hygiene Practices Among Household Mothers in the Tegedie District, Northwest Ethiopia, 2022.

Variables	Frequency (n)	Percent (%)
Presence of latrine
Yes	368	58.0
No	266	42.0
Latrine present within 6 m household (n = 368)
Yes	285	77.4
No	83	22.6
Hand wash facility near the latrine
Yes		119
No		515
Water source
Piped water	349	55.0
Protected well	73	11.5
Protected spring	162	25.6
Unprotected well	11	1.7
Unprotected spring	39	6.2
Time took to fetch water
≤30 min	464	73.2
>30 min	170	26.8
Water treatment
Yes	173	27.3
No	461	72.7
Water treatment options
Chlorine/wuhaagar	153	24.1
Boiling	20	3.2
No usage treatment	461	72.7
Frequency of cleaning water storage
Daily	92	14.5
Weekly	262	41.4
Monthly	61	9.6
When dirty	219	34.5
Water reliability throughout the year
Yes	315	49.7
No	319	50.3
Amount of water used
≥20 L/C/D	112	17.7
<20 L/C/D	522	82.3
Waste disposal management
Open field	320	50.5
In the pit	213	33.6
Burning near the yard	101	15.9
Have livestock
Yes	420	66.24
No	214	33.76
Observed flies in the house
Yes	341	53.8
No	293	46.2
Cooking food place
Separate kitchen	197	31.1
Not separated kitchen	437	68.9
Hand wash after toilet used
Yes regularly/always	302	47.6
Yes, sometimes	274	43.3
Never	58	9.1
Contact community health services
Yes	247	39.0
No	387	61.0
Attitude to house and environment hygiene
Favorable	392	61.8
Un favorable	242	38.2

Level of Knowledge, Practice of House and Environment Hygiene

The results of this study showed that the overall levels of good knowledge and practice of housing and environmental hygiene were 72.34% CI [68.9, 75.7] and 58.67% CI [54.7, 62.5], respectively (Figure 2).

Figure 2.

Knowledge and practice of home and environmental hygiene.

Factors Associated With Good Knowledge of the House and Environmental Hygiene

The relationships between all potential independent variables with good knowledge of housekeeping and environmental hygiene were analyzed using binary logistic regression. Accordingly, maternal age group, ethnicity, marital status, educational level of mothers, family size, residence, access to media, presence of latrine, type of water source, reliability of water throughout the year, waste disposal management system, presence of livestock, presence of flies in the house, place of cooking, and presence of animal feces near the household were analyzed using binary logistic regression. Finally, urban residence, access to media, fly presence in the house, and place of cooking food were factors significantly associated with good knowledge of housing and environmental hygiene.

Urban dwellers were 1.61 (AOR: 1.61; 95% CI [1.04, 2.49]) times more likely than rural dwellers to have good knowledge about housing and environmental hygiene. Participants who have access to media were 1.82 (AOR: 1.82; 95% CI [1.17, 2.84]) times more likely to have good knowledge about housing and environmental hygiene than those who did not have access to housing and environmental hygiene information in the media. Those who had flies were 1.77 (AOR: 1.77; 95% CI [1.08, 2.91]) times more likely to have good knowledge about housing and environmental hygiene. Additionally, those study participants who made food in a separate room were 1.89 times more likely to have good knowledge of housing and environmental hygiene than those who made food inside the main living room (AOR: 1.89; 95% CI [1.13, 3.18]). Those study participants who made food in an open space outside the household were 4.72 times more likely to have good knowledge of housing and environmental hygiene than were the study participants who made food inside the main living room (AOR: 4.72; 95% CI [1.66, 13.56]; Table 4).

Table 4.

Univariate and Multivariate Binary Logistic Analyses of Factors Associated With Good Knowledge of Housing and environmental hygiene among household mothers in the Tegedie District, Northwest Ethiopia, 2022.

	Hygiene knowledge		COR [95% CI]	AOR [95% CI]
Variables	Good	Poor	COR [95% CI]	AOR [95% CI]
Ethnicity
Amhara	426	156	1.57 [0.87, 2.85]	-
Tigray	33	19	1
Age groups
18–26	69	18	1.62 [0.85, 3.08]	-
27–35	169	65	1.10 [0.68, 1.77]	-
36–44	131	54	1.03 [0.63,1.68]	-
45–70	90	38	1
Maternal education
Secondary and above	52	11	1.94 [0.99, 3.84]	-
Primary school	30	9	1.37 [0.64, 2.95]	-
No formal education	377	155	1
Mothers’ marital status
Single	120	35	1.42 [0.93, 2.17]	-
Currently married	339	140	1
Family size in number
≤4	249	80	1.41 [0.99, 1.20]	-
>4	210	95	1
Residence
Urban	306	87	2.02 [1.42, 2.88]	1.61 [1.04, 2.49]*
Rural	153	88	1	1
Access to media
Yes	284	94	1.40 [1.09, 1.99]	1.82 [1.17, 2.84]*
No	175	81	1	1
Presence of latrine
Yes	275	93	1.32 [0.93, 1.87]	-
No	184	82	1
Water source
Protected	429	155	1.85 [1.02, 3.35]	-
Unprotected	30	20	1
Waste disposal management
Open field	221	99	1
In the pit	161	52	1.39 [0.94, 2.06]	-
Burning near the yard	77	24	1.44 [0.86, 2.41]	-
Have livestock
Yes	292	128	1.56 [1.06, 2.29]	-
No	167	47	1
Animal faces near the household				-
Yes	222	108	1
No	70	20	1.70 [0.99, 2.94]	-
Observed flies in the house
Yes	230	111	1	1
No	229	64	1.73 [1.21, 2.470]	1.77 [1.08, 2.91]*
Cooking in food place
Inside the main living room	85	54	1	1
Separate room	323	114	1.80 [1.20, 2.69]	1.89 [1.13, 3.18]*
Open space outside HH	51	7	4.63 [1.96, 10.98]	4.72 [1.66, 13.56]*

Note. HH = household.

p-Value <.05, the p-value of the Hosmer–Lemeshow test was .422

Factors Associated With Good Hygiene Practices in the House and the Environment

Maternal age group, marital status, maternal educational level, maternal occupation, family size, residence, access to media, presence of latrines, presence of handwashing facilities, type of water source, presence of livestock, reliability of the water source throughout the year, access to water source, water consumption in liters per capita per day (L/C/D), and knowledge about house and environment hygiene were identified as predictor variables in the univariable binary logistic regression analysis. However, only maternal age group, place of residence, access to media, presence of a latrine, and access to a water source near to house within 30 min were significantly associated with hygiene practices among mothers.

Accordingly, participants aged 18 to 26 years were 6.09 years (AOR: 6.09; 95% CI [3.04, 12.19]), those aged 27 to 35 years were 3.43 years (AOR: 3.43; 95% CI [2.05, 5.74]), and those aged 36 to 44 years were 2.02 years (AOR: 2.02; 95% CI [1.20, 3.40]) more likely to practice good hygiene than those aged 45 to 70 years. Those participants who lived in urban areas had 2.71 times (AOR = 2.71, 95% CI [1.79, 4.12]) greater odds of good practices than those who lived in rural areas. Study participants who had access to media were 44% less likely to practice good hygiene than their counterparts were (AOR : 0.66, 95% CI [0.45, 0.98]). Study participants who had a private latrine at the household level were 2.27 times more likely to practice good hygiene than those who did not have a private latrine at the household level (AOR: 2.27, 95% CI [1.50, 3.45]). This study revealed that participants in households with access to a water source within 30 min of their homes were 60% less likely to practice good hygiene than participants in households with access to a water source more than 30 minutes away (AOR:0.40, 95% CI [0.26, 0.62]; Table 5).

Table 5.

Univariable and Multivariate Binary Logistic Analyses of Factors Independently Associated With Good Hygiene Practices Among Household Mothers in the Tegedie District, Northwest Ethiopia, 2022.

	Hygiene practice		COR [95% CI]	AOR [95%) CI]
Variables	Good	Poor	COR [95% CI]	AOR [95%) CI]
Age in years
18–26	69	18	7.32 [3.88, 13.80]	6.09 [3.04, 12.19]**
27–35	162	72	4.30 [2.72, 6.79]	3.43 [2.05, 5.74]**
36–44	97	88	2.10 [1.32, 3.35]	2.02 [1.20, 3.40]*
45–70	44	84	1	1
Maternal education
Secondary and above	49	14	2.79 [1.50, 5.18]	-
Primary	27	12	1.79 [0.89, 3.62]	-
No formal education	296	236	1	-
Maternal occupation
Housewife	251	206	1	-
Civil servant	95	50	1.56 [1.06, 2.30]	-
Merchant	26	6	3.56 [1.44, 8.81]	-
Marital status
Single	83	72	1	-
Currently married	289	190	1.32 [0.92, 1.90]	-
Family size in number
≤4	225	104	2.33 [1.68, 3.21]	-
>4	147	158	1	-
Residence
Urban	283	110	4.39 [3.12, 6.19]	2.71 [1.79, 4.12]**
Rural	89	152	1	1
Access to media
Yes	202	176	0.58 [0.42, 0.81]	0.66 [0.45, 0.98]*
No	170	86	1	1
Latrine presence
Yes	266	102	3.94 [2.82, 5.50]	2.27 [1.50, 3.45]**
No	106	160	1	1
Hand washing facility presence
No	283	232	1	-
Yes	89	30	2.43 [1.55, 3.81]	-
Type of water source
Unprotected	25	25	1	-
Protected	347	237	1.46 [0.82, 2.61]	-
Access to water source
On premises	70	21	2.01 [1.13, 3.59]	0.78 [0.40, 1.52]
≤30 min	196	177	0.67 [0.46, 0.97]	0.40 [0.26, 0.62]**
>30 min	106	64	1	1
Water source reliability throughout the year
Yes	205	110	1.70 [1.23, 2.33]	1.38 [0.95, 1.20]
No	167	152	1	1
Water consumption in L/C/D
<20 L/C/D	288	234	1	-
≥20 L/C/D	84	28	2.44 [1.54, 3.87]	-
Presence of livestock in house
Yes	225	195	1	1
No	147	67	1.90 [1.34, 2.69]	1.49 [0.20, 2.23]
Level of knowledge
Good knowledge	280	179	1.41 [0.99, 2.01]	-
Poor knowledge	92	83	1	-

p-value < .05, **p-value < 0.001, p-value of .608 according to the Hosmer–Lemeshow test.

Discussion

This study aimed to assess the level of knowledge, practices, and associated factors of housing and environmental hygiene among household mothers in the Tegedie district. The overall prevalence of good knowledge was 72.34% (95% CI [68.9, 75.7]), and good hygiene practice was 58.67% (95% CI [54.7, 62.5]).

The level of knowledge about housing and environmental hygiene in this study aligns with findings from peri-urban Northwest Ethiopia (75.7%; Berhe et al., 2020), and Nepal (74.28%; Sah et al., 2017). The possible explanations for these similarities might be the similar sociodemographic characteristics of the study participants and the fact that all those studies were community-based and in rural areas. However, it is higher than reports from northern Ethiopia (42.2%; Berhe et al., 2020), southern Ethiopia (62.1%; Afework et al., 2022), and Angola, Ethiopia (52%; Vivas et al., 2011). These differences may stem from variations in study periods and participant characteristics, such as the exclusively rural population in northern Ethiopia (Berhe et al., 2020) and inclusion of school-age children in Angola (Vivas et al., 2011).

The percentage of good house and environmental hygiene practices (58.67%) was lower than in Rwanda (66.3%; Nikwigize, 2022), Addis Ababa, Ethiopia (74%; Gebreeyessus & Adem, 2018), and Arsi Nagele Town, Southeast Ethiopia (68.1%; Mako et al., 2019). The possible reasons behind these differences might be the level of education of the study participants. This difference may be due to lower education levels among participants in this study compared to those in Addis Ababa (Gebreeyessus & Adem, 2018) the fact that 93% of participants in Arsi Nagele Town were educated (Mako et al., 2019). However, the result aligns with findings among mothers in Nepal (60%; Sah et al., 2017). In contrast, the level of good housing and environmental hygiene practices (58.67%) was higher than the 49.2% reported in a previous study in Tigray, Ethiopia (Berhe et al., 2020). This difference may be due to variations in the measurement tools used and the study periods.

The study found that participants living in urban areas had higher odds of good hygiene knowledge compared to those in rural areas. This may be because urban residents have easier access to information through various mass media outlets, increasing their awareness of proper household hygiene. This aligns with a Tanzanian study (Alexander et al., 2019) showing that media access significantly improves hygiene knowledge. Additionally, participants whose homes were free of flies were more likely to have good hygiene knowledge, consistent with Ethiopian studies (Tesfaw et al., 2023), indicating that better knowledge helps maintain cleaner homes and reduces fly breeding. Furthermore, those who cooked food in open spaces outside the main living area showed greater hygiene knowledge than those cooking inside the main house. This matches findings from Dedo, Southwest Ethiopia (Eshete Soboksa & Nenko Yimam, 2017), suggesting that cooking outside promotes cleanliness in the living area, likely because having a separate kitchen reduces contamination and supports better hygiene practices overall.

Studies show that household mothers aged 18 to 26, 27 to 35, and 36 to 44 years are more likely to have good hygiene practices compared to those aged 45 to 70 years. This aligns with findings from southern Ethiopia (Shehmolo et al., 2021), where younger age groups were significant predictors of better hygiene. This may be due to differences in education: nearly 98% of those aged 45 to 70 had no formal education, whereas 55.2%, 81.6%, and 90.8% of the younger age groups had some education. Additionally, reduced physical activity with age may limit older participants’ ability to maintain good hygiene practices.

Living in urban areas was significantly associated with better hygiene practices compared to rural areas, likely due to sociodemographic differences and urbanization pressures that encourage improved hygiene. Interestingly, this study found that access to media reduced the likelihood of poor hygiene practices. While this may seem counterintuitive, it suggests that media mainly influences knowledge rather than long-term behavioral change, which is essential for consistent hygiene practices. Thus, media access may improve awareness but does not always translate immediately into better hygiene habits.

Consistent with studies in Gondar City (Sahiledengle et al., 2018), Addis Ababa (Yallew et al., 2012), Gedeo Zone, South Ethiopia (Eshete Soboksa & Nenko Yimam, 2017), this study found that mothers with household latrine access were more likely to practice good hygiene than those without. This may be because having a latrine at home provides the opportunity for proper use, which supports better overall hygiene practices among participants.

Participants with water sources within a 30-min round trip were less likely to practice good hygiene than those with water sources farther away. This unexpected finding may relate to the quantity of water available rather than proximity; only 13.7% of those with closer water access received adequate daily water per capita, compared to 20.6% of those traveling longer distances. Further research is recommended to explore this association.

Strengths and Limitations of the Study

This study was conducted at the community level, so the findings could be a better representation of the source population. Despite this cross-sectional design, which prevented causality determination, we did not include qualitatively addressable data. Social desirability bias and recall bias might be introduced while interviewing the study participants.

Conclusions

These findings show that household and environmental hygiene knowledge and practices are insufficient, influenced by factors like maternal age, urban residence, media access, flies’ presence, food preparation location, latrine availability, and water access. To address this, targeted hygiene training and counseling for mothers are essential. Policymakers and health professionals must collaborate to deliver clear, evidence-based messages, while health workers and women’s groups should actively promote hygienic home practices. Emphasis on latrine use, hygiene facilities, and separate food preparation areas is crucial, especially in rural areas, to improve maternal and child health outcomes.

Footnotes

We would like to thank the district health department for providing relevant information about the population and kebele for this research. Finally,we would also like to thank our friends for their constructive comments.

ORCID iD

Agerie Mengistie Zeleke

Ethical Considerations

Before data collection commenced,ethical approval was secured from the Research Ethics Board of the Institute of Public Health,under protocol number Ref. IPH/2257/2022. Additionally,permission was obtained from the Zonal Health Department and District Health Offices.

Consent to Participate

We thoroughly explained the potential benefits of the research to society and the risks involved for study participants. Written consent was obtained from each participant before the study. To protect privacy,the names and specific addresses of participants were coded to maintain anonymity,and confidentiality was ensured. During data collection,mothers who were seriously ill were referred to a nearby healthcare facility and reported to the district health office. Participation in the study was voluntary,and participants had the right to withdraw from the interview at any time.

Author Contributions

DA designed the study. HF,JA and AM supervised the data collection. DA cleaned and analyzed the data. DA,HF,JA,and AM interpreted the data and wrote the manuscript. All authors have read and approved the final manuscript.

Funding

The author(s) received no financial support for the research,authorship,and/or publication of this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest concerning respect to the research,authorship,and/or publication of this article.

Data Availability Statement

Data are available upon request to the primary and corresponding authors.

References

Abdul

K. M.

Abdul Hamid

S. M.

Mohsin Ali

S. M.

Ehsanul

H. M. H.

(2020). Study on Knowledge& Practice of WASH among under 5 children’s mother in rural community of Bangladesh. International Journal of Rural Development, Environment and Health Research, 4(6), 232–241. https://doi.org/10.22161/ijreh.4.6.3

Berhe

A. A.

Aregay

A. D

Abreha

A. A.

Aregay

A. B.

Gebretsadik

A. W.

Negash

D. Z.

Gebreegziabher

E. G.

Demoz

K. G.

Fenta

K. A.

Mamo

N. B.

(2020). Knowledge, Attitude, and Practices on Water, Sanitation, and Hygiene among Rural Residents in Tigray Region, Northern Ethiopia. Journal of Environmental and Public Health, 2020, 5460168. https://doi.org/10.1155/2020/5460168

Abera

Mulu

Yizengaw

Hailu

Kibret

(2018). Water safety, sanitation and hygiene-related knowledge, attitudes, and practices among household residents in peri-urban areas in Northwest Ethiopia. Ethiopian Journal of Health Development, 32(3).

Afework

Beyene

Ermias

Tamene

(2022). Moving up the sanitation ladder: A study of the coverage and utilization of improved sanitation facilities and associated factors among households in southern Ethiopia. Environmental Health Insights, 16, 11786302221080825.

Alexander

C. C.

Shrestha

Tounkara

M. D.

Cooper

Hunt

Hoj

T. H.

Dearden

Kezakubi

Atugonza

West

Crookston

Hall

(2019). Media access is associated with knowledge of optimal water, sanitation, and hygiene practices in Tanzania. International Journal of Environmental Research and Public Health, 16(11), 33.

Assefa

Gelaw

Y. A.

Hill

P. S.

Taye

B. W.

Van Damme

(2019). Community health extension program of Ethiopia, 2003-2018: Successes and challenges toward universal coverage for primary healthcare services. Globalization and Health, 15(1), 24.

Berhe

A. A.

Aregay

A. D.

Abreha

A. A.

Aregay

A. B.

Gebretsadik

A. W.

Negash

D. Z.

Gebreegziabher

E. G.

Demoz

K. G.

Fenta

K. A.

Mamo

N. B.

(2020). Knowledge, attitude, and practices on water, sanitation, and hygiene among rural residents in Tigray Region, Northern Ethiopia. Journal of Environmental and Public Health, 2020, 5460168.

Cairncross

Hunt

Boisson

Bostoen

Curtis

Fung

I. C.

Schmidt

W. P.

(2010). Water, sanitation and hygiene for the prevention of diarrhoea. International Journal of Epidemiology, 39(Suppl 1), i193–i205.

Degebasa

Dawit

Marama

(2018). Diarrheal status and associated factors in under five years old children in relation to implemented and unimplemented community-led total sanitation and hygiene in Yaya Gulele in 2017. Pediatric Health Medicine and Therapeutics, 9, 109–121.

10.

Dhimal

Aryal

K. K.

Dhimal

M. L.

Gautam

Singh

S. P.

Bhusal

C. L.

Kuch

(2024). Knowledge, attitude and practice regarding dengue fever among the healthy population of highland and lowland communities in central Nepal. PLoS One, 9(7), e102028. https://doi.org/10.1371/journal.pone.0102028

11.

Eshete Soboksa

Nenko Yimam

. (2017). Assessment of household level sanitation practice of mothers and associated factors in Gedeo Zone, South Ethiopia. American Journal of Public Health Research, 5(2), 43–49.

12.

Gebreeyessus

G. D.

Adem

D. B.

(2018). Knowledge, attitude, and practice on hygiene and morbidity status among tertiary students: The case of Kotebe Metropolitan University, Addis Ababa, Ethiopia. Journal of Environmental and Public Health, 2018, 1–9. https://doi.org/10.1155/2018/2094621

13.

Girma

Hussein

Norris

Genye

Tessema

Bossuyt

Hadis

van Zyl

Goyol

Samuel

(2024). Progress in Water, Sanitation and Hygiene (WASH) coverage and potential contribution to the decline in diarrhea and stunting in Ethiopia. Maternal & Child Nutrition, 20(Suppl 5): e13280. https://doi.org/10.1111/mcn.13280

14.

Hutton

Chase

(2016). The knowledge base for achieving the Sustainable Development Goal Targets on water supply, sanitation and hygiene. International Journal of Environmental Research and Public Health, 13(6), 536.

15.

JMP, WHO, UNICEF. (2021). Progress on household drinking water, sanitation, and hygiene. JMP, WHO, UNICEF.

16.

Johnson

R. C.

Boni

Barogui

Sopoh

G. E.

Houndonougbo

Anagonou

Agossadou

Diez

Boko

(2015). Assessment of water, sanitation, and hygiene practices and associated factors in a buruli ulcer endemic district in Benin (West Africa). BMC Public Health, 15(1), 801.

17.

Mahmudiono

Nindyasari

Segalita

Nasikhah

A. D.

Peng

L. S.

(2020). Nutrition education on food hygiene and sanitation to increase knowledge, attitude, and practice among canteen food handlers in Indonesia. Systematic Reviews in Pharmacy, 11(11), 1396–1400.

18.

Mako

G. M.

Gelanh

Y. K.

Mamo

B. Y.

(2019). Knowledge, attitude, and practice toward water supply, sanitation and hygiene (wash) among residents in Arsi Nagele Town, South Eastern Ethiopia. https://doi.org/1021203/rs214375/v1

19.

Mengistie

Baraki

(2010). Community based assessment on household management of waste and hygiene practices in Kersa Woreda, Eastern Ethiopia. Ethiopian Journal of Health Development, 24(2), 4.

20.

Miko

B. A.

Cohen

Haxall

Conway

Kelly

Stare

Tropiano

Gilman

Seward

S. L.

Jr. Larson

(2013). Personal and household hygiene, environmental contamination, and health in undergraduate residence halls in New York City, 2011. PLoS One, 8(11), e81460.

21.

Nath

K. J.

(2003). Home hygiene and environmental sanitation: A country situation analysis for India. International Journal of Environmental Health Research, 13(sup1), S19–S28.

22.

Nikwigize

(2022). Factors associated with hygiene and sanitation practices among adults in Muhanga District, Rwanda. EC Nursing and Healthcare, 4(6), 26–38.

23.

Sahiledengle

Alemseged

Belachew

(2018). Sanitation practice and associated factors among slum dwellers residing in urban slums of Addis Ababa, Ethiopia: A community based cross-sectional study. Journal of Public Health and Epidemiology, 10(10), 370–379.

24.

Sah

R. K.

Kumar

Chiluwal

Kumar

(2017). Assessment of the knowledge, attitude, and practice regarding water, sanitation, and hygiene among mothers of under-five children in rural households of Saptari District, Nepal. American Journal of Public Health Research, 5(5), 163–169. https://doi.org/10.12691/ajphr-5-5-5

25.

Shehmolo

Gari

Jember Tesfaye

Boti

Oumer

(2021). Magnitude and factors associated with hygiene practice among primary school children in Mareko District, southern Ethiopia: A cross-sectional study. Journal of Multidisciplinary Healthcare, 14, 311–320.

26.

Sultana

Alam Mahumud

Razzaque Sarker

Mahmud Hossain

(2016). Hand hygiene knowledge and practice among university students: Evidence from private universities of Bangladesh. Risk Management and Healthcare Policy, 9, 13–20.

27.

SWAp AM-S. (2013). Federal Democratic Republic of Ethiopia. SWAp AM-S.

28.

Tesfaw

Tiruneh

Mamuye

Walle

Teshager

Teshome

Taye

Dessalegn

Walle

Gebeyehu

A. A.

(2023). Magnitude and determinants of improved household latrine utilization in Ethiopia: Multilevel analysis of the mini Ethiopian Demographic Health Survey (EDHS) 2019. PLoS One, 18(8), e0289427. https://doi.org/10.1371/journal.pone.0289427

29.

Teshome

H. A.

Yallew

W. W.

Mulualem

J. A.

Engdaw

G. T.

Zeleke

A. M.

(2023). Practices of hygiene during complementary food feeding and associated factors among women with children aged 6−24 months in Dedo district, Southwest Ethiopia: A cross-sectional study. Hygiene, 6(12), e1771–e1784.

30.

Vivas

A. P.

Gelaye

Aboset

Kumie

Berhane

Williams

M. A.

(2011). Knowledge, attitudes, and practices (KAP) of hygiene among school children in Angola, Ethiopia. Journal of Preventive Medicine and Hygiene, 51(2), 73–79.

31.

Wasonga

Olang’o

C. O.

Kioli

(2014). Improving households knowledge and attitude on water, sanitation, and hygiene practices through school health programme in Nyakach, Kisumu County in Western Kenya. Journal des Anthropologues, 2014, 1–6.

32.

World Health Organization. (2017). Key facts about diarrheal disease. World Health Organization.

33.

World Health Organization. (2019). Safer water, better health. World Health Organization.

34.

World Health Organization. (2023). Addressing climate change: Supplement to the WHO water, sanitation and hygiene strategy 2018–2025. World Health Organization.

35.

Yallew

W. W.

Terefe

M. W.

Herchline

T. E.

Sharma

H. R.

Bitew

B. D.

Kifle

M. W.

Tetemke

D. M.

Tefera

M. A.

Adane

M. M.

(2012). Assessment of water, sanitation, and hygiene practice and associated factors among people living with HIV/AIDS home based care services in Gondar city, Ethiopia. BMC Public Health, 12(1), 1–10.

Mothers’ Knowledge,Practices on House and Environmental Hygiene and Associated Factors in the Tegedie District,Northwest Ethiopia: A Community-Based Cross-Sectional Study

Abstract

Keywords

Background

Methods

Study Design

Participants

Inclusion and Exclusion Criteria

Sample Size Determination

Sampling Technique

Variables and Measurements

Data Quality Management

Data Processing and Analysis

Results

Sociodemographic Characteristics

Environment-Related Factors

Level of Knowledge, Practice of House and Environment Hygiene

Factors Associated With Good Knowledge of the House and Environmental Hygiene

Factors Associated With Good Hygiene Practices in the House and the Environment

Discussion

Strengths and Limitations of the Study

Conclusions

Footnotes

ORCID iD

Ethical Considerations

Consent to Participate

Author Contributions

Funding

Declaration of Conflicting Interests

Data Availability Statement

References