Factors associated with sanitation practices among household-level in Mogadishu, Somalia

Inadequate sanitation contributes 4% to global mortality and 5.7% to morbidity, disproportionately among children under five. The incidence of diarrhea is disproportionately high among children in low-and middle-income countries. Somalia is one of the several countries in Africa with a high proportion of diarrhea. This study evaluated sanitation practices and associated factors in homes with children under five in Hodan District, Mogadishu, Somalia. A household-based cross-sectional study was conducted in the Hodan district of Mogadishu, Somalia, from December 2021 to February 2022. A structured pretested questionnaire with checklist household observations was used to collect data. A total of 241 caregivers who have children under five years were interviewed. Logistic regression analysis was used to find factors associated with sanitation practices and diarrhea at the home level. A confidence interval of 95% and a p-value of 0.05 were considered statistically significant. The 29% in Hodan district had poor sanitation conditions. Most of the respondents, 60.6% were in multi-family homes. Over 58.9% of households lacked access to handwashing facilities.Apartments with multiple families have 0.037 greater odds of diarrhea in children under five than single-family residences [95% CI: 0.010-0.022]. Family without toilets had a 2.257 odds ratio [95% CI: 0.2.257-23.45] of their kids having diarrhea compared to those with toilets. Children in households using pit latrines had diarrhea at 0.139 [95% CI: 0.053-0.365], and the participants who did not know the importance of water treatment had a 42.400 [95% CI: 1.777-11.213] chance of drinking contaminated water. Also, families with shared latrines were odds of 13.116 [95% CI: 06.781-25.369], more likely to have diarrhea than families who used single latrines. Similarly, family income is associated with diarrhea occurrence in children with an odds ratio of 0.363 [95% CI: 0.184-.718]. Provide water, sanitation, and hygiene (WASH) services, such as adequate latrines and water points for drinking and bathing areas with running water, particularly for children and women, including WASH supplies like soap and buckets for collecting and storing water at the housing level. We believe that the WASH educational messages also led to behavioral changes in sanitation practices among children under 35 months, caregivers, and residents in both the Zona-K internally displaced people (IDPs) area and the host community promotion is recommended.

卫生条件不足导致全球4%的死亡及5.7%的发病，5岁以下儿童受影响尤为严重。腹泻发病率在中低收入国家儿童中显著偏高，索马里是非洲多个腹泻高发国家之一。本研究评估了索马里摩加迪沙霍丹区有5岁以下儿童家庭的卫生习惯及相关影响因素。2021年12月至2022年2月，在索马里摩加迪沙霍丹区开展了一项基于家庭的横断面研究，采用经预测试的结构化问卷及家庭观察清单收集数据，共访谈241名有5岁以下儿童的照护者。通过逻辑回归分析探究家庭层面卫生习惯与腹泻的相关因素，统计显著性标准为95%置信区间（Confidence Interval, CI）及p值<0.05。

霍丹区29%的家庭卫生条件较差，60.6%的受访者居住在多户合住房屋中，超58.9%的家庭缺乏洗手设施。多户合住家庭的5岁以下儿童腹泻发生几率比单户家庭高0.037倍[95% CI：0.010-0.022]；无厕所家庭的儿童腹泻发生比值比（odds ratio, OR）为2.257[95% CI：0.2.257-23.45]，相较于有厕所家庭；使用坑式厕所家庭的儿童腹泻发生几率为0.139[95% CI：0.053-0.365]；不了解水处理重要性的参与者饮用受污染水的几率为42.400[95% CI：1.777-11.213]。此外，使用共用厕所的家庭儿童腹泻发生几率比使用独立厕所的家庭高13.116倍[95% CI：06.781-25.369]；家庭收入与儿童腹泻发生相关，OR值为0.363[95% CI：0.184-0.718]。

应提供水、环境卫生与个人卫生（Water, Sanitation and Hygiene, WASH）服务，例如充足的厕所、饮用水及带自来水的沐浴区域（尤其针对儿童和女性），并在家庭层面配备肥皂、储水桶等WASH用品。研究认为，WASH教育宣传可促使Zona-K境内流离失所者（Internally Displaced People, IDPs）区域及收容社区中35月龄以下儿童、照护者及居民的卫生习惯发生行为改变，因此建议推广此类宣传。