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- Building an integrated analytical framework: a new methodology to analysing social-ecological systemsPublication . Gari, Sirak Robele; Newton, Alice; Icely, John DavidAppropriate adaptive management frameworks are useful for analyzing social-ecological systems. Natural resource managers and concerned stakeholders can co-design locally adapted, appropriate management systems based on the information obtained using frameworks, which leads to a better understanding of the social-ecological system (SES). However, no single framework addresses all environmental and social issues with equal efficiency. Therefore, the Driver-Activity-Pressure-State-Impact (Welfare)-Response (Measure) framework (DAPSI(W)R(M)), Ostrom's SES Framework (SESF), and the Systems Approach Framework (SAF) were combined to create an integrated analytical framework (IAF). Finally, the integrated analytical framework was tested in the Community Council of Alto and Medio Dagua (AMDA), Colombia, to assess a water quality problem emanating from anthropogenic activities. The approach seems to be valid and useful for the assessment of social-ecological systems.
- Water management practices and antibiotic-resistant Pseudomonas aeruginosa contamination in Ethiopian tertiary hospitals: implications for waterborne healthcare-associated infectionsPublication . Hailemichael, Etsub Brhanesilassie; Desta, Adey Feleke; Taye, Girma; Gari, Sirak Robele; Alemu, Amare; Gobena, Waktole; Amogne, WondwossenThe threat of healthcare-associated infections is significantly heightened when caused by drug-resistant pathogens. This study evaluates water management practices and prevalence of antibiotic-resistant Pseudomonas aeruginosa in water systems of two tertiary hospitals of Ethiopia. We employed a mixed-methods approach, combining the qualitative data thematic analysis with quantitative microbiological results from 120 potable water samples. P. aeruginosa isolates were identified and subjected to antimicrobial susceptibility testing. Data collection was conducted between December 2023 and January 2024. The findings indicate that neither hospital had a dedicated water management programme for preventive maintenance. Microbial analysis revealed a 16% prevalence of P. aeruginosa in the water samples, with 26.3% of isolates demonstrating resistant to at least one antibiotic class. Notably, two isolates from the maternity ward of Hospital A exhibited multidrug resistance (MDR) to ciprofloxacin, amikacin, and imipenem. Overall, the structural and operational standard of the water management programmes in both hospitals were found to be non-conformant to international standards. A higher rate of Pseudomonas positivity, including resistant and MDR strains, indicates persistent hospital water contamination and a tangible risk for HAIs. These results underscore the critical need for the formation of multidisciplinary water safety team to optimize water quality management in these hospitals.
- Factors influencing access to advanced sanitation service level and drinking-water quality in healthcare facilities in Addis Ababa, Ethiopia: a convergent sequential studyPublication . Retta, Mulumebet Tadesse; Gari, Sirak Robele; Alemu, Bezatu Mengistie; Ambelu, ArgawThis study investigates factors influencing access to advanced sanitation services and drinking water quality in healthcare facilities (HCFs) in Addis Ababa, Ethiopia. Despite the critical role of sanitation and safe water in preventing healthcareassociated infections, many facilities face significant challenges. A convergent sequential study was conducted in 382 healthcare facilities, which involved observations of sanitation facilities, interviews with facility managers, and water quality tests of 382 samples. Additionally, five water samples from reservoirs and distributors were collected, and eight key informant interviews were conducted purposively. In this investigation, only 14.5% of healthcare facilities had advanced sanitation service, while 23.2% had basic sanitation services. Over half (62.3%) of the facilities provided limited sanitation services. Additionally, 22.7% of water samples tested positive for enterococci, 26% for Escherichia coli, 35% for fecal coliforms, and 38.8% for total coliforms. All samples analyzed for fluoride, conductivity, and total dissolved solids (TDS) were below permissible limits, except for 6.6% of the samples that exceeded the pH level of 8.5. In contrast, all water samples from reservoirs and distributors were free from bacterial contaminations, and their fluoride, conductivity, and TDS levels were within the standard. Factors such as having infection prevention committee (IPC)(AOR = 2.8, 95% CI: 1.07-7.52), trained managers on sanitation safety plan (AOR = 2.96, 95% CI: 1.10-7.94), managers trained in infection prevention (AOR = 3.6, 95% CI: 1.25-10.48), having sanitation standards (AOR = 3.5, 95% CI: 1.06-11.64), availability of sufficient budget for sanitation services (AOR = 3.2, 95% CI: 1.14-9.15), having specific annual sanitation plan (AOR = 3.6, 95% CI: 1.52-8.58), using updated WASH guidelines (AOR = 3.4, 95% CI: 1.05-11.20), absence of a sanitation safety plan (AOR = 0.22, 95% CI: 0.05-0.91), lack of regular monitoring and evaluation (AOR = 0.24, 95% CI: 0.07- 0.83), and managers who did not involve in leading renovation of WASH infrastructure (AOR = 0.56, 95% CI: 0.35-0.70) were significantly associated with access to advanced sanitation service level. Access to advanced and basic sanitation services is low in HCFs of Addis Ababa. Several core factors affecting access to advanced sanitation service level has been identified. Many water samples from healthcare facilities were contaminated by bacteria. Enhancing training programs for healthcare managers and securing adequate funding are critical steps toward improving sanitation and water quality.
- Incidence and risk factors of soil‐transmitted helminths among vegetable farmers of Addis Ababa, EthiopiaPublication . Gurmassa, Bethelhem kinfu; Gari, Sirak Robele; Solomon, Ephrem Tefera; Dessie, Bitwe K.; Alemu, Bezatu MengistieBackground: Soil-transmitted helminth (STH) infections are common neglected tropical diseases in areas with poor sanitation. InEthiopia, urban farmers using contaminated river water for irrigation are exposed to parasite infection. This study examined theincidence and associated risk factors of STH infections among vegetable farmers in Addis Ababa, comparing those usingwastewater with those using clean water.Methods: A mixed-methods design was applied, incorporating a community-based cross-sectional survey and a longitudinallaboratory investigation from December 2021 to December 2023. The study involved 290 farmers (136 wastewater-exposed and 129unexposed) across 10 sites along the Big and Little Akaki Rivers. Data were collected via questionnaires, observation, health diaries,and stool samples, with diagnosis performed using the Kato–Katz method. STATA 14 was used for data analysis, including logisticregression to identify signifcant risk factors (p < 0.05).Results: STH incidence was signifcantly higher among wastewater-irrigating farmers (19.8%) compared to nonusers (8.5%), withincidence rates of 7.1 and 3.04 per 1000 person-months, respectively. The relative risk was 2.32, indicating wastewater irrigationincreases STH infection. Risk factors among wastewater-exposed farmers, poor fngernail hygiene (AOR = 2.25; 95% CI: 1.65–42.7),and not wearing boots (AOR = 3.4; 95% CI: 1.66–11.5) increased STH infection risk. Defecating on farms raised infection odds inboth exposed (AOR = 2.89; 95% CI: 1.55–3.05) and unexposed (AOR = 1.92; 95% CI: 1.55–2.10) groups. Hand contamination(AOR = 6.9; 95% CI: 2.92–55.7), washing vegetables with wastewater (AOR = 11.6; 95% CI: 3.64–23.9), and not wearing protectiveclothing (exposed: AOR = 1.97; 95% CI: 1.11–87.9; unexposed: AOR = 1.89; 95% CI: 1.31–22.8) also signifcantly contributed to STHinfection.Conclusion: Wastewater irrigation signifcantly elevates the risk of STH infections, promoting afordable safe wastewater ir-rigation practices (sand or gravel flters, drip irrigation) along with hygiene, sanitation, and health education for farmers, to protectfarming communities.