INVESTIGATION OF DRINKING WATER QUALITY, SANITATION-HYGIENE PRACTICES AND THE POTENTIAL OF INDIGENOUS PLANT SEED FOR WATER PURIFICATION IN SOUTHEAST ETHIOPIA By AHMED YASIN MOHAMMED Submitted in accordance with the requirements for the degree of DOCTOR OF PHILOSOPHY IN ENVIRONMENTAL MANAGEMENT in the COLLEGE OF AGRICULTURE AND ENVIRONMENTAL SCIENCES DEPARTMENT OF ENVIRONMENTAL SCIENCE at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROFESSOR HAMEED SULAIMAN (PhD) July 2017 Abstract Background : Access to safe water and sanitation are universal need and basic human right, but the provision of quality water and improved sanitation remains a challenge in many African countries including Ethiopia. Objectives : The study investigated drinking water quality, sanitation-hygiene practices and the potential of Moringa stenopetala seed powder for the purification of water in Bale Zone, Southeast Ethiopia. Methodology : A community-based cross-sectional study was conducted among 422 randomly selected households in Robe and Ginnir Towns. Data were collected by interviewer-administered structured questionnaires from June 2012 to August 2013. An observation checklist was used to observe the sanitary condition of water sources. A total of 71 water samples were collected using sterile glass bottles in accordance with the standard method of American Public Health Association APHA. The physicochemical and bacteriological water quality analyses were done in Addis Ababa Environmental protection and Oromia water and Energy laboratories. The efficiency of Moringa stenopetala seed powder for removal of turbidity, hardness, and nitrate was evaluated. Data were analyzed SPSS Version 21.0 for the window. Descriptive analysis was done for appropriate variables. Logistic regression was used to identify the factors associated with under-five diarrhea. The results were presented using adjusted odds ratio and P-value of < 0.05 was used to declare significance association. Results : From the total sample, 401 respondents participated making a response rate of 95%. More than one third (37.9%) of the respondents were found to use pipe water. Two hundred and eighty (69.8%) of households wash storage containers before refilling and 325 (81%) of households were using separate containers for water storage. Two hundred seventy (67.3%) of the households had pit latrine. Prevalence of childhood diarrhea was found to be 50.1%. From the logistic regression model, those households having access to clean water source are 68% less likely to have under-five diarrhea, the households having clean storage of drinking water are 45% less likely to have under-five diarrhea in their home, and those households having poor latrine sanitation are 68% more likely to have under-five diarrhea in their home. Seed powder of 200mg/l Moringa stenopetala reduced the Nitrate concentration doses from 5.49mg/l to 8.18mg/l, a 75mg/l was reduced the turbidity from 4.49NTU to 1.07 NTU. A total hardness of 427 was reduced by 7.8% after treatment with powder seed of Moringa stenopetala. Conclusion : Prevalence of childhood diarrhea was high and it is associated with lack of access to a clean water source, poor sanitation of drinking water storage and latrine. Prevalence of open field defecation was remarkably high. The iron content of drinking water was above the range of World Health Organization standards. Moringa stenopetala seed powder has efficiency in the reduction of total and faecal coliform, turbidity, hardness and nitrate level in drinking water Recommendation : Health education on water handling, sanitation and low-cost effective water treatment methods like Using Moringa stenopetala seed should be practiced at the household level. Keywords : Drinking Water Quality, Sanitation-Hygiene, water purification, Indigenous Plant Seed. Abbreviations and Acronyms ADF African Development Fund AMCOW African Ministers Council of Water BH Bore Hole CFU Colony Forming Units CSA Central Statistical Agency EDHS Ethiopia Demographic and Health Survey FDRE Federal Democratic Republic of Ethiopia FSM Fecal sludge management GTP Growth and Transformation Plan HE Health Extension Workers IDRC International Development Research Center IFRC/RCS International Federation of Red Cross and Red Crescent Societies ISC Improved Sanitation Coverage ISWM Integrated Solid Waste Management IWRM Integrated Water Resource Management JMP Joint Monitoring Program MDGs Millennium Development Goals MOH Ministry of Health MoWE Ministry of Water and Energy MPN Most Probable Number NTU Nephelometric Turbidity Meter Unit R Reservoir RWSS Rural Water Supply and Sanitation TDS Total Dissolved Solid SNPPR Southern Nations, Nationalities and People’s Region SPSS Statistical Package for Social Sciences UNICEF United Nations International Children’s Emergency Fund WASH Water Sanitation and Hygiene WHO World Health Organization SDG Sustainable Development Goals II Acknowledgements It is indeed a gift, much undeserved for that matter, from Allah that I have been able to accomplish this work. He had brought the right people at the right time so that I would be able to carry on and complete this work. First and foremost He has blessed me with a wonderful Supervisor, Dr. Hameed Sulaiman at Sultan Qaboo University, Oman and Visiting Faculty at Addis Ababa University, Ethiopia. His kindness, optimism, and encouragement have meant so much to me. Had it not been for his careful and meticulous review of the work, this paper would not have been what it is now. His insightful and accurate comments have been both an encouragement and a frame of reference for the work. I am deeply grateful for all his kindness and support. I am also indebted to Professor Tenalem Ayalew of Addis Ababa University, Department of Earth Sciences, for his review of work and comments. I Express my gratitude to Assistant Professors Mr.Kedir Hussein, Mr. Muhammedawel Kaso, Mr. Tomas Benti, Mr. Negassa Dida and Mr. Daniel Bogale of Madda Walabu University for the review of the work, detailed comments and taking time to go through the work with me. I am also indebted to Madda Walabu University, Ethiopian Ministry of Education and UNISA for their support. I would like also to thank my family, particularly my Mother Zehara Ali, Wife Meseret Eshete, Daughter Lula Ahmed and brother Dr. Engg. Bizuayehu Yasin. Finally, I dedicate this work as a memory for my father Yasin Mohammed, mother Aregash Mohammed and sister Habiba Yasin. I hope that I would become a better care taker of this Precious Allah gave planet, for if anything this work has done, it has made me feel how much I do not know. Ahmed Yasin Mohammed July 2017 III Lists of Figures Figure 1: Trends in water supply and sanitation coverage in Ethiopia, comparing JMP with MoWE estimates and projections, from 1990 to 2015. .............................................................. 5 Figure 2: Trends in water supply and sanitation coverage in Ethiopia, comparing Joint Monitoring Program (JMP) with MoWE estimates and projections, from 1990 to 2015. ......... 6 Figure 3 Regional disparity in water access and Latrine Coverage, 2009 ............................... 7 Figure 4 Oromia National Regional State River Basin ............................................................ 12 Figure 5 Map of Bale Zone ...................................................................................................... 14 Figure 6 Bale Zone River and River basins ............................................................................. 15 Figure 7 Ten years trend of potable water in percent, Bale zone, Ethiopia, 2014 ................... 19 Figure 8 : The taped springs of Robe Town water sources ...................................................... 19 Figure 9: Madda Walabu University Reservoir ....................................................................... 20 Figure 10 Photo of Borehole I of Robe Town, 2012 ............................................................... 20 Figure 11 Photo of Reservoirs number 2 of Robe Town (Photo taken 2014) ......................... 21 Figure 12 :Water scarcity at study area (taken during survey period) ..................................... 22 Figure 13: Schematic map of Ethiopia’s river basins. Source: Nuru, 2012. ............................ 29 Figure 14: The F-diagram for fecal-oral disease transmission (Curtis, Cairncross) ................ 40 Figure 15: Causal pathways linking lack of water with food insecurity .................................. 53 Figure 16 : The Main Pathways of Human Exposure to Pathogens in the Aquatic Environmen t ............................................................................................................................ 54 Figure 17: Consumption and Income Effects ( Sources: Christophe Bosch et al . Water, Sanitation, and Poverty, 2001) ................................................................................................. 57 Figure 18: Trends in access to improved water sources coverage, in Ethiopia (1997-2012 GC). Source MoH & MoWE, 2013; Source; MoH& MoWE, 2013 ................................................. 65 Figure 19: Trends in access to improved sanitation coverage, in Ethiopia (1990-2004EC) Source; MoH & MoWE, 2013. ................................................................................................ 66 Figure 20: Estimated trends of use improved drinking water sources in Ethiopia. Source: WHO/UNICEF JMP, 2013, 2014, 2015. Source: WHO/UNICEF JMP, 2013, 2014, 2015 .... 67 Figure 21: Estimated trends of use of sanitation