Study design and setting

A community-based cross-sectional study design with structured observation was conducted from April to June 2017 in the former north Gondar administrative zone (Figure 1). At present, the administrative zone is subdivided into 3 zones: namely central Gondar, north Gondar, and west Gondar. The former north Gondar Administrative zone was bordered on the south by Lake Tana, west Gojam, Agew Awi, and the Benishangul-Gumuz region, on the west by Sudan, on the north by the Tigray region, on the east by Wag Hemra, and on the southeast by south Gondar. Based on the 2007 Census conducted by the central statistical agency of Ethiopia (CSA), the Zone has a total population of 2 929 628, an increase of 40.26% over the 1994 census, of whom 1 486 040 are men and 1 443 588 women; with an area of 45 944.63 km², North Gondar has a population density of 63.76. While 462 700 or 15.79% are urban inhabitants, a further 2148 or 0.07% are pastoralists. A total of 654 803 households were counted in this Zone, which results in an average of 4.47 persons to a household, and 631 509 housing units.¹¹

Figure 1.

(A) Map of Ethiopia showing regional states and city administrations, (B) map of Amhara region showing zones, and (C) map of North Gondar zone showing districts. The red colored maps indicate the study areas.

Sample size determination and sampling procedures

The sample size was calculated using simple population proportion formula with the following assumptions: prevalence of self-reported vector-borne disease in rural communities = 50% hence there was no similar study, level of significance (α) = 5%, 95% confidence interval (standard normal probability), z: The standard normal tabulated value, and margin of error (d) = 5%.

Since we have passed 3 stages to reach out to the study subjects a design effect of 3 was considered; and a non-response rate of 5%, the final sample size was 1210. A multistage random sampling technique was used to recruit study subjects. First, 4 districts were randomly selected from the former north Gondar Administrative zone. Then, 7 kebeles (the lowest administrative unit in Ethiopia) were selected, we used the lottery method for both selection procedures.¹² Finally, households in each selected kebele were selected using a systematic random sampling technique.¹³

Measurement of outcome variable

Prevalence of self-reported vector-borne diseases in the rural communities of northwest Ethiopia, the primary outcome variable of the study was defined as the presence of at least 1 vector-borne disease among the 7 common diseases: scabies, relapsing fever, malaria, yellow fever, filariasis, Leishmaniasis, and tungapenetrans.

Data collection tools and procedures

Data were collected using a structured questionnaire and observation checklist. The questionnaire was used to access self-reported vector-borne diseases and other related information such as socio-demographic characteristics, health information delivery system, supportive supervision system, personal hygiene practices, environmental hygiene practices, liquid and solid waste management, water quality and safety, food hygiene, and safety, housing sanitation, control of insects, rodents, and other biting species; and disease morbidity/mortality and management. We recorded and check the living environment, housing conditions, and personal hygiene practices of each family member in the selected household using the checklist. We interviewed the female head for the household level information. Both the questionnaire and observation checklist was developed from similar published studies with some modifications to address area-specific characteristics.^14–19 The tools were first prepared in the English language and translated to Amharic language and back-translated to English to check the consistency of translation. The translation was done by the team members and experts out of the team from our institution. The tools were piloted among 121 households (10% of the sample) outside the study area before the actual data collection. Data were collected by trained environmental health experts. Field supervisors checked the data collection process and confirmed the completeness of data on a daily basis. Every challenge faced by the data collectors each day was discussed with the principal investigator and field supervisors to take the necessary action.

Data processing and analysis

Data were entered using EPI-INFO version 3.5.3 statistical package²⁰ and exported into Statistical Package for Social Sciences (SPSS)²¹ for further analysis. For most variables, data were analyzed by frequencies and percentages. The model fitness was checked by Hosmer and Lemeshow test (P = .384). After checking the correlation of independent variables, significance was determined using crude and adjusted odds ratios with 95% confidence intervals. To determine the association between the different predictor variables with the dependent variable, first bi-variable analysis between each independent variable and outcome variable was investigated using a binary logistic regression model and then all variables having P-value <.25 in the bi-variable analysis were suggested as a criterion for variable selection for inclusion into a multivariable model. So that all variables with a P-value of <.25 in the bi-variable were analyzed for multi-variable logistic regression.^22–24

P-value <.05 with a 95% confidence interval were regarded as significant determinant factors and the strength of the association between the variables were classified based on their value of odds ratio (OR).

Socio-demographic characteristics

In this study, a total of 1191 rural households were included with a response rate of 98.4%. The majority, 1060 (89%) of the head of the household was fathers. Six hundred eighty-nine (57.9%) and 878 (73.7%) of the fathers and mothers couldn’t read and write respectively. Five hundred fourteen (43.2%) of the households had a family size of greater than 5 (Table 1).

Table 1.

Socio-demographic characteristics of households included in this study, 2017.

Health information delivery and supportive supervision systems in the last 3 month

Five hundred twenty-four (44.0%) households reported as they discussed hygiene and sanitation for the last 3 months in the 1 to 5 community health teams. Similarly, 812 (68.2%) of the households reported as they discussed hygiene and sanitation at the family level. Six hundred twenty-six (52.6%) households reported they did not hear of any hygiene and sanitation-related information in the last 3 months ( Supplemental Material 1). One to five is a structure in Ethiopia’s health care system at the local level; this is a community-based health team structured by the local government to make health information accessible easily. Which mean that 6 peoples would be organized in 1 group and among the group 1 could be the leader of the group based on few criteria. So that the name called 1 to 5 communities team responsible to have a discussion on different health agenda given by the health extension workers.

Environmental and personal hygiene practices

Seven hundred fifty-one (63.1%) households reported that they regularly cleaned the living environment. Similarly, 794 (66%) of households that lived in kebeles declared open defecation free. Seven hundred seventy-eight (65.3%) of households washed hands only by water (Table 2). The defecation practice of 584 (49%) households was an open field. One thousand fourteen (85.1%) of the households reported that there were favorable conditions for the breeding of insects ( Supplemental Material-2).

Table 2.

Environmental and personal hygiene practices of the rural communities in northwest Ethiopia, 2017.

Prevalence of self-reported vector-borne diseases

Among the total of 1191 rural households, 216 (18.1%) 95% CI 16%-20%) rural households reported at least 1 vector-borne disease. Scabies (9.5%) was the most reported vector-borne disease followed by malaria (6.9%) (Figure 2).

Figure 2.

Self-reported vector-borne diseases in the rural settings of northwest Ethiopia, 2017.

Factor associated with prevalence of self-reported vector-borne diseases

Using bivariate analysis factors associated with self-report vector-borne diseases were first assessed. All the variables with a P-value of <.25 in the bivariate analysis were included for the multivariable analysis. Which includes; Kebele sanitation status, family discussion on hygiene and sanitation practice, 1 to 5 community teams discussion on hygiene and sanitation practice, supervised by kebele leaders, closely follow-up by health workers, heard health information for the last 3 month, waste disposal system, wild animal able to access water source, water source, cleaning of the internal and external environment, cleanness of the floor, ventilation of the house, favorable conditions for the breeding of insects, maternal education, head of the family, parental education, parental occupation, maternal occupation, wash hand only by water, wash hand with soap, wash hand with sand leaves, wash hands with ash, regularly change child cloth, an infestation of body lice, and defecation practice.

After controlling the confounding using the multi-variable logistic regression analysis regular cleaning of the living environment, cleanness of the floor, and head of the family were statistically associated with self-reported vector-borne diseases (P < .05).

The prevalence of self-reported vector-borne diseases was 1.77 times more likely to be higher in households with poor cleanness of the floor as compared to good cleanness of the floor (AOR = 1.77, 95% CI = 1.03-3.03). Similarly, the prevalence of self-reported vector-borne diseases was 1.64 times more likely to be higher in those households with medium cleanness of the floor (AOR = 1.64, 95% CI = 1.06-2.52). On the other hand, the prevalence of self-reported vector-borne diseases was lower by 49% in those households who had regularly cleaned the living environment compared to their counterparts (AOR = 0.51, 95% CI = 0.36-0.74). In households where females are heads, the prevalence of vector-borne diseases was minimal (AOR = 0.13, 95% CI = 0.02-0.72) (Table 3).

Table 3.

Factors associated with prevalence of one or more self-reported vector-borne diseases in the rural communities of Ethiopia, 2017.