title: Prediction of Low Community Sanitation Coverage Using Environmental and Sociodemographic Factors in Amhara Region, Ethiopia.
abstract: This study developed and validated a model for predicting the probability that communities in Amhara Region, Ethiopia, have low sanitation coverage, based on environmental and sociodemographic conditions. Community sanitation coverage was measured between 2011 and 2014 through trachoma control program evaluation surveys. Information on environmental and sociodemographic conditions was obtained from available data sources and linked with community data using a geographic information system. Logistic regression was used to identify predictors of low community sanitation coverage (< 20% versus ≥ 20%). The selected model was geographically and temporally validated. Model-predicted probabilities of low community sanitation coverage were mapped. Among 1,502 communities, 344 (22.90%) had coverage below 20%. The selected model included measures for high topsoil gravel content, an indicator for low-lying land, population density, altitude, and rainfall and had reasonable predictive discrimination (area under the curve = 0.75, 95% confidence interval = 0.72, 0.78). Measures of soil stability were strongly associated with low community sanitation coverage, controlling for community wealth, and other factors. A model using available environmental and sociodemographic data predicted low community sanitation coverage for areas across Amhara Region with fair discrimination. This approach could assist sanitation programs and trachoma control programs, scaling up or in hyperendemic areas, to target vulnerable areas with additional activities or alternate technologies.
authors.affiliation: Department of Epidemiology, Emory University, Atlanta, Georgia. william.oswald@lshtm.ac.uk.
authors.forename: William E
authors.initials: WE
authors.lastname: Oswald
authors.affiliation: The Carter Center, Atlanta, Georgia.
authors.forename: Aisha E P
authors.initials: AE
authors.lastname: Stewart
authors.affiliation: Department of Epidemiology, Emory University, Atlanta, Georgia.
authors.forename: W Dana
authors.initials: WD
authors.lastname: Flanders
authors.affiliation: Department of Epidemiology, Emory University, Atlanta, Georgia.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kramer
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Tekola
authors.initials: T
authors.lastname: Endeshaw
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Mulat
authors.initials: M
authors.lastname: Zerihun
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Birhanu
authors.initials: B
authors.lastname: Melaku
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Eshetu
authors.initials: E
authors.lastname: Sata
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Demelash
authors.initials: D
authors.lastname: Gessesse
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia. International Trachoma Initiative, Addis Ababa, Ethiopia.
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Teferi
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Zerihun
authors.initials: Z
authors.lastname: Tadesse
authors.affiliation: Amhara Regional Health Bureau, Bahir Dar, Ethiopia.
authors.forename: Birhan
authors.initials: B
authors.lastname: Guadie
authors.affiliation: The Carter Center, Atlanta, Georgia. World Health Organization, Geneva, Switzerland.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: King
authors.affiliation: The Carter Center, Atlanta, Georgia. International Trachoma Initiative, Atlanta, Georgia.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.affiliation: The Carter Center, Atlanta, Georgia.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Callahan
authors.affiliation: Hubert Department of Global Health, Center for Global Safe Water, Emory University, Atlanta, Georgia.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Moe
authors.affiliation: Department of Environmental Health, Emory University, Atlanta, Georgia.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Clasen
mesh_terms: D004777:Environment; D005002:Ethiopia; D006801:Humans; D015233:Models, Statistical; D011156:Population Density; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012499:Sanitation / Q000592:standards / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014038:Toilet Facilities / Q000592:standards / Q000706:statistics & numerical data