Introduction

Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and feces. ^{Reference Minh and Nguyen-Viet1} Improved sanitation involves physically closer facilities, less waiting time, and safer disposal of excreta in the urban or town settings with extreme crowding, poor housing quality, and unsanitary environmental conditions that are growing health and social problem in sub-Saharan Africa, as well as elsewhere in low-income countries. ^{Reference Nordberg, Bernard and Diamond2} Poor sanitation is responsible for one of the heaviest existing disease burdens world-wide. Diseases associated with poor sanitation are diarrheal diseases, acute respiratory infections, undernutrition, and other tropical diseases such as helminths and schistosomiasis infections. ^{Reference Minh and Nguyen-Viet1} Sanitation is defined by the World Health Organization (WHO; Geneva, Switzerland) as the provision of facilities or services that separate people from urine and feces. ^{Reference Seetharam3} Adequate sanitation is defined as the safe management of human excreta and includes both “hardware” (ie, sanitation technologies such as toilets and hygienic latrines) and “software” (ie, hygiene promotion, such as handwashing with soap). ⁴

Pollution, defined as any artificial or human-induced change to the environment, originates from either a point source or a non-point source. ^{Reference Hun5} The major point sources of pollution to freshwater originate from the collection and discharge of domestic wastewaters and industrial wastes, whereas the major non-point sources are agricultural activities that include pesticide spraying or fertilizer application. ⁶ Access to adequate sanitation is fundamental to personal dignity and security, social and psychological well-being, public health, poverty reduction, gender equality, economic development, and environmental sustainability. ⁷ Sanitation is a critical step towards reducing the impact of these diseases because it creates physical environments that enhance safety, dignity, and self-esteem; the joint monitoring program for water supply and sanitation reports that 62% of Africans do not have access to an improved sanitation facility. ⁸ Inadequate sanitation can cause several diseases, which are transmitted from feces to humans via contaminated hands, soil, water, animals, and insects. Sanitation provides a barrier to fecal diseases by isolating human excreta and removing traces of fecal material from hands after contact. ⁴ Communicable diseases are considered as major causes of morbidity and mortality, as well as disability in Ethiopia, and their high prevalence in the country is linked to the poorly developed socio-economic and environmental factors that have been inherent for centuries. ^{Reference Kumie and Ali9}

According to the report on Access to Sanitation in Developing Countries, ⁴ many diseases can largely be prevented with basic sanitation and hygiene. Lack of access to sanitation and poor hygiene together are responsible for diarrheal diseases in developing countries, and sanitation and health experts also estimated that improved sanitation alone could reduce by one-third the global incidence of diarrheal disease ^{Reference Beyene, Hailu, Faris and Kloos10} and could also play a major role in reducing parasitic infections that impede child development. ¹¹ Medical researchers have also extensively recognized the health impacts of poor sanitation. ^{Reference Minh and Nguyen-Viet1} Food handlers with poor personal hygiene working in food establishments could be potential sources of infections of many intestinal helminths, protozoa, and pathogenic bacteria. ¹² Food handlers are anyone who works in food and drink establishments and who handle food or are in contact with any equipment or utensils that are likely to be in contact with food, such as cutlery, plates, bowls, or chopping boards. ^{Reference Tessema, Gelaye and Chercos13}

Diarrhea causes an estimated two million deaths per year, mostly among children under the age of five. Cholera - as of September - there were 106,547 reported cases of cholera and a total of 3,155 reported deaths in 2004. Schistosomiases (Bilharzia) infect 100 million people, of which 20 million people suffer severe consequences. Improved water and sanitation may reduce this by 77%. Trachoma causes blindness in six-to-nine million people. Access to sanitation may reduce this by 25%. Intestinal worms infect approximately one-third of the population in developing countries; improved sanitation would control their transmission. Hookworms cause malnutrition. Using concrete slabs to cover pit latrines can prevent them from being transmitted to humans. According to Gebre Mariam, et al, ^{Reference Gebre Mariam and Girsha14} increased magnitude of sanitation and hygiene problems in the urban surroundings of the country demand community-based studies that will facilitate a better understanding of the issues and influence at the national, regional state, town, and community levels. When urbanization increased, governments were unable to manage natural resources suitably with an additional demand on productive resources and additional wastes. ^{Reference Novotny15}

The provision of safe disposal of wastes for the towns of developing countries became increasingly more complex and serious. ^{Reference Mwangi16} Domestic wastes from the towns were emptied untreated into the rivers causing gross pollution. This was hazardous for human health (cholera) and deleterious odors rise from water bodies, ^{Reference Brown, Cairncross and Water17} and although provision of a fresh, clean water supply would substantially reduce water-borne illnesses, ¹⁸ less attention was given to sanitary issues. A safe sanitation system designed and used to separate human excreta from human contact at all steps of the sanitation service until final disposal or end-use, and holist roach to address fecal risks from toilets for safe use or disposal, should be facilitated through sanitation safety planning. As a household moves away from open defecation towards the use of better sanitation services, and ultimately to safely managed systems, health benefits increase. ¹⁹ In 2013, the United Nations also issued a call to action on sanitation that included the elimination of open defecation by 2025. The situation of the urban poor poses a growing challenge as they live increasingly in cities where sewerage is precarious or non-existent and space for toilets and removal of waste is at a premium. Limited data available on this topic suggest that a large proportion of wastewater in developing countries is discharged partially treated or untreated directly into rivers, lakes, or the ocean. ¹⁹

In recent years, sanitation has raised the international policy agenda. Although most people do not know, safe hygiene practices and access to sanitation are crucial for combating the main health threats to us all. Safe water, sanitation, and hygiene are crucial for human health and well-being. Yet, millions of people globally lack adequate sanitation services and consequently suffer from or are exposed to a multitude of preventable illnesses. Lack of safe sanitation negatively impacts their quality of life and undermines fundamental human rights. Poor sanitation services also weaken health systems, threaten health security, and place a heavy strain on economies. ¹⁹

It is obvious in the context of developing countries, such as Ethiopia, there is variation in terms of sanitation status (ie, as one goes from the capital city to the local town or town of the zone or district, the town municipality management of the solid and liquid waste has received step-wise declining attention). This means there is a problem in the timely collection, transportation, and disposal of wastes at the right place. Related diseases and risks are wide-ranging. They include infections transmitted by the fecal, or health impacts from exposures to chemicals and other contaminants in drinking water, as well as the impacts on well-being. Poor sanitary-related diseases and risks can be exacerbated by a number of factors including climate change, population growth, rapid urbanization, or in the case of antimicrobial resistance, antibiotic use. Consequently, the communities of Dambi Dollo Town have been exposed to unsafe environments and are vulnerable to communicable diseases. Dambi Dollo is one zonal town within the Oromia Regional State and lacks access to sanitation; diarrheal diseases, acute respiratory infection, measles, malaria, and malnutrition are the most common causes of death in emergencies. The majority of these driving factors are related to environmental conditions: inappropriate shelter and site planning, unclean water, poor sanitation, vector spreading, lack of personal protection such as insecticide-treated nets, personal hygiene, and health demotion that are known as risk factors because they can cause disease. It is important to understand the relationship between disease and environmental risk factors because interventions must target risk factors properly; an overview of environment-related diseases and environmental risk factors that contribute to disease is needed. It is worth noting that although malnutrition is not an environment-related disease, it is linked to diarrhea because malnutrition increases the severity of diarrhea, while diarrhea can cause malnutrition.

Despite attempts made nationally and locally, environmental sanitation, especially waste management, continues to be a major challenge in developing countries such as Ethiopia, in general, and poor attention has been given to waste management and sanitary issues in Dambi Dollo Town, in particular. The main objective of this research is to assess hygienic status, sanitation issues, and associated problems in Dambi Dollo Town. Thus, the main concern of this study is focusing on assessing sanitation and hygiene status and the associated problems in selected Kebeles of Dambi Dollo Town.