Exposure behaviour to Escherichia coli and user risk perceptions of sanitation options among households in Imvepi Refugee Settlement, Terego District Uganda

Abstract

Background: Exposure to Escherichia coli (E. coli) from sanitary facilities remains a significant problem, especially in settings like refugee settlements where the majority of the households use sub-optimal sanitary facilities. Whereas the sanitation coverage in Imvepi refugee settlement is high, diarrhoeal diseases remain prevalent, and yet little is known about the exposure behaviors to E. coli and user risk perceptions of sanitation options.

Objective: To assess exposure behaviour to E. coli and user risk perceptions of sanitation options among households in Imvepi refugee settlement so as to guide government and non-government organizations in the design of interventions for the control of diarrheal diseases, ultimately benefiting the health and well-being of the household members.

Methodology: Guided by the Sanitation Safety Planning tool and the Health Belief Model, a cross-sectional study utilizing quantitative data collection methods was conducted among 426 households. A structured questionnaire digitized using Kobocollect was administered to women to obtain data on their background characteristics, exposure behaviours and user risk perceptions. An observation checklist was used to inspect sanitation facilities for exposure risk. Additionally, 80 environmental samples were collected from latrine walls, soil, door handles/frames, and floors in 20 sanitary facilities. Each sample was analyzed by culture on Compact Dry plates and incubated at 37°C. Data were downloaded into Microsoft Excel v2016 for cleaning and later imported into STATA v17.0 for analysis. Descriptive statistics were performed to summarize continuous and categorical variables. Modified Poisson was used to establish the factors associated with E. coli exposure behaviour.

Results: The study revealed that the prevalence of E. coli was 61.3% (49/80). Only 53.3% (227/426) had high perceptions regarding exposure to E. coli, and over 59.4% (253/426) exhibited high-risk exposure behaviour. Residing in compound homes (Adjusted Prevalence Ratio (APR) = 0.72, 95% Confidence interval (CI): 0.58-0.90), being aged 35-49 years (Adjusted Prevalence Ratio (APR) = 0.76, 95% Confidence interval (CI): 0.60-0.97), having household heads with post-primary education (APR = 0.54, 95% CI: 0.38-0.77), high knowledge (APR = 0.69, 95% CI: 0.59-0.80), and high-risk perceptions regarding exposure to E. coli (APR = 0.75, 95% CI: 0.64-0.88) were associated with a lower prevalence of high-risk E. coli exposure behaviours. Conversely, having sanitary facilities with excreta overflowing from the squat hole (APR = 1.26, 95% CI: 1.08-1.48) was associated with a higher prevalence of high-risk exposure behaviours.

Conclusion: The study indicates a significant prevalence of E. coli contamination in various environmental samples from the Imvepi Refugee Settlement, with higher levels detected in soil. Furthermore, the study found a substantial prevalence of high-risk E. coli exposure behaviour and low risk perceptions. There's a need to implement interventions targeted at reducing high-risk behaviours, especially among households whose heads have low education attainment, those with young caretakers and those with limited knowledge and low-risk perceptions regarding exposure to E. coli. Additionally, efforts should focus on reducing the prevalence of E. coli in the environment, particularly in soil near sanitary facilities.