Abstract
Introduction:
Exposure to Escherichia coli (E. coli) is a leading cause of diarrheal diseases, which pose a significant problem in refugee settlements. Refugee populations are exposed to feacal microorganisms through multiple pathways including sub-optimal sanitary facilities, contaminated drinking water, produce and food, flood water, bathing water, soil among others. While these pathways are well-documented, specific exposure behaviors remain underexplored. We assessed exposure behaviour to E. coli among households in Imvepi refugee settlement, Uganda, and provided evidence-based recommendations for the design of interventions to reduce excreta-related diseases.
Methods
Guided by the Sanitation Safety Planning approach, we surveyed 426 households in Imvepi refugee settlement, Uganda, using a digitized questionnaire and an observation checklist. We collected data on the background characteristics and exposure behaviour of women and emancipated girls (primary caretakers). The outcome variable, E. coli exposure behaviour, was measured using a five-point Likert scale, assessing behaviours that increase the risk of exposure. Data were cleaned in Microsoft Excel and analyzed in Stata version 17. Descriptive statistics were performed to summarize the data. We used modified Poisson regression to determine the factors associated with the outcome.
Results
Over 59.4% (253) exhibited high-risk exposure behaviour. Residing in compound homes (Adjusted Prevalence Ratio (APR) = 0.78, 95% Confidence Interval (CI): 0.62–0.97), having household heads with post-primary education, (APR = 0.53, 95% CI: 0.36–0.78), high knowledge of exposure to E. coli (APR = 0.68, 95% CI: 0.58–0.80), and high-risk perceptions regarding exposure to E. coli (APR = 0.78, 95% CI: 0.66–0.93) were associated with a lower prevalence of high-risk E. coli exposure behaviours. Conversely, relying on a surface water source (APR = 1.76, 95% CI: 1.23–2.51) and having sanitary facilities with excreta overflowing from the squat hole (APR = 1.39, 95% CI: 1.13–1.70) were associated with a higher prevalence of high-risk exposure behaviours.
Conclusion
The study indicates a high prevalence of high-risk E. coli exposure behaviour, implying an elevated risk of exposure. There's a need to implement interventions targeted at preventing or minimizing exposure, especially among households whose heads have low education attainment, those using surface water sources, and individuals with limited knowledge and risk perceptions regarding exposure to E. coli.