Household food safety, WASH and environmental health practices in the context of nutrition-sensitive agriculture: a comparative study in Northwest Ethiopia

BACKGROUND: Household food safety and Water, Sanitation, and Hygiene (WASH) are critical for nutrition and infectious disease prevention. This study assessed food safety, WASH, and environmental health practices among beneficiaries of Ethiopia's Productive Safety Net Programme (PSNP) and Nutrition‑Sensitive Agriculture (NSA) interventions. METHODS: A cross‑sectional survey of 586 households in Ebinat and Farta woredas was stratified by intervention status. Data were collected via structured questionnaires. Composite indices were constructed using mean values and Bloom's cut‑off criteria. Binary logistic regression identified predictors of food safety, WASH adequacy, and environmental health. RESULTS: Food safety practices were poor overall: 74.2% of households reported inadequate practices, and only 9.0% achieved a "good" rating. In contrast, WASH outcomes were stronger, with 59.2% of households classified as adequate and 73.5% among PSNP + NSA participants. Regression analysis showed PSNP + NSA households were nearly three times more likely to report adequate WASH (AOR = 2.95, 95% CI: 1.64-5.31, p < 0.001), while NSA‑only households had even higher odds (AOR = 3.36, 95% CI: 1.30-8.70, p = 0.013). Wealth status was protective: medium‑wealth (AOR = 0.45, 95% CI: 0.28-0.71, p = 0.001) and rich households (AOR = 0.42, 95% CI: 0.24-0.71, p = 0.001) were significantly less likely to report unsafe practices. Maternal literacy improved outcomes (AOR = 2.54, 95% CI: 1.64-3.94, p < 0.001), and frequent Health Extension Worker (HEW) visits further reduced poor practices (AORs = 0.20-0.27, all p < 0.05). CONCLUSION: Integrated programs were associated with stronger WASH infrastructure, while entrenched food‑handling behaviors remained resistant. Sustainable improvements will require culturally tailored interventions, investment in parental literacy, and practical hygiene demonstrations within multisectoral platforms to bridge the knowledge-practice gap.