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By Ernest Waititu
BBC Focus On Africa magazine
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The sewage is accumulating from below Addis Ababa's skyscrapers
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Sanitation in Ethiopia's capital city leaves a lot to be desired - and it is the poor who are most vulnerable as a result.
In a small shack made of iron sheets and pieces of clothing in the slums of Addis Ababa live the Alemu family - Abiy, Marasit Bishaw, and the couple's three-year-old son and 25-day-old baby daughter Yanit.
And just a few metres from their one-room home is a mass of sewage and garbage, mixed with the carcasses of dead chickens and cow and goat skulls.
The Alemus live near the gully where the Kabena river used to meander gracefully through the Ethiopian capital.
But the river is now full of the city's waste, and a stench of sewage is the first thing that hits.
During the rainy season, the filth and sewage from the skyscrapers up the hill flows freely onto the floor of the house.
A sewer by the entrance jets waste water incessantly, sending a gush of greying liquid down into the river.
The situation is typical of many in the slums of Ethiopia's capital, and highlights a desperate need for clean water.
Defecating outside
The government is aware of the problem, admitting that dilapidated sewers, a lack of toilet facilities and general poor sanitation in the city are some of the leading causes of disease and death in the country.
The World Health Organization estimates that 64% of people in Ethiopia defecate in the open - although this is down from 91% in 1990.
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 The family will have to put up with the conditions for now 
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Water is critical. With a new baby, the Alumus' household water needs have increased - they spend the equivalent of 10 US cents a day to buy 50 litres of water which has to be fetched from a kilometre across the river.
But even the water they buy may not be clean enough to keep the family healthy. Burst pipes or a lack of constant pressure in the pipes can contaminate the water.
And the jerry cans used to fetch the water are often unclean, says Gadissa Hailu, a project officer for Water and Sanitation for Africa Medical and Research Foundation (Amref).
"People need to be educated on how to take good care of the water they fetch to avoid contamination,'' he says.
Worryingly, though, the Alemus do not boil the water since they believe that it is clean simply because it is piped.
But they fear for the health of their children, especially the infant.
Yosef Asfau, a general practitioner working at a hospital in the city, says that the constant stench hanging over the house is likely to cause rhinitis (allergy of the nose), sinusitis (allergy of the sinus) and an even more serious condition called bronchial asthma.
Just next to the Alemu household, young men openly bathe in the filthy water, scooping it with their hands. For those even worse off, there is no way of accessing piped water - the river is their only option to attempt to keep clean.
No man's land
Further downstream lies a settlement called Gorgorios. At the bottom of a quick-sloping hill, numerous tributaries of sewage have joined the river and turned it into a raging and black mass of water.
Here no-one has a toilet.
Children and adults relieve themselves in the open by the river, adding to the furious flow of filth that is carried to other communities downstream.
There are major concerns about the use of dirty jerry cans in Ethiopia
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Endale Asmare, a lab technician with Amref in the slum, says that waterborne diseases such as typhoid and parasites that cause dysentery consistently show up in his laboratory tests - a clear manifestation of poor sanitation in the area.
In the town of Kechene, a little further downstream, is Amleworke Wordfa - an 80-year-old woman who shoulders the difficult task of raising her four grandchildren alone.
A year ago she lost one of her granddaughters to illness resulting from contaminated water.
"It was so hard for me to see her die," she says.
"She was so beautiful."
Now Wordfa attempts to boil all the water she gives to the younger two of her four surviving grandchildren, who are under five years of age.
Nonetheless, fuel to do so is scarce. At times she just trusts their immunity, acquired through time, to keep them from getting sick.
The government says the situation is steadily improving: regional heath authorities are reporting better access to sanitation, while 30,000 key health workers are expected to be deployed in 2009 to promote personal hygiene as part of a campaign by the health department.
The UN has declared 2008 the International Year of Sanitation, and Amref is working on a plan to provide water and sanitation facilities to the people of Kechene.
But as long as extreme poverty in this country persists, families like the Alemus and the Wordfas will continue to live in a filthy no man's land on the banks of Addis Ababa's rivers.
Ernest Waititu is the editor-in-chief of the Afrikanews group based in Nairobi.
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