UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH SCIENCES

INSTITUTE OF PUBLIC HEALTH

A THESIS PROPOSAL SUBMITTED TO THE INSTITUTE OF PUBLIC HEALTH,

COLLEGE OF MEDICINE AND HEALTH SCIENCES, UNIVERSITY OF GONDAR IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE IN APPLIED HUMAN NUTRITION

Name of investigator Anbesaw Mitiku(BSc)

Name of advisors Mr Tadese Awoke(Ass. professor)

Full title of the project
Duration of project
Study area
Total cost of the project
Address of investigator
Mr Amare Tariku (Bsc, MSc)
Nutritional status and associated factors among HIV
positive adults attending ART clinic in the three health
centers of Dembia woreda, Northwest Ethiopia,2015
August 03-30/ 2015
Dembia woreda
20,487.50 birr
Tel: +251920255079
E-mail : anbesawm@gmail.com
 Acknowledgement

I would like to thank Mr Tadesse Awoke and Mr. Amare Tariku for their assistance in
writing the proposal by giving me very useful comments. This proposal could not have
been completed without the intellectual and technical contributions of my advisors.
Many thanks also extend to Missa Tarekegn,Dembia woreda health office nutrition and
child health officer, for her cooperation in giving crucial data and direction in the time of
this proposal development.
My thanks also go to Othoniel College, my working area, for supporting me different
materials and for the internet access.
Last but not least I would like to say thank you to my brother Mr.Yohanes Andargachew
for his tireless devotion to support me in the development of this proposal.

Table of Contents
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Acknowledgement........................................................................................................................................i
Abbreviations and acronyms.......................................................................................................................iv
List of figures...............................................................................................................................................vi
Summary....................................................................................................................................................vii
1. Introduction.............................................................................................................................................1
1.1. Statement of the problem................................................................................................................1
1.2.1. Statement of the problems....................................................................................................2
1.2.2 Associated factors...................................................................................................................2
1.3. Justification of the proposed study...................................................................................................7
2. Objectives................................................................................................................................................8
2.1. General objective..............................................................................................................................8
2.2. Specific objectives.............................................................................................................................8
3. Methods..................................................................................................................................................9
3.1. Study design......................................................................................................................................9
3.2. Study area and period.......................................................................................................................9
3.3. Source population and study population..........................................................................................9
3.3.1. Source population..................................................................................................................9
3.3.2. Study population.....................................................................................................................9
3.4. Inclusion and exclusion criteria.......................................................................................................10
3.4.1 Inclusion criteria.....................................................................................................................10
3.4.2 Exclusion criteria...................................................................................................................10
3.5. Sample size and sampling procedure..............................................................................................10
3.5.1. Sample size determination..................................................................................................10
3.5.2. Sampling procedures...........................................................................................................11
3.6.1. Dependent variables............................................................................................................13
3.6.2. Independent variables.........................................................................................................13
3.7. Operational definitions...................................................................................................................13
3.8. Data collection instruments and procedures..................................................................................14
3.9. Data quality issues..........................................................................................................................15
3.10. Data processing and analysis........................................................................................................16
3.11. Ethical considerations...................................................................................................................16
4. Work plan..............................................................................................................................................17

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5. Budget/cost of the research project......................................................................................................18
Annex I: English and Amharic version of Consent form.........................................................................23
Annex II: Information sheet...................................................................................................................25
Annex III English and Amharic version questionnaire............................................................................29

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Abbreviations and acronyms
RNA-Ribonucleic Acid

ART-Antiretroviral Therapy

BMI-Body Mass Index

AOR- Adjusted Odds Ratio

COR-Crude Odds Ratio

CI – Confidence Interval

CSA – Central Statistic Agency

SPSS-Statistical Package for Social Science

WHO-World Health Organization

IDDS-Individual Dietary Diversity Score

NAIDS -Nutritionally Acquired Immune Deficiency Syndrome

UOG-University Of Gondar

GIS-Gastrointestinal Symptoms

PLHIV-People Living With HIV

PLWHAs-people living with HIV/AIDS

HAART- Highly Active Antiretroviral Therapy

HFIAS-Household Food Insecurity Access Scale

FAO-Food and Agricultural Organization

FANTA-Food and Nutrition Technical Assistance

SAM -Sever Acute Malnutrition

MAM -Moderate Acute Malnutrition

CD4+- Cluster of Differentiation 4

USD-United States Dollar

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List of table

Table Page number

Table 1: Sample size for associated factors…………………………………….....13

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List of figures
Figures Page number

Figure 1: Conceptual framework of malnutrition …………………………………………..9

Figure 2: Schematic presentation of sampling procedure ……………………………….15

Figure 3: Gantt chart showing the work plans of the study……………………………….21

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Summary
Introduction: Under nutrition combined with Human Immunodeficiency Virus/Acquired
Immunodeficiency Syndrome (HIV/AIDS) brought significant crisis in the world,
particularly in Saharan African countries. The proper implementation of nutritional
support and its integration with the routine highly active antiretroviral therapy package
demands a clear picture of the magnitude and associated factors of under nutrition.
However, in Ethiopia particularly in Dembia woreda this information is not well
documented.
Objective: To assess nutritional status and associated factors among HIV positive
adults attending ART clinic in the three health centers of Dembia woreda,

Method: Institution based cross-sectional study will be conducted in Dembia woreda

from August 3-30, 2015. Systematic sampling technique will be used to recruit the study
subjects. A total of 452 HIV positive adults will be assessed in this study and data will
be collected by using pre tested and structured questionnaire. Data will be entered in to
EpiINFO version 7 and exported to SPSS version 20.0 for analysis. Bivariate logistic
regression analysis will be used to identify the confounders and multivariate logistic
regression analyses will be done to identify significant factors associated with under
nutrition. The degree of association between independent and dependent variables will
be assessed by using Adjusted odds ratio (AOR) with 95% confidence interval.
Variables with p-value < 0.05 in the multivariate analysis will be considered significant.

Work plan and Budget: A total of 20,487.50 birr will be utilized to carry out the study
from August 3-30 / 2015.

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1. Introduction
1.1. Statement of the problem
Globally, about 34 million people were living with HIV (1). Sub-Saharan Africa remains the most
heavily affected region in the global HIV epidemic. In 2011, an estimated 23.5 million people living
with HIV resided in sub-Saharan Africa, representing 69% of the global HIV burden(2).

The advent of Highly Active Antiretroviral Therapy (HAART) and prophylaxis for opportunistic
infections has dramatically changed the course of HIV infection(8, 9). Advances in the treatment of
HIV infection during the last 20 years have resulted in reduced HIV RNA level and improved
immunologic function, leading to dramatic improvements in health, reductions in morbidity, and
prolonged life(3).Despite tremendous advances in care for HIV infection and increased funding for
treatment, morbidity and mortality due to HIV/AIDS in developing countries remains unacceptably
high(8).Individuals who are severely malnourished have a six times higher risk of dying in the first 3
months of starting ART than those with a normal nutritional status(9). Globally, more than >800
million people remain chronically undernourished and the HIV epidemic largely overlaps with
populations already experiencing low diet quality and quantity(8).
Although a few studies had been conducted to ascertain prevalence of under nutrition and
associated factors among HIV positive clients in Ethiopia, they were largely focused on large cities
of the country mainly from referral hospitals. Even though majority of our population is living in the
rural parts such areas are ignored from the previous studies. Some of the studies have been
conducted five years before which cannot be representative for the current situation of under
nutrition status among HIV positive clients where many regimen changes have been observed in
HIV/AIDS treatment protocol through time.

Therefore the purpose of this study aimed to assess nutritional status and associated factors among
adult HIV positive adults attending ART clinic in the three health centers of Dembia woreda, Amhara
region, Northwest Ethiopia, 2015.

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1.2. Literature Review
1.2.1. Prevalence of under nutrition
Under nutrition among HIV positive clients is a global problem. From study on the nutritional status
in Iranian HIV infected individuals, the Severe, moderate and mild malnutrition were 15%, 38% and
24%, respectively(20).

In developing continents the magnitude of under nutrition in HIV positive clients is highly observed.
Study conducted from 3 countries in Africa (Nigeria, Botswana, and Tanzania)(15, 21, 22),the
prevalence of under nutrition was 43.3%, 28.5% and 18.4%, whereas from studies in Latin
America (Brazil)(13) and in Asia (China, Singapore)(23, 24) the prevalence of under nutrition was
43%, 37.2% and 16%,respectively.
In Ethiopia different studies were conducted in different areas to determine the prevalence of under
nutrition among PLWHA. The result of the study conducted among adult people living with
HIV/AIDS and receiving anti-retroviral therapy (ART) in Butajira Hospital revealed an overall
prevalence of 25.2% of under nutrition among the study PLWHA, of which 49%, 19%, and 9%
patients were mildly, moderately, and severely malnourished, respectively(12).Similar finding was
also reported in Bahirdar, in which about 25.5% of HIV positive clients were found with under
nutrition (BMI<18.5kg/m2). Among these the proportion of mildly, moderately, and severely
malnourished participants were 64.4%, 19.2%, and 16.4% respectively(10).The other hospital-
based cross-sectional study carried out in Gondar was also reported that the overall prevalence of
under nutrition was 27.8 %(17). However, significantly lower prevalence of under nutrition was
reported in Dilla University referral Hospital in which the overall prevalence of under nutrition was
12.3% (11).
1.2.2 Associated factors
1.2.2.1 Socio-demographic and Economic factors
Various socio-demographic factors determine the nutritional status of HIV positive clients. These
factors are Age, sex, marital status, religion, wealth index, education status, and residence. A study
on malnutrition among Hospitalization Patients with Acquired Immunodeficiency Syndrome in Brazil
showed that there was an association between age and malnutrition in which there was a 2%
increase in the prevalence of malnutrition for each additional year of age(13). But Studies from Dilla
and Butajira showed that there was no significant association between Age and nutritional status
among adult PLWHA(11, 12).

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Concerning sex different studies from Ethiopia showed different results. A study from Bahir dar
showed that there was significant association between sex and under nutrition among adult
PLWHA, which was females were less likely to be undernourished(10). In contrast a study from Dilla
showed that there was no association between sex and under nutrition among PLWHA(11).

A study finding in Nepal revealed that the association of literacy status with under-nutrition was
statistically significant. Illiterate people were 2.3 times as likely to be undernourished as compared
to people who can read and write (14). Parallel study finding was reported in Dilla, in which
PLWHA with educational status of college and above were 90% less likely to be malnourished as
compared to PLWHA with primary school education grade 1-4 (11).

From institution based cross sectional study in Dilla, being single and divorced did not show
significant association but this study showed that a significant positive association between
widowed and under nutrition among PLWHAs(11).

Across-sectional study in Brazil revealed that a very low per capita household income

independently associated with malnutrition(13). Living with a daily per capita household income of
less than USD 2.00, USD 2.00–4.99 or USD 5.00–9.99 increased the prevalence of malnutrition by
2.01 times, respectively, as compared to the patients whose per capita household income was USD
10.00 per day or greater.

Even if there was no significant association between residential area and malnutrition among
PLWHA from the study conducted in Dilla(11), significant positive association was observed
between resident in rural area and under nutrition. Accordingly, being rural residence increases
likelihood of developing under nutrition among PLWHA from the study conducted in Butajira(12).

1.2.2.2 HIV related factors

Three studies from Nepal, Hosanna and Dilla showed that there was significant positive association
between WHO clinical AIDS stage and malnutrition in which PLWHA in WHO clinical stage IV were
more likely to be under nourished as compared to clients with WHO clinical AIDS stage I (11, 14,
16).

According to a cross-sectional study from Nepal CD4 count was significantly associated with under-
nutrition. Accordingly PLWHA with CD4 counts of 350cells/mm 3 or more were 74% less likely to be
undernourished than their counters(14).

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A facility based cross sectional survey in Felege Hiwot referral Hospital from Bahir dar showed that
clients who suffered from eating difficulties prior to the survey were nearly two times more likely
under nourished than those who didn’t have eating difficulty(10). Parallel findings were also
reported in Gondar(17) and Butajira(12) in which clients who had one or more eating difficulty were
2.69 times more likely to be malnourished as compared to those who were free of eating
difficulty(12).

A study conducted from Bahir dar,Ethiopia,claimed that ART status was significantly associated
with under nutrition in which clients on pre- ART care were 1.5 times more likely to be under
nourished as compared to those who were on ART care(10).

Two studies from Ethiopia revealed that the odd of being malnutrition was decreased when the
duration on ART increases(10, 17). The study from Gondar showed that clients treated for less than
one month were 14 times more likely to be malnourished as compared to those treated for more
than six months(17). In Bahir dar study, those who were on ARV drugs less than 12 months were
1.7 times more malnourished than those who took the drug more than a year(10).
Institution based cross sectional study was conducted in Dilla University referral Hospital revealed
that independent of all other variables gastrointestinal symptoms (GIS) had significant association
with malnutrition. Those patients with one or more GIS had a higher risk of developing malnutrition
as compared to those with no GIS(11). The same result was also obtained from Botswana; the
screening results revealed that 54.5% of all subjects reported experiencing unintentional weight loss
of any degree, while 42.2% reported a history of gastrointestinal symptoms(15).
From studies done in Ethiopia, presence of OIs showed significant association. A study from Dilla
University referral Hospital showed that one opportunistic infection and two & above previous
opportunistic infections were significantly associated with malnutrition(11). A study from Hosanna
which tried to determine magnitude of malnutrition and identify factors associated with it among
adult people on highly active anti-retroviral therapy (HAART) in health facility showed that
individuals who were diagnosed with OIs during the past six weeks were nearly 2.6 times likely to
be malnourished than not infected with OIs (16).
One of the variables showed significant association with malnutrition among PLWHA was current
clinical condition. A study at University of Gondar Referral Hospital using the systematic sampling
technique to select study subjects from all adult ART clients showed that Persons who remained in

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the same clinical condition were 18 times more likely to be malnourished than those who improved
from the previous state and those deteriorating from their previous condition were 25 times(17).
1.2.2.3 Nutritional related factors
The nutritional related factors in this particular study are nutritional support, dietary diversity and
household food security. Food security is defined as a state in which “all people at all times have
both physical and economic access to sufficient food to meet their dietary needs for a productive
and healthy life (25). A study on the nutritional status and its association with quality of life among
people living with HIV attending public anti-retroviral therapy sites of Kathmandu Valley, Nepal
showed that Households with food insecurity were more than twice as likely to be undernourished
as those PLHIV with adequate access to food(14).
Studies from Ethiopia also showed similar results. An Institution based cross-sectional survey
among 276 women on antiretroviral therapy in Humera Hospital also showed that household food
security was positively associated with nutritional status. Women who were household food
insecure were 1.85 times more likely to be undernourished (BMI < 18.5 kg/m2) as compared to those
who were household food secure(18).

From a facility based cross sectional study in Hosanna Town food insecurity was also showed a
statistically significant positive association with malnutrition. Respondents who were food insecure
were more than two times likely malnourished than food secure(16).
A health facility study in Hosanna Town displayed a negative association between nutritional
support and malnutrition in PLWHA on HAART. From such study individuals who were not receiving
nutritional support and care 55% less likely to be malnourished than those who were receiving
nutritional support and care but from a similar study in Hosanna town a statistically significant
positive association between malnutrition and dietary diversity was also observed .Clients who were
taking adequate diversified food 56% less likely to be malnourished than who had inadequate
diversified food (16).
1.2.2.4 Environmental factor

A community-based cross-sectional study conducted in Harbu Town showed that the prevalence of
under nutrition in adults was greater in those who had latrine than in those who did not have latrine
in the multivariate regression model(19). By reviewing different literatures the investigator prepares
the following conceptual framework.

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Socio demographic and
Economic Factors

Age
Sex HIV AIDS related factors
Marital Status Clinical Stage
Wealth index CD4 Count
Religion Eating difficulty
Residence ART status
Education status ART Duration
GI symptoms
Number of current or previous OIs
Current clinical condition

Presence of under
nutrition

Nutritional related

Factors Environmental

Nutritional support Factor

Dietary diversity
Food Security Latrine

availability

Source of

drinking water

Fig.1 Conceptual framework

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1.3. Justification of the proposed study
For People living with HIV/AIDS measuring nutritional status is an essential part of the ART program
which enables to assess the risk, estimating percentage of body weight loss and Body Mass Index
(BMI) in HIV/AIDS positive persons(17).
An evidence-based response is required to alleviate the overall burden of under nutrition and to
reduce the severity and complexity of the impact that HIV/AIDS and under nutrition have on each
other. To give such a response in a comprehensive manner associated factors with under nutrition
among HIV positive clients needed to be identified at referral hospital, hospital and health center
levels.
However there is a paucity of researches done in health centers in this study topic. In investigator's
best knowledge there is no a study done and documented to this specific topic in the study area, an
institution based study on under nutrition status and associated factors among HIV positive adults
in Dembia woreda is needed.
It is believed that the results of this study will provide valuable information to strengthen HIV/AIDS
continuum of care in governmental and nongovernmental health institutions. The finding of this
study will also be used as base line data for further study.

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2. Objectives
2.1. General objective
To assess nutritional status and associated factors among HIV positive adults attending ART clinic
in the three health centers of Dembia woreda, Amhara region, Northwest Ethiopia, 2015.

2.2. Specific objectives

 To determine the prevalence of under nutrition among HIV positive adults
 To identify associated factors of under nutrition among HIV positive adults

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3. Methods
3.1. Study design
Institution based cross sectional study will be conducted to assess the prevalence and determinants
of under nutrition among HIV positive adults attending ART clinics in Dembia woreda health
centers.

3.2. Study area and period

The study will be conducted from August 3-30, 2015 in Dembia Woreda, which is located in North
Gondar administrative Zone of Amhara region, Northwest Ethiopia.

Kolladiba, the woreda capital of Dembia woreda,is found 729 km away from the capital city of
Ethiopia,Addis Ababa.(26). The woreda covers an estimated area of 1270 km 2 and had a total
population of about 271,053 of which 247,699 (91.4%) are rural inhabitants(27) The altitude of the
woreda ranges between 1750 and 2100 m above sea level. The livelihood of this community is
largely dependent on subsistence farming which dependents on the single summer rainy season.
Maize, barley and millet are the main food crops, while rice, vetch and chickpea are the main cash
crops(26, 28)

Based on the information obtained from the woreda health office, the health institutions found in the
woreda are ten health centers, forty health posts and one hospital under construction. The study will
be conducted at three health centers of Dembia woreda which are providing ART services to HIV
positive clients i.e KollaDiba health center (first health center in Ethiopia), Chuahit and Aymba
health centers. These health centers started ART services in 1997, 2004 and 2006 E.c,
respectively. The total HIV positive clients registered in these three health centers are 3005 of these
2803 are adults.
3.3. Source population and study population
3.3.1. Source population
All HIV positive adults (≥18 years) who are enrolled for chronic HIV care at three health centers
proving ART service in Dembia woreda.
3.3.2. Study population
HIV positive adults (≥18 years) who are attending ART clinic within data collection period and fulfill
the inclusion criteria.

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3.4. Inclusion and exclusion criteria
3.4.1 Inclusion criteria
All HIV positive adults who had at least one prior follow up in ART clinic regardless of their HAART
status will be included in the study.

3.4.2 Exclusion criteria

 Those with spinal deformity.
 Those female HIV positive clients who are pregnant will be excluded.
3.5. Sample size and sampling procedure
3.5.1. Sample size determination
The required sample size is determined using Epi info statistical software version 7 by assuming
the following assumptions: 2,803 total number of HIV positive clients enrolled for chronic HIV care,
27.8% prevalence of under nutrition (17), and 4% margin of error. Finally, the minimum sample size
of 411 was obtained.
Sample size also calculated for determinants of under nutrition [Table 1].
Table 1: Sample size calculation for determinants of under nutrition

Variables Assumptions Sample size

ART status P- 34.5%(10) power- 80%, CI- 95%, OR- 430
1.77 Ratio 1:1
Eating difficulty P- 33.63%(10), power- 80%, CI- 95%, OR- 410
1.8, Ratio 1:1

Note :( P-percentage of outcome for unexposed group)

Among the calculated sample sizes the largest sample size was 430. After adding 5% non-
response rate the final sample size will be 452.

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3.5.2. Sampling procedures
The total 2,803 HIV positive clients are registered for chronic care in three health centers of Dembia
Woreda. Numbers of HIV positive clients who will be included in each health center are determined
using proportionate-to-population size. After considering the average number of HIV positive clients
attending ART clinic per month in the three health centers as 2,450, the sampling fraction K th was
calculated (k= N/n = 2,450/452=5). The first study participant will be selected using lottery method
from the first five client charts of day-one visit. The study subjects will be selected by the systematic
sampling technique at every fifth of the first study participant in official working days.

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 Total number of HIV positive adults enrolled for HIV care in Dembia woreda (2803) in the
three HCs

Kolladiba HC ChuahitHC Aymba HC

(2266) (457) (80)

Systematic random sampling (k=5)

n= (74) n= (13)
n= (365)

Total sample

(452)

Fig. 2 Schematic presentation of sampling procedure.

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3.6. Variables of the study

3.6.1. Dependent variables

Under nutrition (BMI<18.5 kg/m2)
3.6.2. Independent variables
Socio-demographic and economic factors: - Age, sex, religion, marital status, educational status,
wealth index, and residence.
HIV related factors: - WHO clinical stage, CD4 count, eating difficulty, ART status, ART duration,
gastrointestinal symptoms, number of current/ previous OIs, and current clinical conditions
Nutritional related factor- nutritional support, dietary diversity and household food security
Environmental factor-The environmental factor are the availability of toilet and source of drinking
water.
3.7. Operational definitions
People with HIV/AIDS (PLWHA) refers to people who have undertaken an HIV test and have been
declared positive whether or not they show any symptoms of infection or AIDS disease.

Under nutrition is defined as BMI < 18.5 kg/m2 (15).

Dietary diversity refers to the consumption of a variety of food groups considered an indicator for
dietary quality and general nutritional adequacy(29).

Dietary diversity score: The number of foods or food groups consumed across and within food
groups by an individual within 24 hour(30).
High dietary diversity: - respondents with individual dietary diversity score of five and above
(consume 5 and above food groups)(30, 31).
Low dietary diversity: - respondents with individual dietary diversity score below five (consume
below 5 food groups)
Food secure household experiences none of the food insecurity (access) conditions, or
just experiences worry, but rarely.
Mildly food insecure (access) household worries about not having enough food
sometimes or often, and/or is unable to eat preferred foods, and/or eats a more
monotonous diet than desired and/or some foods considered undesirable, but only rarely.
But it does not cut back on quantity nor experience any of three most severe conditions
(running out of food, going to bed hungry, or going a whole day and night without eating).
Moderately food insecure household sacrifices quality more frequently, by eating a
monotonous diet or undesirable foods sometimes or often, and/or has started to cut back
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 on quantity by reducing the size of meals or number of meals, rarely or sometimes. But it
does not experience any of the three most severe conditions.
Severely food insecure household has graduated to cutting back on meal size or number
of meals often, and/or experiences any of the three most severe conditions (running
out of food, going to bed hungry, or going a whole day and night without eating), even as
infrequently as rarely.
3.8. Data collection instruments and procedures
A structured and interviewer-administered questionnaire will be used as to collect data. Tools for
measuring dietary diversity and food security status is adopted from guidelines for measuring
household and individual dietary diversity and household food insecurity access scale(25, 30). The
questionnaire consists of 4 parts: socio economic and demographic characteristics, HIV related
factors, nutritional related factors and environmental factor.

Economic status will be assessed by using Wealth Index incorporating monthly income, animal
ownership, and number of family members, availability of public services, source of fuel, occupation,
and home and farmland ownership. Dichotomous variables will be constructed and factor analysis
using principal component analysis (PCA) will be used to reduce 20 items to 5 (loaded as factor 1).
The Wealth Index score then will be equally divided into 5 quintiles designating fifth (highest),
fourth, third, second and low (poor economic status)(32).

Document or chart review will be used to extract information related to HIV related characteristics.

Determination of dietary diversity score (DDS) will be started by asking lists of all foods consumed
in the previous 24 hour of a day preceding survey. Food eaten by the respondent will be classified
into twelve food groups as starch staples (Grains, roots and tubers); dark green leafy vegetables,
other vitamin A rich fruits and vegetables, other fruits and vegetables, liver/organ meats, Meat and
fish , Eggs, Legumes, nuts and seeds, and Milk and milk products (milk, yoghurt, cheese). By
Considering five food group as minimum dietary diversity(30, 33), the study participants with DDS
less than five will be classified as poor dietary diversity otherwise good dietary diversity if DDS≥5.

Food security will be assessed by using a short version of the Household Food Insecurity Access
Scale (HFIAS) developed by the Food and Nutrition Technical Assistance (FANTA) project(25).
Occurrence questions relate to three different domains of food insecurity such as anxiety and

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uncertainty about the household food supply, insufficient quality (includes variety and preferences of
the type of food) and insufficient food intake and its physical consequences will be used.

Each of the questions is asked with a recall period of four weeks (30 days).In the first place the
respondent will be asked an occurrence question that is, whether the condition in the question
happened at all in the past four weeks (yes or no). If the respondent answers “yes” to an
occurrence question, a frequency- of-occurrence question will be asked to determine whether the
condition happened rarely (once or twice), sometimes (three to ten times) or often (more than ten
times) in the past four week. Then Household Food security will be categorized into four based
on the household food insecurity access scale (25).
Nutrition support will be assessed interview administered questionnaire.

The final part of the questionnaire will collect information on environmental factosr which are the
availability of latrine and source of drinking water.
Anthropometric measurement
To have information on the individuals’ BMI, Anthropometric measurement will be used. Weight of
the study participants will be measured to the nearest 0.1 Kg of a beam balance with graduation
0.1kg and measuring range up to 160kg. Weight will be measured with lightly clothing and no
shoes. Calibration will be done before weighing each participant by setting it to zero. Weighing
scale also checked against a standard weight for its accuracy on daily basis. Height of the
participant will be measured using Seca vertical height standing upright in the middle of board. The
participant’s head, shoulders, buttocks, knees and heels touch's against the vertical board.

Height measurement of participants will be taken using the standard measuring scale. Participants’
takeoff their shoes, stand erect, and look straight in horizontal plain. The occipit, shoulder, buttocks,
and heels touched measuring board and height will be recorded to the nearest 0.01cm(34).
Three data collectors (clinical nurses) and one MPH supervisor will be recruited and two days
intensive training will be given. The data collection process will be followed daily by the supervisor
and principal investigators.
3.9. Data quality issues
Initially the English version questionnaire will be translated into Amharic (local language), and then
back translated to English by English language experts to maintain its consistency. Two days
training will be given for data collectors and supervisor. Pre testing of the questionnaire will be
made on 50 HIV positive clients in Gondar health center (out of the study area) for checking the
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presence of ambiguous words/sentences, checking order of questions and to estimate time
required. Data collection process will be strictly followed on daily basis by the supervisors and
principal investigator.
3.10. Data processing and analysis
Data will be checked and entered using Epi-info version 7 statistical software and then exported to
SPSS (Statistical Package for Social Science) version 20 for analysis. Descriptive statistics using
Cross tabulation, frequency tables and graph will be used to describe study variables. Using binary
logistic regression model, bivariate analysis will be used to identify the confounders. Variables with
p-value≤0.2 will be fitted to multivariate analysis. Thus, variables having p-value of ≤ 0.05 will be
considered as significant. Adjusted odds ratio (AOR) with 95% confidence interval will be used to
show strength of association. The fit of the model will be assessed using the hosmer-Lemeshow
goodness-of-fit test. Model having p-value of 0.05 and above would be declared as fit.
3.11. Ethical considerations
Prior to data collection, ethical approval will be obtained from ethical review committee of University
of Gondar. Official permission letter will be obtained from Dembia woreda health office. Verbal
consent will be taken from each participant after explaining the purpose of the study. They will be
told to withdraw at any time and/or to refrain from responding to questions. Participants will also be
informed that all the data obtained from them would be kept confidential using codes instead of any
personal identifiers. HIV positive adults with Sever Acute Malnutrition (SAM) or Moderate Acute
Malnutrition (MAM) criteria with medical complications will be linked to UOG referral hospital for
further investigation and treatment during the study period.

3.12 Dissemination of Finding

The findings of this study will be submitted to the institute of public health, college of medicine and
health sciences, university of Gondar, and an attempt will be made to publish in one of recognized
scientific journals.

16 | P a g e
 4. Work plan
Activity Res May June July August Septem Octob Nove Dece
pon ber er mber mber
sibl
e
bod
y

Topic selection P/In

vesti
gato
r

Topic defense “

Proposal “
preparation

Proposal “
defense

Final proposal “
submission

Ethical “
clearance

Training of data “
collectors

Pretest Both

Data collection “

Data analysis p/in

ves

First draft subm “

Mock defense “

Thesis defense “

Final
submission

Fig 3. Gantt chart showing the work plans of the study.

17 | P a g e
5. Budget/cost of the research project
5.1 Training and datacollection

5.1.1 Training

Qualification No of Remark
Description No Cost/ day Total cost
days

Supervisor MPH 1 2 200.00 400.00

Data collector CN 6 2 100.00 1200.00

Sub Total(1) 0.00

5.1.2 Data collection

Qualification No of Cost per

No Total cost
days day

Supervisor MPH 1 15 150.00 2,250.00

Data collector CN 6 15 70.00 6,300.00

Secretary 1 15 50.00 750.00

Principal Bsc Training,

investigator 1 15 70.00 1,050.00
pretest
(PI)

Subtotal(2) 0.00

Total(1+2) 11,950.00

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5.2 Transportation and communication cost

No No of Total Justification
Description Unit
days cost(ETB)

Communication with
supervisor, PI and
Mobile card 10birr 8 15 1,200.00 Advisors

Internet 500.00 To review literatures

2 From Gondar to
25birr 15 1,500.00
Travel cost Dembia

3,300.00

5.3. Equipment and supply cost.

Material Unit Total needed Unit cost Total cost

Duplicating Paper Ream 15 77.00 1,155.00

Duplicating ink Each 4 80.00 320

Printing paper Ream 10 77.00 1,155.00

Writing pad Each 15 15.00 220.00

Pen Each 15 2.50 37.50

Pencil Each 15 1.00 15.00

Eraser Each 15 1.00 15.00

Sharpener Each 15 4.00 60.00

Flash disk Each 1 390.00 390.00

Toner Each 1 750.00 750.00

CD (RW) Each 1 20.00 20.00

Total 5,237.50

Grand total 20,487.50

19 | P a g e
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13. Andrade CS, Jesus RP, Andrade TB, Oliveira NS, Nabity SA, Ribeiro GS. Prevalence and
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from six support groups in Botswana. South African Journal of Clinical Nutrition. 2009;22(2).
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Individuals Receiving Highly Active Antiretroviral Therapy in Health Facilities of Hosanna
Town, Southern Ethiopia. Open Access Library Journal. 2015;2.
17. Wasie B, Kebede Y, Yibrie A. Nutritional Status of Adults Living with HIV/AIDS at the
University of Gondar Referral Hospital, Northwest Ethiopia. Ethiopian Journal of Health and
Biomedical Science. 2014;3(1).
18. Hadgu TH, Worku W, Tetemke D, Berhe H. Undernutrition among HIV positive women in
Humera hospital, Tigray, Ethiopia, 2013: antiretroviral therapy alone is not enough, cross
sectional study. BMC Public Health. 2013;13(1):943.
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undernutrition in northeastern Ethiopia. BMC Public Health. 2015;15(1):108.
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Nutritional status and serum zinc and selenium levels in Iranian HIV infected individuals.
BMC infectious diseases. 2008;8(1):165.
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People Living with HIV/AIDS at a Tertiary Hospital in Nigeria. Food and Nutrition Sciences.
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22. Ritte S, Kessy A. Social factors and lifestyle attributes associated with nutritional status of
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Salaam. East African journal of public health. 2014;9(1):33-8.
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Asia Pacific journal of clinical nutrition. 2011;20(4):544.

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24. Paton NI, Sangeetha S, Earnest A, Bellamy R. The impact of malnutrition on survival and the
CD4 count response in HIV‐infected patients starting antiretroviral therapy. HIV medicine.
2006;7(5):323-30.
25. Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for
measurement of food access: indicator guide. Washington, DC: Food and Nutrition Technical
Assistance Project, Academy for Educational Development. 2007.
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Administrative Zone. 2005.
27. Ethiopia C. Summary and statistical report of the 2007 population and housing census.
Federal democratic republic of Ethiopia population census commission, Addis Ababa,
Ethiopia. 2008:1-10.
28. Alemu A, Muluye D, Mihret M, Adugna M, Gebeyaw M. Ten year trend analysis of malaria
prevalence in Kola Diba, North Gondar, Northwest Ethiopia. Parasit Vectors. 2012;5:173.
29. Carol dn. Factors associated with dietary intake among hiv positive adults (18-65 years) at
the mildmay center, kampala, uganda. 2004.
30. Kennedy G, Ballard T, Dop MC. Guidelines for measuring household and individual dietary
diversity: Food and Agriculture Organization of the United Nations; 2011.
31. FAO F. Guidelines for measuring household and individual dietary diversity. Food and
Agriculture Organization of the United Nations (FAO) the Food and Nutrition Technical
Assistance (FANTA) Project, Rome, Italy. 2007.
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ORC Macro. 2004.
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a WHO Expert Committee. 1995.

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Annexes

Annex I: English and Amharic version of Consent form

University of Gondar
College of Medicine and Health Sciences
Institute of Public Health
A questionnaire prepared to assess nutritional status and associated factors among HIV positive
adults
INTRODUCTION AND CONSENT
Dear participant; my name is _______________. I am working as a data collector with Anbesaw
Mitiku, who is doing a research as partial fulfillment for the requirement of Master of Science in
applied human nutrition at University of Gondar.

The main aim of his study is to assess nutritional status and associated factors among adult HIV
positive clients. The results of the study will be used as baseline information to design appropriate
intervention strategies. Your name will not be written in this form and the information you give is
kept confidential. If you do not want to answer all or some of the questions, you do have the right to
refuse. So you are kindly requested to provide your genuine answers to the questions. If you have
any question, don’t stammer to ask the interviewer. It doesn’t take more than 25 minutes.

Would you participate in responding to the questions in this questionnaire?

Yes --------No------
Name and Signature of the data collector ______________
Date of interview_________

Name and signature of the supervisor ____________________

Date_________

23 | P a g e
በጎንደር ዩኒቨርሲቲ ፣ በህክምና እና ጤና ሳይንስ ኮሌጅ የህብረተሰብ ጤና አጠባበቅ ኢንስቲትዩት የአመጋገብ ሁኔታ እና
ተዛማጅ ጉዳዮች ዙሪያ ከኤች ኤይቪ ጋር የሚኖሩ አዋቂዎችን አስመልክቶ የተዘጋጀ መጠይቅ

መግቢያ

ሠላም እንደምን አሉ? ስሜ_____________ እባላለሁ::ከዚህ የመጣሁት ይህንን ጥናት የሚያካዱት የጎንደር ዩንቨርስቲ
የስነ ምግብ ሳይንስ ተማሪ የሆኑት የአቶ አንበሳዉ ምትኩ አስፋዉ የጥናት ቡድን አባል ሆኜ ነው::ከዚህ በመቀጠል ከኤች
ኤይቪ ጋር የሚኖሩ አዋቂዎችን ላይ የአመጋገብ ሁኔታ/ችግር እና ተዛማጅ ጉዳዮችን በተመለከተ የተወሰኑ ጥያቄወችን እና
ልኬታዎችን ማካሄድ ነዉ::የዚህ ምርምር ውጤት ያለውን የአመጋገብ ሁኔታ(ችግር) ከማሳየቱ በተጨማሪ ችግሩን
ለመፍታት ትልቅ ዕገዛ ይኖረዋል :: ለምንጠይቅወት ጥያቄዎች የዕርስዎ ትክክለኛ መልስ በጣም አስፈላጊ ነው ::
በጥያቄዎች ዙሪያ ጥርጣሬ ካደረብዎት ጠያቂውን እንደገና መጠየቅ ይችላሉ:: ከእርስዎ የምናገኘውን ማንኛውንም መልስ
በሚስጥር እንጠብቃለን፡፡ ከዚህ ጥናት ጋር በተያያዘ በማንኛውም ቦታ እና ጊዜ ስምዎ እንዳይመዘገብና እንደማይጠቀስዎ
ልንገልፅልዎ እንወዳለን ::

ለጥናቱ የምናሳትፍዎ የእርስዎ ሙሉ ፈቃደኝነት ስናገኝ ብቻ ነው፡፡ በመጠይቁ ያለመሳተፍ ወይም በመጠየቁ ሂደት
ሊመልሱት የማይፈልጉትን ጥያቄ ያለመመለስ መብትዎ የተጠበቀ ነው፡፡

ለትብብርዎ በጣም እናመሰግናለን ::

24 | P a g e
Annex II: Information sheet
Information Sheet and Consent Form Prepared for person who are going to participate in Research
Project: assessment of nutritional status and associated factors in adult HIV positive clients who
live in Dembia woreda.

Name of Principal investigator: Anbesaw Mitiku

Name of the organization: University of Gondar, college of Medicine And Health Sciences, Institute
of Public Health, Department human nutrition
Sponsor: principal investigator

Introduction
This information sheet and consent form is prepared to explain the study you are being asked to
join. Please listen carefully and ask any questions about the study before you agree to join. You
may ask questions at any time after joining the study. The investigator include final year MSC
graduate student from the Institute of public health, college of medicine and health science,
university of Gondar, and two advisor from the university of Gondar.

Purpose of Research Project: The purpose of this research is to assess nutritional status and
associated factors in adult HIV positive clients. The study will be helpful in determining major factors
affecting nutritional status and identifying associated factors at this woreda. It also will serve as a
baseline for subsequent studies.

Procedure: To assess the nutritional status and associated factors in adult HIV positive clients, we
invite you to take part in this project. If you are willing to participate in this project, you need to
understand and sign the agreement form. Then after, you will be interviewed and measuring
anthropometric data by the data collector to give your response. You do not need to tell your name
to the data collector and all your responses and the results obtained will be kept confidentially by
using coding system whereby no one will have access to your response.

Risk/ Discomfort: By participating in this research project, you may feel that it has some discomfort
especially on wasting time about 25 minutes. We hope you will participate in the study for the sake
of the benefit of the research result. There is no risk in participating in this research project.

25 | P a g e
Benefits: If you participate in this research project, there may not be direct benefit to you but your
participation is likely to help us in assessing the magnitude and associated factors of nutritional
status (under nutrition). Ultimately, this will help us to work on awareness creation, interventions and
reference.
Incentives: You will not be provided any incentives or payment to take part in this project.
Confidentiality: The information collected from this research project will be kept confidential and
information about you that will be collected by this study will be stored in a file, without your name,
but a code number assigned to it. And it will not be revealed to anyone except the principal
investigator and will be kept locked with key.
Right to refuse or withdraw: You have full right to refuse from participating in this research. You
can choose not to respond to some or all questions if you do not want to give your response. You
have also the full right to withdraw from this study at any time you wish, without losing any of your
right.
Persons to contact: If you have any question, please contact the following persons.

Anbesaw Mitiku
Phone number +251920255079
Email address, anbesawm@gmail.com

Mr Tadese Awoke(Ass. professor)

Phone number: +251910173308

Email address, tawoke7@gmail.com

Mr Amare Tariku (MSc)

Phone number፡+251918724376
Email address, amaretariku15@yahoo.com

26 | P a g e
የመረጃና የስምምነት ውል ቅፅ
የምርምሩ/ጥናቱ ርዕስ:
በደንቢያ ወረዳ ከኤች ይቪ ጋር የሚኖሩ አዋቂዎች ላይ ሊከሰት ስለሚቸል የምግብ ሁኔታ /እጥረት እና ተያያዥ ጉዳዮች
በተመለከተ ፡፡

የዋና ተመራማሪው ስም፡ አንበሳዉ ምትኩ

የድርጅቱ ስም: በጎንደር ዩኒቨርሲቲ ህክምናና ጤና ሳይንስ ኮሌጅ የህብረተሰብ ጤና አጠባበቅ ኢንስቲትዩት
ወጪውን የሚሸፍነው አካል፡ አጥኝዉ
መግቢያ:
ይህ የመረጃና የስምምነት ውል ቅፅ የተዘጋጀው በደንቢያ ወረዳ ከኤች ይቪ ጋር ለሚኖሩ አዋቂዎች ነው፡፡ ዋና ዓላማዉም
ስለ ምርምሩ ዓላማ፣ ስለ መረጃ አሰባሰቡ እንዲሁም ጥናቱን ለማካሄድ ፈቃድ ለማግኘት ከላይ የተገለፁትን አካላት ግልፅ
እንዲሆንላቸዉ ለማድረግ ነዉ፡፡
የጥናት ፕሮጀክቱ የሚካሄድበት ምክንያት :
የጥናቱ ዓላማ በደንቢያ ወረዳ በሚገኙና ከኤች ይቪ ጋር በሚኖሩ አዋቂዎች ላይ ሊከሰት ስለሚቸል የምግብ ሁኔታ
(እጥረት) እና ተያያዥ ጉዳዮችን ለማጥናት ታቅዶ የተዘጋጀ ነዉ ፡፡ የጥናቱ ግኝት ችግሩን ለመፍታት በተለይም ደግሞ ጥናቱ
በሚካሄድበት ቦታ ትክክለኛ የሆነ የመፍትሄ አቅጣጫ ለመቅረፅ እንደመነሻ መሠረት ያገለግላል፡፡
አተገባበር:
የጥናቱን አላማ ለማሳከት በደንቢያ ወረዳ የሚገኙ ከኤች ይቪ ጋር የሚኖሩ አዋቂዎችን ያካትታል፡፡
ሊገጥም የሚችል ችግር/አለመመቸት
በዚህ ጥናት ላይ ምንም የሚደርስባቸዉ ጉዳት የለም፡፡ ነገር ግን መረጃቸዉ ለጥናቱ በጣም አስፈላጊ ነዉ፡፡
ጥቅሞች:
በዚህ ጥናት ተሳታፊ የሚሆኑት በቀጥታ ሊያገኙት የሚችሉት ጥቅም ባይኖርም መረጃቸዉ ግን የምግብ ሁኔታን/እጥረት
እንዲሁም ተያያዥ ምክንያቶችን ለማጥናት ይጠቅማል፡፡
የተሳትፎ ክፍያዎች፡ በጥናቱ በመካፈልዎ የሚሰጥ ክፍያ የለም፡፡

ሚስጥር ስለመጠበቅ፤

ለዚህ ጥናት የሚሰበሰብ መረጃ በሚስጥር ይጠበቃል፡፡ የሚሰበሰበዉ መጠይቅ የእርስዎ ለመሆኑ መለያ አይኖረዉም፡፡
መረጃዉ በዋና ተመራማሪዉ ድብቅ ፋይል ተደርጎ በቁልፍ የሚቀመጥ በመሆኑ ሌላ ሰዉ ሊያገኘዉ አይችልም፡፡

በጥናቱ ያለመሳተፍ ወይም ራስን ከጥናቱ የማግለል መብት፡

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በጥናቱ ላለመሳተፍ ከፈለጉ በዚህ ጥናት ያለመሳተፍ ሙሉ መብት አለዎት፡፡ ከመጠይቁ ዉስጥ የተዎሰኑ ጥያቄዎችን ወይም
በሙሉ አለመመለስ ይችላሉ፡፡

ሊገናኙዋቸዉ የሚችሉ ሰዎች

የትኛዉም ዓይነት ጥያቄ ቢኖርዎት ከዚህ ቀጥሎ የተጠቀሱትን ግለሰቦች ማግኘትና በማንኛዉም ጊዜ መጠየቅ ይችላሉ፡፡

1. አቶ አንበሳዉ ምትኩ
የሞባይል ስልክ ቁጥር: +251-920255079
2. አቶ ታደሰ አወቀ:-ጎንደር ዩኒቨርስቲ
የሞባይል ስልክ ቁጥር:- +251910173308

3. አቶ አማረ ታሪኩ:-ጎንደር ዩኒቨርስቲ

የሞባይል ስልክ ቁጥር: +251918724376

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Annex III English and Amharic version questionnaire
Health center ------------------
Questionnaire No___________
Date of Interview___/___/___E.C.
Interviewer Code______
Instructions:
Fill in the blank space.
Circle the appropriate answer.
Do not omit any item of information
PART ONE: SOCIO-ECONOMIC AND DEMOGRAPHIC VARIABLES
No_ Question Response Remark
1 Age ……………years
2 Sex 1. Male 2. Female
3 Marital status 1. Single 2. Married
3. Divorced 4. Widowed
4 Religion 1.Ortodox 2.Muslim
3. Protestant 4. Catholic
5 Place of residence 1. Urban 2. Rural
6. Wealth index of households related questions
6.1 Monthly income(In Birr) _________
How many family members
6.2 are there in your house? _________

Yes No
6.3 Does your household have Electricity 1 0
the following household Radio 1 0
assets? Television 1 0
Telephone landline 1 o
Telephone mobile 1 0
Refrigerator 1 0

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 Yes No

6.4 What type of fuel does your Electricity 1 0

household mainly use for Kerosene 1 0

cooking? Charcoal 1 0

Firewood, straw 1 0

Dung 1 0

Other _______

1. Farmer
2. Housewife only
3. student
6.5 Occupation 4. Government employee
5. Merchant/Trade
6.Others-------------------
Does any member of this
household have an account Yes 1
6.6
with a bank/credit No 2
association/micro finance?
Yes No
Type of animals
Which of the following
Cows/oxen/bulls 1 0
6.7 animals does this
Horses/donkeys/mules 1 0
household own
Goats and Sheep 1 0
Chickens 1 0
Do you have your own Yes 1
private home?
6.8 No 2
skip to
6.12
If yes to the above Concrete and cement
1
question, what is the Wood and mud
6.9 2
material that your house´s Other specify
roof is made of?
6.1 What is the material that Soil=1
0 your house´s floor is made Muck=2
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 of? Cement=3
Wood=4
Plastic paving=5
Brick/clay=6
Others(specify)=7
what is the material that Wood and mud=1
your house´s wall is made Wicker and rush=2
of? Mud and stone=3
6.1 Stone and cement=4
1 Brick=5
Brick=6
Others(specify)=7

Main source of household own production 1

6.1 food purchasing 2
2 government support 3
NGO support 4
6.1 Do you have your own farm አዎ 1
የለኝም 2
land?
3

7 Educational status 1.Can’t read and write

2.Can read and write(Informal
education)
3.Primary education
4.Secondary education
5.College and above
PART TWO: HIV RELATED FACTORS
8 Current WHO Clinical 1. Stage I Document
Stage 2. Stage II
3. Stage III
4. Stage IV
9 Current CD4 count ……………….cells/mm3 Document

10 Cotrimoxazole 1.Yes Document

prophylaxis use 2.No
11 Alcohol consumption 1.Yes
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 2. No
12 Chat chewing 1.Yes
2. No
13 Eating difficulty 1. Loss of appetite Document
2. Vomiting
3. Swallowing difficulty
Others ……………………
14 ART status 1.Pre ART 2.On ART Document

15 ART duration ………………….month/s Document

16 Current hemoglobin level --------------------------g/dl

17 HAART category ------------------------------------ Document
18 GI symptoms 1. Diarrhea 2. Indigestion 3. Document
Constipation 4. Altered test
19 Number of 1. Acute/chronic diarrhea 2. Document
current/previous 6 Tuberculosis 3. Oral thrush 4. Oral
months OIs ulcer 5. Pneumonia 6. Zoster

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20 Current clinical condition 1.Improved 2.Same 3 Document
Deteriorated
PART THREE: Nutritional Related Questions

21 Institutional nutrition 1. Yes 2. No

support
22. 24 hour dietary recall-Dietary diversity score tool
Read the list of foods, place one in the box if the food in question was eaten, and place a
zero in the box if the food was not eaten.
Food group No….0
Yes....1
22.1 Starchy staples
22.2 Dark green leafy
vegetables
22.3 Other Vitamin A rich
fruits and vegetables
22.4 Other fruits and
vegetables
22.5 Legumes, nuts and
seeds
22.6 Meat and fish
22.7 Organ meat
22.8 Milk and milk products
22.9 egg
22.10 Fats and oils
22.11 Sweets
22.12 Spices, condiments and
beverages

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 23.House Hold food security assessment tool
23.1 In the past four weeks, 0=No (skip to Q23.2) 1=Yes
did you worry that your
household would not
have enough food?

23. How often did this 1 = Rarely (once or twice in the past
1a happen? four weeks)
2 = Sometimes (three to ten times in
the past four weeks)
3 = Often (more than ten times in the
past four weeks)
23.2 In the past four weeks, 0 = No (skip to Q23.3)1=Yes
were you or any
household member not
able to eat the kinds of
foods you preferred
because of a lack of
resources?

23.2a How often did this 1 = Rarely (once or twice in the past
happen? four weeks)
2 = Sometimes (three to ten times in
the past four weeks)
3 = Often (more than ten times in the

23.3 In the past four weeks, past(skip

0 = No fourtoweeks)
Q23.4) 1 = Yes
did you or any
household member
have to eat a limited
variety of foods due to
a lack of resources?

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 23.3a How often did this 1 = Rarely (once or twice in the past
happen? four weeks)
2 = Sometimes (three to ten times in
the past four weeks)
3 = Often (more than ten times in the
past four weeks)
23.4 In the past four weeks, 0 = No (skip to Q23.5) 1 = Yes
did you or any
household member have
to eat some foods that
you really did not want to
eat because of a lack of
resources to obtain other
types of food?

23.4a How often did this 1 = Rarely (once or twice in the past
happen? four weeks)
2 = Sometimes (three to ten times in
the past four weeks)
3 = Often (more than ten times in the
past four weeks)
23.5 In the past four weeks, 0 = No (skip to Q23.6) 1 = Yes
did you or any
household member
have to eat a smaller
meal than you felt you
needed because there
was not enough food?

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 23.5a How often did this 1 = Rarely (once or twice in the past
happen? four weeks)
2 = Sometimes (three to ten times in
the past four weeks)
3 = Often (more than ten times in the
past four weeks)
23.6 In the past four weeks, 0 = No (skip to Q23.7) 1 = Yes
did you or any other
household member
have to eat fewer meals
in a day because there
was not enough food?
21.6a How often did this 1 = Rarely (once or twice in the past
happen? four weeks)
2 = Sometimes (three to ten times in
the past four weeks)
3 = Often (more than ten times in the
23.7 In the past four weeks, 0 = No
past(skip
fourtoweeks)
Q23.8) 1 = Yes
was there ever no food
to eat of any kind in
your household
because of lack of
resources to get food?
23.7a How often did this 1 = Rarely (once or twice in the past
happen? four weeks)
2 = Sometimes (three to ten times
in the past four weeks)
3 = Often (more than ten times in
the past four weeks)

36 | P a g e
23.8 In the past four weeks, 0 = No (skip to Q23.9) 1 = Yes
did you or any
household member go
to sleep at night hungry
because there was not
enough food?
23.8a How often did this 1 = Rarely (once or twice in the past
happen? four weeks)
2 = Sometimes (three to ten times
in the past four weeks)
3 = Often (more than ten times in
the past four weeks)
23.9 In the past four weeks, 0 = No (questionnaire is finished) 1
did you or any = Yes
household member go
a whole day and night
without eating anything
because there was not
enough food?
23.9.a How often did this 1 = Rarely (once or twice in the past
happen? four weeks)
2 = Sometimes (three to ten times
in the past four weeks)
3 = Often (more than ten times in
the past four weeks)
PART FOUR: Environmental Factor
24 Availability of toilet 1. Yes 2. No If no, skip to
26
25 Type of latrine you use? Washed with water and removed to drain
pipe=1
Modernized and aerated toilet=2
Made of cement slab=3
Without slab/open=4
Toilet with burrow for decomposition=5
37 | P a g e
 Forest/open field=6
shed to farm land=7
26 What is your main source 1. River
of drinking water? 2. Unprotected spring.
3. Protected spring.
4. Public tap
5. Other (specify)……………
27 Amount of water used in In liters__________
the HH daily?

28 How long does it take to In minutes__________

fetch water? you go and
come back

29 Do you treat water in any 1. Yes (Specify)

way to make it safer? 2. No

Anthropometrical measurement

30 Weight _______________kg

31 Height _______________meter

32 BMI ____________________

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 የአማርኛ መጠይቅ

የጤና ተቋሙ ስም ___________

የመጠየቁ ኮድ ቁጥር___________
መጠይቁ የተካሄደበት ቀን___/___/___E.C.
መምሪያ:
ክፍት ቦታዉን ይሙሉ
ትክክለኛ መልስዎን ያክብቡት
ጥያቄዉን ሳይመልሱ አይለፉ

39 | P a g e
 ክፍል አንድ ፤ ማህበራዊና ኢኮኖሚያዊ ሁኔታ መጠይቆች
1 እድሜ …………………………
2 ፆታ 1.ወንድ 2. ሴት
3 የጋብቻ ሁኔታ 1.ያላገባች
2. ያገባች
3. የፈታች
4. የሞተባት
4 ሀይማኖት 1.ኦርቶዶክስ 2.ሙስሊም 3. ፕሮቴስታንት 4. ካቶሊክ
5 የመኖሪያ ቦታ 1. ከተማ 2. ገጠር
6.ከሀብት ጋር የተያዙ ጥያቄዎች
6.1 የወር ገቢ (ብር) ________
6.2 በሚኖሩበት ቤት ውስጥ ስንት የቤተሰብ አባል ይገኛል ? ________
6.3 በቤትዎ ውስጥ የትኞቹ የቤተሰብ ጥሪቶች ይገኛሉ? አለ የለም
ኤሌክትሪክ 1 0
ራድዮ 1 0
ቴሌቪዥን 1 0
የመስመር ስልክ 1 0
ተንቀሳቃሽ ስልክ 1 0
ማቀዝቀዣ 1 0
6.4 በቤትዎ ውስጥ በአብዛኛው ለማብሰያነት የሚጠቀሙት አለ የለም
የትኛውን ነው? ኤሌክትሪክ 1 0
ነጭ ጋዝ 1 0
ከሰል 1 0
እንጨት 1 0
ኩበት 1 0
ሌላ ካለ ይጥቀሱ --------
6.5 ስራ 1.ግብርና 2. የቤት እመቤት 3. ተማሪ 4.
የመንግስት ሰራተኛ 5. የንግድ ስራ 6.
ሌላ………
6.6 ከቤተሰብ አባላት ውስጥ በባንክ/ በብድርና ቁጠባ/በአነስተኛ የገንዘብ አለ 1
ተቋማት ሂሳብ ያለው አለ? የለም 2
6.7 የትኞቹ የቤት እንስሳት በቤታችሁ ውስጥ ይገኛሉ? አለ የለም
ላሞች/በሬዎች/ወይፈኖች ፈረሶች/በቅሎች/ 1 0
ፍየሎች/በጎች / 1 0
ዶሮዎች 1 0
1 0
6.8 የግል ቤት አለዎት? አዎ 1 መልስዎ የለኝም
የለኝም 2 ከሆነ ወደ ጥያቄ
6.12 ይለፉ
6.9 የዋናው ቤት ጣሪያ የተሰራው ከምንድን ነው? ከአርማታና ሲሚንቶ 1
ከጭቃና እንጨት 2
ሌላ ካለ ይጥቀሱ ____
6.10 የዋናው ቤት ወለል የተሰራው ከምንድን ነው? ከአፈር = 1
ከእበት= 2
ከሲሚንቶ= 3
ከእንጨት= 4
ከፕላስቲክ ንጣፍ= 5
ከጡብ/ሸክላ= 6
ሌላ (ይገለፅ)=7-----------
6.11 የዋናው ቤት ግድግዳ የተሰራው ከምንድን ነው? ከእንጨትና ከጭቃ= 1
ከቀርቃሃና ከሸንበቆ=2
ከጭቃና ከድንጋይ= 3
ከድንጋይና ከሲሚንቶ= 4
ከብሎኬት= 5
ከጡብ= 6
ሌላ (ይገለፅ))= 7-------------
6.12 የቤተሰብ ዋና የምግብ ምንጭ የግል ምርት 1
በመግዛት 2
ከመንግስት ድጋፍ 3
መንግስታዊ ካልሆነ ድጋፍ 4
6.13 የግል እርሻ አለዎት? አዎ 1
የለኝም 2
740 | P aየትምህርት
g e ደረጃ 1.ማንበብ መፃፍ የማትችል
2. ማንበብ መፃፍ(መሰረተ ት/ት)
3. 1 ናኛደረጃ (1-8)
4. የሁለተኛ ደረጃ ትምህርት(9-12)
5. ከፍተኛ ደረጃ(ሙያናቴክኒክ/ኮሌጅ ዩኒቨርሲቲ)
ክፍል ሦስት፡ ምግብ ነክ ጥያቄዎች
21 የተቋም የምግብ ድጋፍ 1.አለ 2. የለም
22.የ 24 ሰአት ትዉስታን መሰረት በማድረግ የአመጋገብ ሁኔታን የምንለካበት ዘዴ የምግብ አይነት ዝርዝሮችን በማንበብ የጥናቱ ተሳታፊ በ
24 ሰአት ዉስጥ በምግብ አይነቶች ስር ከተዘረዘሩት ምግቦች ቢያንስ አንዱን ከተመገበ በሳጥኑ ዉስጥ 1 ን ያስቀምቱ ካልተመገበ ደግሞ 2 ን
ያስቀምቱ፡
ተ.ቁ የምግብ አይነት በአካባቢው የሚገኙ የምግብ አይነቶች ዝርዝር 1.አወ
2.የለም
22.1 እህል እና የእህል ዉጤቶች በቆሎ፣ ዳቦ፣ ፓሰታ፣ አንጀራ፣ ሩዝ፣ ቂንጨ፣ ስንዴ ወይም
የቦቆሎ ንፍሮ
22.2 ቅጠላቅጠል ያበሻ ጎመን፣ ጥቅል ጎመን፣ ሰላጣ፣ ቆስጣ፣ ቲማቲም፣
ቃሪያ፣ ሽንኩር
22.3 ፍራፍሬዎች ሙዝ፣ ማንጎ፣ ብርቱካን፣ ፓፓያ፣ ሎሚ
22.4 ስራ ስር ትድንች፣ ቀይስር፣ ስኳር ድንች፣ ካሮት፣ ዱባ
22.5 ስጋ እና የስጋ ስጋ ቅቅል፣ ስጋ ጥብስ፣
22.6 እንቁላል እንቁላል ጥብስ፣ ቅቅል
22.7 ከእንሰሳት የሚገኙ ዋና ዋና አካላት ምግቦች ጉበት፣ ኩላሊት፣ ልብ
22.8 ጥራጥሬ ባቄላ፣ አተር፣ ሽምብራ፣ ምስር፣ ጓያ፣ ሰሊጥ፣ ሱፍ
22.9 ወተት እና የወተት ዉጤቶች ጥሬ ዎይም የተፈላ ወተት፣ እርጎ፣ አይብ፣ አጓት፣ ጠለላ
22.10 ቅባት እና ዘይት ቅቤ፣ ዘይት
22.11 ስኳር እና ማር ሻይ፣ ማር፣ ቢሲኩት፣ ከረመላ፣ ብስኩት፣ ኩኪስ፣ ኬክ፣
ችኮሌት
22.12 ቅመማ ቅመምና የሚጠጡ ምግቦች ቡና፣ ጠላ፣ ቢራ
23. በቤተሰብ ደረጃ የምግብ ዋስትናን አስመልክቶ የምንለካበት ዘዴ
23.1 ባለፉት አራት ሳምንታት በቤተሰብ ደረጃ በቂ ምግብ 0 = የለም (ወደ ቁጥር 23.2) 1=አዎ
አይኖርም በሚል ጭንቀት ላይ ነበሩ ?
23. ለምን ያክል ጊዜ ተከሰተ? 1= አንዳንድ ጊዜ፣ እንብዛም (በአራት ሳምንት ዉስጥ አንድ ጊዜ
1a ወይም ሁለት ጊዜ)
2= አልፎ፣አልፎ (በአራት ሳምንት ዉስጥ ከ 3-10 ጊዜ)
3= ብዙ ጊዜ ((በአራት ሳምንት ዉስጥ ከ 10 ጊዜ በላይ)
23.2 ባለፉት አራት ሳምንታት በቤት ዉስጥ የምግብ እጥረት 0= የለም (ወደ ቁጥር 23.3)
በመኖሩ ምክኒያት የሚፈልጉትን የምግብ አይነት
ለቤተሰብዎ አባል መመገብ አልቻሉም ነበር? 1= አዎ
23.2a 1= አንዳንድ ጊዜ፣እንብዛም (በአራት ሳምንት ዉስጥ አንድ ጊዜ
ለምን ያክል ጊዜ ተከሰተ? ወይም ሁለት ጊዜ)
2= አልፎ፣ አልፎ (በአራት ሳምንት ዉስጥ ከ 3-10 ጊዜ)
3= ብዙ ጊዜ ((በአራት ሳምንት ዉስጥ ከ 10 ጊዜ በላይ)
23.3 ባለፉት አራት ሳምንታት በቤት ዉስጥ የምግብ እጥረት 0= የለም (ወደ ቁጥር 23.4)
በመኖሩ ምክኒያት እርስዎ ወይም የእርስዎ ቤተሰብ 1 = አዎ
የተወሰኑ የምግብ አይነቶችን በቤተሰብ ደረጃ ለመመገብ
ተገደዉ ነበር?
23.3a ለምን ያክል ጊዜ ተከሰተ? 1 = አንዳንድ ጊዜ፣እንብዛም (በአራት ሳምንት ዉስጥ አንድ ጊዜ
ወይም ሁለት ጊዜ)
2 = አልፎ፣አልፎ (በአራት ሳምንት ዉስጥ ከ 3-10 ጊዜ)
3 = ብዙ ጊዜ ((በአራት ሳምንት ዉስጥ ከ 10 ጊዜበላይ)
23.4 ባለፉት አራት ሳምንታት ዉስጥ የሚፈልጉትን የምግብ 0 = የለም (ወደ ቀጥር 23.5)
አይነት በማጣትዎት ምክንያት እርስዎ ወይም የእርስዎ 1 = አዎ
ቤተሰብ የማይፈልጉትን ምግብ ለመመገብ ተገደዋል?
23.4a ለምን ያክል ጊዜ ተከሰተ? 1= አንዳንድ ጊዜ፣እንብዛም (በአራት ሳምንት ዉስጥ አንድ ጊዜ
ወይም ሁለት ጊዜ)
41 | P a g e
 2= አልፎ፣አልፎ (በአራት ሳምንት ዉስጥ ከ 3-10 ጊዜ)
3= ብዙ ጊዜ ((በአራት ሳምንት ዉስጥ ከ 10 ጊዜ በላይ)
23.5 ባለፉት አራት ሳምንታት በቤት ዉስጥ በቂ ምግብ 0 = ለም (ወደ ቁትር 23.6)
ባለመኖሩ ምክኒያት እርስዎ ወይም የእርስዎ ቤተሰብ 1 = አዎ
የሚፈልጉትን ያክል ምግብ መመግብ አልቻሉም ነበር?
23.5a ለምን ያክል ጊዜ ተከሰተ? 1= አንዳንድ ጊዜ፣እንብዛም (በአራት ሳምንት ዉስጥ አንድ ጊዜ
ወይም ሁለት ጊዜ)
2= አልፎ፣ አልፎ (በአራት ሳምንት ዉስጥ ከ 3-10 ጊዜ)
3= ብዙ ጊዜ (በአራት ሳምንት ዉስጥ ከ 10 ጊዜ በላይ)
23.6 ባለፉት አራት ሳምንታት በቤት ዉስጥ በቂ ምግብ 0 = የለም (ወደ ቁጥር 23.7)
ባለመኖሩ ምክኒያት እርስዎ ወይም የእርስዎ ቤተሰብ በቀን 1 = አዎ
አነስ ያለ ምግብ ለመመገብ ተገደዉ ነበር?
23.6a ለምን ያክል ጊዜ ተከሰተ? 1= አንዳንድ ጊዜ፣እንብዛም (በአራት ሳምንት ዉስጥ አንድ ጊዜ
ወይም ሁለት ጊዜ)
2= አልፎ፣አልፎ (በአራት ሳምንት ዉስጥ ከ 3-10 ጊዜ)
3= ብዙ ጊዜ ((በአራት ሳምንት ዉስጥ ከ 10 ጊዜ በላይ)
23.7 ባለፉት አራት ሳምንታት በቤት ዉስጥ በችግር ምክንያት 0 = የለም (ወደ ቁጥር 23.8)
ምንም አይነት የሚበላ ነገር አልነበረም ወይ? 1 = አዎ
23.7a ለምን ያክል ጊዜ ተከሰተ? 1= አንዳንድ ጊዜ፣እንብዛም (በአራት ሳምንት ዉስጥ አንድ ጊዜ
ወይም ሁለት ጊዜ)
2= አልፎ፣አልፎ (በአራት ሳምንት ዉስጥ ከ 3-10 ጊዜ)
3= ብዙ ጊዜ ((በአራት ሳምንት ዉስጥ ከ 10 ጊዜ በላይ)
23.8 ባለፉት አራት ሳምንታት በቤት ዉስጥ በቂ ምግብ 0 = የለም (ወደ ቁጥር 23.9)
ባለመኖሩ ምክኒያት እርስዎ ወይም የእርስዎ ቤተሰብ 1 =አዎ
እየራባቸዉ ተኝተዉ ነበር?
1= አንዳንድ ጊዜ፣ እንብዛም (በአራት ሳምንት ዉስጥ አንድ ጊዜ
23.8a ለምን ያክል ጊዜ ተከሰተ? ወይም ሁለት ጊዜ)
2= አልፎ፣አልፎ (በአራት ሳምንት ዉስጥ ከ 3-10 ጊዜ)
3= ብዙ ጊዜ (በአራት ሳምንት ዉስጥ ከ 10 ጊዜ በላይ)
23.9 ባለፉት አራት ሳምንታት በቤት ዉስጥ በቂ ምግብ 0 = የለም (ጥያቄዉ ተጠናቀቀ )
ባለመኖሩ ምክኒያት እርስዎ ወይም የእርስዎ ቤተሰብ ሙል 1 = አዎ
ቀን እና ለሊት ምግብ አልተመገቡም ነበር ?
23.9a ለምን ያክል ጊዜ ተከሰተ? 1= አንዳንድ ጊዜ፣እንብዛም (በአራት ሳምንት ዉስጥ አንድ ጊዜ
ወይም ሁለት ጊዜ)
2= አልፎ፣አልፎ (በአራት ሳምንት ዉስጥ ከ 3-10 ጊዜ)
3= ብዙ ጊዜ ((በአራት ሳምንት ዉስጥ ከ 10 ጊዜ በላይ)
ክፍል አራት፡ አካባቢያዊ ጥያቄ
24 ሽንት ቤት አለዎት 1.አዎ 2.የለም
25 መልስዎ አዎ ከሆነ ምን አይነት ነው? በውሃ ታጥቦ ወደ ፍሳሽ ማስወገጃ የሚለቀቅ= 1
ዘመናዊ ማስተንፈሻ ያለው መፀዳጃ ቤት= 2
በሲሚንቶ ስላብ (በአርማታና ብረት) የተሰራ መፀዳጃ ቤት= 3
ስላብ የሌለው መፀዳጃ ቤት(ክፍት)= 4
ማብላያ ጉድጓድ = 5
ጫካ/ሜዳ = 6
ወደ እርሻ ቦታ/ማሳ መጣል=7
26 ለቤተሰብዎ የመጠጥ ውሃ ከየት ያገኛሉ? 1.ከወንዝ 2.ያልታጠረ የጉድጓድ ዉሀ 3.የታጠረ የጉድጓድ ዉሃ
4.የጋራ ቦኖ 5. ሌላ ይበራራ
27 በቀን የቤት ውስጥ የዉሃ ፍጆታችሁ ምን ያህል ነዉ ---------------------------- ሊትር
28 በአብዛኛው ውሃ ቀድቶ ለመመለስ ምን ያህል ጊዜ በደቂቃ-------------
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 ይወስዳል?
29 ዉሃ ንፅህናዉ የተጠበቀ እና ለጤና ተስማሚ እንዲሆን 1.አዎ
ያክሙታል ወይ?(የዉሃ እቃ ማጠብ የሚለዉን 2.የለም
አያካትትም)
Anthropometrical measurement
30 ክብደት ---------ኪ/ግ
31 ቁመት ---------ሜ
32 BMI --------

Declaration

I, the undersigned, MSC student declare that this research proposal is my original work in partial
fulfillment of the requirement for the degree of Master in Applied human nutrition.

Name: Anbesaw Mitiku

Signature: ______________
Place of submission: Institution of public Health, College of Medicine and Health Sciences,
University of Gondar.

Date of Submission: ____________________________

This research proposal work has been submitted for examination with our approval as university
advisor(s).

Advisors name Signature

1. Mr Tadese Awoke(Ass. Professor) _____________________

2. Mr. Amare Tariku (MSc) _____________________

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