Chapter one

1. Introduction
1.1 Background
Community based training program Community Based Training is an on-site training program
tailored to an employer’s specific hiring needs. The training takes place in the actual work area
in the workplace, and a professionally trained job coach is located on-site to provide additional
support in training. CBTP (community based training program) is one parts of community based
education (CBE) which is designed to train health science students, about community diagnosis
to identify the problems related to health in the community, it provide health science students to
apply the theoretical knowledge in to practical application.(1)
The health policy in Ethiopia also takes into account broader issues such as population dynamics,
food availability, acceptable living conditions, and other essentials of better health. The HSDP
prioritizes maternal and newborn care, and child health, and aims to halt and reverse the spread
of major communicable diseases such as HIV/AIDS, TB, and malaria. The Health Extension
Program (HEP) serves as the primary vehicle for the prevention, health promotion, behavioral
change communication, and basic curative care. The HEP is an innovative health service
delivery program that aims at universal coverage of primary health care.(2)
The program is based on expanding physical health infrastructure and developing Health
Extension Workers (HEWs) who provide basic preventive and curative health services in the
rural community sustaining a healthy community is the goal of every part of the world. However,
achieving this goal requires careful planning and organized community members, health
organizations, academic institutions, and various government agencies. Although, in terms of
education, technology, health resources, and per capita purchasing power are higher in United
States, it fails to deliver the best health care at a reasonable cost. About 45 million (15.6%) US
population is not covered by health insurance [2]. The United States, which spends 16% of its
GDP on health care, spends more on health care per capita than any other industrialized country.
For example, Switzerland and Germany (which also spend a relatively high percentage of their
GDP on health care) each spend 11% of their GDP on health care (3).
Neglected populations living under poverty throughout the developing world are often heavily
burdened by communicable and non-communicable diseases, and are highly marginalized by the
health sector due to their limited access to health and social support services. The population
density and diversity of urban communities offers formidable challenges for healthcare delivery.
(4)
The constant mobility (within urban areas, rural–urban–rural cycles) further complicates the
delivery of appropriate health interventions. The current approaches and systems in urban areas
are unable to reach agreed-upon goals and targets (e.g., the MDGs, RBM, national targets).
Without improved delivery of health services, the present obstacles– accessibility, affordability
and utilization of the health systems-will perpetuate disparities and likely increase the risk
factors, incidence and prevalence of treatable and manageable health conditions as the size of
vulnerable and marginalized urban populations grows. Reduction in disease burden would enable

1
these communities and groups to become more economically active and, thereby, further reduce
the socioeconomic factors contributing to disease occurrence.(5)
Achieving reduction in disease burden lies in ensuring available health interventions reach at
risk. Many simple, affordable and effective disease control measures have had limited impact
due to poor access especially by the poorer populations (urban and rural) and inadequate
community participation (6).
‘Community Directed Interventions(CDI) for major health problems in Africa’ was found to be
effective and efficient thus providing overwhelming evidence for its use as a strategy in
delivering multiple interventions at the community level in rural Africa should be mandatory.
There is thus a need to test the feasibility, acceptability and effectiveness of the CDI strategy.(7)
During 2011-12, the World Health Organization’s Special Program for Research and Training in
Tropical Diseases (TDR) sponsored a multi-country situation analysis in four large and medium-
sized urban settings throughout Africa-including Ghana (Bolgatanga, Wa), Liberia (Monrovia),
Nigeria (Ibadan) and the Democratic Republic of Congo (Kinshasa) - to explore the feasibility of
the CDI approach in addressing multiple disease intervention in urban communities (8).
Maternal mortality is unacceptably high. Most maternal deaths are avoidable, the health care
solutions to prevent or mange complications are well known. An important component of effort
to reduce health risks to mothers and children is increasing the proportion of babies that are
delivering in health facilities.
Each year around four million newborns die in the first week of life worldwide especially in low
and middle-income countries where majority of deliveries occur at home and without the
assistance of trained attendants (1). Globally about 585,000 women die each year due to
conditions related to pregnancy and child birth 99% of which occur in developing countries.
Over three quarter of maternal deaths is due to causes directly related to pregnancy and
childbirth (3).
More than 60% of maternal deaths occur immediately following delivery, with more than half
occurring within a day of delivery. Skilled attendance during labor, delivery and the early post-
partum period could reduce an estimated 16–33% of maternal Deaths. However, only 61% of
births are attended by a skilled health worker globally. In spite of the national and global efforts
at reducing maternal morbidity and mortality through the safe motherhood initiative, there is no
significant reduction in maternal morbidity and mortality in developing countries Access to
skilled delivery care is very low in sub-Saharan Africa, where half (50.4%) of all maternal deaths
occur(4).
In Ethiopia, institutional delivery is very low as compared to other countries; only ten percent of
women give birth at health facilities. Over 90% of the deliveries take place at home and mostly
without the assistance of medically trained personnel (3).
Giving birth in a medical institution under the care and supervision of trained health-care
providers promotes child survival and reduces the risk of maternal mortality, However Ethiopian
Demographic and Health Survey (EDHS) of 2005 and 2011, shows that still there are some
factors that influence choice of place of delivery need to be explored. The total latrine coverage

2
of Ethiopian is 45.4% without slave and more than half of household i.e. 54% in Ethiopian has
access of drinking water. The crude birth rate of country is 23.3% and mortality rate is 9.3 per
1000 people. Prevalence of disease in Ethiopia affect around 68% of the population is malaria.
(7)

3
1.2 Statement of problem
Ethiopia is one of the developing country in which most of its population (85%) mainly depends
on agricultures(7). Different factors like lack of professional committeemen, population
awareness about the problems of waste disposal, adequate and necessary medical equipment,
inaccessible health facility and low health seek behavior leads to the community to have low
health status. Communicable dieses, nutritional problems, maternal and child health problems are
the major challenging health care related problems in Ethiopia.

Even though the sanitary coverage is relatively good, there is still lack of proper utilization of
latrine. Although the towns’ municipalities and rural peoples had being attempting to manage the
solid and liquid waste by converting in to compost for agricultural activities, there is a problem
in collection, transportation, and disposal of wastes on time as a result this the community is
exposed to different communicable diseases.
HIV/AIDS is universal in Ethiopia where 97% of women and 99%(EDHS2011) of men have
heard of AIDS. Awareness doesn’t very much by back ground characteristics except by
education those with no education being less likely to have heard of HIV/AIDS. Ethiopia has the
3rd highest population of HIV infected person in the world which accounts 9% of world HIV
cases(9).
The majority of Ethiopians have a little or no education with female even less educated than
males 52% of female and 35% of males have never attended school(7).
Environmental health activities of Ethiopia are maintained and used as a means to control disease
and promoted health during period of basic health provision during 1950-1960 and primary
health care during 1970-1990 and currently in the health sector development program(HSDP),
water sanitation and environmental health induce disease are predominant and have had a huge
public health challenges for long period of time in Ethiopia. Access to safe drinking water and
provision of personal hygiene in Ethiopia is very slow and doesn’t attain the minimum
recommendation set by WHO.
Indicator reported by WHO estimates that of 210 million pregnancy occur each year above 48
million (21%) end in abortion of which 20 million are unsafe. The 2011 EDHS indicates the
maternal mortality ratio for Ethiopia for Ethiopia is 676 deaths per 200,000 live births. As far as
mother health is concerned, Ethiopia is ranked 20th among 40 least developed countries and
concerning child health 32th out of 42 least developed countries. Every year 381,000 children in
Ethiopia die in their 5th birth day. In Ethiopia the level of maternal mortality and morbidity are
highest in the world.

4
As most of health related problems in Ethiopia are preventable, community health assessment is
an important tool to identify health status, health related problems, and factors that could affect
the society’s health. The result of this survey can be used by governmental and non-
governmental institutions to solve the community health related problems.
1.3 Significance of the study
As most of the health related problems in Ethiopia are preventable and minimized by good health
services management and strong political commitment as well as community participation,
community health assessment is an important tool to identify health status, health related
problems, and factors that could affect the society’s health. The result of this survey will be used
by governmental and non-governmental institutions to solve the community health related
problems. This study will also be used as a base line data for further study.

5
 Chapter two
2. LITERATURE REVIEW
2.1 Health status in Ethiopia
Ethiopia is characterized by a predominantly rural and impoverished population with limited
access to safe water, housing, sanitation, food and health care. Estimated life expectancy is about
57 years for males and 60 years for females(10). The burden of disease measured in terms of
premature death is estimated at 350 disability adjusted life years lost per 1000 population, which
is the highest in sub-Saharan Africa.
The disease burden responsible for 74% of deaths and 81% of disability adjusted life year lost
per year, is dominated by malaria, prenatal and maternal death, acute respiratory infection,
nutrition deficiency, diarrhea and HIV/AIDS(11). It is also reported that up to 60% of the current
disease burden in Ethiopia is attributable to poor sanitation where 15% of total deaths are from
diarrhea, mainly among the large population of children under five(12).
In addition to the widespread poverty and low income level of the population, a low literacy
rate(mainly among women) and lack of access to health care have contributed to ill health in the
country(13).
2.2 Maternal and child health status
As 2016 EDHS report shows 62% of women who gave birth in the five years preceding the
survey received antenatal care from a skilled provider at least once for their last birth. 32% had
four or more ANC visits for their most recent live birth. Urban women were more likely than
rural women to have received ANC visits(63% and 27%, respectively). 17% of women took iron
supplement during pregnancy, 6% took intestinal parasite drug. One in five women informed of
sign of pregnant complication darning ANC. Less than half 48% of women most recent birth
were protected against neonatal tetanus (14).
Access to proper medical attention and hygienic conditions during delivery can reduce the risk of
complications and infections that may lead to death or serious illness for the mother, baby, or
both. Slightly over 1 in 4 live births were delivered by a skilled provider(28%) or in a health
facility(26%).the percentage of live births delivered by a skilled provider remained virtually
unchanged for a period of 5 years after 2000, but increased substantially after 2005; from 6% in
the 2000 and 2005 EDHS, to 10% in 2011 EDHS, and reached 28% in 2016 EDHS(8,14,15,).

6
18% of births to urban mothers were assisted by a skilled provider and 79% were delivered in a
health facility, as compared with 21% and 20%, respectively, of births to rural women. Mothers’
educational status is highly correlated with whether their deliveries are assisted by a skilled
provider and whether they are delivered in a health facility(14).
A large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery.
Thus, prompt postnatal care for both the mother and the child is important to treat any
complications arising from the delivery, as well as to provide the mother with important
information on how to care for herself and her child. The proportion of women receiving check
up with in 2 of delivery is higher in urban areas than in rural areas, lowest in Oromia and highest
in Addis Ababa, and increases with women’s education and household wealth(14).
Children age 12-23 months is the youngest cohort to have reached the age by which a child
should be fully immunized. According to 2016 EDHS report 39% of children age 12-23 months
have received all basic vaccinations. 165 of children in this age group have not received any
vaccinations. 69% of children have received the BCG, 73% the first dose of the pentavalent
vaccine, 81% the first dose of polio, 67% the first dose of the pneumococcal vaccine, and 64%
the first dose of rotavirus vaccine. 54% of the children have received measles vaccination(14).
Breast feeding is common in Ethiopia with 98% of children ever breast feed. Over half of
children (58%) of children under 6 month in Ethiopia are exclusive breast feed and 17% of
infants <6 month receive complimentary food. On average children breast feed until age of 25
month and are exclusive breast feed (EBF) for 2.3 month. The EDHS measures the children
nutritional status by comparing height and weight measurement against an international
reference standard. According 2016 EDHS 38% of children under 5 are stunted or too short for
their age. Stunting is most common among children of age 24-35 month; it is slightly higher
among male than female children and is least common among children of more educated mother
and wealthier families. 10% of children in Ethiopia are wasted and 3% are severely wasted.
Regional variation exists, with Somali and Afar having the highest percentage of children who
are wasted, 23% and 18%, respectively. 24% of Ethiopian children are under weight or too thin
for their age(14).
According to 2011 EDHS 27% of Ethiopian women are overweight (obese). Women living in
rural area are more likely to be thin than living in urban area (29% versus 20%). Less than 1% of
women took iron tabulate for at list 90 days during their last pregnancy(14).

7
2.3 Awareness about HIV/AIDS transmission and prevention
According to 2016 EDHS 58% of women and 77% of men age 15-49 know that the of HIV
transmission can be prevented by consistent use of condom and 69% of women and 81% of men
know that limiting sexual intercourse to one faithful and uninfected partner can reduce the
chance of contracting HIV/AIDS. HIV/AIDS can be transmitted by breast feeding and the risk of
mother to child transmission can be reduced by taking drug during pregnancy and 48% of
women and 53% of men know that HIV can be transmitted by breast feeding and that the risk of
mother-to-child transmission can be reduced by taking special drugs(14)
Less than 1% women and 1% men age 15-49 report that they had sex with two or more partner in
the past 12 months from this 19 % of them reported using a condom during their last sexual
intercourse. Currently 23% of women and 22% of men have ever been tested and received their
last result. 20% of women and 19% men have been tested for HIV and received their result in the
12 months before the survey. One in five pregnant women in the 2 years before the survey were
tested for HIV. During ANC and received their result. Testing HIV during ANC is more in urban
area (6%) than rural area(14%). According to EDHS 2011 HIV testing of over 15,000 women
age 15-49 year and over 13,000 thousands men age 52-59, 89% of women and 82% men agree to
be tested for HIV. 1.5% of women and men age 15-49 are HIV positive compared 1.4% in 2005
EDHS. Currently HIV prevalence is 1.9% for men(8,15)
HIV prevalence in SNNPR is 0.9% less than 1% of never married women and men are HIV
positive compared with 12% widowed women and 1&5% widowed men. HIV prevalence is also
higher among women and men who are divorced or separated (14,15).
2.4 Sanitation status
Although there are regional variations, it is thought that some kind of latrine access ranges
between 9% in rural areas to 72% in urban areas. This gives national average coverage of 18%
which is mainly traditional latrines made from locally available materials(13). Almost all 95%
households in urban area have access to improved water source compared with 42% households
in rural area. 8% of households use an improved not shared toilet facility, 38% of Ethiopia
households has no toilet facility 44% of houses have dung flour and 41% have earth or land
floor. Rural houses have likely than urban house to have dung floor while urban are more likely
to have cement floor. According to EDHS 2005 an improved source and sanitation of water
supply in urban area 38% of rural area and 12% rural area for improved sanitation(14,15)

8
2.5 Knowledge about family planning
Knowledge of family planning in Ethiopia is nearly universal, 97% of all women and 98% of all
men age 15-49 knows at least one method of family planning. More than one in four married
women’s(27%) currently use modern methods of family planning. Public source such as health
center and governmental health post currently pride contraceptive, to 5% of current use. The
privet medical center supplies contraceptive to 13% of user’s condom are most commonly
obtained at shops (51%) while most other methods are obtained at governmental health center.
Family planning users has almost doubled since 2005, when only 14% of married women were
using modern method. This is primarily due to a continued increase in the use of Injectable
SNNPR. Currently 25% of married women age 15-49 who are using modern method of
FP(8,14).

9
 Chapter Three
3. Objectives
3.1 General objective
 To assess health and health related problems among households in Kidigisa kebele, in Hadiya
zone, 2018

3.2 Specific objectives

 To assess households’ health status
 To determine health related problems among households
 To prioritize major community health problems

10
 Chapter four
4. Methods and material
4.1 Study design
A community based cross-sectional study was conducted to assess health and health related
problems among households in Kidigisa kebele, in Hadiya zone, 2018.
4.2 Study area
The study was conducted at Kidigisa kebele. Kidigisa kebele is found in Lemmo Woreda in
Hadiya zone, SNNPR, Ethiopia. It has 6 sub-kebele/”Goti”. These are Hage, Gabo, Hongorame,
Batena, Duna and Lamisala. In Kidigisa 4979 peoples are live, from these, there are 2480 male,
2499 female. It founds about 6km north east of Hossaina town, 149KM from Hawassa, capital of
SNNPR and 236km south west of Addis Ababa, the capital of Ethiopia.
4.3 Study period
Study was conducted starting from June 11 to June 24, 2018
4.3 Source population
All households in Kidigisa kebele
4.4 Study population
Selected households in Kidigisa kebele
4.5 Study unit
Each household in Kidigisa kebele
4.6 Inclusion and exclusion criteria
4.6.1 Inclusion criteria:
The households of the study in Kidigisa kebele
4.6.2 Exclusion criteria:
• Individual, who were seriously ill.
• A households members who lived for less than 6 month in town
• Absence of household’s members during visit.
 If the person have
 Children age <18 years
4.7 Sample size determination
We could used statistical sample size determination formula to determine study sample size.
Since our study addresses many health problems we tried to indicate many health problem
proportions; proportion of child immunization = 39%, proportion of modern contraceptive use =
35%, proportion of improved sanitation = 47.9% and proportion of HIV test coverage = 41.5.
So, we can take proportion of improved sanitation, because both extremes of p-value decreases
sample size and increases sampling error.
By taking 95% confidence interval, 47.9% proportion and 5% estimate error it can be calculated
as follows:
2
z + p(1 − p)
n=
d2

11
 2
(1.96) + 0.479(1 −0.479)
n=
(0.05)2
= 383.5

Since household numbers in Kidigisa kebele is 1016 which is less than 10,000, we use correction
formula as follows to gate sample size:

n 383.5 383.5
nf = = = =278.5 ≈ 279
n 383.5 1.377
1+ 1+
N 1016

So, we take 307 households as a study sample, by assuming 90% of response rate.

279 + (10%) 279 = 279 + 27.9 = 306.9≈ 307

4.8 Sampling procedure

We were used systematic random sampling. First, the starting household was selected by lottery
method and the remaining households were selected by k-value (interval) formula which is
N 1016
k= = =3.309 ≈ 3 so, each three household starting from the first one will be selected.
n 307

Hongorame gott 52 household

Kidigisa kebele Duna gott 51 household

Sample size n = 307
1016 household Batena gott 51 household

Hage gott 51 household

Lamisala gott 51 household

Gabo got 51 household

Fig. 1. Sample size determination

12
4.9 Variables of the study

4.9.1 Dependent variables

• Hygiene and sanitation problems

• Maternal and neonatal, child health problems

• Major communicable disease and morbidity and mortality problems.

4.9.2 Independent variables

• Health care delivery system

• Socio economic status of the population (sex, age, religion, ethnicity, marital status,
educational status and occupational status)

• Socio cultural factors

4.10 Data collection tool

The data was collected by using structured questionnaire, observation and secondary data like
immunization card. The questionnaire consists of socio demographic situation, vital statistics,
environmental sanitation, mother and child health and diseases condition in the house hold and
other general information.

4.11 Data quality management

To ensure quality, data was cheeked for completeness, accuracy, clarity, and consistency by the
principal investigator. The structured questionnaire was translated to their local language
(Amharic and Hadiygna).

4.12 Data processing and analysis

Tally sheet was used to analyze the data. The results were presented in tables and graphs.

4.13 Ethical considerations

Approval and permission was sought from Ethical Review Board of College of medicine and
health Sciences of Wachemo University. An official letter of cooperation was written from the
Department of public health officer to Kidigisa kebele health post to obtain their consent the
necessary explanation about purpose of the study and its procedures was done informed consent
was also avils from each respondents. Unwilling participants in the study was not be encountered

13
more over any omission was not present to ensure confidentiality anonymous interviewer was
conducted.

4.15 Operational definition

• Health status: The health condition of the community, assessed on morbidity, mortality,
disability and utilization of health services.

• Head of house hold: is a person with either sex, who is considered to be the head by other
member of that house hold, for polygamous wife living in separate house hold, the house hold is
considered to be head only.

• Maternal and Child Health: Include those who are aged 15-49 year women and those under five
years’ old children.

• Live birth: Number of infants born alive during the last 12 months including anyone who were
born alive.

 Still birth: number of infant who shows no sign of life after birth.
 Morbidity: the relative incidence of a particular disease.
 Mortality: the state or quality of being mortal.

Dissemination and utilization of the results

The results of the study will be presented during the presentation scheduled by the department in
CBTP presentation program. The findings of the study will help as base line data for under
taking community services which are one of the activities performed by college of medicine and
health science department of public officer annual activities.

14
 Chapter five

5. Work plan and budget plan

5.1 Work plan

Activities Responsible Time
body 11-13/6/2018 14- 17-19/6/2018 20- 24-
16/6/2018 23/6/2018 26/6/2018
Title Group members
selection
Proposal Group members
preparation
Preparation Group members
of data
collection
tools
Data Group members
collection
Data Group members
processing
and
analysis
Presentatio Group members
n of
findings
Supervisio Group
n of overall supervisors
activities

Table 1: work plan of the study

15
5.2 Budget pla
Cost description Unit cost Multiplying Unit cost × Total
(ETB) factor multiplying (ETB)
factor
Personnel cost Per diem for 125 2 X 10 days 125 x 2 x 10 2,500.0
supervisors(per
day)
Stationary Questionnaire 2 8 2x8 16.0
cost printing
Questionnaire 0.5 384 having 8 0.5 x 384 x 8 1,536.0
duplication pages each
Pen 6 19 6 x 17 102.0
Marker 15 10 15 x 10 150.0
Chalk(pack) 50 1 50 x 1 50.0
Paper(pack) 130 1 130 x 1 130.0
Flip chart paper 8 10 8 x 10 80.0
Transport cost For each 1 19 individuals 1 x 19 x 22 x 1,672.0
individual per travel 22km 4
km for 4 days
Total 6,236.0
Contingency cost(5% of the total cost) = 0.05 x 6,236 = 311.80
Grant total = 6,236 + 311.80 = 6547.80

Table 2: budget plan of the study

16
 Chapter six
6. Results
1. Socio-demographic characteristics

No. Variables Percentage

Frequency
(%)
Female 643 52
1. Sex Male 592 48
Total 1235 100
Head 273 22.1
Spouse 262 21.2
Relationship to the head
2. Son/daughter 632 51.2
of the household
Other relative 68 5.5
Total 1235 100
0 – 6months 20 1.6
½ - 2 yrs 34 2.8
2 – 5 yrs 70 5.7
5 – 15 yrs 308 24.9
3. Age
15 – 25 yrs 357 28.9
25 – 64 yrs 375 30.4
>64 yrs 71 5.7
Total 1235 100
Hadiya 1213 98.2
Kambata 3 0.2
Silte 7 0.6
4. Ethnicity
Gurage 5 0.4
Other 7 0.6
Total 1235 100
Protestant 1054 85.3
Orthodox 85 6.9
Muslim 80 6.5
5. Religion
Catholic 16 1.3
Other 0 0
Total 1235 100
Can’t read & write 419 33.9
Can read only 29 2.3
Can read and write 337 27.3
6. Educational status
Primary 292 23.6
Secondary and above 158 12.8
Total 1235 100
7. Marital status Married 534 43.2
Single 532 43.7
Divorced 52 4.2

17
 Separated 85 6.8
Widowed 32 2.6
Total 1235 100
Farmer 385 31.2
Gov’t employee 100 8.1
Student 230 18.6
Merchant 159 12.9
Unemployed 137 11.1
8. Occupational status
Tella seller 1 0.08
Housewife 173 14
Wood carver carpenter 0 0
Other 50 4.04
Total 1235 100

400

350

300

250
frequency

200

150

100

50

0
0 -6 months 1/2 - 2 yrs 2 - 5 yrs 5 - 15 yrs 15 - 25 yrs 25 - 64 yrs >64 yrs
Age

Fig. 2. Age of the population

1.1. Means of communication

No. Variables Frequency Percentage

(%)
1. Yes 192 62.5
Radio No 115 37.5
Communication

Total 307 100

Yes 238 77.5
Television No 69 22.5
Total 307 100
Telephone/cell Yes 306 99.7
phone No 1 0.7
Total 307 100

18
 Yes 0 0
Public
No 307 100
telephone Total 307 100
Yes 0 0
News paper No 307 100
Total 307 100
Yes 0 0
Postal system No 307 100
Total 307 100
1.2. Family income

No. Variables Percentage

Frequency
(%)
<1000 83 27
Monthly income

1000-2000 93 30.1
2000-3000 63 20.5
1. 3000-4000 40 13
4000-5000 15 4.9
>5000 13 4.5
Total 307 100
2. Additional income Yes 112 36.5
No 195 63.5
Total 307 100

2. Vital statistics

2.1. Birth
No. Variables Frequency Percentage
Yes 47 15.3
1. Is there any birth? No 260 84.7
Total 307 100
15 – 20 2 4.3
20 – 30 35 74.5
2. Age of the mother
30 – 40 10 21.2
Total 47 100
Live birth 45 95.7
3. Status of birth Still birth 2 4.3
Total 47 100
Female 19 40.4
4. Sex of the birth Male 28 59.6
Total 47 100
Home 8 17
5. Place of delivery Health facility 39 83
Total 47 100
5. Attendant of TTBA 8 72.3
delivery Professional 39 19
Untrained TTBA 0 8.5

19
 Total 47 100

17%

TTBA
Professional
untrained TTBA

83%

Fig. 2 Place of delivery

2.2. Morbidity
No. Variables Frequency Percentage
Is there anyone Yes 51 16.6
1. seek during last 2 No 256 83.4
weeks? Total 307 100
Female 23 45.1
2. Sex Male 28 54.9
Total 51 100
Fever 17
Diarrhea 15
3. Ailments
Cough 14
Other 15
Yes 57 58.76
Did seek any
4. No 40 41.24
help?
Total 97 100
Health institution 35 54.7
Traditional health 20 31.3
5. Place of treatment
Home level 9 6.3
Total 64 100

2.3. Mortality
No. Variables Frequency Percentage

20
 Yes 25 8.4
1. Is there any death in
No 272 91.6
the last 12 months?
Total 297 100
Female 14 56
2. Sex of the dead Male 11 44
Total 25 100
0 - 4 yrs 5 20
5 – 15 yrs 3 12
16 – 25 yrs 3 12
3. Age at the dead
26 – 64 yrs 9 36
>64 yrs 5 20
total 25 100

2.4. Migration
No. Variables Percentage
Frequency
(%)
Yes 229 74.6
Is there any migration in
1. No 78 25.4
the house?
Total 307 100
Female 82 32.3
2. Sex of migrant Male 172 67.7
Total 254 100
<15 yrs 6 2.4
15 – 20 yrs 80 31.5
3. Age of migrant
>20 yrs 168 66.1
Total 254 100
South Africa 189 74.3
USA 10 4
4. Place of migration Europe 2 0.7
Saudi Arabia 53 20.9
Total 254 100
Alive 197 77.5
Current status of Dead 25 9.8
5.
migrant Unknown 32 12.6
Total 254 100
Yes 29 9.5
6. Marriage No 278 90.5
Total 307 100

21
 1%

21%

South africa
USA
Saudi arabia
4%
Europe

74%

Fig. 5. Place of migration

3. Environmental health survey

3.1. Waste disposal

No. Variables Frequency Percentage
Domestic 305 99.3
Commercial 2 0.7
1. Source of waste Industrial 0 0
Other 0 0
Total 307 100
Yes 32 10.4
Schedule to collect
2. No 275 89.6
waste
Total 307 100
Sanitary land field 13 0
Dump in to river 45 28.3
Open dumping 47 19
Disposal system of
3. Burning 112 54.7
waste
Compost 20 5.5
Other 8
Total 307 100
4. Latrine facility Yes 296 96.4
No Is there Yes 8 72.7
adequate space No 3 27.3
for Total
construction of 11 100
a new one?
Is latrine Yes 6 54.5
construction No 5 45.5

22
 affordable? Total 11 100
Total 307 100
Pit 296 100
VIP 0 0
5. Type of latrine
Flush 0 0
Total 296 100
Private 285 96.2
Ownership of the
6. Shared 11 3.8
latrine
Total 296 100
Closed 296 100
Waste disposal
Drain to pipe & then to river 0 0
7. system of the
Clearing the septic tank 0 0
latrine
Total 296 100
<10M 150 50.7
Distance of the 10 – 20 M 146 49.3
8.
house to latrine >20M 0 0
Total 296 100

180
160
140
120
100
frequency

80
60
40
20
0
sanitary land dump in to river open dumping burning compost
field
final disposal system

Fig. 6. final waste disposal system

2.2 water supply
No. Variables Percentage
Frequency
(%)
1. Source of water supply Tap 204 66.45

23
 Well 40 13.01
Stream/river 38 12.38
Other 25 8.14
Total 307 100
For well
Yes 35 87.5
I. Is it protected? No 5 12.5
Total 40 100
Yes 15 37.5
II. Is it downhill from toilet? No 25 32.5
Total 40 100

Yes 68 22.15
Had water purification
2. No 239 77.85
method?
Total 307 100
Boiling 38 55.9
Water purification Traditional filtration 27 39.7
3.
methods Standard filtration 3 4.4
Total 68 100
<40L 124 40.4
40 – 80L 180 58.6
4. Daily water consumption
>80L 3 1
Total 307 100

3.3. Housing condition

No. Variables Percentage
Frequency
(%)
1 44 14.3
2 54 17.4
3 189 61.4
1. Number of rooms
4 20 6.3
>4 2 0.6
Total 307 100
Good 485 60.7
Fair 222 27.8
2. Ventilation
Bad 92 11.5
Total 799 100
Adequate 588 73.6
3. Illumination Inadequate 211 26.4
Total 799 100
Good 404 50.6
Fair 300 37.5
4. Cleanses
Bad 95 11.9
Total 799 100

24
 Yes 137 44.6
5. Crack on floor No 170 55.4
Total 307 100
Cement 206 67.1
Soil 91 29.6
6. Type of floor
Wood 10 3.3
Total 307 100
Good 173 56.4
Fair 92 30
7. Need maintenance
Bad 42 13.6
Total 307 100
1x 64 20.8
2x 123 40.1
Frequency of cleansing
8. 3x 102 33.2
the house
>3x 18 5.9
Total 307 100
Yes 213 69.4
Presence of livestock
9. No 94 30.6
around the house
Total 307 100
Yes 131 61.5
Livestock together with
10. No 82 38.5
human
Total 213 100
Separated room but
96 31.3
attached
Separated room but
11. Type of kitchen 211 68.7
detached
No kitchen at all 0 0
Total 307 100

3.5. Food sanitation

No. Variable Frequency Percentage (%)
Yes 265 86.3
1. Wash hand No 42 13.7
Total 307 100
Yes 279 90.8
2. Washing vegetable No 28 9.2
Total 307 100
Yes 299 97.4
3. Proper cooking No 8 2.6
Total 307 100
Yes 251 81.2
4. Material cleaning frequency No 56 18.2
Total 307 100
5. Prevent contamination Yes 192 62.5
No 115 37.5
Total 307 100
6. Method of preservation Refrigerator 3 0.9

25
 Drying 244 79.5
Other 60 19.5
Total 307 100

3.6. Vector and insect control

No. Percentage
Variables Frequency
(%)
1. Presence of stagnant water Yes 147 42.8
No 160 52.1
Total 307 100
2. Method to control insect Yes 84 52.1
No 63 42.9
Total 147 100
3. Applied method to control Insecticide 53 63.1
insect Insect repellent 0 0
Fumigation 0 0
Bed net 12 14.3
Drain stagnant water 19 22.6
Total 147 100
4. Problem of rodent Yes 246 80.2
infestation No 61 19.8
Total 307 100
5. Applied method to control Poison 89 36.3
rodent Cat 111 45
Mouse trap 46 18.7
Total 246 100

4. Maternal and child health

4.1. Nutritional
4.1.1 Maternal nutrition
No. Variables Frequency Percentage
1x 0 0
2x 74 24.18
1. Diet 3x 182 59.48
4x 50 16.34
Total 306 100
Yes 306 100
2. Dairy food No 0 0
Total 306 100
Yes 306 100
3. Fatty and protein food No 0 0
Total 306 100
4. Staple food Injera 200 -
Bread 258 -

26
 Vegetable & fruit 306 -
Inset 100 -

4.2. Child nutrition

No. Variables Frequency Percentage

Yes 73 92.4
1. Child exposed to sunlight No 6 7.6
Total 79 100
Yes 70 89.7
2. Breast feed the child No 8 10.3
Total 78 100
Yes 53 75.7
3. Currently breast feed No 17 24.3
Total 70 100
Yes 63 79.7
Receive complementary
4. No 16 20.3
food
Total 79 100
<4 months 6 9.5
4 – 6 months 29 46
Age starting
5. 7 – 12 months 18 28.5
complementary food
>12 months 10 15.9
Total 63 100
Cereal only 8 12.3
Cereal & legume 10 15.9
6. Combination of food Milk alone 6 9.5
Milk, cereal & legume 39 61.9
Total 63 100
Once 0 0
Twice 15 23.8
Frequency of child
7. 3x 33 52.4
feeding
>3x 15 23.8
Total 63 100
Responsive 39 61.9
8. Feeding style Controlling 14 22.2
Laissez-faire 10 15.9
Total 63 100

27
 35

30

25

20
frequency

15

10

0
<4 months 4 - 6 months 7 - 12 months >12 months
Age

Fig. 7. age starting complementary food

Anthropometric measurements recording form for <5 years children

No. Name of child House no. Age Sex MUAC in Nutritional
cm. oedema
0,+,++,+++

4.2. Child immunization

No. Variables Percentage
Frequency
(%)
1. Child <2years Yes 54 17.59
No 253 82.41
Total 307 100
2. Is the child Yes 29 53.7
vaccinated? No 25 46.3
Total 54 100
3. Had vaccination Yes BCG &OPV0 10 -
card? Opv1&Penta1,PCV1 10 -
&Rota1
Opv2&Penta2,PCV2&Rota2
Opv1&Penta1,PCV1
&Rota3

28
 Measles 10 -
Vitamin-A 10 -
Deworming Yes 6 -
No 4 -
No 19 -
4.3. Maternal health
4.3.1. Antenatal care

No. Variables Frequency Percentage (%)

Yes 20 6.510
1. It there pregnant mother? No 287 93.49
Total 307 100
1st 7 35
2nd 6 30
2. Term of pregnancy
3rd 7 35
Total 20 100
Yes 12 60
3. Visit health facility No 8 40
Total 20 100
ANC1 6 50
ANC2 2 16.7
4. ANC care ANC3 3 25
ANC4 1 8.3
Total 12 100
Yes 6 50
5. Tested for HIV No 6 50
Total 12 100
Yes 6 100
6. Know status of HIV No 0 0
Total 6 100
Yes 7 58.3
Did she receive TT
7. No 5 41.7
vaccine?
Total 12 100
TT1 5 100
TT2 0 0
How many times receive
8. TT3 0 0
TT vaccine?
TT4 0 0
Total 5 100

4.4. Family planning

No. Variables Frequency Percentage

1. Know about contraceptive Yes 164 63.3
No 95 36.7

29
 Total 259 100
2 Know about contraceptive Yes Pill 62 -
method Condom 65 -
Injectable 40 -
Norplant 25 -
IUCD 20 -
surgical 4 -
Other 86 -
No 95 -
3. Currently using Yes Pill 17 -
contraceptive Condom 5 -
Injectable 16 -
Norplant 8 -
IUCD 0 -
Surgical 0 -
Other 36 -
Total 82 -
No 100 -

Problems identified

1. Home delivery: - about 82.8% of Kidigisa mothers gave birth in home.

2. Fever: - about 33.3% of morbidity is caused by fever.
3. Diarrhea: - about 29.4% of morbidity is caused by diarrhea.
4. Lack of scheduled program to collect waste: - there is no scheduled waste collection
program for about 89.6% of Kidigisa households.
5. Lack of adequate water supply: - from respondents complain and observation.
6. Lack of separate room for livestock: - about 61.5% of households having livestock live
together with them
7. Problem of rodent infestation: - about 80.2% of Kidigisa households have rodent related
problem.
8. Problem related to child immunization: - 34.1% of 2 years old children do not get
immunization.
9. Antenatal care problem: - about 40% of pregnant women do not visit heath facility for
antenatal care.
10. Lack of knowledge about family planning: - 36% of mothers in Kidigsa do not know
about contraceptive.

30
 Problem prioritization

No Problem Magnitude Severity Sustainabil Community Government Total Rank

identified ity concern concern

1. Home delivery 4 5 4 4 3 20

1. Fever 3 3 4 4 4 18

2. Diarrhea 3 4 4 4 4 19

3. Lack of scheduled 4 3 3 4 3 17
waste collection
program

5. Lack adequate 4 2 3 4 3 16
water supply

6. Living with 4 2 3 3 3 15
livestock

7. Rodent 4 3 3 4 3 17
infestation

8. Child 3 5 4 4 4 20
immunization

9. Antenatal care 3 3 3 3 3 15

10. Lack of 4 3 4 4 4 19
knowledge about
family planning

Swot analysis

31
 Strength

• Team sprit during the entire study

• Groups member commitment

• Groups members strong co-operation with advisors and department

Weakness

• Almost no weakness

Opportunity

• Kidigisa kebele health post and communities’ willingness to give information.

• Provision of necessary materials by the department

Problem faced
• Language barrier

• Houses are placed far apart

• The swampy inter Kebele road

• Unavailability of respondent’s b/c of unwillingness.

• Being unable to respond to some sensitive issues like age& income

• Short period of time to collect data

• Transportation service provider

Solution attempted
• To avoid language difficulties we formed group containing students who can speak
Hadiygna.

• Waiting for the respondents until they give their consent

• Regarding sensitive issues we have attempted to get truth out of the respondents indirectly.

• Re-visiting

• Use time effectively

32
Discussion
From our survey there is high home delivery in Kidigisa kebele that 82.9% of mothers in kebele
gives birth in home which is greater than the result in 2016 EDH which is 74%(___). This is may
be due to lack of knowledge about the importance of delivery in health facility and geographical
location of study area or may be due to bad cultural beliefs about delivery in health facility.
There is low child immunization(34.1%) compared with 39% of EDHS 2016 which is may be
due to inaccessibility in health facilities, low maternal literacy rate.

Our finding is also shows that about 50% of mothers who follows antenatal care received ANC
for at least once and only 8.3% received ANC four times which is lower than EDHS 2016 report
which is 62% and 32% respectively(_). This may be due to low maternal literacy, inaccessibility
in ANC service or low awareness about ANC. There is also evidence that, about 45% of women
in active reproductive age currently use contraceptive methods which is greater than the report in
EDHS 2016(36%); this is may be due to the increasing knowledge about family planning
throughout the country.

There is also high prevalence of diarrhea(29.4) and fever(33.3) in the two weeks before survey
compared with EDHS 2016 which is 12% and 14.3% respectively(__). This is may be due to
lack of improved sanitation, lack of culture of preventing food contamination and lack of clean
water supply.

Conclusion

From our findings we concluded that despite many activities are done by governmental as well
as non-governmental organizations to decrease community health problems, there is high
prevalence of many problems especially among Kidigisa kebele households. This include high
home delivery practice, high prevalence of diarrhea, high prevalence of typhoid fever, lack of
knowledge about family planning, low ANC utilization.

Recommendations

To Hadiya zone health office: - has to plan and allocate enough budget on community health
problems; especially among rural kebeles like kidigisa

To Lemo woreda health office: - has to monitor the activities of each health facilities including
rural kebele health posts.

To kidigisa kebele administration body: - has to facilitate community participation and provide
awareness-increasing training for households in kebele.

To kidigisa kebele health extension workers: - have to increase awareness about problems their
solving methods among households during their outreach activity.

33
34
References

35