CHPTER-ONE

1. Introduction

1.1 Back ground

Community Based Training Program (CBTP) is practice that deals with assessing,
identifying, prioritizing, planning, and intervening health and health related problems of
the community. This work is currently being practiced by many Universities in Ethiopia by
health science students. Arbaminch University is running this program as part of
community based education starting from 2002EC. The main aims of these practices are: to
enable students to work as member of team in addressing the problems raised and faced by
community. It also enables the students to apply their theoretical knowledge and gives
special chance to learn through experience and a real life situation.

Ethiopia has nine regions among which South Nations Nationalities and people (SNNP)
region is the one. The region is supposed to consist of 13 zones and around 7 special
woredas. Gamo- Gofa, which is one of the 13 zones of the region has a total area of 12581.4
square kilometer and consists 15 woredas .Mirab abaya is one of the wordas which is
located 465km from Addis Ababa,240km from Hawassa and 46km from Arbaminch .With
in the worrda there are about 24 kebeles. 4 Health centers,12 Health post,1Preparttory
school , some private clinics and Total population of 98,221.

Birbir kebele is one of above mentioned 24 kebeles which consistes of 8 villages,59 Blocks ,
2145 House hold and total population of 8893. One health center and ……..its average
temperature is 29°C and the average annual rainfall is 900 mm.

Mender 5 and 6…………………………..

Birbir Health center…………….

1.2 STATEMENT OF THE PROBLEM
Community health and health related problems are the problems of all countries in the
world. Developing countries share the highest disease burden in terms of infectious
diseases. Ethiopia is among countries with lowest health status in the world because of
Low socio-economic development, Low standard of living, Poor environmental conditions,
inadequate health services and Extreme resource constraints. The main problems include
high maternal, child and infant mortality. Indicator reported by WHO estimate that of 210
million pregnancy that occur each year. Above 46 million (21%) end in abortion of which
about 20 million are unsafe. Ten percent of Ethiopian births occur in health facilities,
primarily in public sector facilities and also home births are almost twice as common in
rural areas (95%) as in urban areas (50%).

The 2011 EDHS indicates the maternal mortality ratio for Ethiopia is 676 deaths per
100,000 live births. Indicator of maternal and children care at the community and health
facility level demonstrated that the coverage and utilization rate of preventive and
promotive service was very low. Less than 34% of women received ANC and only 24% of
children were fully immunized. There is also variation in vaccination coverage by region
ranging from only 9% of children fully vaccinated in Afar region to 79% in Addis Abeba.

According to 2011 EDHS 43% of women and 64% of men age 15-49 know that the risk of
HIV infection can be reduced by using condom and limiting sex to one faithful, uninfected
partner. This knowledge varies by region from only (6% of women in Somali region to 64%
of women in Tigray region).

The housing condition also indicated in 2011 EDHS that 85% of urban households have
electricity compared with only 5% of rural house hold. Almost all 95% house hold in urban
area have access to improved water source compared with 47% of house hold in rural area.
Overall, just 8% of households use an improved, not shared latrine facility, with nearly 4 in
10 (38%) Ethiopian households have no latrine facility.
A study conducted in Jimma to determine mother’s health seeking behavior showed that
45% were treated in health institution 2-4% at home, 4% by traditional healer and 27%
received no care. . According to 2005(2013) annual clinical report of this health center
malaria was found to be highest prevalent diseases followed by typhoid fever, gastritis and
intestinal parasites in adults. In under 5 children the leading cause of morbidity was
malaria, pneumonia and intestinal parasites.
Ethiopia as one of the countries with low health status and high diseases burden, had
launched an effective program which helps to intervene the community level health
problems by health extension packages in 2003. This program is contributing to many
health improvements in rural parts of the country but still there are lots of works to be
done to improve the health of the population. Therefore our CBTP is expected to be one of
the efforts that advances such struggle one step forward

1.3 SIGNIFICANCE OF THE STUDY

This study enables us to find out major health and health related problem in the
community. More over, the result will help to aware the community and solve their
problems by themselves or in collaboration with the concerned bodies. Our study result
will give some hint for the government and NGOs for intervention and finally this study
result will also serve as a base for further research.
CHAPTER-TWO

2. OBJECTIVES

2.1 GENERAL OBJECTIVE

To assess health and health related problems in Birbir town Village 5 and 6, Gamo Gofa
zone, Southern Ethiopia in 2016.

2.2 SPECIFIC OBJECTIVES

 To describe the environmental health problems of the community

 To identify maternal and child health problems
 To deal with the cause of morbidity and mortality of families
 To identify knowledge of the community towards HIV AIDS
 To explore the awareness of the community towards epilepsy
 To increase the awareness of the community towards mental health problem
 To investigate the practice of appropriate drug usage in the community
 CHAPTER-THREE
3. Methods and material

3.1 Study area and period

The CBTP was conducted in Birbir town Village 5 and 6 . It is bounded by Main road in the
North, Village 7 and Gebeya in the East, Birbir health center in the south & village 3 in the
West. The total population and households in Birbir kebele is 8893 and 2145 respectively.
The study was conducted in February 2016.
3.2 Study Design
Community based cross sectional survey was conducted
3.3 Source population
All households in Birbir town Village 5 and 6
3.4 Study population
All households in Birbir town Village 5 and 6
3.5 Sample size and sampling technique
The predetermined 196 sample was given by the departments
3.6 Data collection tools and procedures
Within birbir kebel we have 4 ketenas and 8 villages by using lottery method we pick Ketena 3 was
selected which contain village 5 and village 6.Ketena 3 have 16 blocks and 511 households .Then the
group members divided in to 16 group start to code each house hold with number. Example A1-A31, P1-
P22.From the coded house hold we select each house hold by simple random Lottery method.

The data was collected using structured interviewer administered questionnaires. The
variables included in the questionnaire are concerned with socio-demographic characteristics,
environmental health, MCH, HIV , psychiatric problems and morbidity and mortality factors of
the community

3.7 Data quality control measures

We were supervised and guided by our instructor from department. Of the teams during data
collection and analysis. The team leaders have been checking the completeness and consistency
of the collected data on daily basis. The data collection was started using the readymade
Amharic version questionnaires by face to face interview after consent was obtained from
interviewee

3.8 Operational definition

Housing condition: - condition of house characterized by infrequent widow opening overcrowding, lack
of sanitation, Kichen and latrine connected with main house

Adequate light:-a house is said to have adequate light if a person standing at mid point in the house
with doors and windows opened can read a sentence with 12 words written by pencil effectively.

Lack of awareness on HIV: - individuals who lack information on prevention, transmission and VCT
service.

Unemployed: - consists of individuals who did not engage in income generating activity.

Early marriage: - Females whose marriage age is <18 years.

High prevalence of insects: - existence of two or more type of insects in a single house

High prevalence of substance: - use of substance by more than 20% of the population.
Poor waste disposal: - disposal of waste everywhere, open filed and container which are not clothed

Low utilization of FP: - utilization of FP less than 70% of women’s of child is bearing age.

3.10 Data Analysis and processing

The questionnaire used for data collection was initially prepared in Amharic and translated into
English language at the time of data analysis and writing the result. The data was analyzed
manually by using scientific calculator and tallying. The results were summarized by using
graphs, pie charts and tables. Data analysis followed by interpretation of graphs, pie charts and
tables according to the frequency and percentages found on the survey.

3.11 Ethical considerations

Arbaminch University College of Medicine and Health science gave information for the
respective administrators of the Arbaminch town as well as the community and we were given
orientation how to contact with the community during data collection. Permission of the kebele
leaders was obtained through an official letter. The respondents were informed and Verbal
consent was obtained by each data collector.

3.12 Dissemination and utilization of results

The result of this study will be compiled with two copies and should be given to respective
departments and CV office of college of medicine and health sciences of Arbaminch university.
Result

Socio demographic data

Among 970 study population 465(%) are males and the rest 505(%) are females

Sex distribution
Sex Male Female

49% 51%

Fig 1 Sex distribution in wuha minch kebele, 2014GC

Age distribution
Infant (≤1) Child (2-11) Adolescent (12-19)
Adult ( 20-45) Old ≥45
2%
11%
15%

41% 31%

Fig 2 Age distribution in wuha minch kebele, 2014GC

 Educational status
35.00%
30.00%
25.00%
20.00%
15.00%
10.00% Percent
5.00%
0.00%
n te ar
y ry n
atio era ir m da atio
uc t n uc
Illi P co ed
r ed Se r
fo e
ed gh
ur Hi
at
otm
N

Fig 3 Educational status in wuha minch kebele, 2014GC

Marital status
57%
60.00%

50.00% 42%

40.00%

30.00%

20.00%

10.00%
0% 0% 0%
0.00%
Single Married Widowed Divorced Separated

Fig 4 Marital status in wuha minch kebele, 2014GC

Part 2 Environmental Health condition
Latrine
Among 204 households 197(99%) have latrine and the rest 3(0.08%) have no latrine. From
those households with latrine 54(26,7%) are communal and the rest 148(73.3%) are individually
owned. From the latrine owners 85(42%) have latrine with hand washing facilities and the rest
117(57.9%) lacks hand washing facilities near the latrine

Hand wahing facility

60.00%
50.00%
Percent
40.00%
30.00%
20.00%
10.00%
0.00%
yes no

Fig 5 Presence of hand washing facility in wuha minch kebele, 2014GC

Waste Disposal
Of 204 households 17(34%) dispose the waste on open fields,62(30.4%) dispose through
municipality and the rest 55(26.96%) dispose through other ways.

Waste disposals
others
27% Digging hole
34%

Municipality
30%

Open dump
8%

Fig 6 Waste disposal place in wuha minch kebele, 2014GC

General sanitary condition
From 204 households 151(74.2) have clean sanitary condition of compound and the rest
53(25.9%) have unclean compound.
Housing condition
Among 204 households 17(8.3%),21(10.3%),65(31.8%),101(47.5%) households have 1,2,3,and
≥4 rooms respectively
From those 17(8.2%),34(16.4%),51(24.7%) and 104 (50.6%) have 1,2,3,and ≥ 4 windows
respectively.
From those having widows 166(81.3%) were opened and the rest 38(18.7%) were closed.
Among those who have 160(78.8%),39(19.2%),4(1.97%) of them open there windows ever day,
some times and never respectively.
From 204 house hold 93(43.2%),57(28.3%),49(24.3%) of them have air entry to there home in
one direction, crossectional and in parallel direction respectively.

Water supply
From 204 households almost all or 100% use Pipe water. From those who use pipe water
185(90.7%) use within the compound and 19( 9.3%) use outside the compound.
Among 204 households 132(59.7%) store in gerikan 9(4%) store in pail and 80(36%) in other
materials.
Among those who use water source outside the compound 6(2.9%) travel greater than 30
minute and the rest 198(97%) travel less than 30 minute to have access of water. The average
amount of water consumption per individual indentified to be ≤ 20 liter in the 74( 36%) and the
rest ≥ 20 liter in 130 (63.7%) households.
Among 80(39%) of house hold having domestic animals 2(2.5%) are living together with
domestic animals ( 97.7%) have separate rooms for the animals .
Rodents and insects
Among 204 house hold 190(93%) of households have rodents and insects the rest 10(6.9%) are
free of this.

Chart Title
1 2 79.90% 3 4 5 6

56.86%
51.96%
38.23%
31.67%

13.73%

Fly Flee Buzz Cockroach Mice Bug

Fig 7 Distribution of insect rodents and vectors in wuha minch kebele, 2014GC

Light adequacy
Of 204 households 196(96%) have adequate light during the day and the rest 8(3.9%) lack
adequate light. Among 204 households 172( 84%) get eatery of sun light and remaining
34(15.7%) have no sun light entry. From those households getting entry of sunlight
61(30%),62(34.4%) and 81 (49.7%) have entry of sun light during morning, after noon and both
respectively.
Maternal and child health
108 (52%) and 76(26.5%) of the respondents had first marriage at age ≥18 and ≤18 respectively;
the rest 20 (11.5%) do not remember their age of marriage.
Among those 137(65.9%),49(23%) had their first child ≥18 and ≤18 respectively; the rest
23(11%) do not remember.
Family planning
Among the surveyed female population 133(65%) use family planning and 55(26.9) do not use it
and 16(7.8%) discontinued the service. Among the discontinued 10(24%) is due to side effect of
the drug,9(21%) is because of husband unwillingness.
Abortion within 12 months
Of the interviewed total respondents 7(3.4%) had experienced abortion and 197(96.6%) did not
experience abortion in the last 12 months. Out of those with history of abortion 3(43%)
performed in health institution the rest 4(57%) at home with unskilled person.
ANC follow up
Among those identified pregnant 6(85.7%) attended ANC follow up at least once and 1(14%) did
not attended ANC follow up due to knowledge gap.
Birth history in twelve month
Among the total respondents 19(9.3) had birth in the last 12months of which 17(89.5%)
delivered in health institution and the rest 2 ( 10.5%) at home assisted by untrained TBA
TT vaccination
Among respondents of female population 89(43.6%) vaccinated TT2+ and the rest 115(56.4)
have not vaccinated against tetanus.

Breast feeding
From estimated under five children 16(19.1%) started weaning early than 6 months and the rest
68(80.9%) started after 6 month. Of those breast feeding history 50(58.8%) had breast feeding
for less than 24 months and the remaining 35(41.2%) had breast feeding for at least 24 month

General health condition of the family

Among the total respondents 21(10.3%) had history of diarrhea in the past two weeks. Among
those 15(17.4%) are under five and 6(5.3%) are above 5 years
HIV/AIDS
Among 204 respondents 198(97%) have awareness on HIV and the rest 6(3%) do not. From
those with awareness of HIV 202(99%),195(95.6%),198(97%),4(1.96%) and 2(0.98%) respond
about unsafe sex ,MTC, Brest feeding, greeting and eating together respectively. Most of them
responded transmission by unsafe sex.

Mental illness
From those who have heard about mental health 173(85%),about 70% said head injury,
substance abuse, God curse as reason for mental illness and the rest 30% said other like
genetics and evil spirit. Among those who consider mental illness treatable condition 171
(84%),51(30%),120(70%) prefer traditional medicine, modern medicine and other as treatment
option.10(4.9%) of the respondent who heard about mental illness perceive it as
communicable. From those who have mental illness 3(1.5%) respondents report that patients
get treatment and the rest 201(99.5%) did not report any treatment history. From those who
know history of treatment 1(33.3%) reported traditional medicine were as 2(66.7%) report
modern medicine.
Knowledge on Epilepsy
Among 204 respondents 154(75.5) have seen epileptic patients and the rest 50(24.5%) did not.
The cause of Epilepsy reported by respondents is evil spirit 63(31.3%),Head injury
79(39.3%),God’s curse 48(23.9%) and other 11 (5.5%)

Drug abuse
Among total respondents 58(28.4%) report that there is drug abusers in their family or in the
surrounding and the respective drugs reported were Alcohol 24 (41.4%),chat 39(67.2%)
cigarette 12 (20.7%) and opiates 9(15%).The reason for drug abuse as reported by the
respondents respectively are recreational purpose 39(48.5%) for alertness 40(50%) as
medication 1(1.25%).Among who reported that the presence of drug user around or in their
family 180(88%) know the effect of the drugs to be mental illness, personality change,
economic and social problems and the rest 24 (11.76) do not mention any effect of it.

substance abue in %
Alcohol Chat Cigarette Cocaine Other
15%

55% 24%

7%

Fig 8 Distribution of substance abuse in wuha minch kebele, 2014G

SWOT analysis
Strength
 We cover the site we have been
assigned timely
 We have communicate with kebel
leaders
 Collaboration of our group members
from three different department
Opportunity
 Community guidance to help us to
identify prevalent problems
 We have the opportunity to observe
actual community problems
 Collaboration with health extension
workers
Weakness
 Due to time and resource limitation did
not do total census and survey.
 Scarcity of resource
 Unable to find out the actual map of
wuhaninch keble
Threats
 Unable to find cards as source of data
from respondents :-e.g. ANC cards and
vaccination cards
 Language barriers
Table 1 Prioritization procedure of identified problems
No Problem Magnitude Severity Feasibilit Government Community total Rank
y concern concern
1 Prevalence of 1 3 3 3 1 11 4th
diarrhea
2 Prevalence of 1 2 2 2 1 8 10th
malaria
3 Early marriage 1 2 1 2 1 7
4 Low utilization of 2 3 3 3 1 12 3rd
family planning
5 Unsafe abortion 1 3 1 2 1 8
6 Low ANC follow 1 1 2 3 1 8
up
7 Home delivery 1 2 1 3 1 8 9th
8 Early weaning 1 2 1 3 1 8
9 Lack of hand 3 3 3 3 1 13 2nd
washing after
latrine usage
10 Poor waste 2 2 2 2 1 9 6th
disposal
11 High prevalence 3 3 2 3 3 14 1st
of insect, rodents
and vectors
12 Inadequate water 1 2 1 1 2 7
supply
13 Poor housing 2 2 2 1 1 8 7th
condition
14 Lack of 1 3 2 3 1 10 5th
knowledge on
HIV
transmission
,prevention and
VCT
15 Lack of 1 2 2 1 1 7
knowledge on
mental health
16 Mis- 2 2 1 1 1 7
understanding on
case of epilepsy
17 Prevalence of 2 2 1 1 2 8 8th
substance abuse

Problem Identified

1. High prevalence of insects, rodents and vectors

2. Lack of hand washing after latrine usage
3. Low utilization of family planning
4. Diarrheal disease
5. Lack of Knowledge on HIV/AIDS transmission
6. Poor waste disposal\
7. Poor housing condition
8. High prevalence of substance abuse
9. Home delivery
10. High prevalence of Malaria
Action
Discussion

Although our community assessment has several limitations including inability to survey or
households of the kebele reporting bias in some personal issues, difficulties in interpreting the
result, we consider it may still contribute to understanding of the health and health related
condition of wuha minch kebele. Consequently, we tried to identify the major problem of
community in the area of environmental health, Mental health, child health, HIV,Drug abuse
and control of rodent insect and vector, in this thematic area of assessment we are glad to see
so encouraging result like on HIV where about 97% of respondent have awareness on its
transmission, prevention and VCT.Probably showing the effective health extension program in
the kebele. On the other hand we could to tired to identify so worrying problems on
environmental and housing conditions where significant proportion of the surveyed Household
are the victims. This finding was also in line and true with the EDHS data and previous report of
CBTP by our seniors.

Also very stressing issue in our study was pressure of substance abuse in the kebele that was
beyond our intervention potential. Lastly but not the least we also tried to find better practices
in the community like ,preference of modern medicine and Public health institutions while they
encounter health problems including mental illness.

Conclusion

In conclusion the health extension program and stalk holders working in different areas of
health matters will be effective in promotion of health of this kebele if they work giving priority
in the above thematic areas.

Recommendation

We would like to recommend the health extension workers to make consistent contact with
each house hold to improve the community

AMU-CMHS to also locate adequate resource including time for students so that they would
learn more and bring positive impact on the promotion of the health status of the community.
4.11 problems faced

- Scarcity of stationary

- Shortage of time
3.12. Action taken

- Team members’ contribution for scarce materials

- Use of part time(night and weekend) in addition to regular working hours