Za

UNITY UNIVERSITY
FACULITY OF HEALTH
SCIENCE DEPARTMENT
OF PUBLIC HEALTH

GROUP-TWO
COMMUNITY BASED
TRAINING PROGRAM

1
Group Members ID

1. ABEL TEKELE UUSCHS 112/12R

2. AMRIYA HUSSEN UUSCHS 203/12R
3. BETELHEM GEZAHEGN UUSCHS 168/12R
4. BETELHEM MEKTEW UUSCHS 116/12R
5. DAWIT SAMUEL UUSCHS 202/12R
6. ENDALE ZELEKE UUSCHS 124/12R
7. EPHREM SISAY UUSCHS 125/12R
8. ESKINIDER SOLOMON UUSCHS 126/12R
9. FIKER BANTIRGA UUSCHS 131/12R
10. HABTAMU MEGERESA UUSCHS 135/12R
11. MEKDES YILMA UUSCHS 098/12R
12. RUTH TARIKU UUSCHS 210/12R
13. RUTH TESFAYE UUSCHS 156/12R
14. YOHANNES MOGES UUSCHS 059/12R
15. TSEGAYE OREBO UUSCHS 190/12R
16. YONATHAN MIRKENA UUSCHS 178/12R
17. ZEYNEBA SEID UUSCHS 152/12R
18. LENSA BELAY UUSCHS 192/12R
19. HAWI MOHAMMED UUSCHS 191/12R

Advisors- Mr.ZELALEM K. (PHD candidate)

Mr. BELACHEW

Submitted to - Department of Public Health

Submission date - Jan 13 2023 G.C
ADDIS ABEBA, ETHIOPIA

i
Acknowledgement

Last but not least, we want to thank ourselves. we want to thank ourselves for believing in ourselves, we
want to thank ourselves for doing all this hard works, we want to thank ourselves for having no days off, we
want to thank ourselves for never quitting, we want to thank ourselves for always be a giver and trying to
give more than we receive, we want to thank ourselves for trying to do more than wrong, we want to thank
ourselves for just trying to do more than expected.

Secondly, we would like to pass our super-sensational gratitude for our college, UNITY UNIVERSITY,
FACLITY OF HEALTH SCIENCE, DEPARTMENT OF PUBLIC HEALTH. Words cannot express our
gratitude to our instructors and advisors Zelalem Kebede (PHD candidate) and Mr. Belachew, for there
invaluable patience and feedback. We also could not have undertaken this journey without them, who
generously provided knowledge and expertise.

Lastly, this endover would not have been possible without the generous support from the Dil-Fre health
center, who helped us very well, Mr. Solomon.

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 Catalog
Acknowledgement ................................................................................................................................... ii
List of Tables ...........................................................................................................................................iv
List of figures .......................................................................................................................................... vi
Acronyms ............................................................................................................................................... vii
Abstract ................................................................................................................................................. viii
Background .................................................................................................................................... viii
Methods ..........................................................................................................................................viii
Results ............................................................................................................................................ viii
Conclusion ......................................................................................................................................viii
CHAPTER 1- INTRODUCTION .......................................................................................................... 1
1.1 BACKGROUND ................................................................................................................................1
1.2 STATEMENT OF THE PROBLEM ...............................................................................................1
1.3 SIGNIFICANCE OF THE STUDY ................................................................................................. 3
1.4 LITRATURE REVIEW ....................................................................................................................3
CHAPTER 2- OBJECTIVE ................................................................................................................... 6
CHAPTER 3- MATERIALS AND METHODS ...................................................................................7
CHAPTER 4- RESULT ........................................................................................................................ 10
4.1. WOREDA 14 HEALTH PROFILE ..............................................................................................10
Figure 4: map of ketena 2 ................................................................................................................ 10
Figure 3: map of ketena 4 ................................................................................................................ 10
Figure 5: map of ketena 1 ................................................................................................................ 10
Figure 6: map of ketena 3 ................................................................................................................ 10
Figure 7: map of ketena 5 ................................................................................................................ 10
4.2 Household result .............................................................................................................................. 15
Birth and death record ..................................................................................................................... 17
Birth and death record in the last 12 months ...................................................................................17
Environmental condition ................................................................................................................. 18
Waste management ..........................................................................................................................19
Solid waste management ................................................................................................................. 19
Liquid waste disposal ...................................................................................................................... 19
Water supply ....................................................................................................................................21
Household eating arrangement ........................................................................................................ 22
Morbidity and movement ................................................................................................................ 23
MATERNAL HEALTH ..................................................................................................................25
CHILED HEALTH ......................................................................................................................... 26
Family asset ..................................................................................................................................... 26
CHAPTER 5- DISCUSSION ................................................................................................................28
CHAPTER 6 ...........................................................................................................................................30
CHAPTER 7-RECOMMENDATION .................................................................................................33
CHAPTER 8- CONCLUSION ............................................................................................................. 34
ANNEX ...................................................................................................................................................35
Annex I ............................................................................................................................................ 35
Annex II ...........................................................................................................................................58

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List of Tables
Table 1: socio-demographic
Table 2: housing condition & water supply
Table 3: socio-infrastructure & services
Table 4: education
Table 5: health infrastructure, work force and coverage
Table 6: maternal health service
Table 7: family planning
Table 8: extended program of immunization
Table 9: socio-economic and demographic result
Table 10: birth and death occurrence
Table 11: liquid waste disposal
Table 12: vermin/insects or rodents in the house
Table 13: types of latrine
Table 14: ways of hand washing
Table 15: when they use the salt
Table 16: morbidity in the household
Table 17: number of diabetic patients
Table 18: number of hypertensive patients

iv
List of figures
Figure 1: map of bole sub-city
Figure 2: map of woreda 14
Figure 3: map of ketena 4
Figure 4: map of ketena 2
Figure 5: map of ketena 1
Figure 6: map of ketena 3
Figure 7: map of ketena 5
Figure 8: level of education
Figure 9: number of rooms
Figure 10: solid waste management
Figure 11: vermin/insects or rodents in the house
Figure 12: types of vermin
Figure 13: water supply
Figure 14: method of water treatment
Figure 15: household eating arrangement
Figure 16: types of salt
Figure 17: symptoms of the illness
Figure 18: where they take the patient
Figure 19: place of where she gave birth
Figure 20: types of family planning
Figure 21: means of verification
Figure 22: family asset

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Acronyms

AIDS: acquired immunodeficiency syndrome

ANC: ante natal care
AURTI: acute upper respiratory tract infection
CBE: community based education
CBTP: community based training program
CHERG: child health epidemiology prevalence group
CPR: contraceptive prevalence rate
DPT: diphtheria, pertussis, tetanus
DTTP: development team training program
IDDs: Iodine deficiency disorder
EDHS: Ethiopian demographic and health survey
EPI: expanded program on immunization
GC: Gregorian calendar
HHs: house holds
Hib: haemophilus influenza type b
HSDP: health sector development program
IUCD: intra uterine contraceptive pill
MEDHS: mini Ethiopian demographic and health survey
NAR: net attendance ratio
OCP: oral contraceptive pill
PNC: post natal care
RAG: reproductive age group
SDGs: sustainable development goal
SRP: student research program
TTP: team training program
UNICEF: united Nations international children emergency fund
UTI: urinary tract infection
USAID: united state agency for international development
VIP: Ventilated improved pit
WHO: world health organization

vii
Abstract

Background
In Ethiopia modern medicine emerge in 16th century during the war of Ahmed Giragn by
contribution of Portugal. Ethiopian health system is improved by train health officers, community
nurses and sanitarians of health center. Recognition of importance of community based training as
community development program solving mechanism was documented since 1940. Addis Ababa's
rapid population growth has created various environmental problems for the city. Serious
environmental and health issues have been caused by the current, disjointed approach to sanitation
and poor waste management. CBE is a community-based training program that involves fieldwork
and desk work.

Methods
The Bole sub-city is one of the largest sub-cities located in the eastern part of Addis Ababa. The
demographic information shows that the total population of woreda 14 is 52113 with 30256 female
and 21857 male. Sample size calculated by taking standard deviation at 95% confidence interval.
Systematic random sampling technique will be employed to select study participants. There are total
of 1221 households using these data 20k' value is determined which is 60 then sampling frame will
be selected using lottery method. For households with no eligible respondent (according to the above
settees of criteria) the immediate next household will be selected and then subsequent households
according to the already pre-determined order. ‘Housing condition’ refers to the area in which he or
she lives, while ‘waste disposal’ means disposing of either solid or liquid wastes on a field for
discarding. Data collected by graduate class students of Unity university group members through
face to face interview. An ecological study triangulated with qualitative design was used. Data were
analyzed using the woreda level and situational analyses. The results of the study will be
disseminated to Unity University, college of Health science department of the Public Health head
and other concerned bodies.

Results
The following is the data that is collected and analyzed from Bole sub-city, woreda 14, Ketena 3, 4
and 5 residents. We interviewed and observe every 173 households and we try to put in a more
relaxed and easily understood manner using different presentation techniques. Religion in bole sub-
city, woreda 14, ketena 4, 5 and half of ketena 3 is, out of 20,146 sample population, 316(48.9%)
were orthodox, 139(21.5%) protestant, 109(16.9) Muslim. Occupational status indicates that most of
the population is students with 219(34.6%). The data collected on death in the family presents in the
last 12 months.
Out of 171 houses in the bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3, 135(78.9%) were
built by brick/concrete, 29(17.0%) by mud, 2(1.2%) by wood and 1(0.6%) by stone. In these 171
houses there are a total of 160 windows. 48(28.1%) houses were good quality of cleanliness of the
compound, 54(31.6%) fair and 64(37.4%) bad. In bole sub-city, out of 171 houses, 151(88.3%) have
latrine, the rest 12(7.0%) does not.

Conclusion
Community based training program make important contributions toward understanding how local
environments impact the health status of a population. Increasing medical record of non-
communicable disease predicted to impede poverty reduction initiatives in low-income countries.
There is also an increased rate of non communicable disease like diabetic mellitus and hypertension.

viii
CHAPTER 1- INTRODUCTION
1.1 BACKGROUND

In Ethiopia modern medicine emerge in 16th century during the war of Ahmed Giragn by
contribution of Portugal, following this 1948 the ministry of public health was created. Ethiopian
health system is improved by train health officers, community nurses and sanitarians of health center.
The recognition of importance of community based training as community development program
solving mechanism was documented since 1940. Community based education has four strategies to
implement its activities. these are community based training program ( CBTP), Team training
program ( TTP), student research program and development team training program ( DTTP) .(1)
Locality in the years to come, ensuring that they are aware of the true issues facing the area. This
will enable them to work with the community and other stakeholders involved in community
development over a prolonged length of time to improve the neighborhood. The primary forces
behind CBTP development are colleges. So, in order to execute CBTP and benefit all stakeholders,
prior planning is essential. The community-based training program (CBTP) offers a well-known
educational philosophy course that aims to benefit both students and society. (2)

One of the elements of CBE, which begins in first year and continues through graduation, is
CBTP. Before being assigned to the community, students get orientation as part of the CBE activity.
The goal of orientation is to familiarize students with the customs and traditions of the neighborhood.
Students must attend orientation because they are coming from many cultural backgrounds and
might not be familiar with the customs and cultures of the community (4).
Additionally, the strategies for developing instruments, gathering data, and cultivating a culture
of teamwork are taught to the students. Both fieldwork and deskwork are involved in the CBE
activity.(1)

Addis Ababa’s rapid population growth has created various environmental problems for the city.
Serious environmental and health issues have been caused by the current, disjointed approach to
sanitation and poor waste management. The study used focus groups and individual interviews with
stakeholder organizations and households in the city's slums and residential neighborhoods to
diagnose the institutional arrangements for trash management. Purposive and stratified cluster
sampling approaches were also used. In the central, densely inhabited, and least well-served by
sanitary facilities regions of the city, the dangers to groundwater and riverine systems were most
prevalent.(5)

There are various stages to this community-based training program. In the first stage, difficulties
were identified through interviews or direct observation of the target farmers' backgrounds, cultures,
resources, productivity, and key resources. A prepared questionnaire was also used to ask them about
the challenges they experienced when it came to raising animals. Among these problems some of
them are as follows; lack of animal feed; Shortage of grazing land, Lack of knowledge how to
conserve animal feed, Poor awareness in employing AI service and so on.(1)

1.2 STATEMENT OF THE PROBLEM

In developing country including Ethiopia there are different problems regarding waste
management, controlling solid waste, iodine deficiency, barriers of education, unsafe water source,
and other health related conditions. (6)

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 The problems of waste management are different for the developing world. Because the
economies of developing countries are usually not as robust as the economies of countries such as
the United States, people in these poorer countries tend to buy fewer products with less packaging,
and they produce less waste than Americans or residents of other industrialized nations. On the other
hand, unlike developed nations, poorer countries in the developing world often have not developed
adequate waste management policies or systems, trash collection services, or government institutions
to properly manage their wastes. As the Web site Fabric of Nature explains:

Most developing countries don't have any organized means of controlling solid waste. Garbage is
rarely even collected on a regular basis. Regulations vary from country to country and from town to
town, and often a small bribe from an apprehended illegal trash dumper will trump enforcement of
official regulations, anyway. Laws are often lax—burning of garbage and open dumping allowed.
Frequently, a lack of funds prevents municipalities in such countries from ever being able to even
create a proper waste management system, in the first place.(7)

Iodine deficiency causes stunted physical and mental growth as well as infertility, lethargy and
cognitive impairment. Although iodine deficiency is endemic in most countries and is therefore a
public health issue, it is preventable through adequate intake of iodine in diet. Recent global data
estimated that 1.88 billion people are at risk of iodine deficiency with 241 million children taking
inadequate iodine in diet. Majority of these children with inadequate dietary iodine intake lives in
Africa and South/South-East Asia. Gains have been made towards the eradication of iodine
deficiency disorders (IDDs) through the universal salt iodization (USI) program which has ensured
greater coverage of iodine intake throughout the world. In developing countries however, the
perennial problem of weaker institutions means that much needs to be done if the goal of eradicating
IDDs are to be realized. This mini-review looks at what steps could be undertaken to maximize the
odds of eradicating IDD through food fortification, strengthening of regulatory institutions,
empowering small-scale salt manufacturers and conscientization of the populace to patronize not
only iodized salt but also iodine-fortified foods.(7)

The barriers of education in the developing countries face many barriers in its quality, such as the
technological advancement are disrupted and the unfair accessibility of education. The poor quality
of education is because of using the traditional ways, and the way of teaching which depend on
native language. On the other hand, the fault in technology distribution for not relevant technology
has high cost when it is available, and the huge lack of experienced teachers when it is available. The
unfair accessibility of education is due the discrimination between cities and rural and gender
discrimination. To summarize, education in the developing countries faces many obstacles in its
core.(6)

Populations in developing countries attempt to access potable water from a variety of sources,
such as groundwater, aquifers, or surface waters, which can be easily contaminated. Freshwater
access is also constrained by insufficient wastewater and sewage treatment.

There is a high consequence of rodents and vermin in pipes can be costly and dangerous. These
pests can cause blocked drains and sewers, which can lead to flooding. They can also chew through
electrical wiring, which can cause fires especially in developing countries. And globally, the most
commonly occurring diseases transmitted through drinking of unsafe water are infectious hepatitis,
cholera, bacillary dysentery, typhoid, paratyphoid, salmonellosis, colibacillosis, giardiasis,
cryptosporidiosis, and amoebiasis. Contaminated water may also cause many more bacterial, viral,
and parasitic diseases. (7)

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1.3 SIGNIFICANCE OF THE STUDY
The significance of this study is to provide important information about disease trends and risk
factors, outcomes of treatment or public health interventions, functional abilities, patterns of care,
and health care costs and use to build a healthy community. Healthy community benefits every
person in it. And community health is one means of achieving a healthy community. The field of
public health aims to protect and improve health by addressing the structures and systems that define
a place. This study recognizes and seeks to support or expand social structures and social processes
that contribute to the ability of community members to work together to improve health, and it can
make an important contributions toward understanding of how local environments impact the health
status of a population.

It also suggests new directions for the future, such as the importance of more closely examining
how age, race, gender, and individual socioeconomic position may affect the impact of community
context on individual health. In fact, recognition of the inequities in health status associated with
poverty, inadequate housing, lack of employment opportunities, and has led to a renewed recognition
that individuals are embedded within social, political, and economic systems that shape behaviors
and access to resources necessary to maintain health. In general according to this study perspective, a
reality exists that is influenced by social, political, economic, cultural, ethnic, and gender factors that
crystallize over time.

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
societies’ health. The result of this study can be used by governmental and non-governmental
institutions to solve the community health related problems. This study can also be used as a base
line data for further study.

1.4 LITRATURE REVIEW

The average household size in Ethiopia is 4.6 persons. Urban households are slightly smaller than
rural households (3.5 persons versus 4.9 persons). Men head the majority of Ethiopian households
(75%), with only 1 in 4 households headed by women. The age distribution of the household
population for children under age 15 accounted for 47% of the population and individuals age 65 and
older accounted for 4%. Overall, 51% of females and 65% of males age 6 and over have ever
attended school. (12)

According to Mini Demographic and Health Survey done by Ethiopian public health institute in 2019,
69% of households have access to an improved source of drinking water, including 87% of urban
households and 61% of rural households. Urban and rural households rely on different sources of
drinking water. The three most common sources of drinking water in urban households are water
piped into the household’s dwelling, yard, or plot (40%); water piped into a public tap/standpipe
(30%). By contrast, rural households obtain their drinking water mainly from public taps/standpipes
(31%) and protected springs (13%). (11)

Overall, 20% of Ethiopian households use improved toilet facilities (42% in urban areas and 10% in
rural areas). More than half (56%) of rural households use unimproved toilet facilities. More than
one in four households (27%) in Ethiopia has no toilet facility (35% in rural areas and 10% in urban
areas). (11)

93% households in Ethiopia use some kind of solid fuel for cooking, with virtually all of these
households use wood. Exposure to cooking smoke is greater when cooking take place inside the

3
house rather than in separate building or outdoors. In Ethiopia, cooking is done in separate building
in 47% households, in 6% households someone smoke inside the house on daily basis. (13)
The age at which child bearing commences is an important determinant of overall fertility as well as
the health and well being of women and children, In Ethiopia, the median age at first child birth
among age 25-49 is 19.2. This means that half of women among 25-49 first give birth at the age of
20. (14)

Health care services during pregnancy and after delivery are important for the survival and well-
being of both the mother and the infant. Skilled care during pregnancy, childbirth, and the
postpartum period is critical in reducing maternal and neonatal morbidity and mortality. (11)

As highlighted in the 2015-16 Health Sector Transformation Plan (HSTP), maternal and newborn
health is a priority for the government of Ethiopia (FMoH 2015). The key components of the HSTP
are delivery at a health facility, with skilled medical attention and hygienic conditions; reductions in
complications and infections during labor and delivery; timely postnatal care that treats
complications from delivery; and education of the mother on care for herself and her infant. The
2019 EMDHS results show that 74% of women who had a live birth in the 5 years before the survey
received ANC from a skilled provider for their last birth. Urban women are more likely than rural
women to receive ANC from a skilled provider (85% and 70%, respectively). ANC from a skilled
provider increases with increasing mother’s education, from 62% among women with no education
to nearly 100% among women with more than a secondary education. Women in the highest wealth
quintile (95%) are more likely than those in the lowest quintile (47%) to receive ANC from a skilled
provider. 43% of women in Ethiopia had at least four ANC visits during their last pregnancy, while
26% of women had no ANC visits. Rural women (29%) were more likely than urban women (15%)
to have no ANC visits. Only 28% of women had their first ANC visit during the first trimester, while
32% had their first visit during the fourth or fifth month of pregnancy and 12% had their first visit
during the sixth or seventh month. Two percent of women did not receive any ANC until the eight
month of pregnancy or later. 43% of women in urban areas received ANC within their first trimester
of pregnancy, as compared with 22% of those in rural areas. (11)

A large proportion of maternal and neonatal deaths occur during the first 24 hours after delivery. For
both the mother and the infant, prompt postnatal care is important in treating complications that arise
from delivery and providing the mother with important information on caring for herself and her
baby. In Ethiopia, 34% of women age 15-49 who gave birth in the 2 years before the survey had a
postnatal check during the first 2 days after birth, while 64% did not receive a postnatal check.
Women who delivered in a health facility were 20 times more likely to have a postnatal health check
within 2 days of delivery than those who delivered elsewhere (60% versus 3%). Forty-eight percent
of urban women received a postnatal check-up within 2 days, as compared with 29% of rural women.
(11)

The first 48 hours is a vulnerable phase in the life of a newborn baby and a period in which many
neonatal deaths occur. Lack of postnatal health checks during this period can delay identification of
newborn complications and initiation of appropriate care and treatment. 35% of newborns had a
postnatal check within the first 2 days after birth, while 63% received no postnatal check. Newborns
delivered in a health facility were much more likely to receive a postnatal health check from a skilled
provider within 2 days than those delivered elsewhere (62% versus 2%). Infants born to urban
women (48%) were more likely than those born to rural women (30%) to receive a check-up within
the first 2 days of birth. The percentage of newborns receiving check-ups within the first 2 days
increases with increasing mother’s education. Twenty-two percent of babies born to women with no
education received a postnatal check-up, as compared with 70% of babies born to women with more

4
than a secondary education .Thirty percent of newborns received a postnatal check-up within 2 days
from a doctor, nurse, or midwife, while 3% received a check-up from a health officer, 1% from an
HEW, and less than 1% from a traditional birth attendant.(11)
In Ethiopia, four in ten children age 12-23 months (39%) received all basic vaccinations at some
time, and 22% received these vaccinations before their first birthday. The vaccination coverage
among children age 12-23 months is highest for the first dose of polio vaccine (81%) followed by
first dose of DPT-HepB-Hib vaccine (73%). (13)

Nutritional status of children: 37% of children under age 5 are stunted (short for their age), 7% are
wasted (thin for their height), 21% are underweight (thin for their age), and 2% are overweight
(heavy for their height). Breastfeeding: Almost all children (96%) born in the 2 years preceding the
survey were breastfed at some point. However, only 59% of infants under age 6 months are
exclusively breastfed. Minimum acceptable diet: Only 11% of children age 6-23 months was fed a
minimum acceptable diet in the 24 hours before the survey. 14% of children have an adequately
diverse diet.

According to DHS 2016 Modern contraceptive use by currently married Ethiopian women has
steadily increased over the last 15 years, jumping from 6% of women using modern contraceptive
method in 2000 to 35% in 2016.(13)

By method, the largest growth has been in injectable use, which expanded from use by 3% of women
in 2000 to 23% in 2016, followed by growth in implant use, from less than 1% of women using in
2000 to 8% in 2016. (13) The use of contraception helps women avoid unplanned or unwanted
pregnancies, and prevent unsafe abortions. Additionally, contraceptive use helps women space the
births of their children, which benefits the health of the mother and child. Although information is
presented here for both women and men, the focus is mostly on women (14). Knowledge of
contraceptive methods does not vary by most background characteristics except region. All currently
married women and men in Addis Ababa know at least one method of contraception, while in Somali
only 79% of currently married women and 83% of currently married men know at least one method
of contraception. (14) The contraceptive prevalence rate (CPR) for currently married women age 15-
49 in Ethiopia is 36%, with 35% using modern methods and 1% using traditional methods. Fifty-
eight percent of sexually active unmarried women use contraceptive methods, with 55% using
modern methods and 3% using traditional methods.(4)

5
CHAPTER 2- OBJECTIVE

2.1 GENERAL OBJECTIVE

 To describe the health and health related profile of Bole Sub City Woreda 14, Addis Ababa,
Ethiopia, 2023.

2.2 SPECIFIC OBJECTIVE

 To assess major morbidity status of the community.

 To assess environmental health and sanitation condition of the community.
 To Identify, plan, organize and implement intervention measures for some of the common health
problem in Bole sub-city woreda 14.
 To prioritize the problems of the community specifically on both communicable and non-
communicable disease.

6
CHAPTER 3- MATERIALS AND METHODS
3.1 STUDY AREA

The Bole sub- city, the focus of this study, is one of the largest sub- cities located in the eastern part
of Addis Ababa. The sub city has 14 woredas (districts) and covers an area of 122.8 km².The study is
conducted in woreda 14. There are 5 ketenas that are administrate under the Woreda 14 and this
study conducted on ketena 3, ketena 4 and ketena 5.The demographic information shows that the
total population of woreda 14 is 52113 with 30256 female and 21857 Male.

3.2 STUDY PERIOD

DECEMBER 12, 2022 G.C - JANUARY 14, 2023 G.C

3.3 STUDY DESIGN

Community based descriptive studies what we selected for the study because we can get easily the
specific characteristics of the interest of the community cross section study design was conducted.

3.4 POPULATION
3.4.1 SOURCE POPULATION
All households of Bole sub city woreda 14.

3.4.2 STUDY POPULATION

Households that are registered and recognize by bole sub city woreda 14 administrative office. And
anyone who is included in nuclear family members that is above 18 years old.

3.5 SAMPLE SIZE DETERMINATION AND SAMPLING PROCEDURE

3.5.1 SAMPLE SIZE DETERMINATION

The sample size calculation was based on standard sample size formula (Cochran formula) for finite
population. Sample size was calculated by taking standard deviation at 95% confidence interval, 5%
margin of error the minimum sample size required for the study 5% non-response rate, since there is
no previous prevalence so we take population proportion 0.5.

Given Required Ketena 1= 1677HHs

Z=1.96 n=? Ketena 2=1803 HHs
P=0.5
Ketena 3=951 HHs
q=1-p
Ketena 4=1221 HHs
e=5%=0.05
N=7343 HHs Ketena 5=1691 HHs
Total HHs=7343 HHs
Solution n=365 for the total HHs, to find
n0= (1.96)20.5(1-0.5) the sample size for each ketenas:-
(0.05)2 For ketena 1= (1677)(365) = 83 HHs
n0= (3.84)(0.25) 7343
0.0025 For ketena 2=89
n0=384 For ketena 3=47
n=384 For ketena 4=62
1+384-1 For ketena 5=84

7
 7343
n=365

3.5.2 SAMPLING PROCEDURE

Systematic random sampling technique will be employed to select study participants. First
ketena 04 is selected randomly using lottery method. Then all households of the ketena will be
numbered and there are total of 1221 households using these data 20k‘ value is determined
which is 60 then sampling frame will be selected using lottery method the first house hold to be
sampled will be determined from the already prepared sampling frame.. After that, starting from
the first household sampling will be under taken accordingly every 20 house. The next ketena is
5 it also like ketene 4 selected randomly and there is the total number of households is ketena 5
totally 1691 households are there and the k’ value for this ketene is 20 the same as ketene 5 so
the sample where selected every 20th house. The final ketene is ketenas 3 the total households
are 951 which is this ketene were given for two groups so our study house is 476 total houses the
k’ value for ketena 3 is 10 so the sample is taken every 10th house of the ketene. For households
with no eligible respondent (according to the above settees of criteria) the immediate next
household will be selected and then subsequent households will be selected according to the
already pre-determined order.

3.6 STUDY VARIABLE

 Age
 Sex
 Religion
 Marital status
 Occupation
 Educational status
 Housing condition
 Latrine usage
 Waste disposal
 Immunization status
 Family planning
 Breast feeding
 Antenatal care
 Occurrence of abortion
 Chronic disease
 HIV/ AIDS condition

3.7 OPRATIONAL DEFINITION

 ADEQUATE LIGHTING/ILLUMINATION OF THE HOUSE - is said if when standing in the
middle of the room, one can read a pencil written word with at least 12 letters.
 UNCLEAN COMPOUND; there is at least piece of paper in the compound.
 IMPROVED LATRINE; Toilet that give service for the residents within a compound.
 IMPROPER WASTE DISPOSAL; disposing either solid or liquid wastes on a field not
organized for discarding.
 ENOUGH WINDOWS – presence of at least two windows in one room
 EPI - is a process of protecting a person from specific disease.
 FAMILY PLANNING – a method used by partners to limit their number of children. It
comprises contraceptives
 CONTRACEPTIVES – any method used to prevent pregnancy

8
 ABORTION – termination of pregnancy before 28 weeks of gestation
 ANTENATAL CARE – is the comprehensive care given to a pregnant lady by health
professionals until delivery
 EXCLUSIVE BREAST FEEDING - is a practice by mothers where newborns are only fed
breast milk and medications up to 6 month
 DURATION OF BREAST FEEDING – is the total duration of breast feeding for the child
which includes the time of exclusive breast feeding as well as after the start of complementary
feeding until he/she is weaned
 MONTH AT WHICH COMPLEMENTARY FEEDING IS STARTED - time at which a child
starts additional foods in addition to mothers‘ milk
 DISABLED - anyone who is impaired to perform something due to physical inability.

3.8 DATA COLLECTION TOOLS

Tools or devices that we used were in the study to gather data such as
 Smart phones
 Laptop computer
 Check list from woreda and health center
 Occasionally observation

3.9 DATA COLLECTION METHODS

A structured questionnaire developed by CBTP our group by English language by Google Form is
used to minimize the cost of hard copy. The data collection procedure is done by graduate class
students of Unity university group members through face to face interview. The data collector is
responsible for describing the purpose of the study, giving orientation, telling clients the importance
of honest and sincere reply, on responding to questions.

An ecological study triangulated with qualitative design was used. For the quantitative study, data
were collected from a systematically selected sample of 174HHs. Data were analyzed using the
woreda level and situational analyses. The SPSS version 25.0 statistical software with descriptive
analysis, the frequency, cross tab was used for analyses.

3.10 DATA ANALYSIS PROCEDURE

Data processed by categorizing and SPPS digital software and using digital calculator. Data analyzed
by calculating frequency and percentage. Findings presented in the form of sentence, figures, tables
and charts.

3.11 DATA QUALITY CONTROL

First all students were oriented by assigned group leaders about producers and process on data
gathering. We all group members doing Checking for completeness, consistency and editing is done
by group members. Rechecking the collected data before entering into statistical calculation, tables
and graphs will be also done.

3.12 ETHICAL CONSIDERATION

To conduct this CBTP ethical approval later was secured from Unity University, faculty health
science, department of public health official letter was delivered to bole sub city, woreda 14, Del-Fre
health administrations.

3.13 DISSEMINATION OF RESULTS

The results of the study will be disseminated to Unity University, college of Health science
department of the Public Health head and other concerned bodies.

9
CHAPTER 4- RESULT

4.1. WOREDA 14 HEALTH PROFILE

4.1.1. GEOGRAPHIC FEATURE

Figure 1: map of bole sub-city figure 2: map of woreda 14

Figure 4: map of ketena 2

Figure 3: map of ketena 4

Figure 5: map of ketena 1

Figure 6: map of ketena 3

Figure 7: map of ketena 5

10
4.1.2 POLITICAL AND ADMINISTRATIVE STRUCTURE
The Woreda consists 5 ketena, 14 mender and 53 blocks. Ketena 1-4 blocks, Ketena 2-12 blocks,
Ketena 3-7 blocks, ketena 4-7 blocks , ketena 5-20 blocks. The power organs of the Woreda are the
woreda council, chief executive, and the standing committee.

4.1.3 SOCIO DEMOGRAPHY

Bole sub city as of 2011 its population was of 328,900. Total population of woreda 14 is 52113
with 30256 female and 21857 Male.

Table 1: socio-demographic

4.1.4 HOUSING CONDITION AND WATER SUPPLY

11
 There is massive demand for serviced, health, affordable housing in the urban areas particularly in

Addis Ababa. There are 7343 households in woreda 14.

Table 2: housing condition and water supply

4.1.5 SOCIO INFRASTRUCTURE AND SERVICES

Socio infrastructure plays, a center role in the development of urban settlements. In investment in
infrastructure, translates in to growth in other sectors of the economy. Social services are services
that can be provided by government, non-government, or individual investors for the benefits of the
urban dwellers, such as education, medical care, housing and other social infrastructure that can be
used to promote the wellbeing of the community. Woreda 14 have different socio infrastructure like
youth recreation place.

12
 Table 3: socio infrastructure and services

4.1.5.1 EDUCATION
Education is the basis of countries social, economic, cultural and political development. In
Ethiopia a remarkable successes has been achieved in improving education coverage in the education
sector by expanding schools all over the country. Still there are challenges pertinent to accesses,
equality, efficiency and promotion of standard education system in the country and sub city. In bole
sub city woreda 14, has education office to manage all levels of schools, both run by the government
and private sectors. Academic and training institutions for computer, colleges are also growing,
particularly with the involvement of private.

Table 4: education

13
 4.1.6 HEALTH INFRASTRUCTURE, WORK FORCE AND COVERAGE
Health status of the community is the essential part for the growth and development of the
country. To address the community health needs one country needs health care institutions with fully
equipped materials and health workers accessible to the community. Ethiopia strategy for health
focuses on prevention of communicable diseases and primary health care is the essential part to
implement this strategy.
Bole sub city Woreda 14 health office is responsible for the service delivery of promotive,
preventive and curative health services in the woreda. The health office ensures the delivery of health
services in primary health care by expansion of government health facilities, employing health
professional and monitoring the service delivery. The woreda 14 health office is also responsible for
monitoring private hospitals and clinics found in the woreda.

Type Government Federal Army Police Private NGO Total

Hospital 0 0 0 0 1 1 2
Health center 1 0 0 0 0 0 1
Clinics all type 2 0 0 0 6 0 8
Pharmaciesand drug 0 0 0 0 27 0 27
store
Public health lab 0 0 0 0 0 0 0
Healthscience college 0 0 0 0 1 0 1
Medical college 0 0 0 0 1 1 2

Table 5: health infrastructure, work force and coverage

4.1.7 MATERNAL HEALTH SERVICE

The health status of the community is measured by many indicators and maternal health service
indicators are among the indicators. Theoretically Over the past years the maternal health indicators
in woreda 14 have shown a significant improvement.

2015 1st and 2nd Quarter DIF Achievement ANC

1st visit 651
1st visit -16 wks 307
4 visit
th
795
VDRL 660
HBsAg 660
Iron and 660

Table 6: maternal health service

14
4.1.8 FAMILY PLANNING
To empower women for their health by avoiding unwanted, unplanned, unsupported pregnancy and
providing family planning services can transform women lives and transform social, economical and
health of the community.

2015 1st and 2nd Quarter DIF Achievement family planning

Long acting 949
Short acting 198

Table 7: family planning

4.1.9 EXTENDED PROGRAM OF IMMUNIZATION

To prevent communicable diseases that can erupt as an outbreak and cause a disability and death to
the community EPI has a major role. By vaccinating children and immunizing them many children
lives can be saved.

2015 1st and 2nd Quarter DIF Achievement EPI

BCG 582
Penta 1 663
Penta 3 648
Measles 1 629
Measles 2 542

Table 8: extended program of immunization

4.2 Household result

Socio-economic and demographic result

A total of 173 households were in this survey. The following is the data that is collected and
analyzed from Bole sub-city, woreda 14, Ketena 3, 4 and 5 residents. We interviewed and observe
every 173 households and we try to put in a more relaxed and easily understood manner using
different presentation techniques.

From the total of the study participants 283(43.9%) were married, 315(48.9) single, 12(1.9%)
divorced, 30(4.7%) widowed, 4(0.6%) were separated. This implies us most of the ketena’s
population were single and few of them were divorced and separated.

From 20,146 (ketena 4 and 5) and half of ketena 3 study population, 133(20.3%) were father,
146(22.3%) mother, 2(0.3%)169 grandfather, 15(2.3%) grandmother, 169(25.8%) son, 163(24.8%)
daughter, and 28(4.3%) were relatives. As we know in Ethiopia most of the head of the house are
males, but in this ketena’s there are females also in leading the household. Also in this study the
three ketena’s can see that number of young sons is more predominant. From other relatives residing
in the family only 28 are counted. The other point which is more significant is the figure of
grandfather is near to none.

15
From our research on religion in bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3 is, out of
20,146 sample population, 316(48.9%) were orthodox, 139(21.5%) protestant, 109(16.9%) Muslim,
14(2.2%) catholic, 68(10.5%) were other religion.

The other data that we have collect from the survey is the educational level of the bole sub-city,
woreda 14, ketena 4, 5 and half of ketena 3 is, out of this number of peoples that are college and
above were 288(43.2%), 181(43%) grade 9-12, 75(11.2%) grade 5-8, 51(7.6%) grade 1-4, 40(6.0%)
able to read and write, and 32(4.8%) were unable to read and write. We have tried to show on the bar
graph as follows.

Figure 8: level of education

The table below indicates us there are different varieties of occupational status in bole sub-city,
woreda 14, ketena 4, 5 and half of ketena 3, which people work for their livelihood. The data
indicates that most of the population is students with 219(34.6%). From the total sample size of
population, other than being a student, most of them are private employee 149(23.5%).

Socio-economic and Demographic results

Frequenc
y Valid Percent
Sex male 321 47.6
female 354 52.4
Total 675 100.0

16
 Religion Orthodox 316 48.9
Protestant 139 21.5
Muslim 109 16.9
Catholic 14 2.2
Other 68 10.5
occupation Merchant 36 5.7
Government 72 11.4
Private employee 149 23.5
Daily laborer 9 1.4
Student 219 34.6
Jobless 52 8.2
House wife 69 10.9
Other 27 4.3
Relationship status Father 133 20.3
Mother 146 22.3
Grandfather 2 0.3
Grandmother 15 2.3
Son 169 25.8
Daughter 163 24.8
Other relatives 28 4.3
Educational status Unable to read and write 32 4.8
Abel to read and write 40 6.0
Grade 1-4 51 7.6
Grade 5-8 75 11.2
Grade 9-12 181 43
College and above 288 43.2
Marital status Married 283 43.9
Single 315 48.9
Divorced 12 1.9
Widowed 30 4.7
Separated 4 0.6

Table 9: Socio-economic and demographic result

Birth and death record

Birth and death record in the last 12 months

Based on the table below, the data collected on the occurrence of birth and death in the family
presents in the last 12 months incident that must have happened prior to data collection.

Occurrence of birth and death

Frequency Valid percentage

17
 Occurrence of birth 16 9.6

Occurrence of death 14 8.4

Table 10: Birth and death record

Environmental condition
In the bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3, the 135(78.9%) houses were built
by brick/concrete, 29(17.0%) by mud, 2(1.2%) by wood and 1(0.6%) were built by stone. In this
housing condition 40(23.4%) were cracked or plastered, and the rest 125(73.1%) were not cracked or
plastered. Also the floor of the houses are 153(89.5) were made built by concrete, and 9(5.3%) were
built by mud.
The number of rooms of the houses in the bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3
are, out of 171 houses 45(26%) were have only 1 room, 36(21.1%) 2 rooms, 36(21.1%) 3 rooms,
25(14.6%) 4 rooms, 25(14.6%) have 5 and greater than 5 rooms, with 4 missing values.

Figure 9: number of rooms

In these 171 houses there are a total of 160 windows. 33(19.3%) were 1 window, 41(24.0%) 2
windows, 32(18.7%) were 3 windows, 14(8.2%) 4 windows, and 38(22.2%) were 5 and above 5
windows. The 145(84.8%) of the windows opened for ventilation, and the rest 16(9.4%) cannot open
for ventilation.

Out of 171 households 109(63.7%) have domestic animals, and the rest 57(33.3%) of the households
doesn’t have any domestic animals. From the 109(63.7%) households with domestic animals,
23(13.5%) of the households, the domestic animals live with humans in the same house.

18
The cleanliness of the houses in the ketena 4, 5 and half of ketena 3 are, from 171 houses 48(28.1%)
houses were good quality of cleanliness of the compound, 54(31.6%) fair, and 64(37.4%) houses
were bad in cleanliness of the compound.

In bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3 households, 137(80.1%) households
have kitchen, and the rest 25(14.6%) houses does not have kitchen. And from the 137(80.1%) houses
with kitchen, 55(32.2%) of the kitchens are separated from the living house. 25(14.6%) of the
kitchens have chimney, and 119(69.6%) kitchens have windows for ventilation.

Waste management
Solid waste management
The households in the bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3 dispose there solid
waste materials are as follows in the bar graph. 152(88.9%) dispose in municipality/communal pit,
5(2.9%) in open field, and the rest 8 households dispose there waste materials in other mechanisms,
with 6 missing values.

Figure 10: Solid waste management

Liquid waste disposal

Frequenc Valid
y Percent
open field 30 17.5
seepage 47 27.5
pit
septic tank 54 31.6
latrine 27 15.8
other 9 5.3
Table 11: Liquid waste disposal
There are vermin and insects in 106(63.9%) out of 171 households.
Frequency Valid Percent
Valid yes 106 63.9
no 60 36.1
Table 12: vermin/insects or rodents in the house

19
 Figure 11: vermin/insects or rodents in the house
Valid
Frequency Percent
fleas 5 2.9
bed bags 1 .6
rats 10 5.8
cockroaches 31 18.1
fleas, cockroach and 13 7.6
rats
rats and cockroaches 39 22.8
Table 12: types of vermin/insects

Figure 12: types of vermin

The study also tried to investigate the qualities of the latrines in the households. In bole sub-city,
woreda 14, ketena 4, 5 and half ketena 3, out of 171 houses, 151(88.3%) have latrine, the rest
12(7.0%) does not have latrine. From the 151(88.3%) houses that have latrine, 65(38.0%) houses

20
have super-structured latrines. From 151 houses with latrine, 43(25.1%) were pit latrine, 66(38.6%)
pour flash latrine, 36(21.1%) water flash latrine, 6(3.5%) VIPL, the rest 5(2.9%) other. The
estimated distance of the latrine in meters from the living rooms is, 80(46.8%) 1-2 meters, 23(13.5%)
3-4 meters, 15(8.8%) 5-6 meters, 28(16.4%) 7 and greater than 7 meters from the living house.

Estimated distance of the latrine in meters from kitchens’, 42(24.6%) 1-2 meters, 26(15.2%) 2-4
meters, 19(11.1%) 5-6 meters, 50(29.2%) 7 and greater than 7 meters from the kitchen.

Valid
Frequency Percent
pit latrine 43 25.1
VIPL 6 3.5
pour flash latrine 66 38.6
water flash 36 21.1
latrine
other 5 2.9
Table 13: Types latrine

From 171 households 111(64.9%) of the total population have a habit of hand washing after toilet.
From this 156 total households with latrine 113(66.1%) have a hand washing basin with water at the
door step of the latrine. 59(34%) of the family members or the households wash their hands with
only water, 55(32.2%) by solid soap, and 52(30.4) by liquid soap.

Valid
Frequency Percent
water only 59 34.5
solid soap 55 32.2
liquid soap 52 30.4
Table 14: ways of hand washing

Water supply
In bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3, from the total of 171 total households,
115(67.3%) have a private pipe for water source, and 50(29.2%) public pipe. In this population
82(48.0%) use jerican as a storage of water, 68(39.8%) barrel, 6(3.5%) pot, and 12(7.0%) were use
other methods.

21
 Figure 13: water supply

From the total of 171 households only 85(49.7%) treat the water if they feel that is not safe to drink.
The households that treat the water is 11(6.4%) use let it stand and settle, 23(13.5%) boiling,
29(17.0%) filtration, 48(28.1%) add bleach or chlorine or tablet.

Figure 14: method water treating

Household eating arrangement

From 171 households 73(44.8%) of them eat all family members together, 72(44.2%) separately,
16(9.8%) children separately, 2(1.2%) other arrangement.

Figure 15: Household eating arrangement

22
The study also tried to explore that what types of salt the selected sample population household’s use.
In this study, 21(12.9%) households use rock salt, 3(1.8%) refined unionized salt, 139(85.3%) use
ionized salt.

Figure 16: types of salt

From 171 households, 110(67.9%) households use the salt during cooking and 52(32.1%) use after
cooking.

when do you use the salt

Valid Cumulative
Frequency Percent Percent Percent
Valid during 110 67.9 67.9 67.9
cooking
after cooking 52 32.1 32.1 100.0
Total 162 100.0 100.0
Table 15: when they use the salt

Morbidity and movement

The researchers also study the morbidity and movement of the households in the past two weeks.
From the 171 households, 92(55.1%) were sick in the last two weeks, and the rest 75(44.9%) were
not get sick as the table below shows.

sick family member in the last two weeks

Valid Cumulative
Frequency Percent Percent Percent
Valid yes 92 55.1 55.1 55.1
no 75 44.9 44.9 100.0
Total 167 100.0 100.0
Table 16: morbidity in the households
The symptoms of the households that who gets sick the last two weeks are graphed below.

23
 Figure 17: symptoms of the illness

The households that gets sick in the last two weeks are taken to health institutions 24(34.8%),
37(53.6%) where taken to pharmacy, 4(5.8%) traditional healer, 1(1.4%) to holy pharmacy, 3(4.3%)
to other.

Figure 18: where they take the patient

In bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3 there is also an increased numbers of
non-communicable diseases like diabetes mellitus and hypertension. From our study population
63(38.2%) of 165 households are diabetic patients, and 88(53.3%) of the households are
hypertensive.
Diabetic
Cumulative
Frequency Percent Valid Percent Percent
Valid yes 63 38.2 38.2 38.2
no 102 61.8 61.8 100.0
Total 165 100.0 100.0
Table 17: number of diabetic patients

Hypertensive
Cumulative
Frequency Percent Valid Percent Percent

24
 Valid yes 88 53.3 53.3 53.3
no 77 46.7 46.7 100.0
Total 165 100.0 100.0
Table 18: number of hypertensive patients

MATERNAL HEALTH
In bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3 there are 10(5.8%) maternes that gets
marriage in the last five years. In the past one year the women that gives birth is 15(8.8%). it is the
same as the women who follow ANC, it is 15(8.8%). from this 15(8.8%) women that gave birth
14(93.3%) gave birth in the health institution, and 1(6.7%) gave birth in the way to health institution.
In this study area 8(4.7%) mothers get TTC2, and 7(4.1%) TTC23 vaccination.

Figure 19: place of where she gave birth

This study also tried to investigate the family planning issues. In bole sub-city woreda 14, ketena 4, 5
and half of ketena 3, from 49 mothers 46(26.9%) have a knowledge about contraceptive methods.
And the rest 3(1.8%) have know any ideas of family planning. From the mothers who had a
knowledge about family planning 28(16.4%) use contraceptive methods. While 12 mothers use
injectable contraceptive method, which is a high use of contraceptive, in the other pole only 1 mother
use condom.

25
 Figure 20: Types of family planning

CHILED HEALTH
In bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3, 43(97.7%) children have get vaccinated,
while 1(2.3%) child do not get child. And that is because the fear of its side effects. The means of
verification is, 29(67.4%) are verified by history, 12(27.9%) by card, and 2(4.7%) are verified by
BCG scar.

Figure 21: means of verification

Family asset
In this study area bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3, the estimated monthly
income of the households are, 46(28.0%) and 2(1.2%) in respect to 5001-10,000 thousand birr.

26
Figure 22: family asset

27
CHAPTER 5- DISCUSSION

As education elevates the community's understanding of health, it allows them to develop their
physical, social, and emotional health values. This study shows that 43.2% of households in bole
sub-city, woreda 14, ketena 4, 5 and half of ketena 3, complete college and above, and in the other
pole 18.4% are under grade 8. According to EDHS data, the percentage of woman with no education
has decreased over the last decade, from 66% in 2005 and 51% in 2011 to 48% in 2016. And
likewise, the percentage of men with no education has declined as well, from 43% in 2005 to 30% in
2011 and 28% in 2016.

According to our study 88.3% households had latrine, while EDHS 2011 data showed relatively
lower number of households (62% of households). This may due to adequate health education about
latrine construction and utilization by co-coordinating health extension worker, health development
army, health center, also health officers. Whereas 2.9% of households share with other household’s
toilet facilities. In our study 7.6% and 22.8% of households had no solid and liquid wastes disposal
pit respectively. In bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3 17.5% households do
not have a liquid waste disposal pit,

From 171 households 106(63.9%) houses are challenging with vermin/insects or rodents. And from
this 63.9% houses in 22.8% households there are rats and cockroaches, 31% only cockroaches, and
13% fleas, cockroaches and rats. These insects are high risks of communicable diseases, particularly
AFI and other unspecified digestive system diseases.

In Ethiopia, 97% of urban households have access to an improved source of drinking water. In bole
sub-city, woreda 14, ketena 4, 5 and half of ketena 3, 115(67.3%) have a private pipe for water
source, this indicates that the rest 37.2% households are more likely exposed to a contaminated water.
And also only 85(49.7%) treat the water if they feel that is not safe to drink. In this study area, 64.9%
households have a habit of hand washing after toilet. Only 32.2% and 30.4% populations are using
solid and liquid soaps to wash their hand respectively. The rest 34.5% households use only water.

In this study area, from a total of 20,146 populations, 55.1% populations get sick in the last two
weeks. In this population who gets sick, the high numbers of symptoms are cough and fever
respectively. The household that gets sick in the last two weeks, only 34.8% are taken to the health
institution.

The other issue that this study concerned is the increasing medical record of non-communicable
disease. In this bole sub-city, woreda 14, ketena 4, 5 and half of ketena 3 study population 38.2% and
53.3% have a history of diabetes mellitus and hypertension respectively. As in this century non-
communicable diseases are more spreading, the ministry of health and other health sector institutions
should regulate a well-defined and super sensational policies and strategies.

There are 10(5.8%) women who have been married in the last five years in the bole sub-city, woreda
14, ketena 4, 5, and half of ketena 3. 15 women (8.8%) have given birth in the last year. 15 (8.8%) is
the same as the percentage of ANC-following women. From this group of 15 (8%) women, 14
(93.3%) gave birth at a hospital, and 1 (6.7%) gave birth en route to a hospital. In the study area, 7
mothers (4.1%) and 8 mothers (4.7%) receive the TTC23 immunization.

This study also attempted to look into family planning-related difficulties. From 49 moms in bole
sub-city woreda 14, ketena 4, 5, and half of ketena 3, or 46 (26.7%), had knowledge of contraceptive
techniques. The remaining three (1.8%) do not have any knowledge about family planning. 28

28
mothers—16.4%—of the mothers with knowledge of family planning utilize contraceptive methods.
In one pole, where the usage of contraceptives is high (12 moms use injectable methods), only one
mother uses condoms.

43 (97.7%) of the children in the bole sub-woreda city's 14, ketena 4, 5, and half of ketena 3 have
received vaccinations, while 1 (2.3% of the children) have not. The dread of its adverse effects is the
reason for this. The methods of verification are as follows: 2 (4.7%) are validated by BCG scars, 12
(27.9%) by cards, and 29 (67.4%) by history.

29
CHAPTER 6
6.1 Problem prioritization
The prioritization process is a key step in health planning, enabling the identification of priority problems to intervene in bole sub-city woreda
14 ketena 3, 4 and 5 at a given time.

Problem Criteria
Magnitude Severity Feasibility Government Community
(10%) (10%) (10%) Concern (10%) concern (10%)
Hypertension 8 7 6 6 5
URTI 9 10 8 8 9
Diabetic mellitus 9 6 5 5 5
Poor sanitation 7 5 4 5 8
Poor provision of 8 8 7 3 5
non-communicable
disease screening

RESULT
PROBLEM Total Rank
Hypertension 32 2
AURTI 44 1
Diabetes mellitus 30 4
Poor sanitation 29 5
Poor provision of non- 31 3
communicable disease
screening

Key
35-50=Very high
20-35=High
10-20=Medium
30
6.2 Action plan

Objective Strategies Tactics/action Responsible Due date

person
 Reduce the Risk factors of  Health education  Promotion by using social media Group February 13 –
AURTI by 5%  Promote vaccination  Educate through promotion (social members march 13
 Reduce the magnitude of  Reduce tobacco use media)
AURTI by 5%  By spreading fliers
 Reduce the Risk factors of  Improve healthy eating and  initiate the society for mass sport Group February 13 –
Hypertension by 5% nutrition  Educate through classes, members and march 13
 Reduce the magnitude of  Reduce Tobacco use workshops, promotion (Social bole sib-city,
Hypertension by 3%  Increase physical activity media) woreda 14,
 Early screening of high blood  Reinforce or advocate school and health bureau
pressure community policies that prevent
 Decrease alcohol conception underage alcohol.
 Educate through promotion (social
media)
 distribution of recipe pamphlets or
menu calendars
 Reduce the risk factors of  Improve healthy eating and  Educate through promotion (social Group February 13 –
Diabetic mellitus by 5% nutrition media) members and march 13
 Reduce the magnitude of  Reduce Tobacco use  distribution of recipe pamphlets or bole sib-city,
Diabetic mellitus by 3%  Increase physical activity menu calendars woreda 14,
 Early screening of high blood  Collaborate with institutions that health bureau
glucose have common goals
 By develop and carry out
comprehensive PE policies for
daily physical activity in the
community or school.
 Reinforce or advocate school and
community policies that prevent
31
 underage tobacco use.
 Increase the provision of  Health education  Develop appropriate health Group February 13 –
non-communicable disease  Promoting early screening of promotion and prevention members march 13
screening by 5% non-communicable disease education messages and tools
 produce educational tools in
multiple languages as required
 Identify and train community
health ambassadors and leaders in
evidence-based interventions
 Using media coverage and
promotions
 Reduce poor sanitation  Improving urban sanitation  develop appropriate health Group February 13 –
practices by 10% systems and services. promotion and prevention members march 13
 Promoting good sanitation education messages and tools
behaviors  Utilize multiple approaches for
 Health education risk communication, including use
of the Internet, and link online risk
communication information to the
main event website.
 training to deliver interventions
through brochure, and fliers and
through other means

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CHAPTER 7-RECOMMENDATION
Based on the above Action plan we recommend
 Health facilities should provide communities required personal health services and ensure the
provision of health care.
 Health facilities should establish plans and policies that can improve individual and community
health initiatives.
 Woreda administrators to work with the community and health professional on ways of averting
the effects of previously identified problems.
 Health office stake holders create for new ideas and innovative solutions to health issues.
 Government should facilitate maintaining the basic capacities foundational to a well-functioning
public health system such as data analysis and utilization; health planning; partnership
development and community mobilization; policy development, analysis and decision support;
communication; and public health research, evaluation and quality improvement.
 Government should create activities that improve health in a population, such as investing in
healthy families; engaging communities to change policy, systems or environments to promote
positive health or prevent adverse health; providing information and education about healthy
communities or population health status; and addressing issues of health equity, health
disparities, and the social determinants of health.
 Community Health Workers should provide culturally appropriate health education on topics
related to chronic disease prevention, physical activity, and nutrition.

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CHAPTER 8- CONCLUSION
Community based training program make important contributions toward understanding how local
environments impact the health status of a population. It increase attention to the complex issues that
compromise the health of people living in marginalized communities. Because such research requires
grassroots work in the community, it enables to fully understand the unique local realities that may
either impede or facilitate a public health intervention.
With the increasing medical record of non-communicable disease it is predicted to impede poverty
reduction initiatives in low-income countries, particularly by increasing household costs associated
with health care.
In this study area, most health extension packages were not properly utilization although AURTI and
AFI were most frequently encountered disease. There is also an increased rate of non communicable
disease like diabetic mellitus and hypertension. The knowledge of sanitation and environmental
hygiene is poor . especially the knowledge about latrine development and hand washing habit is very
poor.
Screening policies for non-communicable disease are also a big problem in this study area.
Generally community based training program is one of the problem solving techniques that designed
to benefit the community and student CBTP have been developed for the purpose of improving
community’s problem by direct observation and data collection from the community, organize and
analyze the collected data and presentation of organized and analyzed data for the future intervention.
CBTP is the more important program carried out by preparation of training programs, educational
sessions, and screening for communicable and non-communicable diseases for the community.

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ANNEX
Annex I

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Annex II

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