Universal Medical and Business College

Community based training program on assessment and

intervention of health and health related problems of
Chefe health centers catchment area, Addis Ababa,
Ethiopia, 2021

Investigators- Chefe Health Center teams

September 2021
Addis Ababa, Ethiopia
List of members

1. Abel Yeta
2. Addis Tilahun
3. Amanda Demsew
4. Asmare Zebene
5. Ayantu Hierpa
6. Akello Omod
7. Bamlak Alemayehu
8. Ayub Mohammed
9. Betelhem Kassahun
10. Betelhem Alexander
11. Bol Yiew
12. Melikte Yohannes
13. Leelt Bezawork
14. Tsegalem Girma
15. Melat Fekadu
16. Lul Dokhot
17. Kaot Bile
 ACKNOWLEGEMENT
Firstly we would like to praise our GOD to finish our work while we are facing difficulties.
Secondly we would like to say thanks for Universal Medical and Business College for giving us
this chance that help us for further studies to know and gave solution for the community. Next, we
would like to express our great heartfelt thanks to Mr. Tadesse Alemu (MPH) who helped us
through our work by giving comments and corrections where it is necessary. Finally, we would
like to thank all our family and all our department lectures and students and also the community
for their willingness to answer the questions.

I
 Contents Page No
Acknowlegement ............................................................................................................................ I
List of tables................................................................................................................................. IV
Acronyms/Abbreviations ............................................................................................................. V
Abstract ……………………………………………………………………………………...…VI

Chapter 1
1. Introduction …………………………………………………………………………………….1
1.1 Background …………………………………………………………………………………1
1.2 Statement of the problem …………………..……………………………………………….1
Chapter 2
2. Literature review…………………….....……………………………………………….........3
Chapter 3
3. Objectives …………………………………………………………………………...………5
Chapter 4 ....................................................................................................................................... 6
4. Methods ................................................................................................................................... 6
4.2. Study design ..................................................................................................................... 6
4.3. Population ......................................................................................................................... 6
4.4 Sample size determination ................................................................................................. 7
4.5 Technique/ sampling procedures ....................................................................................... 7
4.6. Data procedure and Instrument......................................................................................... 7
4.7. Study variable ................................................................................................................... 7
4.8. Data analysis procedure & presentation ........................................................................... 8
4.9. Data quality management ................................................................................................. 8
4.10. Operational definition and definition of terms ............................................................... 8
4.11. Ethical Considerations .................................................................................................... 8
4.12. Dissemination plan ......................................................................................................... 9
Chapter 5 ..................................................................................................................................... 10
5. Result ..................................................................................................................................... 10

II
 Chapter 6 ..................................................................................................................................... 24
6. Discussion ............................................................................................................................ 24
Chapter 7 ..................................................................................................................................... 25
7. Problem identification and prioritization .............................................................................. 25
7.1 Problem identification ..................................................................................................... 25
7.2 Prioritization of identified problem ................................................................................. 25
Chapter 8 ..................................................................................................................................... 28
8. Action plan objective ............................................................................................................ 28
Chapter 9 ..................................................................................................................................... 30
9. Intervention ........................................................................................................................... 30
Chapter 10 ................................................................................................................................... 31
10. Conclusion and Recommendation ....................................................................................... 31
10.1 Conclusion ..................................................................................................................... 31
10.2 Recommendations ......................................................................................................... 31
Reference ………………………………………………………………………………………..33

Annex 1 ………………………………………………………………………………………………………………………………………….….34

III2
 List of tables
Table 1: Socio demographic characteristics of the community at Yeka sub-city woreda 8 in 2021
Addis Ababa, Ethiopia (n=380) ………………………………………………………..............10

Table2: Nutritional status of the community at Yeka Sub-City woreda 8 , Addis Ababa, Ethiopia,
2021 G. C. …………………………………………………………………………………….14

Table 3:Environmental survey of the community at Yeka Sub-city woreda 8, Addis Ababa,
Ethiopia, 2013 G. C……………………………………………………………………………15

Table 4: Maternal health survey of the community at a Yeka Sub-City woreda 8 Addis Ababa,
Ethiopia in 2021 G.C ................................................................................................................18

Table 5. Overall characteristics of the community based on categories at Yeka Sub-city woreda 8,
A.A, Ethiopia 2021 G.C ………………………………………………………………………….22

Table 6: Prioritization criteria for the identified problems …………………………………….24

Table 7 Action plan for outreach in community of Yeka sub-city woreda 8, A.A, Ethiopia
2021 G.C ………………………………………………………………………………...27

IV3
 ACRONYMS/ABBREVIATIONS

A.A – Addis Ababa

CBTP – Community Based Training Program

GO – Governmental

SPSS – Statistical Product and Service Solutions

TB – Tuberculosis Bacteria

V
4
IV
 Abstract

Background: Community Based Training Program (CBTP) is one of the community based
educational programs that is aimed at enabling students to assess, diagnose and intervene
prioritized community health problems depending on the level of competence.(1) This program is
believed to help students in gaining more understanding of the socio-cultural environment and
give better service accordingly.

Objective: Assess the nutritional, environmental and maternal health status of the community
Yeka sub city woreda 8, Addis Ababa, Ethiopia 2021

Methods: A community based cross-sectional study was conducted using convenience sampling
method for collecting samples with a time frame September 2 - 9, 2021 G.C, among residents in
Yeka sub city woreda 8, Addis Ababa, Ethiopia. A standardized questionnaire was used to
collect data and analysed using Statistical Product and Service Solutions (SPSS) version 26
software.

Result: From the total of 384 questionnaires collected, 134 (35.3%) were male and 246 (64.7%)
were female. Literate people made up the majority of the population with a 67.6% . Median age
from the collected data was 43. Nutritional status for the community fell into the category of fair.
Overall Environmental condition for the community was found to be fair. Maternal health status
also was in good condition. Health education and intervention were done based on the developed
action plan.

Discussion: Environmental condition for the community does not show progress from previous
studies done. Nutritional status and the community’s perception shows lack of resource in order
to achieve a sustainable healthy life style.

Conclusion and Recommendation: Further intervention and need assessments must be done in
order to tackle health problems faced by the community and extended help form governmental
facilities is needed in order to see a change.

VI
5
 1. Introduction
1.1 Background

CBTP increases awareness of the importance of community involvement and inter-sectoral

collaboration in development. Community Based Training Program (CBTP) is one of the
community based educational programs that is aimed at enabling students to assess, diagnose and
intervene prioritized community health problems depending on the level of competence.(1) This
program is believed to help students in gaining more understanding of the socio-cultural
environment and give better service accordingly.

Chefe Health Centre has been providing the community in woreda 8 Yeka sub-city with effective
health care services, which dramatically improved the health of the community. However, despite
many outreaches and educations about maintenance of health, problems have not been eradicated
and this can be evidenced by persisting diseases and health problems all around. The lack of
productive communications between responsible governmental facilities and the community to
provide a safe and healthy environment is also evident as one observes the surroundings.
Integrating programs like CBTP is crucial as it can be taken as one of the ways to tackle community
problems step by step. Identifying the sources of the problems and addressing them to
organizations it may concern is helpful in achieving the long term goal of having a healthy
community.

1.2 Statement of the Problem

Ethiopia is one of the developing country in which most of its population mainly depends on
agricultures. Different factors like lack of professional committeemen, population awareness about
the problems of waste disposal, adequate and necessary medical equipment, in accessible health
facility and low health seek behaviour leads to the community to have low health states.
Communicable disease, nutritional problems, maternal and child health problems are the major
challenging health care related problems in Ethiopia.

1
Communicable diseases are considered as major causes of morbidity and mortality, as well as
disability in Ethiopia. The high prevalence of communicable diseases in the country is linked to
the poorly developed socio-economic and environmental factors that have been inherent for
centuries. 75% up to 80% of the disease burdens in Ethiopia are assumed to be preventable using
measures like improving environmental health status and nutritional interventions. The term
sanitation in the narrower and environmental health in the broader contexts is defined as the control
of all those factors in man’s physical environment which exercise or may exercise a detrimental
effect on his physical, mental, and social well-being.

2
 2. Literature review
The 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) is the second Mini
Demographic and Health Survey conducted in Ethiopia. The Ethiopian Public Health Institute
(EPHI) implemented the survey at the request of the Federal Ministry of Health (FMoH). In the
interviewed households, 9,012 eligible women were identified for individual interviews;
interviews were completed with 8,885 women yielding a response rate of 99 %.(2) Overall, there
was little variation in response rates according to residence; however, rates were slightly higher in
rural than in urban areas. In Ethiopia, 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%); and water piped to a neighbour (9%). By
contrast, rural households obtain their drinking water mainly from public taps/standpipes (31%)
and protected springs (13%). In urban areas, 53% of households have water on their premises, as
compared with 7% of rural households. Fetching drinking water is a chore of great cost to
household members depending on the time spent to obtain it. Twenty eight percent of rural
households travel 30 minutes or longer, roundtrip, to fetch drinking water. The survey also review
on the sanitation of community. Overall, 20% of Ethiopian households use improved toilet
facilities (42% in urban areas and 10% in rural areas) (Table2.2.1). More than half (56%) of rural
households use unimproved toilet facilities. More than one in four households (27%) in Ethiopia
have no toilet facility (35% in rural areas and 10% in urban areas). By region, the percentage of
households with an improved sanitation facility ranges from a low of 10% in Southern Nation,
Nationalities and People’s Region (SNNPR) to a high of 82% in Addis Ababa (Table2.2.2). Access
to an improved sanitation facility increases with increasing wealth, from 5% among households in
the lowest wealth quintile to 54% among those in the highest quintile. ▪Open defecation is most
prevalent in Afar (70%) and least prevalent in Addis Ababa (2%). The percentage of households
with basic sanitation service rises from 6% in Somali to 49% in Addis Ababa. Basic sanitation
service also increases with increasing wealth, from 3% in the lowest wealth quintile to 30% in the
highest quintile. Similarly, households in the highest wealth quintile are more likely to have limited
sanitation service(24%) than those in the lowest and middle quintiles (2%each) The research also
mentioned that number of children that a woman bears depends on many factors, including the age

3
she begins childbearing, how long she waits between births, and her fecundity. Postponing first
births and extending the interval between births have played an important role in reducing fertility
levels in many countries. These factors also have positive health consequences. In contrast, short
birth intervals (of less than 24 months) can lead to harmful outcomes for both new-borns and their
mothers, such as preterm birth, low birthweight, and death. Childbearing at a very young age is
associated with an increased risk of complications during pregnancy and childbirth and higher
rates of neonatal mortality.(2). The 2019 EMDHS collected information on the number of children
ever born to women age15-49 and those still surviving at the time of the survey. On average,
women age 45- 49 have given birth to 6.7 children, of whom 5.6 survived to the time of the survey.
These survey results were from the Mini demographic and Health survey conducted in Ethiopia
which gives an overall look of rural and urban environmental and health status

A survey done on knowledge and risk of Tuberculosis Bacteria (TB) for about 854 households,
from those households majority 1432 were male and 14 people were those people who live with
HIVAIDS. (3) From the 854 community households those accounting 453 peoples lived with one
house have a risk and 242 people who have no window in their house were at risk of developing
TB. Majority 784 households have an awareness on TB and those 70 households have no
realization for TB. (3) Even though the survey were done only in 854 households it helps the
community to aware about TB, provide an access for individuals who had chronic cough for more
than 15 days to get screened, also it helps the woreda that less number of risk and disease exposure
in the woreda.

4
 3. Objective
3.1 General Objective

Assess the nutritional, environmental and maternal health survey in the community Addis Ababa,
Ethiopia 2021.

3.2 Specific Objective

- Assess the common socio-demographic characteristics of the community

- Determine the community resources and distribution

- Undertake community diagnosis and prioritize the identified problems

- Assess the nutritional status of the community

- Assess the environmental status of the study community

- Draw health action plan and intervene for some common community health problems

5
 Chapter 4
4. METHODS

4.1. Study area and period

The study was conducted from September 2 to September 9 at woreda 8 which is located in Yeka
sub-city, Addis Ababa, Ethiopia.

The woreda total population is approximately 27,000.

4.2. Study design

Study design used a cross sectional method to assess nutritional, environmental, and maternal
health survey of community at Yeka Sub-City woreda 8, Addis Ababa, Ethiopia 2021

4.3. Population

4.3.1. Source population

 All population living around Yeka sub-city, woreda 8

4.3.1. Study population

 All population available at the time of data collection

 People who are voluntary and willing to participate in the study

4.3.3. Inclusion and exclusion criteria

Inclusion criteria

 All population available at the time of data collection

 People who are voluntary and willing to participate in the study

Exclusion criteria

 People not willing to participate in the study

 Peoples who are not present at home during home to home data collection

6
 4.4 Sample size determination
The sample size was estimated by using a single population proportion with the assumption
of a 95% confidence level, 5% margin of error nutritional, environmental, and maternal health of
the community at (50%) at Yeka Sub-City woreda 8, Addis Ababa, Ethiopia 2021.

𝑧𝜕. 𝑝(1 − 𝑝)
𝑑𝜕
1.96 ∂.0.5(1 − 0.5)
0.05 ∂
3.8416∗0.5(0.55)
= 384
0.0025

4.5 Technique/ sampling procedures

 A convenience sampling technique was used to asses nutritional , environmental and

maternal health survey of community at Yeka Sub-city woreda 8, Addis Ababa (A.A),
Ethiopia 2021

4.6. Data procedure and Instrument

The data was collected using interview method consisting of 4 parts. Part I to assess socio
demographic, part II to assess nutritional status, part III to assess environmental health and Part
IV to assess maternal health.

4.7. Study variable

 Socio demographic factors

 Health problems
 Place of delivery
 Neonatal death
 Hand washing facility
 Housing condition

4.7.1. Dependent variable

 Nutritional status
7
  Environmental status
 Maternal health status

4.7.2 Independent variable

 Age
 Sex
 Income
 Education
 Source of information

4.8. Data analysis procedure & presentation

The collected data was coded, entered, cleaned and analysed using SPSS version 26.0. Descriptive
statistics including frequency and percentage were used.

4.9. Data quality management

The completeness of the data collection from interview was checked in order to maintain
consistency. The data were collected by interview by the investigators. The questionnaire was
prepared in English language and translated into Amharic during administration.

4.10. Operational definition and definition of terms

Head of house hold: is a person who is considered the head by other member of that house hold

Maternal health: Those who are 15-49 ages grouped

Child: person under the age of five

4.11. Ethical Considerations

Prior to data collection the medical director of health center was requested formally. Information
from study participants were kept confidential by principal investigator. Consent was obtained
from participants. During data collection process, all study participants was keep confidentially.
Ethical issues was considered during data collection in order to close study participants
information to persons outside the research

8
4.12. Dissemination plan
The final result of this study will be disseminated to Universal Medical and Business College and
Chefe Health Center.

9
 Chapter 5
5. Result
Socio demographic characteristics among respondents

From a total of 380 appropriately answered questionnaires, 246 (64.7%) were females and 146
(38.7%) were orthodox. Greater than half 257 (67.6%) of the study participants were literate, and
246 (64.7%) of participants were married. The age of the subjects ranged with the median age
being 43, and for the employment status greater than half 168 (70.5%) were government
employees. Less than half 183(48.1%) of the study subjects were >50,000 their annual income
(Table 1).

Table 1: Socio demographic characteristics of the community at Yeka sub-city woreda 8 in 2021
Addis Ababa, Ethiopia (n=380)

Characteristics Categories Frequency (%)

Sex Male 134 35.3
Female 246 64.7
Age 16-25 45 11.8
26-35 176 46.3
36-45 70 18.4
>45 89 23.4
Ethnicity Amhara 132 34.7
Oromo 190 50.0
Tigre 58 15.3
Religion Muslim 98 25.8
Orthodox 147 38.7
Catholic 70 18.4
Protestant 65 17.1
Education for people 7 years and above Illiterate 123 32.4
Literate 257 67.6

10
 Marital states Married 246 64.7
Single 81 21.3
Divorced 53 14.0
Occupational states Farmer 112 29.5
Gov. Employee 168 70.5
Do you have radio set? Yes 282 74.2
No 98 25.8
Do you have private TV set? Yes 317 83.4
No 63 16.6
Do you have telephone in your house? Yes 136 35.8
No 244 64.2
If no, do you have access to public telephone? Yes 141 37.1
No 239 62.9
If you went to read, do you get newspapers Yes 146 38.4
fairly in time (within a month after their No 234 61.6
dissemination)?
Do you have access to postal service? Yes 269 70.8
No 111 29.2
What is the average annual income of the 12000-24000 90 23.7
family 24000-50000 107 28.2
>50000 183 48.1
Do you have additional income? Yes 105 27.6
No 275 72.4
If yes, specify the source Family 121 31.8
None 259 68.2
Was there any birth in the last 12 months in Yes 78 20.5
the family? No 302 79.5
States of the birth Live birth 52 13.7
A live birth 26 6.8
no birth 302 79.5

11
 Sex of the new born M 46 12.1
F 32 8.4
no new born 302 79.5
Place of delivery Home 9 2.4
HI 69 18.1
no birth 302 79.5
Attendant of delivery Professional 72 19.0
Untrained person 6 1.5
no birth 302 79.5
Was there any death in the last 12 months in Yes 43 11.3
the family? No 337 88.7
If, yes, age at death 26-35 32 8.4
>45 11 2.9
no death 337 88.7
Perceived cause of death chronic disease 13 3.4
accident 3 0.8
infectious 27 7.1
disease 337 88.7
no death
Was there any community resource in your Yes 380 100.0
Keble?
If yes, which one is it: Kindergarten 88 23.1
Church/mosque 58 15.3
School 96 25.3
ALL 138 36.3
What is the average distance of these <1KM 282 74.2
resources for the community from their 1-2KM 98 25.8
house? List on the space given below
Does the community have shopping center? Yes 380 100.0
If yes for the question what at are the major Shola gebiya 380 100.0
central marketing places available?

12
 Do these marketing centres accommodate Yes 276 72.6
ever thing? No 104 27.4
If No what are other needs and demands of additional 112 29.5
the community? market
qualitative and
cheap material 268 70.5
How far is this marketing area? <1km 293 77.1
1-2km 87 22.9
Was there any wild animal in your Keble? Yes 380 100.0
If yes, mention them Hyena 346 91.0
Monkey 0 0.0
other (specify) 34 9.0
Do these animals have parking? Yes 6 1.6
No 374 98.4
If No, for the question who is responsible for Government 273 71.8
the security? Community 101 26.6
already have 6 1.6
parking
What kind of organizations is available in Health center 13 3.4
your Keble? Clinic 98 25.8
School 136 35.8
Hostel 97 25.5
ALL 36 9.5
Owner of organization GO* 185 48.7
Private 195 51.3
Distance or location <1km 283 74.5
1-2km 97 25.5
Acceptance Accepted 380 100.0
Is there any recreational area? Yes 289 76.0
No 91 24.0

13
 If yes state them Park 29 7.6
game area 78 20.5
Cafeteria 182 47.9
No recreation 91 24.0
area
If No, where do you and your family usually Home 29 7.6
pass your part-time? religion area 62 16.3
have recreation 289 76.0
area
What type of recreational areas do you think community 276 72.6
important for the Community? library 104 24.4
park way
Is there any security for the community? Yes 345 90.8
No 35 9.2
If yes, which responsible body is it? Police 363 95.5
Community 17 4.5
have no security 0 0.0
If No. How does the community keep its Government 4 1.0
security? Community 17 4.5
have security 359 94.5
How far is the location of security office from <1km 309 81.3
the community? 1-2km 71 18.7
Is there been any incidents of security? Yes 90 23.7
No 290 76.3

Nutritional status of the study participants

Most 258(67.9%) of the mothers was able to read and write. Majority 302(79.5%), of the study
participants get diary food. Most 312(82.1%) of the study participants get portentous foods.
Majority of the study participant’s staple food was injera. (Table 2)

14
Table2: Nutritional status of the community at Yeka Sub-City woreda 8 , Addis Ababa, Ethiopia,
2021 G. C.

Characteristics Categories Frequency (%)

Maternal Education Cannot read and write 41 10.8
Read and write 258 67.9
Grade 1-12 45 11.8
College/university 36 9.5
What is your staple food? Injera 312 82.1
Bread 52 13.7
Vegetables and Fruits 4 1.0
Insect 12 3.2
Are there any food taboos for the family? Yes 300 79.0
No 80 21.0
If yes, state the type of food taboos Kocho 214 56.3
Meat 63 16.6
Milk 35 9.2
no food taboos 68 17.9
Do you get diary food? Yes 302 79.5
No 78 20.5
Do you get fatty and proteinous foods? Yes 287 75.5
No 93 24.5
How many times do you eat daily? Once 39 10.3
twice 26 6.8
3x/day 259 68.2
four or more 56 14.7
times/day

15
Environmental survey

Majority 263 (69.2%) source of waste was residential/ domestic and 234 (61.1%)of the study
subjects used burning method for disposing collected waste, flowed by 72(19.0%) used sanitary
land fill method. All 380(100%) of the study subjects had latrine facility, of those 255(67.1%) pit.
All the respondents (100%) source of water supply was from tap. Majority 349(91.8%) encounter
problems of rodent infestation in their house. (Table 3)

Table 3: Environmental survey of the community at Yeka Sub-city woreda 8, Addis Ababa,
Ethiopia, 2013 G. C.

Characteristics Categories Frequency (%)

What is the source of waste in your Residential / Domestic / 263 69.2
community? Household
Commercial 68 17.9
Other 49 12.9
Is there any schedule to collect the waste? Yes 340 89.5
No 40 10.5
What is the final disposal method used for Sanitary land fill 72 19.0
disposing collected waste? Burning 234 61.6
Dumping in the river 38 10.0
Others 36 9.4
Do you have latrine facility? Yes 380 100.0

If yes which type? Pit 255 67.1

VIP 90 23.7
Others 35 9.2
If pit, how far is it from the house? <50 meter 95 25.0
>50 meter 18 4.7
no pit 267 70.3
What is the status of ownership of excreta Owned by the family 380 100.0
disposal Shared or communal 0 0.0

16
 If there is no latrine, is there adequate space No 7 33.3
for construction? Yes 14 66.7
What is the waste disposal system of your Closed 75 19.7
latrine? Drained in to pipes and 305 80.3
then to river
What is the distance of water source from <10 meter 57 15.0
the toilet (in meter)? >10 meter 323 85.0
Is it downhill from the toilet? Yes 345 90.8
No 35 9.2
Do you employ any method of water Yes 130 34.22
purification? No 250 65.78
If yes which of the following? Boiling 52 40
Standard filtration 78 60
Number of rooms (excluding kitchen and Good 232 61.0
toilet) Fair 148 39.0
Number of windows/room- One 168 44.2
Two 212 55.8

Type of floor Cement 215 56.6

Soil 165 43.4
Are there cracks on the floor? Yes 156 41.0
No 224 59.0
Type of Roof iron sheet 258 67.89
others 122 32.1
What is the frequency of House cleaning? Daily 325 85.5
Every other day 55 14.5
Are there any livestock around the house? Yes 40 10.52
No 340 89.47
If yes, are they living together with people? Yes 15 37.5
No 25 62.5

17
 Type of kitchen Separate room attached 268 70.5
to the main house
Separate room but 112 29.5
detached from the main
house
Which of the following procedures do you Washing hands 335 88.2
implement during food preparation? Washing vegetables 14 3.6
Proper and adequate 16 4.2
cooking 9 2.4
frequently cleaning 6 1.6
utensils
all
What method do you use to preserve food? Refrigerator 310 81.6
Drying 66 17.4
Other* 4 1.0
Is there any method you are applying to Yes 283 74.5
control insects? No 97 25.5
If yes which of the following? Bed nets 79 27.91
Insecticides 152 53.7
Fumigation 46 16.25
Insect repellent 6 2.1
Do you encounter problems of rodent Yes 349 91.8
infestation in your house? No 31 8.2
If yes, what method do you take for Poisoning 258 73.92
prevention and eradication? Mouse traps 28 8
Cats 32 9.16
no problem of rodent 31 8.88

18
 Maternal health survey

Of the total 380 (100%) study participants 158 (41.6%) were females and only 98(25.8%) were
between 15-45 years age. From the reproductive age group (25.8%) 0nly 120(31.6%) were know
method for controlling or spacing births, the rest 10(2.6%) were not knew. Of the 31.6% know
method for controlling 70(18.4%) of those used Implants, followed by 15(4.0%) were used loop.
Only 43(11.3%) opposition from their partner were used contraception. Majority 288(75.8%) were
not any type of abused during pregnancy, while the rest (0.0%) affected by physical abuse. Only
87(22.9%) of mothers started breast feeding within one hour after birth. Most 256 (67.4%) of
mothers were started complementary feeding before six months.

Table 4: Maternal health survey of the community at a Yeka Sub-City woreda 8 Addis Ababa,
Ethiopia in 2021 G.C.

Characteristics Categories Frequenc (%)

y
Do you know any method for controlling or spacing Yes 120 31.6
births? No 10 2.6
<15 years female 60 15.8
>45 years female 98 25.8
Male 92 24.2
If yes which ones do you know? Pills 23 6.0
Inject able 5 1.3
Loop 15 4.0
Implants 70 18.4
Rhythm /Calendar 8 2.1
<15 yrs. 60 15.8
>45 98 25.8
Male 92 24.2
Known 9 2.4

19
Do you have any opposition from your partner in using Yes 43 11.3
contraception No 87 22.9
<15yrs 60 15..8
>45yrs 98 25.8
Male 92 24..2
Age at first marriage, if ever married <18 Years 53 14.0
19-25 148 39.0
>25 87 22.8
Male 92 24.2
Age at first pregnancy, if ever pregnant 19-25 176 46.3
>25 112 29.5
Male 92 24.2
Total number of pregnancies, if ever 1-3 134 35.3
4-6 111 29.2
>6 43 11.3
Male 92 24.2
Was there any food prohibited during your pregnancy? Yes 87 22.9
No 201 52.9
Male 92 24.2
If yes which type of foods were prohibited? spice food 23 6.0
fatty food 64 16.8
not prohibited 201 52.9
Male 92 24.2
Have you ever been abused while you were pregnant by Yes 0 0.0
your partner No 288 75.8
Male 92 24.2
Total number of live births 1-3 67 17.6
4-6 27 7.1
no birth 286 75.3
How many are: Alive now One 324 85.3
Two 56 14.7

20
How many are: Dead None 380 100.0
Number of abortions No 380 100.0
No. of still births No 380 100.0
Yes 288 75.8
Did you go to the nearby health facility during pregnancy? Male 92 24.2

If yes, when While sick 39 10.3

For regular check up 249 65.5
Male 92 24.2
Where did you deliver your last child? Home 7 1.8
Clinic 31 8.2
Health center 210 55.3
Hospital 40 10.5
Male 92 24.2
If delivered at home, who attended the delivery? TBA 40 10.5
TBA untrained 35 9.2
Health personnel 3 0.8
not deliver at home 210 55.3
males 92 24.2
When did you wash the child after birth after one hour 149 39.2
after one day 83 21.8
after one week 56 14.7
Male 92 24.2
When did you start breast -feeding after birth within one hour 87 22.9
after one hour 201 52.9
male 92 24.2
For how long did you breast -feed your last baby? for one year 242 63.7
for two year 46 12.1
male 92 24.2
At what age did you start complementary feeding for before 6 month 256 67.4
your last baby 6 month 32 8.4

21
 Male 92 24.2

Did you use bottle for feeding your baby? Yes 246 64.8
No 42 11.0
Male 92 24.2
Did your last child vaccinate Yes 322 84.7
No 58 15.3
Family Medical History of chronic illness DM 268 70.5
TB 36 9.5
None 76 20.0
What are the common AFIs in the family Thyroid 96 25.3
Typhus 284 74.7
What treatment did you take? Traditional 67 17.6
Modern 313 82.4
Have ever had any STDs? Yes 126 33.2
No 254 66.8
If yes state the S/Ss Ulcer 98 25.8
ureteral discharge 126 33.2
vaginal discharge 95 25.0
none 61 16.0
What treatment did you take?
Traditional 98 25.8
Modern 204 53.7
None 78 20.5

22
Table 5. Overall characteristics of the community based on categories at Yeka Sub-city woreda 8,
A.A, Ethiopia 2021 G.C
Characteristics Categories Frequency Percentage
(%)
Overall Nutrition  Good nutritional health 258 67.9
 Bad nutritional health 122 32.1
Overall Maternal  Good maternal health 244 64.2
 Bad maternal health 136 35.8
Overall Environmental  Good environmental 114 30.0
 Bad environmental 266 70.0

23
Chapter 6

6. Discussion
Regardless of the assessment the nutritional health most of the respondents were in good nutrition
status compared to the assessment of done in 2020 at yeka sub. City was in bad nutrition.
According to this assessment less percentage was in bad nutrition.

Based on parasitological assessment the finding most percentage were at good sanitary of parasitic,
compared to 2019 assessment done in Addis Ababa were increased to 61.8% 0n these 2021
assessment. And on this assessment the less percentage were at poor sanitary.

Accordingly to Ethiopia environmental and public health programs schedule of wastage collection,
and regardless on this assessment most than half of the respondent follow the schedule accordingly

Maternal health survey of the total 380 (100%) study participants 158 (41.6%) were females and
only 98(25.8%) ware between 15-45 years age. From the reproductive age group (25.8%) 0nly
120(31.6%) were knew method for controlling or spacing births, the rest 10(2.6%) were not knew.
Of the 31.6% knew method for controlling 70(18.4%) of those used Implants, followed by
15(4.0%) were used loop. Only 43(11.3%) opposition from their partner were used contraception.
Majority 288(75.8%) were not any type of abused during pregnancy, while the rest (0.0%) affected
by physical abuse.

24
Chapter 7
7. Problem identification and prioritization

7.1 Problem identification

Problems Identified through the data collected in Yeka sub-city woreda 8, Addis Ababa, Ethiopia
2021.

1. Low maintenance of hygiene in households

2. Improper waste disposal in both household and environment
3. Poor knowledge on healthy diet and lifestyle
4. Infestation of disease spreading vectors
5. Lack of proper implementation of knowledge in new born care
6. Lack of resource in order to provide a safe and healthy environment
7. Spread of top 5 communicable diseases (Covid-19, Typhoid, Scabies, STI , UTI)

7.2 Prioritization of identified problem

The identified problems were prioritized using the following criteria with a 5 scale score and top
5 were selected for planning an implementation.

Table 6: Prioritization criteria for the identified problems

Governmenta

Applicability
Community

Identified problems
Magnitude

Feasibility

l concern
Urgency
Severity

concern

Rank
1 Low practice of hygiene in households 3 3 4 4 4 3 5 total
26 2

2 Improper waste disposal in both household

3 4 3 5 3 3 4 25 3
and environment
3 Poor knowledge on healthy diet and lifestyle 3 1 2 4 2 1 4 17 6
4 Infestation of disease spreading vectors 4 4 4 3 2 1 3 21 5

5 Lack of proper implementation of

knowledge in new-born care 3 4 5 4 1 1 5 23 4
6 Lack of resource in order to provide a safe 4 5 1 4 4 4 4 26 2
and healthy environment
7 Spread of top 5 communicable diseases 5 4 2 4 4 5 3 27 1

25
Scale for rating problem prioritization criteria

1. Magnitude of the problem

2. Severity of the problem
3. Feasibility of addressing the problem
4. Urgency
5. Applicability
6. Community concern
7. Governmental concern

A score from 1 to 5 is used to rank problems where;

1= concern about the criterion is very low

5 = concern about the criterion is very high

Situational analysis

The following analysis was done in order to address weaknesses in the community and
opportunities that arise to alleviate the problem.

SWOT Analysis

The analysis below identifies the major challenges facing the community

Strength

 Increased cooperation from the community regarding child immunization and health
services given by health extension workers
 Good layout of road works for households to be reached

Weakness

 Traditional beliefs that hold back the effective growth of modern medicine
 Environment not suitable for necessary infrastructures to be built
 Large gap in social class across different households

26
Opportunity

 Health extension workers to be deployed from the health center

 New policies
 Students available for outreach

Threat

 Covid-19 pandemic
 Diminished resources
 Reduced funding for effective intervention

Prioritized problems for intervention

 Spread of top 5 communicable diseases

 Low practice of hygiene in households
 Improper waste disposal in both household and environment
 Lack of proper implementation of knowledge in new born care
 Lack of resource in order to provide safe and healthy environment

27
 Chapter 8
8. Action plan objective

Table 7 Action plan for outreach in community of Yeka sub-city woreda 8, A.A, Ethiopia
2021 G.C
No Identified problem Objectives strategies activities responsible target indicators
1 Low practice Increasing Education Giving Group Househol Number of
of hygiene good practice by Home to education members ds households
in of hygiene in home visit about good who are not
households the practice of applying
community hygiene practice of
hygiene
2 Improper waste Proper waste Education Educating Group Househol Number of
disposal in both disposal in by Home to about the members ds households
household and chefe health home visit side effects Waste improper
environment center area of collectors disposing
improper Community wastes in the
waste Health environment
disposal professionals
in Chefe
health centre
3 Poor knowledge on Good Education Educating Group Househol Number of
healthy diet and knowledge by Home to about the member ds households
lifestyle on healthy home visit importance Health who have
diet and of good professionals poor
lifestyle healthy diet in Chefe knowledge
and health centre on healthy
lifestyle diet and
lifestyle

28
4 Lack of proper Good Education Creating Group House Mothers with
implementation of knowledge at awareness members holds and lack of
knowledge in new- about Chefe about Parents Mothers proper
born care implantation health vaccination Health who have implementati
of new born Centre by professionals infants on of
care education at Chefe knowledge in
and Health new-born
teaching Centre care
mothers
5 Spread of top 5 To prevent Education Education Group House Households
communicable the diseases by home to on members holds who are
diseases home visit prevention Health affected of
and chefe and control professionals those 5
health workers at communicabl
center chefe health e disease
center

29
Chapter 9

9. Intervention
1. Low practice of hygiene in households

Education was given on how to keep hygiene and the consequences if not followed. And
for those portion of community that couldn’t afford basic needs, even tho it is difficult to
solve their problem but we tried to help them by giving them soap and face masks.

2. Improper waste disposal in both household and environment

Education was given on how to properly dispose waste in their environment and gave
recommendation to practice separating wastes.

3. Poor knowledge on healthy diet and lifestyle

We gave knowledge about how to keep their health and can also change their life style.
Drinking impure water is the first problem and gave them weha agar to treat their water
is the other solution given.

4. Lack of proper implementation of knowledge in newborn care

Some mothers did not implement knowledge about new-born child care because they
believed in a more traditional approach. We also gave them education about child
vaccination how can it prevent disease.

5. Spread of top 5 communicable diseases

In the community the 5 top diseases are

 COVID-19
 UTI
 STI
 Scabies
 Typhoid

30
 1. COVID-19: we gave enough education about the disease and tell them the preventive
practice and also about the vaccination. We tried to help them to prevent the disease by
giving mask, sanitizer and mask.
2. UTI: for this problem the only solution we take is giving education for the community.
3. STI: is current issue in the community. There are many female sex workers in the
community. To solve this problem we gave education for the community especially for
the sex worker.
4. Scabies: Children’s are more affected in the community. We gave education about skin
allergy and it can transmit each other skin to skin. We tried to makes some family to
wash their clothes by hot water.

Chapter 10

10. Conclusion and Recommendation

10.1 Conclusion
The current community based survey showed that:

 The common means of communication that used by Yeka sub city wereda 08 were by
phone
 Dominant religion in the Woreda was Orthodox
 Almost half of Yeka 08 Woreda were Oromo Ethnicity
 The number of female is greater than male in this woreda
 The most common disease is in Yeka 08 woreda was parasitic illness
 Under poverty, yet quite surprising number of people are middle class citizens.

10.2 Recommendations
Beside the above stated action plans, we also recommend some motives and ideas

 We recommend health professional to educate the community on different aspect of

health

31
  We recommend woreda administrator to work with the community and health
professional on way of averting the effect of the previously identified problem.
 We recommend the active involvement of the private sector in elevating the standard
of some services we assume are critical to be served at their best.
 We also recommend to yeka sub city health office, Addis Ababa city health office and
minster of health to give attention to the major health problem of the area
 To Addis Ababa city water resource be urea NGO’s Addis Ababa city water resources
office and water and energy minister office to increase proper water supply to Yeka
sub city 08 woreda
 To Yeka sub-city woreda and CBE office to coordinate NGO’s to solve the problem
of woreda 08 population

32
Reference

1. Guidelines and Procedures for Community Based Education, Jimma University, March
2013
2. Federal Democratic Republic of Ethiopia, Democratic and health survey, 2016, Central
Statistical Agency, Addis Ababa, Ethiopia
3. Chefe Health Centre 2017, Assessment of knowledge and risk of Tuberculosis Bacteria

33
Annex 1
Universal Medical and Business College (UMBC)
Research and Community Service Office (RCSO)
Community Based Training Program Survey Questionnaire

General objectives:
At the end of the course the students should be able to assess the nutritional,
environmental, and school health survey in the community.

Specific objectives: At this community based activity students are expected to:
 Assess the common socio-demographic characteristics of the community,,
 Determine the community resources and distribution,
 Undertake community diagnosis and prioritize the identified problems,
 Assess the nutritional status of the community,
 Assess the environmental status of the study community,
 Draw health action plan and intervene for some common community health
problems.

34
 Community Based Training Program Data Collection Tool
PART I: Socio-Demographic Characteristics
Identification particulars

Relationship to the Sex For people 10 year & above

Ser. No. head of household Age Religion
M F Marital Occupational
status status

Relationship Religion Educational level Marital

Status
99. Illiterate 1. Married
1 Head 1. Muslim
98. Literate 2. Single
2. Spouse 2. Orthodox
3. Divorced
3. Son/daughter 3. Catholic
4. Protestant For formal education 4. Widowed
4. Other relative
5. Other ___ attendants, write
highest grade
completed

Occupational Status
1. Farmer 7. Blacksmith 13. Bar tender
2. Gov. Employee 8. Carpenter 14. Under/Over age
3. Merchant 9. Tella seller 15. Other (specify)
4. Soldier 10. Weaver
5. Student 11.Unemployed
6. Shepherd 12.Housewife

35
 Community Resources:
1. Was there any community resource in your kebele? Yes_____ No ____
2. If yes, which one is it:
a) Kindergarten
b) Library
c) Small scale industry (grading mail) etc
d) Church/mosque
e) School f) other (specify)________

3. What is the average distance of these resources for the community from their house? List
on the space given below
______________________________________________________________________________
______________________________________________________________________________
______________
4. Does the community have shopping center? Yes _________ No ________
5. If yes for Q. No 4 what at are the major central marketing places available? (Mention
them orderly)
______________________________________________________________________________
____________________________________________
6. Do these marketing centers accommodate ever thing?
Yes _______ No ____
7. If No what are other needs and demands of the community? ____________

8. What kind of organizations is available in your Kebele?

a) Health centre
b) Clinic
c) School
d) Hostel
e) Other (specify)

For the above organizations you mentioned fill the following table

S/No Organizations Owner of organization Distance or Acceptance

Go Private NGO Other (specify) location

N.B GO- Governmental Organization NGO- non-governmental organization

36
Recreational facilities:
1. Is there any recreational area?
Yes________No________
2. If yes, state them_______________________________
3. If No, where do you and your family usually pass your part-time?
_______________________________________________________
4. What type of recreational areas do you think important for the Community?
__________________________________________

Security:
1. Is there any security for the community? Yes _____ no ____
2. If yes, which responsible body is it?______________
a) Police ___________________
b) Others (specify) _______________
3. If no how does the community keep its security? ___________

II -Nutritional Survey (for the house holds):

1. Maternal Education:
a) Cannot read and write _______
b) Read and write________________
c) Grade _______________
d) College/university complete-----

2. What is your staple food?

Injera- bread- Vegetables and Fruits-  Inset  others (specify) _______
3. Are there any food taboos for the family? Yes—No---
4. If yes, state the type of food taboos--------and why------
5. Do you get diary food? Yes- No --
6. Do you get fatty and proteinous foods? Yes - No --
7. How many times do you eat daily?
Once-- twice --- 3x/day ---- four or more times/day-----

37
III- Environmental Health survey:
1. Information on Waste disposal:
1. What is the source of waste in your community?
a) Residential / Domestic / Household
b) Commercial
c) Industrial
d) Other ( specify) ________________
2. Is there any schedule to collect the waste?
a. Yes b. No
3. What is the final disposal method used for disposing collected waste?
A. Sanitary land fill
B. Burning
C. Composting
D. Dumping in the river
E. Others specify_________________
4. Do you have latrine facility?
a. Yes b. No
5. If yes which type?
a) Pit
b) VIP
c) Flush
d) Others specify _________
6. If pit, how far is it from the house?
7. What is the status of ownership of excreta disposal
a) Owned by the family
b) Shared or communal
c) Others, specify---
8. If there is no latrine, is there adequate space for construction?
a) Yes -- b) No --
9. Is latrine construction affordable for the family? Yes No
10. What is the waste disposal system of your latrine?
a) Closed
b) Drained in to pipes and then to river
c) Cleaning the septic tank

38
2. Information on water supply:
1. What is the source of your water supply?
a) Tap
b) Well
c) Stream/river
d) Other specify__________
2. Do you employ any method of water purification? Yes -- No—
3. If yes which of the following?
a) Boiling
b) Traditional filtration
c) Standard filtration
d) Others, state----------
3. Information on Housing condition:
1. Number of rooms (excluding kitchen and toilet)____________________
No of rooms Ventilation Illumination Cleanliness
1
2
3
4
5
*Options-A. Good B, Fair C. Poor
2. What is the frequency of House cleaning?
a) Daily
b) Every other day
c) Weekly other
3. Are there any livestock around the house? a) Yes- b) No-
4. If yes, are they living together with people?
a)Yes –b) No, they have separate quarters---
5. Type of kitchen
a) Separate room attached to the main house
b) Separate room but detached from the main house
c) No kitchen at all
4. Food sanitation
1. Which of the following procedures do you implement during food preparation?
a) Washing hands

39
b) Washing vegetables
c) Proper and adequate cocking
d) frequently cleaning utensils
e) Other, specify---
2. What method do you use to preserve food?
a) Refrigerator
b) Drying
c) Other, specify---
5. Vector and Insect control:
1. Is there any stagnant water in your locality? Yes No
2. Is there any method you are applying to control insects? Yes No
3. If yes which of the following?
a) Bed nets
b) Insecticides
c) Fumigation
d) Draining stagnant water
e) Insect repellant
f) Other, specify---
4. Do you encounter problems of rodent infestation in your house?
a) Yes b)No
5. If yes, what method do you take for prevention and eradication?
a) Poisoning
b) Mouse traps
c) Cats
d) Other, specify---
V. Maternal health (for Women 15-49 Years of Age)
1. Family Planning
1. Do you know any method for controlling or spacing births? a) Yes b) No
2. If yes which ones do you know?
a) Pills
b) Injectable
c) Loop
d) Implants
e) Rhythm /Calander

40
f) Other (specify) __
3. Have you ever used any of the above methods? a) Yes b) No
4. Do you use them currently? a)Yes b) No
5. If yes which ones? ---------------
a) Pills
b) Injectable
c) Loop
d) Implants
e) Rhythm /Calander
f) Other (specify) __
6. Do you have any opposition from your partner in using contraception? a)Yes b) No
2. ANC practices
2.1. Age at first marriage, if ever married ___________
2.2. Age at first pregnancy, if ever pregnant _________
2.3. Total number of pregnancies, if ever_______________
2.4. Was there any food prohibited during your pregnancy? a) Yes b) No
2.4.1 If yes which type of foods were prohibited? _______________
2.5. Have you ever been abused while you were pregnant by your partner? a) Yes b) No
2.5.1 If yes state type (Physical, Sexual, Psychological) ___________
2.6. Total number of live births ________________
A. How many are: alive now __________________
B. How many are: died __________
B.1. < 1 Year ___B.2. 1-4 Year _____ B.3. > 5 Years _____
C. No. of abortions ______________
D. No. of still births ______________
2.7. Did you go to the nearby health facility during pregnancy? 1. Yes ____ 2) No _______
2.8. If yes, when? a). While sick b) for regular checkup c) Other (specify)-------
2.9. Where did you deliver your last child?
1) Home 2) Health station/clinic 3/ Health center
4) Hospital 5) other (specify) _________
2.10. If delivered at home, who attended the delivery?
1) TBA 2) TBA untrained
3) Neighbours 4) Health personnel
5) Relatives 6) Others (specify)__________

41
3. Child care practices:
*only for women who had at least one delivery, if more than one child ask only the index (last)
child.
3.1. When did you wash the child after birth?_____________________
3.2. When did you start breast -feeding after birth _______________
3.3. For how long did you breast -feed your last baby? ____________
3.4. At what age did you start complementary feeding for your last baby? ---
3.5. Did you use bottle for feeding your baby? 1 . Yes ________ 2. No --
3.6. Which of the following harmful traditional practices occurred on your child?
a) Uvula cutting
b) Female circumcision
c) Extraction of milk tooth
d) Other (specify) _____
e) None
3.7. Did your last child vaccinate? Yes/ No
Sex of the child- Male/Female
3.7.2. If Not vaccinated, reason for immunization failure------
a. Lack of awareness about immunization.
b. Fear of side effects
c. No faith in immunization
d. child sick
e. place of immunization is unknown
f. Immunization site is far
g. Impolite health staff
h. Other, state------------
4. Family Medical History of chronic illness (any history of serious diseases in the family)
1. Diabetes mellitus 1. Yes 2. No
2. Tuberculosis 1. Yes 2. No
3. Hypertension 1. Yes 2. No
4. Epilepsy 1. Yes 2. No
5 Others (Specify) ____________
5. Communicable diseases in the family
5.1. What are the common AFIs in the family--------------------?
5.2. What treatment did you take? 1. Traditional 2. Modern

42
5.3. Have ever had any STDs? 1. Yes 2. No
5.4. If yes state the S/Ss------------------
5.5. What treatment did you take? 1. Traditional 2. Modern

43