DIRE DAWA UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCINCE

DEPARTMENT OF PSYCHIATRY

ASSESSMENT OF KNOWLEDGE, ATTTITUDE AND PRACTICE TOWARD

MENTAL ILLNESS AND ASSOCIATED FACTORS AMONG COMMUNITY OF
LAGAHARE KEBELLE,DIRE DAWA CITY , EAST,ETHIOPIA, MARCH 2023 G.C

BY: ID NO
KURI MOHAMMEDSAFI 1204536
SARTU BEYAN 1204210
AMINA ZIYAD 1204111
ISAHAK ALI 1204413

ADVISOR: YIBEKAL MINAYE (BSC,MPH)

MARCH 2023

DIRE DAWA,ETHIOPIA

DIRE DAWA UNIVERSITY

I
 COLLEGE OF MEDICINE AND HEALTH SCINCE

DEPARTMENT OF PSYCHIATRY

ASSESSMENT OF KNOWLEDGE, ATTTITUDE AND PRACTICE TOWARD

MENTAL ILLNESS AND ASSOCIATED FACTOR AMONG COMMUNITY OF
LAGAHARE KEBELLE, DIRE DAWA CITY , EAST,ETHIOPIA, MARCH 2023 G.C

ADVISOR: YIBEKAL MINAYE (BSC, MPH)

A PROPOSAL SUBMITTED TO DIRE DAWA UNIVERSITY COLLEGE OF

MEDICINE AND HEALTH SCIENCE, PSYCHIATRY DEPARTMENT IN PARTIAL
FULFUILMENT OF THE REQUIREMENTS FOR THE BACHELOR’S DEGREE IN
PSYCHIATRY

MARCH 2023

DIRE DAWA, ETHIOPIA

II
ACKNOWLEDGMENT

We would like to express our deepest gratitude to our advisor Mr. Yibekal.M.

(PHA,PH&MPH)for his endless support throughout the development of this

proposal .we would also like to thank Dire Dawa University College Of Medicine

and Health Science Department of Psychiatry for providing this opportunity to

conduct proposal.

I
 Table of Contents

Contents Page
ACKNOWLEDGMENT.......................................................................................................................................I
Table of Contents.................................................................................................................................................II
ACRONYMS AND ABBREVATIONS..............................................................................................................IV
Summary..............................................................................................................................................................V
CHAPTER ONE...................................................................................................................................................1
1 Introduction.......................................................................................................................................................1
1.1 Background.....................................................................................................................................................1
1.2 Statement of the problem........................................................................................................................2
1.3 Significance of the study........................................................................................................................3
CHAPTER TWO..................................................................................................................................................4
2. OBJECTIVES...................................................................................................................................................4
2.1 General objective....................................................................................................................................4
2. 2 Specific objectives.................................................................................................................................4
CHAPTER THREE..............................................................................................................................................5
3. Literature Review.............................................................................................................................................5
CHAPTER FOUR................................................................................................................................................9
4.Methodology and material.................................................................................................................................9
4.1. Study area and period....................................................................................................................................9
4.2 Study design...........................................................................................................................................9
4.3 Population...............................................................................................................................................9
4.3.1. Source of population..................................................................................................................9
4.3.2. Study population........................................................................................................................9
4.3.3. Study unit...................................................................................................................................9
4.4. Inclusion and Exclusion criteria............................................................................................................9
4.4.1. Inclusion criteria........................................................................................................................9
4.4.2. Exclusion criteria.....................................................................................................................10
4.5. Sample size determination................................................................................................................10
4.6. Sampling technique and procedure......................................................................................................10
4.7. Data collection tools and technique.....................................................................................................11
4.8. Study variable......................................................................................................................................11
4.8.1. Dependent variable...................................................................................................................11

II
 4.8.2. Independent variable................................................................................................................11
4.9.Data quality control..............................................................................................................................11
4.10. Data processing and analysis.............................................................................................................11
4.11.Operational definition.........................................................................................................................12
4.12. Ethical consideration.................................................................................................................12
4.13. Plan for dissemination of the study...........................................................................................12
CHAPTER FIVE................................................................................................................................................13
5. WORK PLAN AND BUDGET BREAK DOWN...........................................................................................13
5.1WORK PLAN.......................................................................................................................................13
6.BUDGET BREAK DOWN.............................................................................................................................14
7. REFERENCES.............................................................................................................................................15
8 .ANNEX..........................................................................................................................................................18

ACRONYMS AND ABBREVATIONS

BSC= Bachelor of Science

III
CMHI=Community Mental Health Ideology
CMUL=College of Medicine of the University of Logos
CI: Confidence Interval
DDU= DIRE DAWA University

DDCMHS=Dire Dawa College Of Medicine and Health Science

GM=Group member

ICD-10= International Classification of Diseases, Version 10

KAP=Knowledge and Attitude and Practice

MDD=Major Depressive Disorder

PWMI = People With Mental Illness

SPSS=Statistical Package for the Social Sciences

SRQ= Self-Reporting Questionnaire

WHO= World Health Organization.

IV
Summary

Background: Although the benefits of public knowledge of physical diseases are

widely accepted, knowledge, attitude as well as practice about mental disorders

has been comparatively poor and neglected. There has been ignorance of mental

health which has leads to increase the disease burden on the community.

Objectives: To assess knowledge, attitude, and practice towards mental illness

among community Dire dawa city, Lega hare kebele, East, Ethiopia, 2023G.C.

Methods: This Proposal will be conducted by cross-sectional study design March,

2023G.C. Systemic Random sampling technique Will be used. Data will be

collected by using properly structured questionnaires which will be translated to

local language during interview by ( Afan-Oromo version). The collected data will

V
be analyzed manually, and significant associations declared at P<0.05. Finally a

result was presented by tables & Graphs.

Work plan: This research will end up from March up to May .

BUDGET: About 4699is needed to carry out this study.

VI
 CHAPTER ONE
1 Introduction
1.1 Background
In our day to day life mental, physical and social health is vital component of every individual
health that is closely interwoven and deeply interdependent. As an understanding of this
relationship increases, it becomes even more apparent that mental health is crucial to the overall
well-being of individuals’, society and countries (1).A mental disorder is characterized by a
clinically significant disturbance in an individual’s cognition, emotional regulation, or
behaviour. It is usually associated with distress or impairment in important areas of functioning.
There are many different types of mental disorders. Mental disorders may also be referred to as
mental health conditions. The latter is a broader term covering mental disorders, psychosocial
disabilities and (other) mental states associated with significant distress, impairment in
functioning, or risk of self-harm. This fact sheet focuses on mental disorders as described by the
International Classification of Diseases 11th Revision (ICD-11).Today mental health problem is
recognized as public health problem in developed as well as developing countries(the notion that
mental illnesses are less common in low income countries than developed countries has long
been disputed(2).
Even though mental illness affects many people around the world, mental illness unlike other
chronic physical illnesses like heart disease and hypertension, is associated with a number of
misunderstandings and myths. Although some nations have been successful in fighting stigma
and increasing acceptance of mentally ill, lack of awareness is very evident in India and other
developing countries. Mental disorders are widely recognized as major contributors (14%) to the
global burden of the disease worldwide (4).Nearly 25% of individuals in both developed and
developing countries develop one or more mental or behavioral disorders at one time in their life
(5).At least 40 million people in the world suffer from sever forms of mental illnesses such as
schizophrenia and dementia. No fewer than 200 million are in capacitated by less severe mental
and neurological disorders such as neurosis and peripheral neuropathy (6).

1
Many studies have demonstrated that persons labeled as mentally ill are perceived with more
negative attributes and more likely to be rejected regardless of their behavior (7).

1.2 Statement of the problem

Mental illness is on the rise worldwide and is widely recognized as major contributor to the
global mortality and morbidity. Even though mental illness is universal, many people still show
negative attitudes towards PWMI despite many efforts by health professionals to create
awareness in the people. Negative attitudes are revealed by the families and mental health
professionals of PWMI as well as lay people(8).Negative attitudes and discrimination deprive
victims of human dignity and prevent social participation(United States Department of Health
and Human Services Mental Health).This negative experiences decrease self-esteem and instill
feelings of shame and guilt(9).Additionally, they prevent individuals from having effective
interpersonal relationships which would then leads to withdrawal and social isolation and hinder
proper treatment(10,11).Mass media, especially television is the major cause of misperceptions
about mental illness(12).Furthermore, such reports often cast peoples with mental illness in a
negative light as indicted by the finding that 228 of 326 news report about PWMI in the daily
newspapers portrayed such individuals as dangerous, violent or involved in murder or attempted
murder(13).Such reports cause people to believe that all PWMI are dangerous which can cause
individuals to be scared even to talk to PWMI(14).Lack of knowledge and experience regarding
mental illness of people also causes misconceptions(14).
In Ethiopia, where malnutrition and preventable infectious diseases are very common, mental
health problems which are regarded as non-life-threatening problems are not given due attention.
However, the mental health problems account for 12.45% of the burden of disease in Ethiopia
and 12% of Ethiopian people are suffering from some sort of mental health problems of which
2% are sever cases (15).
More recent studies using samples from diverse regards population have suggested that1, the
burden of psychiatric morbidity in Africa is very similar to that prevailing in western countries.
Geil and his colleagues reported that 18.5% of outpatients in teaching hospitals in Addis Ababa
suffered from psychiatric disorders compared with 9.5% that are diagnosed as suffering from
infectious disease. Help seeking behavior regarding mental illness may be affected by different
factors such as tolerance and support in the family, lack of money, knowledge, and negative
attitude (15) .

2
 1.3 Significance of the study
Mental illness is misunderstood and mistreated world widely due to different cultural beliefs and
attitude. It is the major economic and social burden in both developed and developing countries.
The aim of this study is to assess Knowledge, attitude, and practice of the people towards mental
illness and it may contribute to reduce stigma on mental ill, negative attitude and misconception
about mental illness .
This study will be sued as a base-line data for others who are willing to know the knowledge and
attitude of residents towards mental illness .

3
 CHAPTER TWO
2. OBJECTIVES
2.1 General objective
 To Assess Knowledge, Attitude, and practice to Ward Mental Illness Among residents of
Lagahare kebele, Dire Dawa, East Ethiopia 2023 G.C

2. 2 Specific objectives
 To assess the knowledge of residents Lagahare kebele, Dire Dawa, East Ethiopia 2023
G.C
 To assess the attitude of people towards mental illness residents of residents Lagahare
kebele, Dire Dawa, East Ethiopia 2023G.C
 To assess the practice of residents of residents Lagahare kebele, Dire Dawa, East
Ethiopia 2023 G.C

4
 CHAPTER THREE
3. Literature Review

3.1. Knowledge and attitude towards mental illness

A systematic review of articles concerning mental health literacy indicates that many members of the
public cannot correctly recognize mental disorders and do not understand psychiatric terms. In western
countries depression and schizophrenia seen by the public as caused by the social environment
particularly recent stressors, biological factors are seen by the public as less important than
environmental ones but in some none western culture supernatural phenomena such as witchcraft and
possession by evil spirits are seen as important causes of mental disorder. This review of article showed
that there is mental illness related stigma which hinder recognition and help seeking. The German public
reports much greater reluctance to discuss mental disorders with relatives and friends. In USA many
members of the public reported unwillingness to seek treatment b/c they feared a negative impact on
their employment situation. In India patients with stigmatized attitude have been found to present their
distress in somatic rather than psychological terms (16).

Regarding source of mental health information a study conducted in UK indicates 32% cited the media
as source of information but unfortunately these media often tend to report on the negative aspect (15).
Another study conducted in Qatar shows that 64.2% gained information from the media, 40.8% from
friends and family members, and 27.5% from health care staff (28).

In a cross sectional survey conducted in Qatar in the year 2009, poor knowledge of common mental
illness seemed to prevail in the community; nearly 72.5% of respondents were not aware of the
common mental illnesses. Only 27.5% mentioned schizophrenia followed by depression (19.8%). 84.7%
thought that substance abuse could result in mental illness followed by a traumatic event or shock
which accounts 83%. 48% believed mental illness could result from punishment from God, where as
38.7% thought mental illness is due to possession by Evil spirit. In this study attitude of respondents
towards mentally ill individuals and treatment of mental health problems also assessed, 40.6% of them
believed that mentally ill people are mentally retarded. More than half of them (53.5%) thought that
people with mental illness are dangerous but very few respondents were afraid to have conversation
with people who have mental illness (33.7%). Only a minority thought that people with mental illness
can work in regular jobs and 12.5% agreeing to share a room with mentally ill person. 73.9% believed
that mental illness can be successfully treated with medication and 39.2% believed traditional healers
can treat mental illness. (25).

In a study conducted in Malaysia to assess mental health knowledge, attitude and practice to ward
mental illness, only 26.5% of respondents answer correctly half of the questions that requested to
assess their knowledge of mental health issues. Respondents in this study generally subscribe to a
neutral attitude towards mental health issue (26).

Study conducted in Quebec, Canada to assess knowledge and attitude of the public towards
schizophrenia indicates 54% described the diseases as biological illness and 40% considered the main
cause of schizophrenia to be genetic. 36% of respondents said that schizophrenia provoke feeling of
incomprehension and 39% feeling of suspiciousness. 54% of them considered that schizophrenic patient

5
are violent and dangerous, 31% felt that an employ with schizophrenia will be fired and 40% of
respondents believed that schizophrenia cannot be cured (27).

Another study conducted in Canada in the year 2008 showed that 42% would no longer socialize with a
friend diagnosed with mental illness, 55% would not marry someone who suffering from mental illness,
25% of respondents are afraid of being around someone who suffers from serious mental illness and
50% would not tell friends or coworkers that a family member was suffering from mental illness (31).

On the study conducted in 35 states district in Colombia and Puerto Rico 62% of adults strongly agree
that treatment could help persons with mental illness lead normal lives but only 22.3% of adults agreed
with the statement that people are caring and sympathetic to persons with mental illness (32).

Study conducted on attitude towards mental illness in southern India 2011 showed that of the studied
population, only few 18% of the respondents stated they would visit a psychiatrist if they had an
emotional problem but 35% agreed to visit a traditional healer for their problem. Nearly 60% of the
subjects were afraid to someone with mental illness as neighbor. More than have of them thought that
marriage can treat mental illness. A poor response was observed among subjects for maintaining a
friendship with someone with mental illness 25% and 65% of them were ashamed to mention that
anyone in their family had mental illness.(40)

According to institutional based study conducted in India, western Maharashtra 2014 on knowledge,
attitude and practice among care givers of patients with schizophrenia, most of the care givers 30% had
no prior knowledge about schizophrenia. The fathers 24% and relatives 24% were the majority care
givers for the patient. Care givers considered medical intervention to be important, but they also
advocated supportive intervention such as counseling and family support. Financial problem was one of
the factors that impacted negatively on the follow up of the patient (41).

In a national survey conducted in Nigeria, Sub Saharan Africa indicates that most respondents (80.8%)
expressed the view that substance misuse could result in mental illness, the next most commonly
endorsed cause of mental illness was a belief that could be due to possession by evil spirits. It accounts
30.2% followed by stress and trauma. 9% of respondents believed that the cause of mental illness could
be punishment from God. The view about mental illness were generally negative people with mental
illness were believed to be mentally retarded, to be a public nuisance and 95.5% of respondents
believed that mentally ill individuals are dangerous. Less than half of the respondents believed that such
people could be treated outside hospital and only 1/4th thought that they could work in regular jobs.
Most respondent were unwilling to have basic social interaction with someone with mental illness.
82.7% would afraid to have a conversation and would be disturbed to work with a person who has a
mental illness. Only fewer would be willing to maintain a friendship and 16.9% still would consider
marrying such person (35).

As community based study conducted in Kinondoni in 2010, showed that knowledge about mental
illness was very poor as most of respondents 61%responded that mental ill people cannot perform
regular jobs, had no friends and were dangerous. Respondents 79.6% had negative attitude towards
mental illness as they stated that they have no right to find job, have friends and be integrated into
society (41).

6
The institutional based study in Malawi 2012, 0n 210 participants participated in the study, most
attributed mental disorder to alcohol and illicit drug abuse 95.7%. This was closely followed by brain
disease 92.8%, spirit possession 82.8% and psychological trauma 76.1 % (41).

In Another study conducted in Karif village, Northern Nigeria the most common symptoms perceived by
respondents as manifestation of mental illness include aggressiveness/destructiveness (22%),
talkativeness (21.2%), eccentric behavior (16.1%) and wondering (13.3%). Drug misuse were identified
as major causes of mental disorder (34.4%) followed by effect to divine wrath or Gods will(18.8%) and
magic or spirit possession accounts(18%). Majority of respondents harbored negative feelings towards
mentally ill people which manifested by fear, 79.2% of female and 20% of male were reported fear of a
person with mental health problem (36).

A study in Bahir Dar, north west Ethiopia showed that 48% of respondents believed that biomedical
defect is the main cause of mental disorders followed by supernatural power(47%) and psychosocial
stressors. About their attitude towards mentally ill persons, only 23.1% were willing to work with
someone who had mental health problem, 19.1% were willing to shake hands with the patient and only
5.2% be frightened of the person with the mental illness. The public has more favorable attitude for
anxiety and depression than that of schizophrenia (22).

In Another study conducted in Butajira, southern Ethiopia talkativeness is the most frequently perceived
symptoms(65%) followed by aggressiveness (54%) and strange behavior (52%), nakedness mentioned by
35% of respondents and the least perceived symptom was destructiveness(11%) of the seven discussed
mental disorders schizophrenia was regarded as the most serious condition followed by mental
retardation and epilepsy(37).

One study conducted in Agaro town, western Ethiopia put 65% of respondents recognize the illness of
the person by sign and symptoms. The most commonly identified sign and symptoms were unusual
behavior(60%) talking and laughing alone (46%) talkativeness(39%), aggression, self-neglect and
restlessness each accounts(28%). 74% identified schizophrenia as a mental health problem,58%,29%
&15% of respondent identified epilepsy, GAD and MDD as mental health problems respectively from the
case vignette. Most of the respondents (55%) perceived that the cause of mental illness is poverty
followed by Gods wills it accounts 40%. Over 90% of respondents have positive attitude towards living
with cases of MDD in the same house or as neighbor but 35% have negative attitude towards living with
person having schizophrenia. The mean score of work opportunity, marital prospects, chance of
education & cured by modern medicine were above average. Epilepsy was considered the most serious
problemfollowed by schizophrenia. MDD was considered the least serious problem (2).

3.2. Practice to ward Mental Illness

According to revised articles of mental health literacy only a minority of people who meet diagnostic
criteria for a mental disorder seek professional help, self-interventions were found to be at the top like
support from family and friends and also engaging in pleasurable activities (16

A study conducted in Canada in the year 2008 mentioned that 15% of the populations diagnosed by a
doctor as being clinically depressed but 20% of them don’t seek treatment and the proportion increases
to 66% for US citizens (31)

In study conducted in Qatar,79.9% of the respondents stated they would visit a psychiatrist if they had
an emotional distress but only 39.1% agreed to visit healers for their problem (28).Another conducted

7
Malaysia show that 72.7% indicated that they seek help when necessary, while 27.3% didn't seek any
help for their problem. The reason was they didn't know where to seek help, didn't want others to know
their condition and other factors include financial issues and religious beliefs (29).

The result of study conducted in Israel indicates that 76 members of the sample were undergoing
psychiatric treatment, respondents were asked where they would first turn for help in case of
emotional distress 50% of them preferred to visit modern mental health professional but almost third
(29.1%) would choose to first utilization other sources (33).

In the study conducted in Swedish about one third of respondent answered that the best form of help
would be to seek counseling, work related interventions preferred by 15% of respondents, only few
respondents ( 1%) preferred medication as best form of help (34).

The national survey conducted in Nigeria showed that only 2% preferred modern mental health service
to seek help for mental health problems (36). Another study conducted in Karif village northern Nigeria
indicates that the respondents preferred place of help, 46% opted for orthodox medical care followed
by spiritual healing (exorcism) which accounts 34% and use of traditional herbal medicine is preferred by
18% of respondents (36).

Another study conducted in Butajira indicates only 41% of informant preferred modern medicine for
neuropsychiatries conditions, of which most informants preferred medical treatment for epilepsy and
insomnia. Where us holy water, witchcraft and herbalists are the most commonly preferred sources of
help for different types of mental disorder (37).

Study conducted in Agaro town showed that modern medicine preferred by 76%, 83%,72.4% and 72.5%
of respondents for the treatment of epilepsy, schizophrenia, MDD and GAD respectively. Holy water was
preferred by 21% of epilepsy and 19% of schizophrenic subjects (20).

According to the result of study conducted in Bahir Dar the most preferred place that persons turn to
seek help were holy water (89%) and modern medicine was preferred by only 30% of respondents (22).

8
 CHAPTER FOUR

4. Methodology and material

4.1. Study area and period

The study was conducted among residents of Dire dawa city, Lagahare kebele, Eastern Ethiopia.
Dire Dawa was founded in 1902 after Addis Ababa-Djibouti railway reached the area. the
railroads could not reach the city of Harar at higher elevation, so Dire dawa was built nearby. It’s
a major hub for many ethnic groups in Ethiopia, especially the Oromo and Somali.
Dire dawa one of city located in eastern Ethiopia which is located at about 516 kms from Addis
Ababa and 49kms from Harari region.
The city has two Woredas and 9 main kebeles .Dire has warmest climatic condition. The city
covers an area of about 1,213km2 with total population of the 760,963 in 2023 .

This Study will be conducted on all Dire Dawa City Lagahare residents from March to May 2023
G.C

4.2 Study design

A community based cross sectional study will be conducted March to May 2023
G.C

4.3 Population
All community that lives in lagahare Kabele
4.3.1. Source of population
All residents of Lagahare kebele , Dire Dawa city, East Ethiopia.

4.3.2. Study population

All selected residents in the kebele will be used as study population for this study.

4.3.3. Study unit

Those individual who will be selected for sample.

9
 4.4. Inclusion and Exclusion criteria
4.4.1. Inclusion criteria
All People who live in lagahare kebele

4.4.2. Exclusion criteria

Participants who severely ill and unable to communicate during data collection.

4.5. Sample size determination

Maximum estimate sample size had to be taken from the results of a previous
study done on Knowledge, attitude & practice towards mental illness among
community but since there is known result of “p value” 59% will be used to
calculate the maximum estimate sample size.
Single population proportion formula was determined sample size at 95% CI
and 5% marginal error:
The sample size is calculated by using the single population formula

n= (Zα/2)2 P (1-p)
d2
Where:
P = prevalence point under consideration that took from kAP of community (59%).
d= degree of precision (assumed to be 5%)

z
2 = denotes the value of stand reed normal variable that corresponds to be 95%
confidence levels (1.96).

Then calculating the sample size

n= (Zα/2)2 P (1-p) = (1.96)20.59(1-0.59) = 371
d2 (0.05)2
We add the 10%, of 371 for non-respondent rate it became 408

10
since study population is greater than 10,000 it’s finite

4.6. Sampling technique and procedure

Systematic random sampling method will be employed to select respondents and
the first respondent will be selected by lottery method, then every K th resident will
be selected with interval of : i.e. Kj =Nj/nj
Where Kj=sampling interval
Nj= total number of respondents
nj=number of sample
4.7. Data collection tools and technique

Data will be collected using structured interviewer administered questionnaire

consisting of open ended questions will be used to collect the data. The
questionnaire covers socio demographic factors and knowledge and attitude related
to mental illness and practice that they perform during illness. A translated Afan
Oromo questionnaire will be used to collect data and it will employed after pre-
testing on 5% of other community outside but close to the study area and
corrections will be made thereafter to improve the clarity of tool. The participants
will be respond to the items on the questionnaire verbally and the data collector
will record using pen. Data will be collected by the principal investigators.

4.8. Study variable

4.8.1. Dependent variable
 Knowledge
 Attitude
 Practice

Toward mental illness

4.8.2. Independent variable

 Age
 Sex
11
 Level of education
 religion
 Ethnicity
 Marital status
 Residential area
 Monthly income
4.9. Data quality control

To assure the data quality great emphasis is given in designing data collection
instrument. For its simplicity the questionnaire will be pre-tested prior to the actual
data collection on 5%Sapian general hospital psychiatric OPD, followed by
modification. The collected data will be reviewed and checked for completeness
before data entry; the incomplete data will be discarded.

4.10. Data processing and analysis

The filled questionnaire will be checked and cleaned manually. Finally data
will be exported to SPSS version20 for analysis. A 95% confidence interval will be
used to determine the strength of association between variables. Descriptive
statistics (frequencies, tables, graphs, percentages,) will be used to characterized
study subjects.

4.11. Operational definition

Good Knowledge – those respondents who answer the knowledge questions more
than 50% correctly.
Poor knowledge– Those respondents who answer the knowledge questions below
50%

12
Positive attitude – those respondents who answer attitude questions above 50%
positively.
Negative attitude – Those respondents who answer attitude questions below 50%.
Good practice- if the person preferred health institution to seek help for personal or
family’s mental health problems.
Poor practice- if the person preferred places other than health institution, hesitates
to seek or they didn't want to seek any help.

4.12. Institutional consideration

The study will be conducted after getting official permission from Inistitutional
Review Board of Dire Dawa University and lagahare kebele administration. The
respondent will be informed about the aim of the study. Confidentiality and
privacy of the respondents will be maintained by using anonyms. Finally verbal
consent will be obtained from the subjects included in the study immediately
before the interview verbal consent will obtained from each participant before
under taking the interview.

4.13. Plan for dissemination of the study

The studying finding will be disseminated to Dire Dawa city health office, and
DDU department of psychiatry.

13
 CHAPTER FIVE
5. WORK PLAN AND BUDGET BREAK DOWN
5.1WORK PLAN
Table 1: Shows work plan for proposal development and final thesis on
assessment of knowledge and attitude towards mental illness in Dire Dawa city
lagahare kebele residents.
Ser. Activities Respons March April May
No ible
personn
el
1 Title selection Advisor

2 Proposal development Investig

ator

3 Preparing questionnaire Investig

ator
4 Obtaining ethical clearance DDU

5 Proposal submission & Investig

approval ator &
Advisor
6 Data collection Investiga
tor

7 Data entering & analysis Investig

ator

8 Preparing draft thesis Investig

ator

9 Preparing final thesis Investig

ator

10 Final defense Investig

ator

14
 6. BUDGET BREAK DOWN
Table 2: Total budget breakdown for accomplishment of the research project
knowledge, attitude and practice toward mental illness among lagahare kebele
residents. Dire Dawa, Eastern Ethiopia 2023 G.C

No Budget categories Unit cost Multiplying factor Total cost

1 Questionery duplication paper 25cont/quest 6page x 422 2532

2 Binder 180 2 360

3 Printing paper ( pack) 500.00 1 500.00

4 Pen 15.00 2 30.00

S Pencil 10.00 2 20.00

6 Eraser 10.00 4 40.00

7 Share per 2.00 2 4.00

8 flipchart paper 5.00 5 25.00

9 Marker 30.00 2 60.00

10 Printing and binding 3birr/page 40page x 10birr 400.00

11 Rural 25.00 2 50.00

12 Note book 60.00 4 240.00

13 Scientific calculator 200.00 1 200.00

14 Transport (Car ) 50birr /day 5 250.00

From DDU to Lagahare

15
15 Data collector 500birr/day 5 2500

16 Total 4699

7. REFERENCES

1. Inistitute of Health Metrics and Evaluation. Global HealthData Exchange(GHDx).

2. Sadock bj, sadock va. Synopsis of psychiatry. Philadelphia: olomonyolomon and wilkins;
2007.s
3 .Gibson RC., Abel WD., White S. (2008) Hickling Internalizing stigma associated with mental
illness: findings from a general population survey in Jamaica. FW. Rev Panam Salud Publica.
4 . Hitchens, L (2008) ssWhy is mental health nursing unpopular. Nursing Times.net accessed
December 19, 2011.
5. Henderson, C et al. Evaluation of the Time to Change Programme 2007-2011.
6. Prince M, Patel V, Saxena S, et al. Global mental health 1, no
Health without mental health. Lancet. 2007;370:859-877.
7. Shyangwa, et al (2003) conducted a survey to assess the knowledge and attitude about mental
illness among nursing staff in Nepal and found that a substantial number of those interviewed
felt that mentally ill were ‘insane’ ‘violent’ and ‘dangerous’.
8. WHO. World Mental Health Survey Consortium. Prevalence,
Severity and unmet need for treatment of mental disorders in

16
the World Health Organization world mental health surveys.
JAMA. 2004;291:2581-2590.
9. Jorm AF. Mental health literacy: public knowledge and
beliefs about mental disorders. Br J Psychiatry. 2000;
177:396-401.
10. Jugal K, Mukherjee R, Parashar M, Jiloha RC, Ingle GK.
Beliefs and attitudes toward mental health among medical
professionalsin Delhi. Indian J Community Med.2007; 32:198-200.
11 . Lappalainen-Lehto R, Seppa K, Nordback I. Cutting down substance
abuse: present state and vision among surgeons and nurses. Addictive
Behaviour 2005; 30: (5)1013-1018
12. Aydin N Yigit A, Inandi T Kirpinar I. Attitudes of hospital staff toward
mentally ill patients in a teaching hospital in Turkey. International Journal
of Social Psychiatry 2003; 49 (1):17-26.
13. Ndetei D M, Ongecha F A, Mutiso V, Kuria M, Khasakhala LI, Kokonya D A.The
challenges of human resources in mental health in Kenya. South
African Psychiatry Review 2007; 10:33-36.
14. Morgan J F, Killoughery M. Hospital doctors' management of
Psychological problems - Mayou & Smith revisited. British Journal of
Psychiatry 2001; 182:153-157.
15. Br J psychiatry.2000; 177:396-401
16. Shibire T ,Negashe A et al; perception of stigma among family members with schizophrenia
and major affective disorder in rural Ethiopia;social psychiatry, psychiatry epidemiology 2002,
36:299-303
17 . Itzhak L, Anat S, Alexander G, Efraim A, Yehiel S, Robert
K. Mental health-related knowledge, attitudes and practices
in Kibbutzim. Soc Psychiatry Psychiatr Epidemiol
2004;39:758-764.
18. Jugal K, Mukherjee R, Parashar M, Jiloha RC, Ingle GK.
Beliefs and attitudes toward mental health among medical
professionalsin Delhi. Indian J Community Med.

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2007;32:198-200.
19. Corrigan PW. Don’t call me nuts: An international perspective
on stigma and mental illness. Acta Psychiatr Scand 2004; 109:
403-404.
20. Lauder C, Anthony M, Ajdacis-Gross V, Rossler W. What about
Psychiatrists’ attitude toward mentally ill people. European
Psychiatry W. 2004a; 19(7): 423-427.
21. Lauder C, Nordt C, Haker H, Rossler W. Community Psychiatry:
Results of a public opinion survey. Internal Journal of Psychiatry
W. 2006b; 52: 234-242.

22. Lauder C, Nordt C, Falcato L, Rossler W. Volunteering in

Psychiatry: Determining factors of attitude and actual
Commitment. Psychiatry Prax 2006a; 27:347350.

23. Tekle-Haimanot R, Forsgren L, Gebremariam A etal.

Attitude of rural people in central Ethiopia towards
Epilepsy. Soc Sci Med, 1991; 32(2): 203-209.

24. Coleman R, Lopptl, Walraven G. The treatment gap and primary health care for people with
epilepsy in rural Gambia. Bulletin of World Health
Organization, 2002;80:378-383.
25. Emmanuel S. Jean C. Carol J and Lane; schizophrenia,peoples perception in
Quebec Canadian medical association journal 2001; 164(9)1299-1300
26. Mike N, Stigma of mental illness: Shocking survery from Canada- US likely
the same; canadan medical association journal 2008.8;38-45
27. CDC.Attitude towards mental illness-35 states, distric of coloumbia and Puerto
Riko; CDC weekly 2010,59(20);619-625

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8 .ANNEX

Questionnaire are adopted from Mettu University Research on Knowledge,Attitude and practice toward
mental illness.

QUESTIONARE ENGLISH VERSION

Part-I; Socio-demographic information
1. Address
Name of health center and kebele-------------------------------
2. Sex A/ male B/female
3. Age
4. Ethnicity A/Oromo B/Amhara C/Guraghe D/Harari E/Others
5. Religion A/Muslim B/Orthodox C/Catholic D/Protestant E/Others

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6. Marital status A/ Single B/Married C/Divorced
E/Separated E/Widowed
7. Educational status A/ First degree B/ Diploma C/ Can’t read and write
D/Others…..
8.Occupation
Part II- knowledge towards mental illness
1. Have you ever heard or read about mental illness?
A/Yes B/No
2. If you say yes for question 1, what symptoms do people with mental illness exhibit? (More
than one answer is possible)
A. Talking alone B. Sleep disturbance
C. Strange behaviors D. Self-neglect
E. Aggression F. Depression
G. Anxiety H. Others (specify) ……………..
3. What do you think would be the cause of mental illness? (More than one answer is possible)
A/God’s will B/Evil spirit C/Drug/substance
D/Stress E/Poverty F/Others (specify)…………….

4. If “yes “for question number 1, from where you first heard or read?
A/ from family B/ From school C/ From religious leader D/ From community E/ Others
(specify) _________________________________

5. Useful intervention for adolescent mental disorder includes BOTH psychological

pharmacological treatments.
A/True B/ False C/ I don’t know
6. Behaviors disturbances seen in mentally ill person are related to strange experience and
thinking disturbance consequent to neurochemical change in the brain
A. True B. False C .I don’t know

7. A diagnosis of mental illness is made based on history of the patient and mental state
examination at the time of interview

20
 A. True B. False C .I don’t know

8. A strange or altered behavior seen in mental illness is related to strange experience and
disordered thinking. These can be ratified (improved) by administered of medications, which
alters the neuro-chemical abnormalities in the brain.
A. True B. False C .I don’t know

9. Mentally ill individual can have strange experience like delusion (firm false belief) and
hallucination (perception in the absence of external stimuli)
. A. True B. False C .I don’t know

10. Substance abuse is commonly found together with a mental disorder

A. True B. False C .I don’t know

11. Lack of pleasure, hopelessness and fatigue can all be symptoms of clinical depression.
A. True B. False C .I don’t know
12. Nobody with schizophrenia ever recovers
A. True B. False C. I don’t know
13. Mental disorders are psychological problems caused by poor nutrition
A. True B. False C. I don’t know
14. being easily annoyed and unusually irritable can be an emotional warning sign of too much
stress
A. True B. False C. I don’t know
15. Stress and anxiety is the same thing
A. True B. False C. I don’t know
16. Some people misuse substances as a form of self medication to alleviate the symptom of
mental health problem
A. True B. False C. I don’t know
17. Recovery from mental illness obtains work and hold down a good job
A. True B. False C. I don’t know

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18. Depression is a choice and a sign of personnel weakness
A. True B. False C. I don’t know
19. Rehabilitation of mentally ill person can be done home.
A. True B. False C .I don’t know
20. Do you belief that mental illness is a major health problem in Ethiopia especially in Mettu?
A. True B. False C .I don’t know

Part III- Attitude towards mental illness.

1. Do you think that the training is enough to manage mentally to manage mentally ill patients in
your set up?
A/ strongly agree B/ agree C/ disagree D/strongly disagree
2. Would you allow your son /daughter to marry a person with mental illness?
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
3. All mentally ill patients are violent and dangerous.
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
4. What do you think about the importance of mental health in primary health care? A/ strongly
agree B/ agree C/ disagree
D/strongly disagree

5. The best way to handle the mentally ill is to keep them behind locked doors?
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
6. Mental illness is an illness like any other?
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
7. Virtually anyone can become mentally ill?
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
8. More tax money should be spent on the care and treatment of the mentally ill?

22
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
9. We have a responsibility to provide the best possible care for the mentally ill
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
10. The mentally ill are a burden on society.
A/ strongly agree B/ agree C/ disagree D/strongly disagree

11. It is best to avoid anyone who has mental problems.

A/ strongly agree B/ agree C/ disagree
D/strongly disagree
12. The mentally ill should not be given any responsibility?
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
13. I would not want to live next door to someone who has been mentally ill?
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
14. Mental patients should be encouraged to assume the responsibilities of normal life?
A/ strongly agree B/ agree C/ disagree
D/strongly disagree

15. The best therapy for many mental patients is to be part of a normal community.
A/ strongly agree B/ agree C/ disagree
D/strongly disagree
Part IV- practice towards mental illness
1. Do you take short-term training in psychiatry?
A/ Yes B/ No
2. What type of training have you received on mental health?
A/ Never trained B/ Theory only C/ Theory and Clinical Demonstration

3. Very effective and safe drugs are available to treat mental illness?

23
 A/ Yes B/ No
4. Mentally ill people are understood as strange because internal experience are sometimes
understandable to on looker.
A/ Yes B/ No

5. Where do you take someone who is mentally ill?

Do you take him/her to traditional medicine
A/ yes B/ no
If you say yes where did you take him/her
A/ Holy water B/Holy father C/Witch craft D/ Traditional healer E/ Other
6. The best therapy for many mental patients is to be part of a normal community
A/ yes B/ no
()

OROMIC VERSION QUESTIONNERIES

Kutaa-I;Gaaffilee haala jiruufi jireenyaan wal qabatan.

1. Umurii
2,Saala A/ Dhi B/Dha
3. Lamummaa A/Oromoo B/Amhara C/Guraagee D/Harari E/ka biroo
4. Amantaa A/Muslima B/Ortodoksii C/Katolikii D/Protestaniit E/kabiroo
5. Haala gaa’elaa A/ kan hin fuune/heerumne B/kan fuudhe/heerumte C/kan wal
hiike/hiikte
E/kan gargar bahan E/kan irraa du’e/duute
6. Sadarkaa barnootaa A/ Digirii jalqabaa B/ Dipiloomaa C/ kabiraa--------------
Kutaa II- Hubannoo(beekumsa) waa’ee dhukkuba sammuurratti
1. Waa’ee dhukkuba sammuu dhageessee ykn dubbistee beektaa? A/Eeyyee B/Lakki
2.Yoo gaaffii tokkoffaaf deebii kee eeyyee jette,namoota dhukkuba sammuu qaban irratti
mallattoolee akkamii argite?(deebii tokkoo ol deebisuu eeyyemamaadha)
A.Qofaa haasa’uu B. Jeequmsa hirribaa

24
 C. Amala addaa D. Qulqullina ofii eeggachuu dadhabuu
E. Nama miidhuuf yaaluu(arrabsuuykn rukutuun) F.Miira gaddaa
G. Yaaddoo(cinqii) H.kan biraa..
3. Dhukkuboota sammuuf maaltu sababa ta’uu danda’a jettee yaadda?(Deebii tokkoo ol
deebisuun ni eeyyama)
A/Fedha rabbiiti B/Hafuura sheexanaati C/Qoricha ykn araada
qabsiistota
D/Aarii E/Hiyyummaa F/kan biraa…………….

4. Yoo gaaffii lakkoofsa tokkoffaaf Eeyyee jette,odeeffannoo eenyurraa dhageesse ykn maalirraa
dubbistee? A/ Maatii irraa B/ Mana barumsaarraa C,Geggeessaa mana amantaarraa D/
Hawaasarraa E/ Kan biraa _________________________________
5. Rakkoo wal dhahiinsa dalagaalee sammuu yeroo Dargaggummaaf furmaata faayida qabeessa
kennuun mala saayikooloojiifi Dawaa of keessattii hammata.
A/ Dhugaa B/Soba C/ Ani hin beeku
6.Jeequmsi amalaa kanneen akka amala addaa agarsiisuufi jeequmsi yaadaa namoota dhukkuba
sammuu qaban irratti mullatu sababa jijjiirama keemikaalotaa fi niiwuroonota sammuu
keessa jiraniin kan walqabateedha.
A. Dhugaa B. Soba C . hin beeku

7.Amalli haaraan ykn jijjiiramaan namoota dhukkuba sammuu qaban irratti mullatu, kanneen
akka amala addaa fi yaada waldhahaan kan wal qabateedha. Kunis kan inni fooyya’uu danda’u
qorichoota kanneen jijjiirama keemikaala niiwuroonotaa sammuu keessa jiran jijjiiruu danda;an
laachuufiidhaan.
A. Dhugaa B. Soba C . hin beeku

9. Namni dhukkuba sammuu qabu tokko amaloota haaraa kanneen akka amantaa jabaa waan
dhugaa hin taane irratti hundaa’e qabaachuufi utuu waan tokko isa bira hin jiraatin akka waa
argaa jiruutti kan haasa’u amala isa godhu qabaachuu nii danda’a.
. A. Dhugaa B. Soba C .Hin beeku

10. Wantoota araada nama qabsiisan akka malee fayyadamuun irra jireessa
jeequmsa/waldhahiinsa dalagaa sammuun walfaana kan wal qabatuudhaykn argamuudha.
A. Dhugaa B.Soba C .Hin beeku

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11.Gammachuu dhabuun, abdiikutachuunii fi dadhabbiin kunneen hunduu mallattoolee Gaddaa
ta’uu nii danda’u.
A. Dhugaa B. Soba C .Hin beeku
12. Namni dhukkuba sammuu qabu yoomillee irraa fayyuu hin danda’u.
A. Dhugaa B. Soba C. Hin beeku
13.Waldhahiinsi dalagaa sammuu rakkoolee Saayikooloojii(xiin-sammuu) sababa hir;ina nyaata
madaalamaan dhufaniidha.
A. Dhugaa B. Soba C. Hin beeku
14.Haala salphaan mufachuu fi yeroo tokko tokko aaruun mallattoo miira bay’sanii cinqamuu
ykn muddamuu agarsiisu ta’uu nii danda’a.
A. Dhugaa B. Soba C. Hin beeku
15.Cinqamuu ykn dhiphachuu fi Yaadda’uun wantoota tokkoodha(wal fakkaataniidha.)
A. Dhugaa B. Soba C. Hin beeku
16.Namoonni tokko tokko mallattoolee rakkoo fayyaa sammuun dhufu xiqqeessuuf jecha
wantoota araada nama qabsiisan akka inni qoricha ta’etti itti fayyadamu.
A. Dhugaa B. Soba C. Hin beeku
17.Dhukkuba sammuu irraa fayyuun dalagaa fi hojii gaarii akka itti fufan taasisa.
A. Dhugaa B. Soba C. Hin beeku
18.Mukaa’uun(qofaa taa’anii gadduu) filannoo fi Mallattoo dadhabina humna namummaati.
A. Dhugaa B. Soba C. Hin beeku
19.Namoota dhukkuba sammuu qaban jajjabeessuun(ijaaruun,gargaaruun) mana jireenya
isaaniitti ta’uu ni danda’a.
A. Dhugaa B. Soba C .Hin beeku
20.Dhukkubni sammuu Ithiyoopiyaa keessattii,keessumaayyuu mattuu keessattii rakkoo fayyaa
isa guddaati jettee ni Amantaa?

Kutaa III-Ilaalcha waa’ee dhukkuba sammuurrattii.

1. Naannoo jiraattutti namoota dhukkuba sammuu qaban to’achuuf leenjiin jiru gahaadha
jettee yaaddaa?
A/Sirriittin itti walii gala B/ Ittin walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu
2.Ilma kee ykn Intala kee Nama dhukkuba sammuu qabu ykn qabdutti heerumsiisuu yk fuusisuu
nii eyyamtaa?
A/ Sirriittin itti walii gala B/ Ittin walii gala C/ Itti waliin galu

26
 D/Tasumaa itti waliin galu

3. Namoonni dhukkuba sammuu qaban hundinuu kan balaa uumanii fi hamoodha.

A/ Sirriittan itti walii gala B/ Ittin walii gala C/ Itti waluun galu
D/Tasumaa itti waliin galu
4.Waa’ee Barbaachisummaa fayyummaa sammuu sirna kenniinsa fayyaa keessattii maal
yaadda ?
A/ Sirriittan itti walii gala B/ Ittin walii gala C/ Itti waliin galu
D/Tasumaa waliin galu

5.Karaa filatamaan itti namoota dhukkuba sammuu qaban to;achhuu dandeenyu, keessa tokko ,
mana cufame keessa keenyee achitti isaan eeguudha.
A/ Sirriittan itti walii gala B/ Ittin walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

6. Dhukkubni sammuu akkuma dhukkuba kanneen birooti.

A/ Sirriittan itti walii gala B/ Ittin walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

7.Walumaa galatti namni kamiyyuu dhukkubaa sammuu dhukkubsachuu nii danda’a a?

A/ Sirriittan itti walii gala B/ Ittin walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

8. Kunuunsaa fi Yaaliinsa dhukkuba sammuurratti baasiin maalaqaa hedduun irratti bahuu

qabaa?
A/ Sirriittan itti walii gala B/ Ittin walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu
9. kunuunsa danda’amaa fi barbaachisaa ta’e namoota dhukkuba sammuu dhukkubsataniif
dhiheessuu fi itti gaafatamummaa qabna.
A/ Sirriittan itti walii gala B/ Ittin walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

10.Namoonni dhukkuba sammuu qaban hawaasarratti dhiibbaa(ba’aa)dha.

27
A/ Sirriittan itti walii gala B/ Ittin walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

11.Nama rakkoolee sammuu qabu kamiyyuu jibbuun(balaaleffachuun) gaariidha.

A/ Sirriittan itti walii gala B/ Ittan walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

12.Itti gaafatamummaan kamiyyuu nama dhukkuba sammuu qabuuf kennamuun hin danda’amu.
A/ Sirriittan itti walii gala B/ Ittan walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

13.Ani ollaa mana nama dhukkuba sammuu qabutti aanee jiru jiraachuu hin barbaadu.
A/ Sirriittan itti walii gala B/ Ittian walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

14.Dhukkubsattoonni sammuu jireenya sirrii jiraachuuf itti gaafatamummaa akka bahaniif

(qabaataniif)jajjabeeffamuu qabu.
A/ Sirriittan itti walii gala B/ Ittan walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

15. Wal’aansa gaariin namoota dhukkuba sammuu qabaniif godhamu, akka isaan hawaasatti
makamanii, walii galuun jireenya sirrii akka jiraatan gochuudha.
A/ Sirriittan itti walii gala B/ Ittan walii gala C/ Itti waliin galu
D/Tasumaa itti waliin galu

Kutaa IV-Bartee(shaakala) waa’ee dhukkuba sammuurratti.

1.Ogummaa wal’aansa sammuu irratti Leenjii yeroo gabaabaa fudhattee beektaa?
A/ Eeyyee B/ Lakki
2.Waa’ee fayyaa Sammuu irratti Leenjii akkamii fudhatte ?
A/ Tasumaayyuu hin leenjiine B/Tiyoorii qofa C/ Tiyoorii fi agarsiisaan ykn yaaliin

3. Dhukkuba sammuu wal’aanuuf, qorichoonni sirriitti dalaganii fi mijatoo ta’an nii

argamuu?

28
 A/ Eyyee B/ Lakki
4. Namoonni dhukkuba sammuu qaban waan tokko akka haaraatti huubatu, sababiinsaa
yaadi keessa saanii jiru nama isaan daawwatuuf ykn ilaaluuf yeroo tokko tokko nii
huubatama.
A/ Eeyyee B/ Lakki
5- Nama dhukkuba Sammuu dhukkubsatu tokko eessatti geessita?
Gara qoricha aadaatti geessuudhaa?
A-Eeyyee B-Lakki
Yoo “ eyyee “ jette , kanneen gadii keessa isa kamitti geessita?
A-Bakka xabalaa C-Hooda himtuu
B-Bakka amantaa DBakka qoricha aadaa E, kan biroo
6- Dhukkubni sammuu qorichoota ammayyaatiin nii yaalama jettee ni amantaa?
A-Eeyyee B-Lakki

29