COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF PUBLIC HEALTH

COMMUNITY BASED PRACTICE PHASE I PROJECT PROPOSAL

BY GROUP-1

ADVISORS

1. Mr. Rebik Shukur

2. Mr. Ketema Gashaw

3. Mrs. Hiwot Dejene

4. Mr. Sisay Abebe

JAN. 2022,

FITCHE, ETHIOPIA
 LIST OF GROUP MEMBERS

S. no Name Department ID
1 Asfaw Bizuayehu Desta RH
2 Asnakech Beyene Gudeta RH
3 Desta Kebe Bayu RH
4 Laschalew Haymanot Yitay RH
5 Temesgen Zebene Ayele RH
6 SeyoumeTolessa Gunjo RH
7 Tsehaynesh Yenew Melesse RH
8 Zemenu Kabew Melesse RH
9 Beharu Getachew Tola GMPH
10 Debela Negashu Bekele GMPH
11 Ebrahim Mohammed Usman GMPH
12 Gezahegn Damena Tadesse GMPH
13 Habtamu Dechasa Garedew GMPH
14 Shelema Wedajo Olkeba GMPH
15 Sintayehu Dadi Bediye GMPH
16 Solomon Negash Gutema GMPH
17 Yeshihareg Takele Yibas GMPH
18 Amanuel Girma Legesse H/Nutrition
19 Fikadu Ketema Feye H/Nutrition
20 Marga Abate Jima H/Nutrition
21 Rediet Demmelash G/Maryam H/Nutrition
22 Diriba Beharu Feye H/Nutrition
23 Tafa Garedow Jiru H/Nutrition
24 Tesfaye Hailu Mamo H/Nutrition
25 Wendimu Girma Gobena H/Nutrition

2
Contents
List of Figures and tables..............................................................................................................................5

ABBREVIATIONS/ ACRONYMS.......................................................................................................................6

ABSTRUCT.....................................................................................................................................................7

ACKNOWLEDGMENT.....................................................................................................................................8

1. Introduction...............................................................................................................................................9

1.1. Back ground.......................................................................................................................................9

1.2 Statement of the problem..................................................................................................................12
1.3. Significance of the study..................................................................................................................14
2. Literature Review....................................................................................................................................15

2.1. Socio demographic status.................................................................................................................15

2.2. Environmental sanitation and Hygiene.............................................................................................15
2.3 Maternal and Child health (MCH).....................................................................................................17
2.4 Child morbidity and mortality...........................................................................................................18
2.5 School Health and Adolescent health................................................................................................21
3. Objectives...........................................................................................................................................24
3.2. Specific Objectives...........................................................................................................................24
4. Methods and materials............................................................................................................................25

4.1 Study area and period........................................................................................................................25

4.2 Study design......................................................................................................................................26
4.3 Population...................................................................................................................................26
4.3.1 Source population................................................................................................................26
4.3.2 Study population..................................................................................................................26
4.4 Inclusion and exclusion criteria...................................................................................................26
4.4.1 Inclusion criteria..................................................................................................................26
4.4.2 Exclusion criteria.................................................................................................................26
4.5 Sample size determination and sampling procedure....................................................................26
4.6 Sampling technique and procedure..........................................................................................28
4.7 Study variables............................................................................................................................28
4.7 Data Collection processes and methods................................................................................................28

4.8. Data processing and Analysis...........................................................................................................29

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 4.9 Operational definition.......................................................................................................................29
4.11. Ethical consideration......................................................................................................................31
5. RESULTS...............................................................................................................................................32

5.1 Qualitative data result............................................................................................................................32

5.1.1. Sanitary and hygiene related problems..........................................................................................33

5.1.2. Health education related problems................................................................................................36
5.1.3. Solid and liquid waste management related problems...................................................................36
Maternal and child health related problems.............................................................................................40
5.2 QUANTITATIVES DATA RESULT...............................................................................................42
6. DISCUSSION.........................................................................................................................................57

8. Conclusion and Recommendation...........................................................................................................59

9. IDENTIFIED PROBLEMS.....................................................................................................................59

SWOT Analysis.............................................................................................................................................62

11. Reference..............................................................................................................................................63

12. Annex....................................................................................................................................................67

4
List of Figures and tables

Figure 1:- Sketched Map of Chefe Kebele, 2022 (source: Chefe Kebele HEW
Office).....................................................................................................................24
Figure 2:- P valu
Table 1 qualitative results.................................................................................... xxxii
Table 2: Frequency analysis of socio demographic variables in chefe kebele, Fitche
Town, Oromia, Ethiopia, February, 2022............................................................. xxxv
Table 3: community sources of information for Genda Chefe kebele, Fitche tow,
2022...................................................................................................................... xxxv
Table 4: summary of communicable disease prevalence among respondents in
chafe kebele, Fitche town, 2022........................................................................ xxxviii
Table 5: non communicable disease awareness and its means of prevention of
genda Chefe kebele, Fitche town, 2022.................................................................... xl
Table 6: Community water source of genda Chefe, Fitche town, 2022...................xli
Table 7: Latrine and hand facility in genda Chafe kebele, Fitche town. 2022 ..........xli
Table 8: Households solid and liquid waste disposal in genda Chafe kebele, Fitche
town, 2022.............................................................................................................. xlii
Table 9: Maternal and child health in genda Chafe kebele, Fitche town, 2022 .....xliii
Table 10: maternal and child nutritional status of genda Chafe kebele, Fitche town,
2022........................................................................................................................ xlv
e of different variables

Figure 3: Number of households selected from each zone of Chefe kebele

Figure 4: work plan
Figure 5 budget break down

5
ABBREVIATIONS/ ACRONYMS
CBE Community Based Education

CP Community practice

PG Post graduate

ANC Anti natal care

MOH Ministry of health

MOE Ministry of Education

UHEW urban health extension workers

U5 under five

PHCU primary health care unit

6
ABSTRUCT
Background: Community practice (CP) is a strategy of learning through practice and
accomplished by consecutive procedures like qualitative assessment, data collection, community
diagnosis, planning, implementing and evaluation of health related issues. It is one part of
community based education (CBE), having the main aims of identifying priority health problems
in the community, learning from community and changing learned theories into actions or
interventions by community There is a growing demand on school hygiene and sanitation
facilities given the growing number of school enrolment in Ethiopia.

According to EDHS, in our country 93% of urban households and 8% of rural households have
access to electricity, 35% of house hold unimproved source of drinking water, only 6% of
Ethiopian house hold use improved toilet facilities, 47% of Ethiopia House hold use separate
building for cooking, 60% of house hold have hand washing facility but 43% and 68% of urban
and rural resident haven’t soup and other washing detergent and The average household size in
Ethiopia is 4.6 persons

Objective: To assess Community Health and health related problems and provide interventions
based on prioritized problems of Chafe kebele in Fitche Town, North Shoa, Oromia 2022

Methods: A community based quantitative cross sectional study design will be used to assess the
community health problems. The study will be conducted from February 7 to February 12, 2022.
Then, descriptive statistics will be carried out to analyze and explain the magnitudes of the
problems.

Budget: - budget required for the study is estimated to be 30856.1

Keywords: Community practice, Community Based Education, communicable disease, non-

communicable disease, sanitation, clean water, nutrition and reproductive health.

7
ACKNOWLEDGMENT
We would like to thank Salale University College of health sciences, department of Public Health
for arranging this practical field training program and giving us the opportunity to go through
identification of the major community health problems and take part in problem-solving activities
of the community.

We would like to acknowledge our respected instructors and supervisors Mr Rebik Shukur, Mr.
Ketema Gashaw, Mrs. Hiwot Dejene and Mr. Sisay Abebe for providing us with valuable,
support & assistance throughout the preparation of this proposal as well as all administers of
Chafe kebele leaders and Health Extension workers for providing us information about Chafe
kebele Community and facilitation during community observation, In depth interview and FGD.

8
1. Introduction

1.1. Back ground

Community practice (CP) is a strategy of learning through practice and accomplished by
consecutive procedures like qualitative assessment, data collection, community diagnosis,
planning, implementing and evaluation of health related issues. It is one part of community based
education (CBE), having the main aims of identifying priority health problems in the community,
learning from community and changing learned theories into actions or interventions by
community (Michael et al, 2011).

Community based education (CBE) was introduced to the world in the late 1970’s as a response
to popular demand that education should give service to the society. In the 1979 innovative school
in collaboration of world health organization formed the “network of community oriented
education institution of health sciences” organization with members that reached 55 countries that
work together to the achievement of CBE (Michael et al, 2011).

During the same period there was a similar social management in Ethiopia that resulted in a
prominent revolution with the main theme “education should serve the masses”.The CBE
program was first adopted and implemented in Ethiopia by Jimma University since 1985/86 as
part of health science education. Currently most of the universities offer the program (Jimma
University Community Based Education, 2013).

It consists of learning activities that use the community extensively as a learning environment, in
which not only students but also teachers, members of the community, and other sectors are
actively engaged throughout the educational experience. CBE, as an educational philosophy aims
at developing professionals with problem identification and solving skills and positive attitudes to
serve the society (Gudisa and Gamachis, 2021).

CBE is a popular approach for all forms of education and for all age groups especially at higher
education level where the primary purpose is to foster interdependence between education and
communities for enhancing the capacity of individuals and groups for improving their quality of
life. (Gelaw et al 2014).

The CP is implemented in post graduate (PG) programs. The PG student in a college/university

level is creating a team and the team encompasses a mix of disciplines. The students of different

9
discipline in a college will form a team to review the Kebele plan and take activities from the
Kebele and plan for data analyses and intervention. The team will also mobilize the community,
solicits funds from the community, government and nongovernment sources. The CP program
involves the community in problem identification, drawing of action plan and implementation
(Jimma University Community Based Education, 2013).

Based on the concept of CP, Salale University College of Health science post graduate students
are established from three different disciplines (general, reproductive and nutrition public health
departments).A total of 25 students are assigned to identify and prioritize, take actions on
problems which have been observed in the community so as to achieve the aim of CP .

Currently one of the major health Problems, that our country facing is spread of communicable
diseases that could be prevented by proper disposal of human excreta and maintaining
environmental sanitation. To improve the community health, it is very important that human
excreta are disposed in sanitary manner excreta are disposed hygienically, the community can be
protected from majority of diseases and money can be saved which are spent every year in
controlling and treating various diseases (Gedefaw, et al 2014).

Indeed, the correct disposal of excreta is one of the most effective measures, which any
community can undertake to prevent disease. Excreta are defined as human feces and urine.
Human feces or excreta are the principal vehicles for the transmission and spread of a wide range
of communicable diseases. Some of these diseases are chief causes of sickness and deaths in
societies; especially where poverty and malnutrition are rampant (FMOE, 2017).

Human excreta are a major source of infection as that contains pathogenic microorganisms,
viruses, protozoa, helminthes, parasites and their eggs. Diseases which are associated with
improper disposal of excreta include typhoid, paratyphoid, diarrhea, dysentery, cholera,
poliomyelitis, viral hepatitis. So proper disposal of excreta is an important part of environmental
health work in order to ensure a safe environment both in rural and urban areas (Oljira and
Berkessa, 2016).

According to the world health organization (WHO), unsafe WASH practices, (i.e., lack of access
to safe water sources, poor environmental sanitation, poor latrine utilization and inadequate
personal hygiene practice), are linked to various diseases and risks of the community including

10
communicable diseases, non-communicable diseases from exposures to contaminants in drinking
water, and their consequences (WHO, 2014b).

Globally, 2.6 billion People lack adequate sanitation and safe disposal of human excreta. Lack of
sanitation contributes to about 10% of the global disease burden, causing mainly diarrheal
diseases. Improved sanitation has significant impacts not only on health, but on social and
economic development, particularly in developing countries. The health sector has a strong role to
play in improving sanitation in developing countries through policy development and the
implementation of sanitation programs. 2.1 billion People globally still lack safe water services at
home. Great inequalities in access to safe drinking water are present between sub-Saharan Africa
and the rest of the world, within countries (especially at the rural-urban divide), and between the
richest and the poorest residents across all geographies (Durao et al, 2020).

In Africa, only 60% of the population has access to improved sanitation services, but the situation
is worse in rural areas, in which below half (45%) of the rural population has access to improved
sanitation services. According to the World Health Organization (WHO), 2011 report, individuals
with no access to improved sanitation are forced to defecate in open fields, in rivers, or near areas
where children play and food is prepared.

From the Ethiopian Demographic and Health Survey (EDHS, 2016) only 6% of households in
Ethiopia use an improved and not shared toilet or latrine facility. Another 9 percent of households
(35 percent in urban areas and 2 percent in rural areas) use facilities that would be considered
improved if they were not shared by two or more households. Half of households in urban areas
(50 percent) use an unimproved toilet facility, compared with more than 9 in 10 (94 percent) of
households in rural areas (EDHS, 2016).

Maternal mortality continues to be of great public health importance, however for each woman
who dies as the direct or indirect result of pregnancy, many more women experience life-
threatening complications. The global burden of severe maternal morbidity (SMM) is not known,
but the World Bank estimates that it is increasing over time. Consistent with rates of maternal
mortality, SMM rates are higher in low- and middle-income countries (LMICs) than in high-
income countries(Geller et al., 2018)..

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1.2 Statement of the problem
Globally, in 2018, there were75 million death worldwide, with communicable disease
accounting for 31 million of them. Every minute 20 children under the age of five die around
the world, resulting in more than 10.6 million deaths per year. The majority of these deaths are
caused by diseases that are either preventable by simple WASH practice or treatable after they
have been contracted (Whiteford et al., 2013)

According to WHO estimates, nearly 630 million years of healthy life in Africa lost each year
due to disease, costing the continent more than 2.4 trillion dollars (Sanjuán, Latorre and
Lechuga, 2011).Worldwide.

In Ethiopia, Infectious diseases account for 60-80% of the country’s health problems, with
diarrhea accounting for 15% of all deaths, primarily among the country’s enormous population
of children under the age of five. Diarrhea is the greatest cause of death among Ethiopian
children under the age of five, accounting for 23% of all under-five deaths, or over 70,000
children every year (U.S CDC, 2013).

Study conducted in Ethiopia on the burden of non-communicable disease from 2000 _2016
show that NCD caused an estimated 274998.8 deaths among all ages and both genders with a
crude death rate of 268.5/100000 and age-standardized death rate (ASDR) of 554.7/100000
population. It contributed to 39.3% of the total death, 53% of ASDR, and 34% of DALYs. The
number of deaths and DALYs from NCD has increased by 38% and 31.5%, respectively,
whereas CDR and ASDR from NCD have declined by 10.3% and 12.5%, respectively (Girum
et al, 2020).

Globally, 2.5 billion people do not use improved sanitation; 1.2 billion, practice open
defecation. Poor sanitation remains a major threat to development, impacting countries’
progress in health, education, gender equity, and social and economic development worldwide.
(Al, 2018).

Another global health priority is the link between our health and the environment we live in,
from the water we drink, to the air we breathe, to the food we grow and eat. More than three
million children under the age of five die each year from environment related causes, such as

12
polluted indoor and outdoor air, contaminated water and lack of adequate sanitation. (Zeru and
Kumie, no date)

Each year, 200 million tons of human waste goes uncollected and untreated around the world
and an estimated 1.5 million death of children under the age of five,5 billion productive days
lost, 443 million school days lost are attributed to diarrheal disease globally. (Bergen et al.,
2018).

According to UNICF, 65% of household in Ethiopia have access to improved water sources
while only 6.3% of households have access to improved sanitation. Only 17 % of people
practice improved hygiene behaviors and live in a healthy environment (United Nations
Habitat, 2016).

In Ethiopia Communicable diseases, nutritional problems, maternal and child health problems
are the major challenging health care related problems. Also there is wide spread poverty, low
educational levels, inadequate access to clean water and sanitation facilities, poor nutritional
status, a high fertility rate, together with low levels of access to health services contributing to
the high burden of ill health in the country (Bergen et al., 2018) .

The prevalence of undernourishment is increasing and around 815 million of the world
population has been undernourished in 2016 (FAO, 2017). The prevalence of
undernourishment is the highest in Africa where agriculture is the dominant sector and where
there is huge yield gap (FAO, 2017; Luan et al., 2013). Moreover, the rural households in
most developing countries remain disproportionally poor. As a result, the primary goal of many
of the developing countries remains producing sufficient food (Luan et al., 2013).

In response, the Ethiopian government has prepared a health sector transformation plan based
on the National Health Policy and the Health Sector Long-Term Plan, with a strong political
commitment and budget allocation, focusing on universal Primary Health Care coverage
through strengthening the health system to ensure equity and quality of services in all
geographical areas and segments of the population. To put the strategy into action, the
government and several partners are working together in an integrated effort. The FMOH has
also initiated a second-generation health extension program, which will largely focus on
improving health clinic services and health professional capability (FMOH, 2015).

13
Despite government is doing different strategies to reduce the burden of diseases, different
factors such as lack of professional commitment, population awareness about the problem of
waste disposal, inaccessible health facility and low health seeking behavior are leading to poor
health status of the community.

Fitche town municipality had attempted to manage the solid waste and liquid waste by
constructing different waste disposal sites. Although the above measure has been taken, there
were a problem in collection, transportation, and disposal of wastes timely as a result the
community is exposed to different communicable disease Therefore, this study will be
designed to assess the status of health and health related problems of peoples living in Chefe
kebele, Fitche town, Oromia regional state, Ethiopia.

1.3. Significance of the study

These CP program will help us to identify health and health related problems of chafe kebele
societies and give solutions for that problem by using different intervention methods. It will
assist stake holders and Fitche Town health office and administration to be aware of health
related problems of the town and consequently plan and take critical measure to improve the
health condition of the community in the future. It also guides other interested researchers to
conduct more studies in this area to figure out the community health related problems, and also
providing health education for the community in different health issues.Finally, it will also help
the students to be familiarize in identification, prioritization, planning, and intervention of
health and health related problems of the community.

14
2. Literature Review

2.1. Socio demographic status

Universal health coverage aims to ensure that all individuals and communities receive the health
services they need, without suffering financial hardship. Health services include all services
dealing with the promotion, maintenance and restoration of health. They include both personal
and population-based health

Services (WHO, 2016).

Ethiopia is the second most populous country of Africa and ranks 12th in the world. Ethiopia is
the home to various ethnicities, with more than 80 different spoken languages and characterized
by rapid population growth (2.6%), young age structure, and a high dependency ratio, with a high
rural-urban differential. Ethiopia has a high total fertility rate of 4.6 births per woman (2.3 in
urban areas and 5.2 in rural areas) and a corresponding crude birth rate of 32 per 1000 in 2016.
The average household size is 4.6. By 2024, the population is projected to reach 109.5 million
(Central Statistics Agency, Juy 2013) and will reach 122.3 million by 2030(Ministry of health
Ethiopia, 2021).

2.2. Environmental sanitation and Hygiene

According to EDHS, in our country 93% of urban households and 8% of rural households have
access to electricity,35% of house hold use unimproved source of drinking water, only 6% of
Ethiopian house hold use improved toilet facilities, 47% of Ethiopia House hold use separate
building for cooking, 60% of house hold have hand washing facility but 43% and 68% of urban
and rural resident haven’t soup and other washing detergent and The average household size in
Ethiopia is 4.6 persons( EDHE 2016).

The generation of solid waste is indeed on the rise globally. Currently, cities around the world
generate over 1.3billion tonnes of waste annually, with this approximated to increase to 2.2 billion
tonnes by 2025 (D. Hoornweg and P. Bhada, 2012).

15
The study done in Uganda showed that proper solid waste management was generally low with
majority of households using sacks as their waste storage receptacles and not segregating their
waste. Use of plastic containers, awareness of waste management laws, and danger of poor waste
management were associated with exhibition of proper management practices, while use of
substandard receptacles like polythene and paper bags was associated with improper waste
management practices (Ssemugaboet al 2020).

In Ethiopia, the health status of the people is very low compared with other low-income countries
(largely attributable to potentially preventable infectious diseases and nutritional deficiencies) and
a high rate of population growth. Widespread poverty along with general low income level of the
vast majority of the population, low education levels, inadequate access to clean water and
sanitation facilities and poor access to health services have also contributed to the burden of ill-
health in Ethiopia and only 32% of the people have access to safe water supply while the sanitary
situation is considered even worse, with only 17% having access to adequate latrines, and the
condition are similar for urban and rural, however somewhat better in the urban area.(Begashaw,
2019; Thiam et al., 2017).

The study done in Asella town showed that, more than 82% of Asella town residents practice
improper solid waste management and Lack of adequate knowledge about solid waste
management and not having access to door to door solid waste collection could have contributed
to the reported improper solid waste practice which indicated that there is a need for enhancing
the awareness of solid waste management at the community level (Lema et al,2019 ).

The study done in Woldia town revealed that educational status (AOR = 10.92, 95% CI = (3.12-
38.27)), occupational status (AOR = 8.08, 95% CI = (2.08-31.31)), monthly income (AOR = 5.72,
95% CI = (1.55-21.13)), and age (AOR = 2.53, 95% CI = (1.04-6.19)) were found to be the major
factors associated with solid waste management practices (Abegaz et al, 2021).

Hand washing is very effective in preventing communicable diseases. Hand washing is

particularly important for children, as they are more vulnerable to infections gained from
unwashed hands and also due to their unhealthy behavior(Dajaan et al., 2018). The study done in
Debark town shows that hand washing practice at critical times of study participants was found to

16
be low. A significant proportion of mothers of under five children have a poor hand washing
practice at critical times. It is necessary to increase the access to water and to improve knowledge
and attitude of mothers to improve their hand washing practice at critical times (Dagne et al,
2019).

The Ethiopian Demographic and Health Survey done in 2016 shows that 6% of Ethiopian
households use improved toilet facilities, 56% of rural households use unimproved toilet
facilities, 35% and 2% of toilet are shared in urban and rural households respectively and One in
three households in Ethiopia have no toilet facility.(EDHS, 2016).

Community based cross sectional survey conducted in Derbamarkos 2013, show that 94% of
house hold of the kebele have latrine facility, 50% of households haven’t hand washing
facility(Gelaw et al., 2015).

A systematic review and meta-analysis done on prevalence and factors associated with intestinal
parasitic infections among food handlers working at higher public University student’s cafeterias
and public food establishments in Ethiopia shows that parasitic infections among food handlers
were significantly high. Untrimmed fingernail, do not washing hands after defecation, do not
washing hands after touching any body parts, do not made regular medical checkup and do not
receive food safety training were factors that increase the prevalence of intestinal parasitic
infections (Alemnew et al. 2020).

2.3 Maternal and Child health (MCH)

According to mini demographic and health survey of 2019, 70.8 % of pregnant women has
attending antenatal care in Oromia region, 40.6 % of pregnant women attend antenatal care four
times in Oromia region. In the presence of antenatal care follow up, iron folic acid intake for 90
days and above is low during pregnancy in Ethiopia, particularly in Oromia region which is 11.8
%(EMDHS, 2019).

Despite there are efforts on maternal health promotion, maternal mortality continues to be of great
public health importance, however for each woman who dies as the direct or indirect result of
pregnancy, many more women experience life-threatening complications. The global burden of
severe maternal morbidity (SMM) is not known, but the World Bank estimates that it is

17
increasing over time. Consistent with rates of maternal mortality, SMM rates are higher in low-
and middle-income countries (LMICs) than in high-income countries(Geller et al., 2018).

Study conducted in Bodit, Walayita on modern contraceptive utilization, by 2017 show that
48.2% women utilized any modern contraceptive(Gebremeskel et al., 2017). Another study
conducted in Derbamarkos 2013, 100% of pregnant women are attained at least ANC1 and of
them 90% attain delivery at health facility, 18% of them not breast feeding their children (Gelaw
et al., 2015). The review conducted 2018 shows that, Out of 89 cases reviewed, nearly 40% of
maternal death cases reviewed were identified as pregnancy-related of which34 cases (38%) were
determined to be pregnancy-related, 50 cases (56 %) are pregnancy-associated, but not pregnancy
related and For 5 cases (6 %), pregnancy-relatedness is unable to be determined. The leading
conditions contributing to SMM across all regions are hemorrhage and hypertensive
disorders(Main, Markow and Gould, 2018).

2.4 Child morbidity and mortality

Despite the global decline in death rates of children younger than five years old, the risk of a child
dying before turning five years of age remains highest in the WHO African Region.The problem
of child death ,in Ethiopia is worse, with an Ethiopian child being 30 times more likely to die by
his/her fifth birthday than a child in Western Europe (Dagnew et al., 2019).

According the study conducted in north west Ethiopia in 2014,among 775 mothers included in
the analysis, 21.5% of the children have diarrhea in the two weeks before the survey with the
prevalence of one-fifth of the children included in the study reported diarrheal disease of which
residence, sex of the child, type of water storage container, methods of complementary feeding,
and cleansing materials to wash the hands are the most important variables that affected the
occurrence of diarrhea in children (Anteneh et al, 2017).

A study conducted on diarrheal prevalence and associated factors in Bahar Dar in 2016 showed
that 14% of the children have diarrhea in the past 2 weeks prior to the study period and identified
the main factors that contributes for the occurrence of diarrheal cases are lack of hand washing
facilities in the household lack of separate feeding materials, poor hand washing practice and not

18
breastfeeding were predictors of the concurrence of diarrhea ( Anteneh, et al, 2017; Dagnew et
al., 2019).

Despite the high prevalence of vaccine preventable disease in Ethiopia, immunization coverage
rates stagnated and remained very low for many years.In most Woreda of Ethiopia the important
weakness that impede immunization program to achieve expected goals are found to be
insufficient outreach services, poor staff motivation, infrequent in-service training and inadequate
supervision, insufficient communication between health staff and community members,
inadequate monitoring systems at all levels and lack of community participation due to lack of
awareness and absence of social mobilization (Alebel et al, 2018).

The life expectancy at birth is the lowest (54 years), and infant and under-five mortality rates are
among the highest in the world (97/1000 live births and 140/1000 live births, respectively)
(Begashaw, 2019).

Study Conducted in Rural Bangladish in 2019, revealed that diarrhea and acute respiratory
infection (ARI) are major causes of child mortality (Ullah et al, 2019).

Another study done in Senegal in 2016,reported high prevalence of diarrhoea among children
under the age of five during the 2 weeks preceding the survey is 26% , and diarrhoea is
responsible for 15% of all deaths in children under the age of five and is the third leading cause of
childhood deaths in Senegal (Dhital et al., 2017; Thiam et al., 2017).

A study done in Zimbabwe showed that poor coverage of Immunization was related to the poor
quality of EPI service; specifically to invalid doses and missed opportunities (Dhital et al., 2017;
Main, et al, 2018).
According to CDC global 2021 Ethiopia, indicate that Tuberculosis (TB) is the leading cause of
death for people living with HIV (CDC, 2021). Health Sector Transformation Plan II initiative
and HTP1 performance monitoring and evaluation, show that communicable, non-communicable
diseases and mental health, and injuries the main cause of morbidity and mortality in Ethiopia. In
2019, 58% of disability adjusted life years (DALYs) were due to maternal and neonatal
conditions, communicable diseases, and malnutrition.(MOE, 2021).

19
Study conducted in Ethiopia on the burden of non-communicable disease from 2000 _2016 show
that NCD caused an estimated 274998.8 deaths among all ages and both genders with a crude
death rate of 268.5/100000 and age-standardized death rate (ASDR) of 554.7/100000 population.
It contributed to 39.3% of the total death, 53% of ASDR, and 34% of DALYs. The number of
deaths and DALYs from NCD has increased by 38% and 31.5%, respectively, whereas CDR and
ASDR from NCD have declined by 10.3% and 12.5%, respectively (Girum et al, 2020).

Nutritional status
Nutrition is central to the SDGs, with 12 of the 17 SDGs containing indicators relevant to
nutrition. Ending malnutrition in all its forms will catalyze improved outcomes and have powerful
multiplier effects across the SDGs. Likewise, progress across the SDGs is essential to address the
causes and consequences of malnutrition. Proactive consideration and inclusion of nutrition
actions, goals and indicators across the SDGs will ensure that nutrition becomes a cross-cutting
priority on the global development agenda and will promote engagement at all levels. In addition
to the vast health and economic consequences, the global malnutrition burden has environmental
impacts affecting the entire planet. Today, one in every nine people in the world is hungry, and
one in every three is overweight or obese. More and more countries experience the double burden
of malnutrition, where under nutrition coexists with overweight, obesity and other diet-related
non-communicable diseases (NCDs) (2020 Global Nutrition Report: Action on equity to end
malnutrition). The prevalence of undernourishment is increasing and around 815 million of the
world population has been undernourished in 2016 (FAO, 2017). The prevalence of
undernourishment is the highest in Africa where agriculture is the dominant sector and where
there is huge yield gap (FAO, 2017; Luan et al., 2013). Moreover, the rural households in most
developing countries remain disproportionally poor. As a result, the primary goal of many of the
developing countries remains producing sufficient food (Luan et al., 2013).

An estimated 805 million people worldwide are chronically undernourished (FAO, 2014). One
hundred fifty-nine million children under 5 are stunted and 41 million children under 5 are
overweight and obese. In addition, at least 50 million are severely or moderately wasted (WHO/
UNICEF/The World Bank, 2015).

20
According to the World Health Organization (WHO), approximately 2 billion people worldwide
suffer from hidden hunger, which is the subclinical deficiency of micronutrients, and the main
ones ate vitamin A, iron, zinc and iodine. (WHO, 2014)

There are about 2 billion children and adults who are deficient in vitamins or minerals(UN SCN,
2015). Overweight prevalence has gone up slightly between 1990 and 2014, from 4.8% to 6.1%.
There are 41 million overweight children in the world. About 10 million more than there were 2
decades ago (WHO, 2014). In Ethiopia, child undernutrition and anemia are major public health
concerns, resulting in increased childhood morbidity and mortality. Despite progress made to
reduce the prevalence of malnutrition (especially stunting) from 50% in 2000 to 38% in 2016,
little is known about the magnitude and risk factors for concurrent nutritional deficiencies in
Ethiopia.( Multiple anthropometric and nutritional deficiencies in young children in
Ethiopia: a multi-level analysis based on a nationally representative data (2021), Published
online 2021 Jan 5. doi: 10.1186/s12887-020-02467-1) The prevalence of stunting decreased by
31% (from 58% to 40%) between 2000 and 2014. The proportion of underweight children
declined even more substantially, by 39% over the same period. Conversely, the prevalence of
wasting has remained fairly static over the last 15 years. Anemia prevalence among under-five
children remains high at 44%, even though it declined by 19% over the last 6 years (EDHS,
2011).

2.5 School Health and Adolescent health

The study done in 2019 on adolescents aged 15-19 years at Governmental High Schools in
Aksum Town, shows that the prevalence of risky sexual behavior was found to be alarming
among adolescents of high school aged 15-19 years. This can significantly affect health quality in
the community and the country at large. We recommend setting strategies that are against the
determining factors of risky sexual behavior; the control of alcoholic beverages among
adolescents aged 15-19 years must be enhanced, and awareness creation must be made regarding
its unpleasant consequences (Mengeshaand Enguday, 2019).

The overall prevalence of current alcohol use among adolescents aged 15–19 years at high
schools in Aksum town was found to be 39.7% (95% CI; 35.7, 43.6). Slightly increased
prevalence of alcohol use has been found among grade ten students (74/302) and male students

21
(98/344) when compared to grade nine students (67/331) and female students (43/289),
respectively (Gebeyehu and Biresaw, 2021).

The sexual behavior of youth is important not only because of the possible reproductive outcomes
but also because of the fact that risky sexual behavior is associated with sexually transmitted
infections.
In Jimma Town, 17.9% the high school of adolescents (6.7% of females and 11.2% of males)
were involved in unprotected sexual activities. In Addis Ababa City, about 25% of the sexually
active males were reported to have visited female commercial sex workers. Out of these, 36%
reported that they had used condom (Fantahun and Mamo,2014).
A cross sectional survey conducted in southern Ethiopia revealed that the prevalence of stunting
was 16.9% and its correlation with school underperformance was significantly high. Similarly
studies conducted in Goba town and primary schools of Hawa Galan district shown that
nutritional status like stunting, underweight and wealth index were found to be correlated with
academic performance of students (seyoum et al,2019).
The impact of menstrual hygiene, which is critical for women, has been largely neglected by
Water, sanitation, and hygiene (WASH) sector researchers. As a result, millions of women and
Girls continue to be denied WASH, health, education, dignity, and gender equity. In Gujarat In
India, 91% of girls reported staying away from flowing water during menstruation. In a Study in
South Asia, 20% of the women who had access to toilets stated that they refrained From using
them during their periods, partly due to fear of staining the toilet. Menstruation is a natural
process, but if not properly managed it can result in health problems. Researchers Have suggested
links between unhygienic menstrual hygiene management and urinary infections,RTIs, and other
diseases (Ademas et al,2020).
Studies in Ethiopia show that menstruation-related problems resulted in 43.0% - 54.5% of Female
students being absent from school for 1 to 4 days each menstrual period. In one study, 57.8% of
girls reported that menstruation affected their academic performance negatively since menarche,
90.0% did not feel comfortable when they came to school during menstruation and 20.2% missed
exams that coincided with their menstruation days.
A qualitative study regarding school absenteeism and menstruation-related problems Showed that
24.7% of school girls knew one or more girls who had dropped out of school and 25.4% reported
they had heard about girls who had dropped out of school. Although MHP is a pressing issue, not

22
much attention has been given to this subject and studies on menstruation and its hygienic
management as well as its influence on girls’ education in Ethiopia ( Habtegiorgis et al, 2021).

23
3. Objectives
3.1. General Objectives

To assess Community Health and health related problems and provide intervention based on
prioritized problem in Chafe kebele, Fitche Town, North Shoa, Oromia 2022.

3.2. Specific Objectives

 To assess environmental health management in the Chefe kebele Fitche town, February,
2022
 To asses maternal and child health care practice of Chefe kebele Fitche town, February,
2022
 To asses adolescent health problems of Chefe Kebele Fitche town, February, 2022
 To identify Communicable disease in Chefe kebele Fitche town, February, 2022
 To identify non-communicable disease in chefe kebele ,\fitche town
 To assess the nutritional problem in chefe kebele Fitche town, February, 2022
 To provide intervention based on prioritized problems

24
 4. Methods and materials

4.1 Study area and period

The study will be conducted in chefe kebele of fitche town from February to February 12,
2022. Fitche is a town in central Ethiopia and administrative center of north shewa oromia
region which is located at 114Km from Addis Ababa. Fitche has a latitude and longitude
of 90 48N 38044E and an elevation between 2738 and2782 meters above sea level. It has
total surface area of 3325 hectares and divided in to 4 administrative Keble. The total
population of chefe keble is 13054 and 2720 households; of this 6913 are females while
6141 are males. Furthermore, pregnant women are 453 while < 5 five children and women
of reproductive age are 2145 and 2889 respectively. Geographically chefe kebele is
bounded by Dida heto kebele from south, Goro Kebele from the North, Girar Jarso woreda
in both East and West. There are different institutions in the Kebele; kebele Admin, one
police station, one health post, one health center, one public secondary and primary
school, one TVET College and one private primary school and one kindergarten school
and one orthodox and mosque religious organization (Source: Fitche town Health office
and Kebele HEWs).

Figure 1:- Sketched Map of Chefe Kebele, 2022 (source: Chefe Kebele HEW Office)

25
4.2 Study design
 Mixed (quantitative cross-sectional and Qualitative) approach was conducted.

4.3 Population
4.3.1 Source population
Quantitative: All House Holds living in Ganda Chefe kebele of Fitche town.

Qualitative: All purposely selected key informants ( kebele leaders ,school directors ) FGD
( Students) ,In-depth interview ( Students)

4.3.2 Study population

 Quantitative :-All selected house holds in Gende Chefe Kebele
 Qualitative: All purposely selected key informants ( kebele leaders ,school directors ) FGD
( Students) ,In-depth interview ( Students)

4.4 Inclusion and exclusion criteria

4.4.1 Inclusion criteria
 All selected house hold heads and institution in gende chefe kebele were included
4.4.2 Exclusion criteria
 Individuals who are severely ill and unable to respond.
 Non-functional Institution found during data collection.

4.5 Sample size determination and sampling procedure

4.5.1. For Quantitative
The sample size was determined using single population proportion formula by considering the p
value 82 % for identified health problems as the following to get the maximum sample size using
95 % confidence level and different margin of error.

Margin Non - Calculated

Proportio
Variables of CI response Sample References
n (%)
error rate size
Solid waste
82 3% 95% 10% 693 Lema et al., 2019
disposal
Latrine coverage 94 3% 95% 10% 265 Gelaw et al., 2015
nutritional status 38 4% 95% 10% 622 WHO,2014

26
 of the child
Water coverage. 32 4% 95% 10% 575 Begashaw,2019
Health service Gebremeskel
48.2 5% 95% 10% 422
utilization etal,2017
Diarrhea among (Dagnew et al.,
14 3% 95% 10% 565
children 2019).

Figure 2:- P value of different variables

Then; n= (Z α/2)2 p (1-p)/d2

n = ((1.96)2*(0.82*0.18) (/0.03)2

n= 630

Where: -n is the maximum possible sample size

Z α/2 is standard score value for 95 % confidence level for two sides normal distribution
P = is the proportion of households with health and health related problems
d = is margin of error

Since the total households of the kebele was less than 10,000 (2720) we had used the correction
formula

Nf = n/((1+n)/N)

Where nf = required sample size

n = calculated sample size

N = total households in chafe kebeke

nf= 552

Considering 10% non-response rate, total sample size was 605 households.

4.5.2. For qualitative

 For Focus group discussion;- Two focus group discussion each contain a group of 12
students were involved

27
  In depth interview:- Ten students were invited for in-depth interview
 Key informants:-Two school directors, kebele leaders, health center head,selected
community leaders were involved
4.6 Sampling technique and procedure
Systematic random sampling method was employed to select 605 households in Chafe Kebele.
To select individual households, we determine the value of K (interval) and households were
randomly selected by lottery method from 1-k so that n is the first random household in which
the data was collected and continue every K household in each Gote until the required sample
size will be maintained. Our K will be k=N/n=2720/605=4

4.7 Study variables

 Socio-demographic characteristics (Age, Sex, Marital status, Religion, Educational
status, Income, Ethnicity, Family size, Occupation)

 Source of water supply

 Communicable disease awareness
 Nutritional awareness of community
 Excreta disposal (Latrine utilization and coverage)
 Solid waste disposal management
 Personal and housing hygiene
 Adolescent health service utilization
 MCH (ANC, Delivery, PNC, FP,)
 Child Health (Feeding practice, Immunization, HTP, Child illness)

4.7 Data Collection processes and methods

Data was collected using interviewer administered questionnaire that was developed and adopted
in English with modification from related studies. The questionnaire was containing socio-
demographic status of the population and the identified thematic areas. It was used after pre-
testing on 5% of the same source population other than the sampled population. To identify the
general problems of the kebele, qualitative study was conducted by using focus group discussion,
observation and in depth interview data collection methods.

28
4.8. Data processing and Analysis
Quantitative: Data entry was done by using Epi-Data 3.1 version and exported to SPSS version
23.0 software package to edit, clean for inconsistencies and missing values, and finally to
analyses. Different frequency tables, graphs, and descriptive summaries were used to describe the
study variables.

Qualitative: videos recorded and transcribed qualitative data was organized in narrative forms
similar to the respondents' own words and analyzed under selected themes based on the

4.9. Data Quality Assurance

The questionnaire was evaluated by supervisors. Visited houses were marked (given number) to
avoid doubling by other data collectors and to enable revisit in case of incomplete and
inconsistent responses. Prior to the actual data collection, questionnaire was pre tested on 5% of
the sample on similar population who are not part of the actual sample. Common understanding
would be taken about the process of data collection.
After data collected it was edited and each questionnaire was given a unique code. The group
members were prepared the template and entered data using Epi Data (version 3.1) then exported
to SPSS (version 23).

4.9 Operational definition

Improved water source: A water source which can be tape water, protected spring, protected
well.

Protected well –well that have all the following components

Casing: the inside wall of the well should be made water proof by cementing from the top of the
well down to a minimum depth of 3 meters. The deeper it is extended, the better. The casing of
the well should also be extended for a minimum of 60 cm above the surrounding ground level.
Cover: A concrete cover should be fitted over the casing to prevent dust, insects, small animals,
etc. From falling in to the well and also to prevent leakage of flushed water.
Sanitary water drawing device: Ideally, a pump should be installed, but if a pump is not
available a sanitary bucket and rope system should be used
Fencing: The immediate area of the well should preferably be fenced to keep animals away.

29
Diversion ditch: The area surrounding the well should be graded off in order to prevent the flow
of storm water into the well. Is a dug well that is protected from runoff water by a well lining or
casing that is raised above ground level and a platform that diverts spilled water away from the
well. A protected dug well is also covered, so that bird droppings and animals cannot fall into the
well (WHO/UNICEF, 2006). A well that is raised but not covered is not protected. A well that is
covered but not raised is not protected. Only wells that are both covered and raised, and also
lined, are protected.
Protected spring –The spring is typically protected from runoff, bird droppings and animals by a
"spring box", which is constructed of brick, masonry, or concrete and is built around the spring so
that water flows directly out of the box into a pipe or cistern, without being exposed to outside
pollution.
Functional toilet –is one that have at least a shade, door, not full and can be used for its intended
purpose at the time of the visit.
Clean compound – A compound can be considered as clean if there is no here and there waste in
the compound
Solid waste segregation: A household considered as segregating waste if they separately store
waste based on their type.
Common mental disorder - Refers to the mental illness characterized depressive, anxiety and
medically unexplained symptoms. A Score of eight or more in SRQ-20 in the past 4 weeks will be
considered as having CMD in this study.

Psychosocial stressor:- Any stressor which affects the individual’s mental health in the context
of their social and functional capacity within the community as well as the quality of life the
individual, family, group and community. In this study score of one or more on list of LTE
considered as having psychosocial stressor.

Substance use: if an individual use any of the list of substance that are classified as having
addiction potential for the recent 3 months (Khat, Alcohol, Tobacco, Hashish, Glu, inhalant gas).

Antenatal care visits: A pregnant woman considered as having ANC visit if she has focused
antenatal care check up with respect to her gestational age.

4.10.Data process and Analysis

30
Quantitative: Data entry was done by using Epi-Data version 3.1. and exported to SPSS version
23.0 software package to edit, clean for inconsistencies and missing values, and finally to
analyses. Different frequency tables, graphs, and descriptive summaries were used to describe the
study variables.

Qualitative: Transcribed qualitative data was organized in narrative forms similar to the
respondents' own words and analyzed under selected themes .

4.11. Ethical consideration

Formal letter of permission to conduct study was obtained from Selale University office to
communicate with local administrative body in the gende Chefe kebele. Permission letters also
obtained from administrative body of the kebele to communicate with relevant bodies in the
kebele. Finally, verbal consent was obtained from the subjects included in the study immediately
before the interview and sample collection.

5. RESULTS

5.1 Qualitative data result

Table 1: Qualitative results

31
Themes Categories Codes
Environmental Solid wastes disposal Lack of Sanitary land field ,
sanitation related Dumping in the river, Burning in
problem open field ,lack of waste collection
schedule

Waste water and human excreta Lack of drainage system, open

disposal system defecation, low coverage of public
latrine and hand washing facility.
Water supply Poor availability of Tap water,
Stream/River,
House condition Low coverage of standard houses.
Inadequate Ventilation and
illumination no separated kitchen
for most of the households.

Maternal and child Child health Early initiation complementary

health problems feeding, lack of exclusive breast
feeding at some households, low
coverage of fully immunization.

Maternal health Early marriage, lack of early ANC

follow up, low coverage of long
acting family planning method, low
PNC,

Communicable and Communicable disease Inadequate HIV/AIDS, TB, covid-19

non-communicable and diarrhea transmission,
chronic diseases prevention, control knowledge.

non-communicable chronic diseases Lack of awareness regarding HTN,

32
 DM, CVD and Cancer predisposing
factors and preventive methods
Nutritional problem Child nutrition Lack of exclusive breast feeding,
early initiation of supplementary
food, frequently of child feeding,
variety of food to child feeding,

5.1.1. Sanitary and hygiene related problems

Methods used: Key informant interview of the school director, Focus group discussion
School Students containing 12 people, in-depth interview of female students and
observation of the compound by team members
The school director said that learning classes and latrine are very old and not renovated for
long years. In addition he said the proportion of available latrines to the number of
students is very low (12 doors to 1852 students).He also narrates that only two cleaners
are deployed to clean the whole classes and latrines. No educate cleaning materials, there
is no hand washing facility at latrine area and in the compound as a whole. Open
defecation is quite common in the school compound.
A group of 12 students were also involved in FGD with two group members (data
collectors), one moderator and the other recorder. They also stressed on shortage of
latrines, no water lines in the school compound and no hand washing facility.

33
Fig 2.FGD at Fitche secondary school
After FGD, 10 female students were invited for in-depth interview about menstrual cycle
management system in the school compound. They talk seriously about lack of shower
(water) and supplies even though there is a class prepared for this purpose.
The team members also confirm through observation that there is serious issue on sanitary
and hygiene especially shortage of latrine and waterlines for hand washing facility. The
number of toilet doors is 12 and the number of users is 1852 which give 154 (user to
number of doors ratio). In addition all gets have no door either partially or completely.
Hand washing sinks and toilet plates are not functional.

34
Fig.3. Male student Latrine of Fitche secondy school school

Over all identified problems: number of available latrines are very low with no hand washing
facility at all, the available latrines are very old and need renovation.
The same approach to Fiche Secodary School was implemented at Abiyot Fire primary school.
The school director said that the proportion of number of latrine to number of students is very
low. Only one cleaner is working by contract.no running water for hand washing facility, but they
use jogs or other materials for fetching water. The same idea was reflected from FGD of 10
students. Through observation by group members, the finding was in line with what the key
informant and group of students was said. But the general clean lines the latrine and functionality
status was better than that of the Fitche secondary school.
Over all identified problems with sanitary and hygiene were shortage of latrine with full hand
washing facility.
During observation three doors are already locked because they are non-functional. Only two
doors are functional and used in common by staffs and patients.

35
The director of the health center was asked as key in formant. He said that it may take only some
money to maintain and the institution is cooperative in supporting local materials like stone, wood
and some other row Martials. He also added there is well water which can be best hand washing
facility and running water if there is support for constructing water line.
During observation the river passing through the kebele was found to be one of the major area
where open defecation and waste disposal was take place.
Ten community leaders were asked about water sources water related problems of the kebele.
They said that their main water source is from the water supply line of the town but, there is
serious shortage of water supply. The poor families do use common pump of the kebele. But,
these common pumps some of them are non-functional and others are too far from their home. As
a second option the communities do buy a jurkan of water with three birr and pay 10 birr for
transportation. Finally, they put their recommendation if the common water supply of the
community is able to be maintained and some common water supply pumps are added at
reasonable distances.

5.1.2. Health education related problems

The director of the school as key informant interview says that there is no education on health and
health related issues. So, the school community may have low awareness on infectious disease
diseases and their prevention, about HIV/AIDS and other sexually transmitted diseases and
adolescent reproductive health. 12 students involved in FGD also reflect the same idea obtained
from key informant interview. In addition there are some clubs in the school, but their focus on
health and health related issue is almost, null. The director was further asked why health
education was not given and he answered that there is no health care professional in the school
and no budget for inviting health professionals.

5.1.3. Solid and liquid waste management related problems

The solid waste management at Fitche high school and Abiyot Fire primary School was found to
be very poor during observation. The directors were asked for the reason of poor solid waste
management. They answered that there is no well-prepared solid waste disposal system. In
addition they said that continuous and organized awareness creation is required for school
community about poor solid waste management and its consequences.

36
 Fig.4. Solid waste disposed at the surrounding of Fitche High school

Fig.5. Solid waste disposal site of Fitche high school

The Chafe Kebele administrator was invited for key informant interview to talk about health and
health related problems through open ended questions. He explained that Common health related
problems of the community include Poor waste disposal system for both dry and liquid wastes
resulting in common communicable diseases. Kebele administrator said the causes for these
problems are lack of awareness on proper waste disposal system, lack of attention on waste

37
disposal and lack of proper waste disposal system. He also added there is no NGO at the kebele to
avert the root causes. Finally he recommended that as ketena 08 and market area are the priority
areas where open defecation problem is rampant, constructing public toilet in those areas will
helto avert the problem.

Fig.6. Road side ditches and bridge filled with solid wastes

38
 Fig.7. Key informant interview with Kebele Administrator
Health Extension workers of Ganda Chafe was also selected as key informant. She was asked to
explain health and health related problems of the kebele. Regarding environmental sanitation, she
said that Poor waste disposal system for both dry and liquid wastes is a priority problem for this
kebele community. Absence of public toilet especially at areas where there are large gatherings
like market and at bus station, and poor dead body disposal system are second priority problem.
She said that, causes of the above problems include lack of sites available for waste disposal and
absence of public toilet at the area and lack of awareness on waste disposal and environmental
sanitation is the immediate cause. Finally, she explained that no intervention was attempted to
alleviate the problem and constructing public latrine at large public gathering areas and
constructing liquid and waste disposal system will solve one of the major health and health related
problem of the community.

39
 Fig.8.Key-informant interview with HEW of Genda Chafe Kebele

Field observation and key informant interview was used for identifying health and health related
problems of Chafe Kebele. During field observation Kebele Roads found to be not clean. The
road sides are full of wastes which may pollute drinking water during rainy season. Under bridges
and ditches are full of solid wastes. No waste disposal containers are available. The Market Place
located in the kebele is the major site where every solid wastes including dead bodies disposed
and open defecation takes place. There is latrine at market place and bus station though there is no
hand washing facility. The latrine utilization is quite poor that the latrine surrounding is full of
fecal matter.

Maternal and child health related problems

Data was collected on maternal and child at Fiche town health center no.1. The focal person of
the service was asked, using key informant interview. He said that some women have lack
awareness about nutrition and pregnant women, fear to eat variety of nutrient dense food during
pregnancy because they believe that rapid growth fetus and complication may occur during

40
deliver .The other problem assessed and identified were under nutrition pregnant women and
adolescent pregnant women are at risk of being born with low birth weight. During counseling
ANC and conduct conference there was no education for cooking demonstration and how to
prepare good complimentary foods. In addition, pregnant women was screened for malnutrition
either there is malnourished or not, but all lactating women were not screened due to negligence
of health worker. Most children started breastfeeding within an hour after birth but few neonates
was born with low body weight/premature initiated after stayed for long time. Infant with low
body weight difficult to initiate breast feed immediately and are at high risk of acquiring infection
and poor breastfeeding. Infant started complimentary food before 6months due to occupation
employment work, breast problem. The main problem were assessed and identified problem
under five children reported that ,the health center has no stabilization center (SC) room and
management of severe acute malnutrition a serious problem which need immediate intervention
to reduce child morbidly and mortality. In addition, there is no appropriate follow up for children
on OTP treatment, and no good counseling and skilled man power on nutrition. Generally, there
were poor child care and inappropriate feeding practice and inadequate access to health services.
In addition the health extension and kebele administrator point out that there are many orphans
lost their family by HIV/AIDS who need immediate food aid.

41
5.2 QUANTITATIVES DATA RESULT
The response rate of participants was 95%. About 88% of the household were head by male. The
rest households were female was head of the households. The average family size of the study
area is about 4(four) children per household. The dominant Ethnic group is Oromo with 382
(64.9%). Majority of the respondents were married 526(89.3) and earn >4500 monthly income.
The summary of socio-demographic characteristics of the study area is shown in the table blow

Table 2: Frequency analysis of socio demographic variables in chefe kebele, Fitche Town,
Oromia, Ethiopia, February, 2022

variables Category Frequency Percent

Age of respondents 15-24 48 8

25-45 438 74.1

46-65 105 17.9

Sex Male 156 26.5

Female 433 73.5

Religion Orthodox 430 73.0

Muslim 30 5.1

Protestant 129 21.9

Catholic

Ethnicity Oromo 382 64.9

Amara 192 32.6

Gurage 15 2.5

Marital status Single 24 4.1

Married 526 89.3

Divorced 21 3.6

42
 Widowed 15 2.5

Separated 3 .5

Educational status Unable to read and write 96 16.3

1–8 201 34.1

9 – 12 121 20.5

College and above 171 29.0

Occupation Gov’t employee 163 27.7

Farmer 87 14.8

Merchant 143 24.3

House wife 180 30.6

Daily labor 13 2.2

Student 3 .5

Average monthly <500 6 1

income
500-1500 130 22

1500-3000 162 27.5

3000-4500 100 16.9

>4500 197 33.4

Number of children 1-3 65 12

3-5 342 63.5

>5 132 24.5

PART 2: SOURCE OF INFORMATION

43
Majority of the respondents use TV as the source of information in addition to Radio and Mobile
541 (91.9%)

Table 3: community sources of information for Genda Chefe kebele, Fitche tow, 2022

VARIABLES CATEGORY FREQUENCY PERCENT

Do you have a radio Yes 399 67.7

No 190 32.3

Do you have TV Yes 541 91.9

No 48 8.1

Do you have mobile Yes 472 80.1

No 117 19.9

PART 3: COMMUNICABLE DISEASE

All of the respondents were heard about communicable disease and their major source of
information 289(49.1%) is health care workers while the media such as radio and television has
significant role as source of information 255 (43.3%). Out of the 589 respondents 259(44%) of
them know HIV/AIDS as communicable disease while only 3(0.5%) of the respondents know
intestinal parasite. Majority of them know how to prevent communicable disease 541(91.9%). Fig
5.3 shows how the respondents prevent communicable disease.

44
 parcentage (%)
90

80
80
76
72
70

62
60 59
54

50

40

30

20

10

0
Hand washing cooking food safe sexual Drinking safe proper waste vaccination
throughly practice water management

Figure 3: bar graph shows how respondents prevent communicable disease genda chafe kebele,
Fitche town. 2022
Out of 541 respondents who know prevention methods of communicable disease 355(65.6%) of
them wash their hand with soap to prevent communicable disease. All of the respondents were
heard about HIV/AIDS and majority of them (49.2%) believe its ways of transmission is
unprotected sex and its prevention method is absenteeism. About 350 (59.4%) of the respondents
were ever tested for HIV/AIDS.
Among 589 respondents 552 (93.7%) of them ever heard about Tuberculosis and majority of them
463 (78.6%) mention droplet as its ways of transmission while 328(55.7%) of the respondents
said avoiding contact with known TB patient as ways of TB prevention.
Out of the 589 respondents 586 (99.5) heard about Covid – 19. Most of them (80.6%) heard
about covid-19 from the media. 473 (80.3%) of the respondents called contact and droplet as
the means of Covid-19 transmission and majority 353 (59.9%) of them also called coughing as

45
 the main sign and symptoms of the disease ,while 514 ( 87.3%) of the respondents mention
wearing a mask as the prevention of covid -19.
Table 4: summary of communicable disease prevalence among respondents in chafe kebele,
Fitche town, 2022

VARIABLES CATEGORY FREQUENCY PERCENT

Haered about Communicable Y 589 100.0

disease
N

Source of information HCW 289 49.1

Radio/TV 255 43.3

HAD 30 5.1

School 9 1.5

Other 6 1.0

Which Communicable Malaria 81 13.8

disease do youk now
HIV 259 44.0

Typhoid 146 24.8

Diarrheal disease 42 7.1

Intestinal parasite 3 .5

TB 58 9.8

Covid-19 58 9.8

Do you know How to Yes 541 91.9

prevent and control this
No
48 8.1
disease

By what means can we Cooking food properly 180 33.3

prevent it
Hand washing with soap 355 65.6

46
 Drinking water after boiled 6 1.1

Have you heard about Yes

589 100.0
HIV/AIDS and STI

Its ways of transmission Unprotected sex 290 49.2

Multiple sexual partners 155 26.3

During Preg., labor and BF 12 2.0

Sharp object use 90 15.3

Blood and its product 42 7.1

Ways of prevention Abstinence 286 48.6

Condom use 225 38.2

Be faithful 66 11.2

Others 12 2.0

Have you ever tested for Yes 350 59.4

HIV
No 239 40.6

Ever heard about TB Yes 552 93.7

No 37 6.3

Ways of transmission Coughing 463 78.6

Sneezing 89 15.1

Droplets 6 1.0

Ways of its prevention Early Dx and Rx 206 35.0

methods
Avoiding contact with known TB pt 328 55.7

Avoid overcrowding 9 1.5

47
 Cover the mouth coughing 15 2.5

Have you heard about covid- Yes 586 99.5

19
No 3 .5

From where did you heard Radio/TV 475 80.6

HCW 81 13.8

Social media 30 5.1

Transmission method of Coughing 473 80.3

covid-19
Sneezing 86 14.6

Droplet 9 1.5

Hand shaking 18 3.1

Sign and symptoms of Fever 221 37.5

covid-19
cough 353 59.9

sneezing 12 2.0

Methods of prevention Wearing mask 514 87.3

Hand washing 66 11.2

2m distance from possible carriers 6 1.0

PART 4: NON COMMUNICABLE DISEASE

From 589 respondents 418 (71%) of them heard about non communicable disease. Out of 418
respondents who have been heard about NCD majority of them 247 (41.9%) knows about
Hypertension. Among the respondents who have been heard about NCD majority of them
247(41.9%) of them knew its prevention methods. Among respondents who knew the prevention
methods of NCD majority of them 128(21.7%) of them mention regular physical exercise as
prevention method of NCD.

48
 parcentage
70
61
60 57

50 46
39
40

30

20

10

0
Life style modification Diatery Modification Avoidance of Regular physical
substance abuse exercise

Figure 4: bar graph shows the prevention methods of non-communicable disease in genda Chafe
kebele, Fitche town, 2022.

Table 5: non communicable disease awareness and its means of prevention of genda Chefe
kebele, Fitche town, 2022

VARIABLE CATEGORY FREQUENCY PERCENT

Have you heard about Yes 418 71.0

NCD
No 171 29.0

Which NCD do you know HTN 247 41.9

Cardiac disease 47 8.0

DM 109 18.5

Cancer 3 .5

Bronchial asthma 12 2.0

Do you know prevention Yes 290 49.2

methods of NCD
No 88 20.4

49
PART -5 ENVIRONMENTAL SANITATION AND HYGEINE

Pipe water is the main source of drinking water for genda Chafe respondents 577(98%). Out the
respondents majority of them 496 (84.2%) store drinking water by jarken at HH level. 85.9 % of
the respondents know how drinking water made safe. Out of 506 respondents who were knew
the methods how drinking water made safe at HH level majority 280(52.9%) of them mention
boiling as the method of making drinking water safe at HH level.

Table 6: Community water source of genda Chefe, Fitche town, 2022

VARIABLE CATEGORY FREQUENCY PERCENT

Source of water for Pipe water 577 98.0

drinking & food
spring 6 1.0
preparation
well 6 1.0

Haw to store drinking jarken 496 84.2

water at HH
pot 24 4.1

baldi 27 4.6

bermel 42 7.1

Do you know how Yes 506 85.9

drinking water maker
No
83 14.1
safe

If yes what are those boiling 257 50.8

methods
Chemical treatment 171 33.8

filtration 78 15.4

LATRINE FACILITY AND HAND WASHING FACILITY

About 544 (92.4%) of the kebele respondents have a latrine facility and 443(75.2%) of them were
Pit latrine. Out of the 544 respondents who have a latrine 12 (2.2) of them were not functional and
majority of them practice open defecation. Out of the respondents who have a latrine, 183

50
(33.6%) of them have no superstructure while 359(66%) of them have no pit cover and 467
(85.8%) of respondents with latrine facility have no hand washing facility near to the latrine.

Table 7: Latrine and hand facility in genda Chafe kebele, Fitche town. 2022

VARIABLES CATEGORY FREQUENCY PERCENT

Do you have a latrine yes 544 92.4

no 45 7.6

What type Flush LATRINE 93 15.8

Pit 443 75.2

VIP 8 1.4

Is it is functional Yes 532 98.1

no 12 2.2

If no where do you Neighbor’s latrine 10 17.5

use
Public latrine 20 35

Open defication 27 47.5

Does the latrine has Yes 361 66.4

superstructure
No 183 33.6

Does it has a pit Yes 185 34

cover
No 359 66

Is there hand washing Yes 77 14.2

near to the latrine
No 467 85.8

What detergent do Ash 5 6.4

you use
soap 72 93.6

51
WASTE DESPOSAL SYSTEM

Majority of the respondents 386 (65.5%) have temporary waste disposal storage and 347(58.9%)
of them use Sack as the storage material. About 299 (56%) of respondents dispose solid waste on
the field while 500 (84.9%) of them also dispose their liquid waste on the field.

Table 8: Households solid and liquid waste disposal in genda Chafe kebele, Fitche town, 2022

VARIABLES CATEGORY FREQUENCY PERCENT

Temporary waste yes 386 65.5

storage
no 203 34.5
If yes what storage sack 347 58.9
you use
room 15 2.5
others 24 4.1
How do you despose On field 299 50.8
solid wastes
pit 45 7.6
Garbage contianer 108 18.3
burn 77 13.1
Where do you dispose On field 500 84.9
liquid waste
pit 53 9.0
Septic tanker/toilate 30 5.1
PART -6 MATERNAL AND CHILD HEALTH IN HH LEVEL

About 487 (82.7%) of the respondent were 15-49 years of age. Only 103( 17.5%) of HH have
pregnant women in the last 12 months and 97 (94.1%) of them got ANC services while the rest
were failed to get ANC service due to lack of awareness. 62( 13%) of the respondent’s women
gave birth at home. out of 477 women who were ever gave birth 370(77.2%) of them initiate BF
with in a hour and 299(62.7%) of them breast feed their child for 6 months while majority of
them 228( 47.9%) breast feed their child for a total of 6-18 months duration. About 70.1 % of
them got PNC services. Out of 148 children of <1 year 22% of them were not fully immunized.
Out of 61 children with diarrhea in the past two weeks majority of them 55(92%) of them were

52
taken to health facility. 92 % of the respondents knew contraceptive methods and majority of
them 350 (79.5%) of them knew injectable method while 315 (71.6%) of them were using any
method of contraceptive.

Table 9: Maternal and child health in genda Chafe kebele, Fitche town, 2022
VARIABLES CATEGORY FREQUENCY PERCENT
Is there 15-49 women in HH yes 487 82.7
No 102 17.3
PW in the last 12 months yes 103 17.5
No 438 74.4
Does you get ANC service Yes 97 94.1
during your last pregnancy
No 6 5.9
Why did you fail to follow Lack of awereness
ANC 6 100

Place of delivery of last birth Public HF 403 68.4

Private HF 12 2.0
Home 62 10.5
When did you initiate BF of Within hour 370 77.2
your last baby
Within day 109 22.8
Duration of EBF in months <6 175 36.7
6 299 62.7
>6 3 0.6
Total duration of BF 6-18 228 47.9
19-24 180 37.6
>24 69 14.5
PNC service during your last Yes 334 70.1
delivery
No 143 29.9
Fully immunization status of Yes 115 77.7

53
 < 1 yr child in the family No 33 22.3

What was done for the child Taken to HF 55 90.2

with diarrhea
Home remedy taken 6 9.8
Taken to traditional healer 0 0
Nothing done for the child
Do you know methods of Yes 440 91.3
contraceptive
No 4o 8.7
Which method you know well pills 47 10.7
Injectable 350 79.5
implant 41 9.3
IUCD 2 .4
Are you currently using Yes 315 71.6
contraceptive
No 125 28.4

PART -7 MATERNAL AND CHILD NUTRITION STATUS

There are 197 pregnant and lactating women in the last 12 months and 91.8% of them took
nutritional counseling by health workers. 9 (56.3%) of PWLW who didn’t took nutritional
counseling is due to not attained health facility. 32 (16.3%) of pregnant and lactating women in
the last 12 months didn’t took iron foliate. majority of them 21(65.6%) were due to they didn’t
gone to health facility. 145 (73.6%) of them took iodized salt. 102(70.3%) of them add iodized
salt late at the end of cooking. Out of 589 HH288 (49%) of them have children of 6-23 months
old and majority of their age was categorized to 6-11 months 103 (35.7%). Among respondents
who were ever started complementary feeding 106 (36.8%) of them started at the age of < 6
months. About 65.5% the respondents feed their child 3-4 times per day porridge is the main food
type that the respondents feed their child (69.1%).

Table 10: maternal and child nutritional status of genda Chafe kebele, Fitche town, 2022

54
VARIABLES CATEGORY FREQUENCY PERCENT

Pregnant and lactating Yes 197 30.4

women in HH in the last 12 No
392 69.6
months

If yes is she counseled on Yes 181 91.8

nutrition issues No 16 8.2

If no why Not attained HF 9 56.3

HW didn’t visit my house 4 25

Un willingness of HW 3 18.7

Have you taken iron folate Yes 165 83.7

tablet
No 32 16.3

If no why No access 7 21.8

It has gastric irritation 4 12.5

Didn’t go to HF 21 65.6

Have you taken iodized salt Yes 145 73.6

No 52 26.4

If yes at what time do you Early during cooking 9 6.2

add during cooking
At the middle of cooking 34 23.5

Late at the end of cooking 102 70.3

Is there 6-23 months old Yes 288 48.9

child in the HH
No 301 50.1

If yes what is the age of child 6-11 103 35.7

12-17 90 31.4

18-23 95 32.9

55
 Ever start complementary Yes 288 100
feeding for your child
No 0 0

If yes when you start <6m 106 36.8

At 6 m 120 41.6

>6 m 62 21.5

Materials used for feeding Bottle 163 56.6

Cup with spoon 99 34.3

Others 26 9

Number of feeding time per 2-3 times 58 20.1

day
3-4 190 65.9

>4 40 14

Types of food you provide to Porridge 199 69.1

your child
Adult types 32 11.1

Others 57 19.8

6. DISCUSSION
In this study all of the respondents were heard about communicable disease and their major
source of information 289(49.1%) is health care workers while the media such as radio and
television has significant role as source of information 255 (43.3%). Out of the 589 respondents
259(44%) of them know HIV/AIDS as communicable disease while only 3(0.5%) of the
respondents know intestinal parasite. Majority of them know how to prevent communicable
disease 541(91.9%). This result is in line with study conducted in Nigeria (Gail B et.al 2003). The
probable reason can be the similarity of socio economic status of the two countries.

About 544 (92.4%) of the kebele respondents have a latrine facility and 443(75.2%) of them were
Pit latrine. Out of the 544 respondents who have a latrine 12 (2.2) of them were not functional and

56
majority of them practice open defecation. Out of the respondents who have a latrine, 183
(33.6%) of them have no superstructure while 359(66%) of them have no pit cover and 467
(85.8%) of respondents with latrine facility have no hand washing facility near to the latrine. This
finding is higher than the EDHIS 2015 report. The reason of this discrepancy can be the
improvement in social educational status and socio economic status in the past five years.

Pipe water is the main source of drinking water for genda Chafe respondents 577(98%). Out the
respondents majority of them 496 (84.2%) store drinking water by jarken at HH level. 85.9 % of
the respondents know how drinking water made safe. Out of 506 respondents who were knew
the methods how drinking water made safe at HH level majority 280(52.9%) of them mention
boiling as the method of making drinking water safe at HH level. This finding is also higher than
the EDHIS 2016 report. This may be due to the EDHIS report includes both rural and urban. But
this finding is only from urban kebele of fitche town.

Majority of the respondents 386 (65.5%) have temporary waste disposal storage and 347(58.9%)
of them use Sack as the storage material. About 299 (56%) of respondents dispose solid waste on
the field while 500 (84.9%) of them also dispose their liquid waste on the field. This result is in
line with study conducted in Uganda (Ssemugabo et al 2020). This may be due to the closeness
of socio economic status of African country and low emphasis given for waste management rather
than struggling for what to eat and drink.

About (94.1%) of mothers got ANC services while the rest were failed to get ANC service due to
lack of awareness and 62(13%) of the respondent’s women gave birth at home. out of 477
women who were ever gave birth 370(77.2%) of them initiate BF with in a hour and 299(62.7%)
of them breast feed their child for 6 months while majority of them 228( 47.9%) breast feed their
child for a total of 6-18 months duration. About 70.1 % of them got PNC services. Out of 148
children of <1 year 22% of them were not fully immunized. Out of 61 children with diarrhea in
the past two weeks majority of them 55(92%) of them were taken to health facility. 92 % of the
respondents knew contraceptive methods and majority of them 350 (79.5%) of them knew inject
able method while 315 (71.6%) of them were using any method of contraceptive.

57
This finding is in line with the mini demographic and health survey of 2019. The reason can be
high emphasis given for maternal and child health from 2000 till now both in millennium
development goal and sustainable development goal.

About 91.8% of pregnant and lactating mothers took nutritional counseling by health workers. 9
(56.3%) of PWLW who didn’t took nutritional counseling is due to not attained health facility. 32
(16.3%) of pregnant and lactating women in the last 12 months didn’t took iron foliate. majority
of them 21(65.6%) were due to they didn’t gone to health facility. 145 (73.6%) of them took
iodized salt. 102(70.3%) of them add iodized salt late at the end of cooking. Out of 589 HH288
(49%) of them have children of 6-23 months old and majority of their age was categorized to 6-11
months 103 (35.7%). Among respondents who were ever started complementary feeding 106
(36.8%) of them started at the age of < 6 months. About 65.5% the respondents feed their child 3-
4 times per day porridge is the main food type that the respondents feed their child (69.1%). The
result of this study is higher than EDHIS report of 2011. The probable reason can be the time to
time improvement in education and dissemination of health information through different media.

8. Conclusion and Recommendation

From the finding of this study we can conclude that there is problem in Environmental Sanitation
and hygiene in the community. Lack of solid and liquid waste management, especially these
problems were prevailing in the school with inconvenient and partially destructed school latrine,
inadequate student to latrine ratio with no hand washing facility in the school, no accessible
management of menstruation bleeding for students and shortage of improved drinking water. Low
awareness of modes of transmission and prevention of HIV/AIDS, TB and COVI-19 infections.
Misconceptions were pertaining with COVID-19 prevention and preventive strategies were not
widely practiced. There were also lack of awareness on how to prevent non communicable
disease and inadequate source of health and health related information. Regarding Maternal and
Child health care there were good institutional delivery and ANC service utilization. But there
were low coverage of child immunization, Long act family planning and Duration of exclusive
breast feeding.

Health professionals and HEWs have to create community health education programs on maternal
and child health issues, including: FP, EBF, and vaccinations. The government shall be employed

58
town cleaner and continue teaching on the danger of open field waste disposal to community and
increase the accessibility of municipality waste disposal service like seating temporary waste
collection site and transportation to decompose or recycle.

We recommend the high school community, Teachers, Students and local NGO to urgently solve
the problems of high school latrine and hand wash facility. The Government also should be avail
proper menstrual hygiene management site and equipments in order to achieve SDG-4.

Finally the fitche town health sector should be continuously provided health education on the of
prevention and control of communicable and non-communicable diseases.

9. IDENTIFIED PROBLEMS
List of identified health and health related problems of chafe Kebele, Fitche town, 2022G.C

1. Lack of solid waste disposal area in the kebele

2. Destructed and inconvenient Latrine for utilization and with no hand washing facility
in high school.
3. Low Coverage of long acting FP
4. In adequate student to latrine ratio in the school
5. No implementation of Menstrual hygiene management (MHM) in School
6. Lack of liquid waste management in the kebele
7. Lack of hand washing facility in the kebele
8. Low coverage of child immunization
9. Lack of knowledge regarding NCD
10. Lack of public latrine in the kebele
11. Households with non functional latrine are
12. Early initiation of complementary foods for infants below 6 months
13. Households Latrine with no Cover.
14. Low Awareness of Iodized salt utilization
15. Low RVI sero status known.

59
 Table 11: Identified and prioritized problems at chafe Kebele, Fitche town, 2022G.C

Prioritization critateria
S.N Identified problems Commun Govern
Magnitu Severit Feasibilit Tota Ran
ity ment
de y y l k
concern concern
Lack of solid waste disposal
1 5 4 1 5 5 20 3
area in the kebele
Destructed and inconvenient
latrine for utilization and with
2 5 5 4 4 5 23 1
no hand washing facility in high
school
In adequate student to latrine
3 4 4 3 3 5 19 4
ratio in the school
Households Latrine with no
4 3 4 3 3 4 17 6
Cover
5 Low Coverage long acting FP 3 4 3 4 4 18 5
No implementation of Menstrual
6 hygiene management (MHM) in 5 4 4 4 4 21 2
School
Lack of liquid waste
7 5 5 3 3 4 20 3
management in the kebele
8 Lack of hand washing facility 4 3 3 3 3 16 7

60
 Low coverage of child
9 3 4 3 4 5 19 4
vaccination
Lack of knowledge regarding
10 3 3 3 3 3 15 8
NCD
Lack of public latrine in the
11 5 4 3 4 4 20 3
kebele
Households with non functional
20 3
12 latrine 2 5 4 4 5
Low Awareness of Iodized salt
17 6
13 utilization 4 3 4 2 4
Early initiation of
complementary foods for infants 19 4
14 below 6 months 4 4 4 3 4
15 Low RVI sero status known 3 5 4 2 4 18 5

PRIORITIZED PROBLEMS

1. Destructed and inconvenient latrine for utilization and with no hand washing
facility in high school
2. No implementation of menstrual hygiene management (MHM) in School
3. Lack of solid waste disposal area in the kebele
4. Lack of liquid waste management in the kebele
5. Lack of public latrine in the kebele
6. Households with non functional latrine

SWOT Analysis
Table 11: 1SWOT analysis for problem intervention in chafe Kebele, februaryr,2022

STRENGTH WEAKNESS
-Multi-disciplinary background of CP team members Inappropriate use of time

-Committed and active participation of team members

-Team members a come from d/t departments which provide sharing of

good information

-Discuss on activities detail

-Problem identification through qualitatively and quantitatively

61
-Monitoring and evaluation on daily activities

OPPORTUNITY THREATS
-Having supportive supervision from Salale university Cost( inflation) on construction
materials
-Committed different governmental and private institutions
-Inappropriate road site plan to
-Supporting policy on hygiene and sanitation reach every household

-Active participation of the community -Absence of

health development army at
-Support from different development organizations community level

-Presence of urban health extension professionals Instability the community

-Good commitment of kebele leader and staff members

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WHO (2014a) ‘Human Reproduction Programme : Maternal Mortality’, WHO, pp. 1–5.
WHO (2014b), ‘Rapid assessment of drinking water quality in the federal democratic
republic of Ethiopia’.
World Health Organization. The double burden of malnutrition policy brief. World Health
Organization; 2017.
Zeru, K. and Kumie, A. (no date) ‘Sanitary conditions of food establishments in Mekelle
town ’, 722288, pp. 1–9.

65
66
12. Annex
Salale University, collage of health science, department of public health, community practice in
Chafe kebele, Fitche town by group 1

Consent form

An interviewer guided questionnaire consent form to obtain permission immediately before

data collection time from those households that will be included in our survey at Genda chafe
kebele 03,Fitche. Good morning/afternoon Dear Sir/madam____________________________

My name is____________________ and my colleague name _____________________________

We are Masters Degree students from Selale University. As part of our academic requirements,
we are expected to conduct assessment on the major health and health related problems in
Ganda chafe kebele and design possible intervention strategies to tackle the problems.

Thus the following questionnaire is prepared for this purpose to get appropriate information on
the major health and health related problems in the sub-city and it may take 15-20 minutes.

The information that we will obtain using this questionnaire will be used only for survey purpose
and also we need to assure you that confidentiality is our main quality. The study has no risk to
you and your family members. Therefore we politely request your cooperation to respond to our
questionnaire. You have the right not to respond at all or to withdraw in the meantime,
but your input has great value for the success of our objective .

Do you agree? Yes, continue No, good bye

Name of the interviewer ------------------------ ---------------------------Sign------------ Date -----------

67
 Part I: Socio-demographic characteristics of the respondents/HH/

Gott/Gare _________HH No___________Date_____________

S/No Question Response Remark

1 How old are you ______in year

2 Sex of the respondent 1/Male

2/Female

3 What is your religion? 1/Orthodox

2/Muslim

3/Catholic

4/Protestant

5/Others (specify)_______

4 What is your ethnicity? 1/Oromo

2/Amhara

3/Tigre

4/Gurage

5/Others (specify )______

5 What is marital status of the respondent? 1/Single

2/Married

3/Divorced

4/Widowed

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 5/Separate

6 Educational status of respondent: 1/Unable to read and write

2/Primary school (1-8)

3/Secondary school (9-12)

4/College and above

7 Occupation of respondent 1/Government employee

2/Farmer

3/Merchant

4/House wife

5/Daily labor

6/Student

8 Average monthly income of the HH in birr__________________.

9 Numbers of children of HH: Male:______ Female:______ Total:_______

Part II: Source of Information on Health and health related problems.

S.no Question Response Remark

10 Do you have radio set? 1/Yes 2/No

11 Do you have TV set? 1/Yes 2/No

12 Mobile (Social Media)? 1/Yes 2/ No

Part III. Questions on Communicable and Non communicable disease

Communicable Disease

S./no Variable Response categories Remark

13 Have you heard about 1/Yes If No skip to Non

69
 communicable diseases? 2/No Communicable disease

14 If yes for Q13.source of 1/ HW More than One answer

information? possible
2/ Radio/ TV

3/ HDA

4 /school

5 /others (specify)_______

15 Which communicable diseases do 1/Malaria More than One answer

you know? possible
2/HIV

3/Typhoid

4/Diarrheal diseases

5/Intestinal parasites

6/TB

7/Covid- 19 8. Other(specify)______

16 Do you know How to prevent and 1/ yes More than One answer
control this diseases? possible
2/ no

17 If yes for question number 16 by 1. Cooking food properly

what means can we prevent it.
2/Hand washing with soup and water
before preparation and eating food

3/Drinking water after boiled

4/Others (specify)________

18 Have you heard about HIV/AIDS 1. Yes 2. No If no skip to Q 20

and Other STI related disease?

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19 If yes for Q-18 Would you 1. unprotected sex More than One answer
mention its ways of transmission? possible
2. multiple sexual partners

3. during preg/, labor, delivery and

breast feeding

4. sharp object use

5. Blood and its product

6.ohers specify____________

20 Can You mention its ways of 1. abstinence

prevention?
2. condom use

3. be faithful 4. others, specify_____

21 Have you ever tested for HIV? 1. Yes 2. No

22 Have you ever heard about TB? 1.Yes 2.No If No skip to Q.24

23 If yes for Q- 22 From where did 1. Radio/ TV 2.HCP More than One answer
you hear? possible
3. social media 4.others( specify

24 Can You mention its ways of 1.Coughing More than One answer
transmission? possible
2.sneezing

3. Droplets

4.others, specify____________

25 Would you mention its ways of 1. Early diagnosis and treatment More than One answer
prevention method? possible
2. Avoid contact with known TB
patients

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 3. Avoid over crowding

4. cover the mouth while coughing

5 others( specify)______

26 Have you heard about COVID - 1.YES 2. NO If no skip to Non

19 communicable disease

27 From where did you heard? 1. Radio/ TV 2.HCW More than One answer
possible
3. social media 4.others( specify

28 Would you mention Transmission 1.coughing More than One answer

method of COVID -19? possible
2.Sneezing

3. Droplets contact

4. hand shaking

5 others, specify_______

29 what are signs and symptoms of 1. fever 2. Cough.3. sneezing 4. More than One answer
Malaise 5. Others__________ possible
COVID -19 ?

30 What are methods of Prevention? 1.Wearing mask. 2. Hand washing 3. 2 More than One answer
meters Distance from possible carriers possible

4. Others(Specify)_____

Part IV: Non-Communicable disease

31 Have you hear about Non- 1/Yes If no skip all

Communicable disease? Q
2/No

32 If yes for Q - 31 Which Non- 1/Hypertension More than

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 Communicable disease do you 2/Cardiac diseases One answer
know? possible
3/Diabetes Mellitus

4/Cancer

5/Bronchial asthma

6/Others (specify)__________________

33 Do you know Prevention methods 1.Yes 2.No

of Non communicable diseases?

34 If yes to Question 33 what 1.Life Style Modification

prevention methods do you know?
2. Dietary modification

3.Avoiding Substance Abuse

4.Regular Practicing Physical Exercise

5. Other(Specify)_________

Part V: - Environmental sanitation and hygiene related tools

A. Water Condition in House Hold

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s/n Question Response Remark

35 Source of water for drinking and food 1.Pipe water

preparation
2.Spring /protected

3.Well

4.Hand punp

5. River 6. Others specify----------

36 How you store drinking water at HH 1. Jerkan 2. Pot 3. Baldi 4.Bermel

level?
5. Other specify________

37 Do you know how to make drinking 1. Yes 2. No If No,

water safer? Skip to
Q 39

38 If yes on Q 37, what are those methods? 1. Boiling 2. Chemical treatment

(Wuhaagar, aqua tabs...) 3.Filtration
4.Other(specify)____________

B. Latrine facility and hand washing condition related to House Hold

s/n Question Response Skip

39 Is there latrine facility in the compound? 1. Yes 2. No

40 If yes, what type? 1. Flush toilet 2. Pit 3.VIP

4. Other, specify____

41 Currently is it functional? 1. Yes If Yes skip to

Q 43
2. No

74
42 If No to question Q 41 above, where do 1. Latrine of the neighbors
you use? 2. Public latrine
3. Open defecation
4. Others(Specify)___________
43 Does the latrine have superstructure 1. Yes 2. No

44 Does the latrine have a pit cover? 1. Yes 2. No

45 Is there hand washing facility near to the 1.yes 2.No

latrine?

46 If yes to Q 45 ,What type of detergents 1. Ash 2. Soap

you use for hand washing in addition to
3.other Specify------
water

C. Waste disposal system Related in House Hold

s/n Question Response Skip

47 Do you have temporary solid waste storage 1.Yes 2.No

48 If yes, what type of storage you use 1. Sack 2.Room 3.Other

specify______

49 How do you dispose solid wastes? 1. On field 2. Pit 3.Garbage container

4.Burn

5. Other, specify___________

50 Where do you dispose liquid waste at 1. On field 2. Pit 3.Septic tank/toilet

Household level (Multiple answers are
4. Other, specify___________
possible)?

Part VI: Maternal and Child Health in House hold

75
No. Variables Response categories Remark
51 Is there women in reproductive age 1. Yes
group in this house (15-49 years)? 2. No
52 Age at first birth gave __________years
53 Are there any pregnant women in 1. Yes If No, skip to 78
the last 12 months? 2. No
54 If yes to Q 53, does she get ANC 1. Yes If no, skip to Q- 65
service during your last pregnancy? 2. No
55 If yes to Question 54 How many 1. First visit 2.Second visit 3. Third visit
visit? 4. Fourth visit 5. All visit
56 Why did you fail to follow ANC 1.Lack of awareness
visit? 2.Being far from health institutions
3.Being healthy 4.Other
(specify)_____________

57 Where did you delivered your last 1. .At public health facility
birth? 2. .At private health facility
3. .At home

58 If at home for Q57, who attend the 1.SBA

delivery
2.HEW

3.TBA

4.Any of the relatives

59 When did you initiate breast feeding 1. Within one hour 2. Within a day 3.
for your last child after delivery? After a day

60 Duration of exclusive breast feeding _______in months

in months

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61 Total duration of breast feeding in _______in months
months

62 Meal frequency for the child per _______times per day

day

63 Month at which supplementary food 1. <6months 2. at 6 months

started
3. After 6month.

64 Have you attended post natal care 1. Yes

visit during your last delivery? 2. No
65 Is there children below 1 years in .1. Yes
your family? 2. No
66 If Yes to Q65 are they fully .1. Yes Check immunization
immunized? 2. No card

67 Is there any under-five age children 1.Yes 2.No

in HH

68 Has the child taken vitamin A 1.Yes 2.No 3=Don’t know

supplementation

69 Was the child given any drugs for Yes 2. No 3.Don’t know
intestinal parasites in the past six
months?

70 Is there any child who had diarrhea Yes 2. No 3.Don’t know

in the past two weeks

71 If yes to Q 70, what was done for 1.Taken to health facility

the child
2. Home remedy taken

3. Taken to traditional healer

4. Nothing done for child

77
72 Is there any child who had fever in Yes 2. No 3.Don’t know
the past two weeks

73 If yes to Q 72, what was done for 1.Taken to health facility

the child
2. Home remedy taken

3. Taken to traditional healer

4. Nothing done for child

74 Do you know any method of family 1.Yes 2.No 3=Don’t know

planning /contraception?

75 1 Pills 2.Injectable

If yes, which method you know? 3. Implant 4. IUCD

5. Rhythm 6. Other---------------

76 Are you currently using any these 1.Yes 2.No

methods

Part VI. Maternal and Child Nutrition status

No. Variables Response categories Remark

77 Are there PW/lactating women in the last 1.Yes If No skip to 84

12 months in the home?
2.No

78 If yes for the above, have you Counseled 1.Yes

on nutrition related issues from health

78
 professionals? 2.No

79 If No to Q 78, mention the reason? 1.I have not attended health

institution

2. Health professionals didn't attend

my house

3.Unwillingness of health
professionals

4. Health professionals are busy

5. other( specify)

80 Have you taken iron/folate tablet during 1.Yes 2.No

last pregnancy?

81 If No for Q80 What is the reason? 1) No access for iron/folate tablet

2) It is costy

3) it has gastric irritation

4) I didn't go to health institution

5) Other specify

82 Have you taken iodized salt? 1.Yes 2.No

83 At what time you added iodized salt 1. Early during cooking

during cooking of food?
2. At the middle of cooking

3. Late at the end of cooking

4.After cooking

84 Is there children 6-23 months age in the 1)yes

home ? 2 )No
85 If yes to Q 84, What is the age of the 1) 6–11 months
child?
79
 2) 12–17 months

3) 18–23 months

86 Ever started complementary feeding for 1)Yes

your child?
2)No

87 If Yes to Q 86,When you started 1. Less than 6 months

complementary feeding for your child?
2. At 6 months

3. Greater than 6 months

88 What type of material you use for feeding 1. Bottle

your child?
2. Cup with spoon

3. Others (specify)

89 Number of times you fed your child per 1. 2–3 times

day
2. 3–4 times

3. 4+ times

90 Did you include snacks between foods? 1. Yes

2. No

91 If yes to Q90, what type of food or fluid 1. Porridge

mostly provided to your child?
2. Adult types

3. Gruel

4. Others (specify)

VII. Checklist for School Health

S.N Questions Response Skip

1 Is there any school in your visiting area?  Yes  No

80
2 If yes, What type of school? Kindergarten Elementary

Senior high School Others_

3 Name of school ____________________

4 Number of students: male____ female___

5 Does the school have its own fence?  Yes  No

6 Is there excessive noise from nearby?  Yes  No

7 If yes, from where? Market Passing vehicles Mills

Factory others__

8 Condition of the floor Earth Concrete others_

9 Ventilation of the room Adequate inadequate

10 Illumination of the room Adequate inadequate

11 What are the types of feasible playgrounds available Football ground Basketball
in the school compound? ground Volley-ball ground Others
___

12 Are there dustbins in front of each class room?  Yes  No

13 Is there any waste disposal system in the school?  Yes  No

14 Is there toilet facility?  Yes  No

15 If yes, type of latrine? Pit latrine VIP

other(specify)______

16 Are there separate blocks for boys and girls, staffs?  Yes  No

17 Number of squatting holes ___________

18 Is superstructure well maintained?  Yes _____  No ______

19 What is Floor of latrine? Earth Concrete other_

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20 Cleanliness of latrine at the time of visit Clean  not clean

21 Is there hand washing facility after toilet use?  Yes  No

22 How far is the water source from the latrine (in meter)? ____________

23 Is there a functional water supply system for the school?  Yes  No

24 If yes, What types of water supply source? Tap well protected spring river
pond others (specify)_

25 Is there any health clubs in this school?  Yes  No

26 If yes, what type of club? Sanitation club Gender club

HIV/AIDS others(specify)__

27 What type of support you get from health workers ____________

including HEWs?

THE END

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