COLLEGE OF PUBLIC HEALTH & MEDICAL SCEINCES

PC II Medicine students
CBTP –Phase-II
TEAM- Tiliku Bore
 ASSESSMENT OF ENVIRONMENTAL, NUTRITIONAL &
PARASITOLOGICAL STATUS OF TILIKU BORE

APRIL,2021
 Group members

NAME ID.NO.
1. Hawi Teshale ………………. ………………RU2602/10
2. Hailemichael Dashen ……………………….RU2599/10
3. Jima Gobena ………………………………....RU2614/10
4. Hebron Hayredin …………………………….RU2604/10
5. Imran Abdella………………………………...RU2612/10
6. Israel Solomon ……………………………….RU2613/10
7. Kaleab Gezahegn ……………………………...RU2615/10
8. Keariam Abinet ……………………………......RU2617/10
9. Lema Tesema ………………………………….RU2623/10
10. Magarsa Abdumalik …………………………RU2625/10
11. Matiwos Tariku ………………………………RU2627/10
12. Mekedes Demssie …………………………….RU2628/10
13. Meron Mulugeta………………………………RU4092/09
14. Meron Negash………………………………....RU2629/10
15 Mihret Fikru …………………………………...RU2636/10
16.Bisrat Yohannes………………………………..RU3232/09
 Outline
• Introduction • Operational definitions
• Objectives • Ethical consideration
• Result & discussion
• Methods
• Problem identification &
• Variables prioritization
• Materials and • Action plan
instruments • Conclusion
• Problem encountered • Recommendation
& limitation • Acknowledgment
 INTRODUCTION

• The World Health Organization (WHO) explains that the main

determinants of health include the social and economic
environment, the physical environment and the person's
individual characteristics and behaviors.

• The social and economic environment are key factors in

determining the health status of individuals given the fact that
higher education levels are linked with a higher standard of life
as well as a higher income.
• Ethiopia's main health problems are said to
be communicable diseases associated with
modifiable behavioral and environmental
problems such as hygiene and sanitation.

.
 STATEMENT OF THE PROBLEM

• In Africa, Communicable diseases remain the

most important health problems. In Ethiopia,
almost three quarters of health problems in
children and communicable diseases originate
from the environment.
• Diarrheal disease alone accounts for 46% of
total under-five mortality.
• These coverage levels for water and sanitation
in Ethiopia are among the lowest in the world.
• The main problem associated to the lowest coverage
is increased susceptibility to water-borne diseases
such as diarrhea and dysentery

• In Bore Kebele, most of the residents use well water

as a source of water supply and the remaining use
stream/river as their source of water supply and the
usual ways of waste disposal mechanisms are
composting, burning, dumping in river and sanitary
landfills.
• Most households use burning as the waste
disposal method.
• Inefficient and improper method of waste
disposal result in serious and hazardous public
health problems such as favorable conditions
for reproductions of vectors and microbial
pathogens which are major causative agents of
disease in relation with poor hygiene.
 SIGNIFICANCE OF THE STUDY

• This study will provide detail information

about the environmental conditions, nutritional
problems and parasitic infections seen in the
study area.
 Literature Review

• Nutritional status of children in Ethiopia have

shown a progress between the years 2005
and2019 with decrease of stunting prevalence
from 51%
• These conditions are highly related to maternal
educational status and wealth conditions which
both increase children nutritional status. in
2005 to 37% in 2019.
• According to 2019 EDHS,Nutritional status of
young children in Ethiopia 37% of children <5
years age are short for their age or stunted and
12% of them are severely stunted.
• According to Ethiopian demographic and
health survey in 2016, the proportion of
households with access to improved drinking
water and toilet facilities were 69.9% and
25.36% respectively
• 18% of households have access to piped
drinking water, 40% of households fetch water
from open springs, 27% gets their drinking
water from rivers and 8% of households have
access to a protected well or spring.
• The majority of Ethiopian households (82% )
don’t have a toilet facility. small proportion
(17%) uses a traditional pit toilet. Ventilated pit
latrines and flush toilets accounts for <1%.
• Intestinal parasitic infections commonly
affects preschool and school children.

• Prevelance of intestinal parasite

-Ethiopia -48%
-Oromia -46%
-Jimma-41.1%
• The 2019 EMDHS data shows
• 14% infants that are <6 months consume plain
water
• 1% consume non-milk liquids
• 8% consume other milk and
• 13% consume complementary food in
addition to breast milk.
 OBJECTIVES

• General Objective
To determine the environmental, nutritional and
parasitological problems of Tilku Bore
• Specific Objectives
o To assess the waste disposal methods of the kebele.
o To assess the source of water supply of the kebele.
o To determine the housing condition of the kebele.
o To assess food sanitation methods of the kebele.
o To identify vector and insect control methods of the kebele.
o To assess the nutritional status of the kebele.
o To determine the parasitological status of the kebele.
o To prioritize the major problems.
• To plan measures for the prioritized problems
 STUDY METHODOLOGY AND
MATERIALS
STUDY AREA AND PERIOD
•The study was conducted in jimma zone,jimma town,Tiliku
bore;from April 12-15,2021
 Background of Tiliku Bore
• Tiliku Bore is a rural kebele situated 7kms away in the west of
jimma university main campus.
• It shares administrative boundaries with
- Gibe river from north & east,

- Seka from west side

- Bacho Bore from south

 STUDY DESIGN
• Community based cross sectional design was
the used in the study.
• The design used quantitative findings
supported with a qualitative data generated
through focus group discussion.
• 3 discussions were taken and more as there
was saturation of ideas (redundancy of ideas).
 Source Population

• Our source population for the environmental

study is all the people living in Tilku Bore.
The source population for nutritional survey
and parasitological examination is all under-
five children in Tilku Bore.
 Study Population
•The study populations for the environmental
survey were selected individuals in all
households at Tilku Bore.
•The study populations for nutritional survey and
parasitological examination were selected under-
five children.
 SAMPLE SIZE AND SAMPLING
TECHNIQUES
• According to the census technique
recommended for the study, the team had to
take survey of every third house in the Tiliku
Bore Kebele and this gave us a total of 750
households covered in the study.
• Single sample size determination formula is used

• n= z2p(1-p)/d2

• n= (0.95)20.5(1-0.5)/0.52

•n= 384

•Where, n= sample size

•z= confidence interval of 95%

•p=prevalence (environmental) = 0.5

• d= margin of error=5%
• Since the total house hold is less than ten thousand we use
the correction formula. i.e. correction formula
•Correction formulas (nf) = n/(1+n⁄N) used since total house
hold was <10000

• Where: n= samples size (384)

• N=Number of house hold (750)

•nf= 384/(1+384⁄750) =254

 Sample size determination for the anthropometric
measurements

•The sample size was determined by simple population formula assuming

95% confidence interval, 5%margin of error and 28.7% under five
malnutrition according to the 2014 mini EDHS report (MEDHS 2014).

•The sample size is taken by the formula

=
n= (0.95)20.287(0.287)/0.052

314
•The value was corrected using correction
formula

•nf

•=43
Sample size determination for the parasitological survey

• The sample size was determined by simple population formula

assuming confident interval, 5% margin of error and 14.7%
prevalence of intestinal parasite in Jimma zone according to
the Ethiopian journal of health science (2012 November).
•The sample was taken by the formula

•n =
•n= (0.95)20.147(0.853)/0.052

• =192
 The value was corrected using correction formula

• nf

•=40
• N =total number of children under age five selected randomly=50
 MATERIALS

•The data collection consisted of three parts;

•Environmental survey

•Nutritional

•Parasitological assessments
 Materials used
• Questionnaires
• Meter
• Light Microscope
• Microscope Slide and cover slip
• Pen, pencil and paper
 STUDY VARIABLES

Dependent variables
• Nutritional status of under five children
• Parasitological infestation of under five
children
• Environmental condition of the community
Independent variables
• Socio-demographic characteristics (Age, Sex, income, waste
disposal system…)
• Maternal education status
• Breast feeding habit
• Shoes wearing habit
• Hand washing habit
• Availability of the vector and insect
 METHODS OF DATA COLLECTION

• Data collection instrument

The data was collected using formally prepared
questionnaires which consisted questions
encompassing the environmental, nutritional and
parasitological problems that are seen in the
community.
• Data collection procedures
Data was collected by face to face interview
using structured questionnaire.

Under-five children were considered for

parasitological examination and they were
screened.
• Data analysis
• Household labeling & coding system was used
for differentiation and to avoid repetition

• The results are presented using tables, graphs,

charts and narrative text. The data was
analyzed by tallying, organizing, grouping and
processing by using Microsoft excel.
 ETHICAL CONSIDERATIONS

The kebele administrators have given us full

permission to collect data in the kebele.
During data collection all norms and socially
accepted values and rights have been
considered and respected by interviewers.
 LIMITATIONS

• Recall bias when asked about supplementary

food starting age
• Due to shortage of time, stool examination
was examined only once.
 Operational definition
• Exposure to sun light- A child who is directly
exposed to sun light, naked for about ten minutes.
• Illumination-
Adequate: A house in which lead or pencil
written material can be read by natural light.
Inadequate: A house in which ink written
material can’t be read by natural light.
• Substandard pit latrine: a latrine with no slab and
with poor housing condition.
 Cont’d
• Need of maintenance-
• Good: No sign of deterioration and the house is
erect
• Fair: Sign of deterioration but it is erect
• Bad: Deterioration and is not erect

• Ventilation-
o Good: a house which has one or more window which is
functional.
o Fair: a house which has one window but functions partially.
o Bad: no window or closed all the time or non functional.
 Socio-demographic data of Tiliku Bore

• . In Tiliku Bore kebele, most of the families

earn low income. The second common
proportion of the population lies under middle
income and few families earn high income.
Income (in Birr) Amount Frequency Percentage (%)
1000 – 10000 117 46.8
10001 – 20000 90 36
20001 – 30000 35 14
30001 – 40000 7 2.8
> 40000 1 0.4
 Waste Disposal
• Around 25.7% of the population uses
scheduled program waste collection.
• Burning is the main waste disposal method
accounting for 72% of the population while
sanitary field comes next.
Waste disposal method Frequency Percentage (%)
Sanitary field 68 27.2
Burning 180 72
composting 2 0.8
 Latrine
• 91% of the population has latrine facility while
the remaining 9% has no access to latrine.
Among those who have latrine, the type of
latrine they use is 100% pit type.
Distance(m) Frequency Percent(%)

0-15 150 60

16-30 82 32.8

31-45 15 6

>45 3 1.2
 Water Supply
• The Majority of population of the community
Tap water for drinking and washing.The
average daily water consumption of the
sampled family is 45L
Daily conception of water(liter) Frequency Percent (%)

0-20 56 22.4

21-40 77 30.8

40-60 93 37.2

>60 24 9.6
• Among the 250 households 89.76% don’t use
any methods of water purification. The
remaining 10.24% of the population use
different methods to purify water.

Method of water purification Percent (%)

Boiling 72.44

Traditional 23.62

Standard 3.94
 Housing condition
No. of rooms Frequency Percent
1 4 1.6
2-4 192 76.8
5-6 46 18.4

>6 8 3.2

About 59.6% of houses have an adequately illuminated room while the rest
40.4% have inadequately illuminated rooms
-The type of floor in majority of the houses (63.4%) is cement and the rest is soil.
-The majority of households (72.52%) has no floor cracks, the rest (27.47%) has floor
cracks
• Most of the houses have a separate but
detached kitchen (62.6%), while 28.1% of
them have a separate and attached kitchen and
the rest 6.07% have no kitchen at all.
percent
6.07%

Separated and attached

Separated and detached
No kitchen
48.33%
45.67%
 Food sanitation

• The main method implied to preserve food is

drying which accounts for 69.157%, followed
by other methods which is 30.843%
Nutritional Assessment
Maternal Status Percent (%)

Can’t read and write 69.65

Read and write 30.35

Grade completed 0
 Child Nutrition
• 52.07% of the mother’s breast feed their child.
And 89.6% of them give supplementary foods
percent

14.38

28.08

4 to 6 months
7 to 12 months
others

57.3
 Breast feeding

Supplementary food yes no Total

Yes 98 36 134

No 89 27 116

Total 187 63 250

 Parasitological Survey
• Stool Examination

Age of Sex Result Type of parasite found  

child
M F + _ Ascaris S mansoni Hookworm Trichuris H
  nana

≤3yrs 4 2 1 5 - 0 1 0 0

3-4yrs 4 4 2 6 2 0 0 0 0

4-5yrs 7 2 2 7 1 0 0 1 0

Total 15 8 5 18 3 0 1 1 0
Anthropometric Examination

MUAC Male Female

Frequency Percentage( Frequency Percentage(
%) %)
Severe/ red <11 cm 0 0 0 0
Moderate/orange >11 0 0 0 0
and 12.5 cm
Mild malnutrition 0 0 0 0
Moderate
risk of malnutrition
yellow
>12.5 and 13.5cm
Satisfactory nutritional 37 55.2 30 44.8
status/ green >13.5cm
Status Male Female Total
Frequency Percentage Frequency Percentage Frequency Percentage

Stunted(chroni Mild (90- 2 3.52 0 0 2 3.4

c malnutrition, 94%)
H/A Moderate 0 0 0 0 0 0
<90%,Gomez (85-89%)
classification) Severe 0 0 0 0% 0 0
(<85%)
Normal(>94% NCHS standard) 28 48.2 28 48.3 56 96.6
Total 30 51.7 28 48.3 58 100%
 Discussion
• In Tiliku Bore the majority of the houses
(63.4%) is cement and the rest is soil ( 36.6%)
while In Ethiopia 43.2% of the households
have soil floor ,14.9% have cement floor and
the rest is wood, bamboo,
asphalt(vinyl),ceramic(EDHS 2014)
• Almost all the entire population of Tiliku Bore use
latrine and 100% of it is pit. Among the whole latrine
facilities around 94.1% is owned by the family and
the rest 5.9% is shared among nearby households.

• In Tiliku Bore 79.87% have livestock, out of this

77.23% lives separated from the main house. While
80% of the populations in the country have livestock
(2016 EDHS)
• In Tiliku Bore the average daily water consumption is
45L.In Ethiopia Urban residents consume 20L water
per day per family and rural residents consume 15L
water per day per family.

• Tiliku Bore 52.07% of the mothers breast feed their

child. In Ethiopia 47.5% of breast feeding children
consume supplementary foods between the age of 7-
12months(EDHS 2016) whereas in Tiliku Bore 89.6%
of them give supplementary foods
• Ascaris constitutes 37% of diagnosed parasites in
Ethiopia whereas in Oromia region it is 41.3% but the
prevalence of ascaris in Tiliku Bore is around 60% and
the prevalence of tricuristricuria is around 20%
• 25.2% of mothers in Ethiopia can read and write and
in Tiliku Bore 30.35% can read and write and there is
no grade completed .In Ethiopia 74.8% of mothers
can’t read and write(EDHS 2016) whereas in Tiliku
Bore 69.65% of mothers can’t read and write.
• 78.4% of households in Ethiopia have only
one room (EDHS 2014) but in Tiliku Bore
only 1.6% of households have one room and
76.8% have 2-4 rooms.
 Problem Identification
Problems identified
• Poor food sanitation
• Inadequate child nutrition
• High rodent infestation
• Stagnant water
• Intestinal parasite
• Absence of clean drinking water
No Identified problem Magnitude Feasibility severity Government Total
concern
1 Less use of scheduled 4 3 3 2 12
program for waste
disposal
2 Poor hand washing 4 3 4 3 14
before eating and after
toilet
3 House flour cracks 4 2 3 1 10
4 Inadequate illumination 3 2 3 1 9
5 Low frequency of house 2 2 3 2 9
cleaning
6 Maternal illiteracy 4 2 4 5 15
7 Poor vegetable washing 3 2 3 2 10
before meal
8 River water exposure 3 4 4 2 13
9 Inadequate child 4 4 4 5 17
nutrition
10 Rodent infestation 5 2 3 1 11

11 Absence of clean drinking 5 4 4 4 4

water
12 Backward food 5 4 4 4 4
preservation methods
13 Poor vegetable washing 3 3 3 2 1
habit
14 Stagnant water 2 2 4 5 13

Problems
High infection of parasites
Action Plan
Objective
To decrease the infection of
parasites even to totally
deworm the population
Strategy Responsible body Time
By creating awareness ,by The gov’t, the community, According to CBE office
providing safe water CBE office schedule
sources like pipes

Inadequate child nutrition To improve child nutritional By creating awareness, By The gov’t, health According to CBE office
status providing necessary professionals the schedule
supplementary supplies community, CBE office

Maternal illiteracy To make all mothers able to By giving basic adult Gov’t, community, CBE According to CBE office
read and write, To increase education office schedule
the percent of literate By creating awareness
mothers By providing health info

Poor hand washing habit
Less use of scheduled
programme for cleaning
Backward food
preservation methods
Stagnant water
To increase hand washing Mobilization of the Gov’t, health professionals, According to CBE office
habit before meal and aftercommunity, By increasing community, CBE office schedule
toilet awareness, health
information
To have clean environment, By creating awareness, The gov’t, the community, According to CBE office
to decrease environmental By providing technical CBE office schedule
associated diseases. support,
By providing health info
To use modern type of food By providing electric Backward food preservation To use modern type of food
preservation methods sources either it is methods preservation methods
hydropower or geo-electric
power like biogas
To decrease transmission of By creating awareness Gov’t, community, NGOs’, According to CBE office
malaria By supplying needed CBE office schedule
materials
 Conclusion

• The major source of waste is residential waste.

• All household have latrine and the majority is
pit.
• Housing condition in the Kebele has good
ventilation and cleanness
• Majority of mothers breast feed their child and
give supplementary food for the children
• Bed net is the most common insect control
method.
• Rodent infestation is high and most people use
cat for prevention
• 74% of mothers cannot read and write
• In the community, Ascaris takes the highest
percentage of parasitical survey
 Recommendation
• This recommendation is forwarded to the
concerned bodies, i.e. the Tiliku Bore
administrators, the community members,
health center workers of the Tiliku Bore,
Jimma University CBE office and participant
students of this survey
 Acknowledgment
• Tiliku Bore community
• Tiliku Bore kebele administration
• CBE office
• Our supervisors
 References
• Federal Democratic Republic of Ethiopia (1997-2004/2005.), Ministry of
health and health related indicators.
• MOH (2000 E.C), Health & Health Related Indicators.
• Central Statistical Agency Addis Ababa Ethiopia, March (2012), Ethiopian
Demographic Health Survey 2014.
• WHO (2006),child growth standards
• Manuals of previous surveys in CBE office
• Faculty of Medicine (1995), Association in Southwestern Ethiopia..
• CSA Ethiopia as demographic and health survey 2000
• Community based education guide line 2004
• EDHS 2016
• CIA world fact book
• Tiliku Bore kebele Administration