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MEKELLE UNIVERSITY
COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH
ASSESSMENT OF HEALTH AND HEALTH RELATED PROBLEMS IN MAICHEW TOWN, KEBELLE 04
BY: ROUND ONE 5TH YEAR MEDICAL STUDENTS
February 2013
Table of contents
Acknowledgment
List of abbreviation
CHAPTER 1: INTRODUCTION
1.1 Background
1.2 Statement of the problem
CHAPTER 2: OBJECTIVE OF THE STUDY
2.1 General objective
2.2 Specific objectives
CHAPTER 3: METHODOLOGY
3.1 Study area and period
3.2 Study design
3.3 Sample size and sampling techniques
3.4 Sample size
3.5 Sampling technique
3.6 Data collection technique and instruments
3.7 Data processing and analysis
3.8 Quality control
3.9 Ethical consideration
CHAPTER 4: RESULTS AND DISCUSSION
List of abbreviations
ANC: Antenatal care
AFI: Acute febrile illness
BCG: Bacillus calmette guirine
CBE: Community based education
CBTP: Community based training program
COPD: Chronic obstructive pulmonary disease
DV: Demonstration village
DM: Diabetes mellitus
EDHS: Ethiopian demographic health survey
EPI: Expanded program for immunization
ETB: Ethiopian birr
FGM: Female genital mutilation
FP: Family planning
HH: Household
HIV/AIDS: human immunodeficiency virus/ acquired immune deficiency syndrome
HTN: Hypertension
KG: Kindergarten
LRTI: Lower respiratory tract infection
MDG: Millennium development goal
OPV: Oral polio vaccine
PMTCT: Prevention of mother to child transmission
PUD: Peptic ulcer disease
SD: Standard deviation
SPSS: Statistical program for social sciences
STD: Sexually transmitted diseases
STI: Sexually transmitted infections
TB: Tuberculosis
TT: Tetanus toxoid
URTI: Upper respiratory tract infection
VCT: Voluntary counselling test
Acknowledgement
It is a pleasure to pass our heartfelt thanks to Mekelle University College of Health Sciences Department of Public Health for
arranging this program for us. Our thanks also go to the dean of the college, head of department of medicine, and student service
centre.
Our special gratitude goes to the community of Maichew town and the residents of kebelle 04 in particular, who were welcoming and
for their collaboration during house numbering and survey.
We are also highly indebted to the health officials of Maichew town, wereda administrators and municipalities.
Our appreciation also goes to deans of Maichew technical college, Hashenge College, Maichew agricultural college, administrators of
Maichew central prison, directors of Maichew preparatory school, Tilahun Yigzaw secondary school, and Addisalem, Zelalem Desta
and Wefriselam bekalsi primary schools. We would also like to appreciate the collaboration of the administrators and staffs of
Ebenezer and Biere Raya KGs.
Our gratitude also extends to health extension workers and environmental sanitarians of Maichew town, and in particular, the
environmental sanitarians Ato Zinabu and Ato Mesfin who guided us during our outreach program.
We also owe a great gratitude to kebelle 04 administrators who provided us all the necessary information regarding the kebelle and
helped us during our DV site map sketching.
Our greatest thanks go to the administrators and staffs of Maichew health centre who supported us by providing us teaching materials
which greatly helped us during our outreach intervention. We also would like to thank each health worker who genuinely shared their
clinical knowledge during our static intervention.
Last but not least, we would like to express our deepest gratitude to our supervisors for their commitment and genuine comments
during our stay. We will also never forget the contributions of Mr Abreha who stood beside us during our difficulties by arranging a
temporary cafeteria by discussing with the officials of Maichew agricultural college.
CHAPTER 1:INTRODUCTION
1.1 Background information
Worldwide, there were 58 million deaths in 2005 of which communicable diseases were estimated to account for 23 million.
Communicable diseases remain the most important health problems in Africa. The commonest causes of death and illness in the
region are acute respiratory tract infections, TB, HIV/AIDS, STI, diarrhoea disease, malaria and vaccine preventable infection.
Epidemic prone diseases such as meningococcal meningitis, cholera, yellow fever, and viral hemorrhagic fevers are prominent health
threats in the continent (1).
In low income countries like Ethiopia, people predominantly die of infectious diseases: lung infections, diarrhoeal diseases,
HIV/AIDS, tuberculosis, and malaria (2)
In Ethiopia, Communicable diseases, malnutrition, and HIV/AIDS dominate Ethiopia’s burden of disease. Epidemic-prone diseases
such as meningitis, malaria, measles, and shigellosis are also prominent health problems (2). For example the leading cause of
outpatient visits includes: Malaria, Helminthiasis, Tuberculosis, Bronchopneumonia, Gastritis and Duodenitis, Acute upper respiratory
tract infections, inflammatory diseases of eye (except Trachoma), Infections of skin and subcutaneous tissue respectively. Whereas
malaria, pregnancy related problems and respiratory infections are the leading causes of hospital admission (3).
Sanitation is fundamental to human development and security. Improper waste management may have health, environmental and
economic problems. There are low levels of hygiene awareness, which compound the health risks associated with low water and
sanitation coverage levels (4).
In Maichew town, lack of proper latrine access and use are still one of the major problems that the community faces. According to
woreda health office officials, upper respiratory tract infections and acute febrile illnesses rank the top two diseases in the first quarter
of 2005.
Currently, the ministry of health targeted in accomplishing the MDG goals by launching various strategies. The health policy of the
government focuses primarily on prevention. This implies that focuses should be given to the prevention of all communicable disease
that focus should be given to the prevention of all communicable diseases and env’tal factors that predisposes to the occurrence of
different disease whereby threatening our citizens. Hence the policy aims at the protection of the environment, the prevention of
disease, promotion of health and prolongation of life with the application of science and technology (5).
One of the strategies to achieve those goals is by having skilled health professional, from the 33 universities in the country Mekelle
University is one of the pioneer in community based education so the approaches to meet the goals are community based training
program and developmental team training program.
Community based Education (CBE) is a means of achieving educational relevance to community needs and consists of learning
activates that use the community -oriented education program. It consists of learning activities that use the community extensively as a
learning environment in which not only students but also teacher members of the community and representatives of other sectors are
actively engaged throughout the educational experience. The program is of clear benefit to both students and the community.
Statement of the problem
The commonest causes of death and illness in Africa are acute respiratory tract infections, tuberculosis, HIV/AIDS/STI,
diarrheal disease, malaria and vaccine preventable infections.
In the past few years the achievements obtained in decreasing infant and child mortality are largely attributable to health and nutrition
interventions and improvements. Nevertheless the level of infant mortality in sub-Saharan Africa continues to be among the highest in
the world. According to the 2011 EDHS report, for the five years preceding the survey, the level of infant mortality rate was 59 per
1000 live births and under five mortality rate was 88 per 1000 live births.
According to the 2011 EDHS report maternal deaths for the seven years preceding the survey were 217 per 1000 women aged 15-49
years. The maternal mortality rate is high due, in part, to food taboos for pregnant women, poverty, early marriage, and birth
complications.
Harmful traditional practices such as FGM, uvulectomy, milk-teeth extraction, and early child marriage all contribute to short and
long term health related problems.
Even though the health service coverage of the country and of Tigrai region is said to be growing, communicable diseases attributable
to poor sanitation, inappropriate and insufficient latrine utilization, are still major health problems.
CHAPTER 2:OBJECTIVE
General objective
 To assess health and health related problems in Kebele 04 of Maichew town and intervene accordingly from Tahsas 16-Yekatit
1, 4/2005E.C.
Specific objectives
 To determine latrine coverage of each household.
 To determine the practice of infant and child feeding.
 To find out coverage of family planning methods.
 To determine the level of immunization of children who are below 2 years of age.
 To determine the level of TT immunization of mothers within the reproductive age (15-49 years).
 To find out harmful traditional practices.
 To determine family medical history.
 To establish water supply coverage of households.
 To determine the practice of waste disposal management.
 To determine ANC follow up.
 To find out delivery practice.
CHAPTER 3:METHODS AND MATERIALS
Study area and period
Maichew which means “salty water” is the capital city of southern zone of Tigray. It is found 660 km north of Addis Ababa
and 127 km south of Mekelle. It is located at an altitude of 12047I north and, longitude of 39032I east. It is found 2479m (8133
ft) above sea level. It has total surface area of 145,568 Hectare of which 868 Hectare is covered by houses.
According to the 2003 E.C information the total population of Maichew town is around 25,926, with 13,719 females and
12,207 males.
Maichew town has 4 kebelles and 19 zones, and our DV site Kebelle 04 is one of the four kebelles in the town. The total
population of the kebelle is about 5167 with males constituting 2563 and females 2664. The number of households in the
kebelle is around 1358.
The study was conducted from Tahsas 16- Yekatit 1, 2005 E.C.
Study design
A cross- sectional study design was used
Population
Sourcepopulation
Total households of kebelle 04 in Maichew town.
Studypopulation
Total households of kebelle 04 in Maichew town.
Samplingunit
Each household of kebelle 04 in Maichew town.
Studyunit
Each head of the households (mother, father or any family member whose ages are above 14 years).
Mothers in the reproductive age group (15-49 years).
Eligibility criteria
Inclusioncriteria
 All mothers who have children whose age is below 2 years: to determine the level of immunization of children.
 All mothers who have children whose age is below 5 years: to determine the practice of infant and child feeding and
harmful traditional practice.
 All mothers in the reproductive age group (15-49 years): to determine the level of TT immunization and coverage of
family planning methods.
 All pregnant mothers and all mothers who were pregnant in the past 12 months of the study: to determine ANC follow
up.
Exclusioncriteria
 Those households with absent respondents at 3 visits on 3 different days.
 Those rental households which are occupied by students.
Sample size determination
The sample size was calculated using the formula used to calculate sample size from single proportion:
n= z² p (1-q)
d²
Where:
n= sample size for population > 10000
Z= standard normal deviation usually set as 1.96 (which Corresponds to 95 % confidence level)
P= the proportion of positive prevalence estimated to be 50%
d = marginal error estimated to be= 5%
Then the sample size is:
n=384
Since the study population is less than 10,000, correction formula was used.
Finally, by adding 5% non respondent rate, 324 HHs were included in the study.
Sampling technique and sampling procedure
 We used systematic sampling method
 First we gave unique numbering for each household in the DV site.
 We used lottery method to arrange all the unique alphabets used for numbering in order.
 we calculated the interval of sampling using the formula:
K=Study population /samplesize
k=1533/324
k= 4.73~5
 We used another lottery method to find our random start.
 We identified every study unit using our interval.
Data collection techniques and tools
 Structured questionnaire which was developed by public health department was used to perform community health
surveys.
 The questionnaire was prepared in English, and so the interviewer interpreted all the questions in to the language that
the respondents would understand.(all the interviewers had a common understanding about all the questions in the
questionnaire)
Data quality control measures
 Detailed explanations of the whole aim of collecting the data was given by the supervisor for the data collectors
 Each questions of the whole questionnaire was explained by the supervisor for the data collectors and a brief group
discussion was done among the data collectors.
 The supervisor took one questionnaire from each data collectors randomly and checked whether the questionnaires
were complete and genuine
Data quality control
 To ensure the quality of the data, adequate discussion was held among students and respective supervisor.
 On the spot checking clarification of any missing data and ambiguity was held.
Data processing and analysis
 Data entry, editing, cleaning and analysis were done on SPSS version 16.0 software.
 Descriptive statistics of the data was analyzed and the data was presented in the form of text, tables and graphs or
figures.
Operational definitions
 Proper Utilization of Latrine:
-The family members starts to use (under construction latrine or new latrine which does not give service is not rated at all).
-The latrine should not be filled with excreta to about at least more than 50 cm space left.
-The latrine or drainage system of the toilet shouldn’t have any leakage to the compound or surrounding?
-The Slab should not be soiled with excreta.
 Protected well:
-The well should be constructed with water tight cement wall and slab, not exposed to flood or have diversion ditch, having
hand pump or with a system of wind lass having a rope and with clean bucket which has a system of rotating and/ or pauy
system.
-The slab of the well should have 30-50 cm raised above the ground.
-the well should have cover
 Protected Spring:
-The wall and slab of the spring should be water tight.
-The out let should be fitted with pipe.
-The surrounding of the spring should not be exposed to animals.
 Hand washing basin: the hand washing basin could be made from any local or any other material but should be located adjacent
to the latrine.
 Artificial ventilation: HH with electrical ventilator.
 Illumination:- Good if easy to read a letter written by pencil standing in the house with window open
- Fair if we can see letter somewhat
- Bad if we cannot read any letter
 Cleanliness of the compound:- Good if free of any waste
- Fair if with some solid waste
- Bad if with both solid and liquid waste
 Window opening:- Sometimes is less than or equal to two per week
- Occasionally-- less than or equal to one per week
- Always-daily
Ethical consideration
 The study was commenced after official letter of permission was obtained from Mekelle University, CBTP
coordinating office.
 Official permission letter was sent to Maichew kebelle 04 office and town administration.
 Each respondent’s verbal informed consent was obtained and detail purpose of the survey was explained prior to data
collection.
 Confidentiality of the data was strictly respected.
Plan for dissemination of findings
 The final report will be presented to the community of Mekelle University.
 The finding will be disseminated to CBTP coordinating office.
 Final document of the finding will be submitted to the concerned bodies of the kebelle and other stakeholders.
Limitations of the study
 Due to resource limitation all the study units were not included in this study.
 Inferential statistics was not applied to identify explanatory variables for the given outcome variable.
CHAPTER 4:RESULTS
5.1 Socioeconomic and demographic characteristics
Out of the 289 households all were included in the analysis making a response rate of 100%. The median age of the population
was 20 years. There were 497(43.4%) male, and 648(56.6%) females involved in the study. From these there were 361(31.5%)
single, and 346(30.2%) were married. The study showed that 1074(93.8%) are Orthodox Christians and 63(5.5%) Muslims.Out
of the total population 274(23.9%) were unable to read and write, whereas 155(13.5%) were at college level and above. Most
of the study population were students with figure of 421(36.8%), 33(2.9%) were farmers and 108(9.4%) were government
employees. 53(4.6%) of the population were found to be living with their relatives. The mean family size of the population
was 3.9(SD+ 1.88).The majority of the population 195(67.5%) had a monthly household income of <1,000 ETB. (Table 1)
Fig1.Population pyramid of kebelle 04 in Maichew Town.
Key:
1=<5years
2=5-9 “
3=10-14 ”
4=15- 19 ”
.
.
.
16=75-79 “
17=>80 “
Table1 .Sociodemographic characteristics of kebelle 04 Maichew Town.
Frequency and percent distribution of sociodemographic data by sex, marital status, religion, educational level and
relationships with in the family.
Variables Frequency Percent
Sex
Male 497 43.4
Female 648 56.6
Total 1,145 100
Marital status
Single 361 31.5
Married 346 30.2
Divorced 33 2.9
Widowed 83 7.2
Under 15 years of age 322 28.1
Total 1145 100
Religion
Orthodox 1074 93.8
Catholic 8 0.7
Muslim 63 5.5
Total 1145 100
Educational status
Unable to read and write 274 23.9
Able to read and write 51 4.5
Grade1-4 137 12.6
Grade 5-8 244 21.3
Grade 9-12 284 24.8
College level and above 155 13.5
Total 1145 100
Occupational status
Farmer 33 2.9
Merchant 78 6.8
Government employee 117 10.2
Personal employee 47 4.1
House wife 161 14.1
Daily labourers 46 4
House maid/servant 15 1.3
Pensioned 12 1
Student 421 36.8
Weaver 2 0.2
Commercial sex worker 4 0.3
Local bear seller 1 0.1
Under age for occupation 189 16.5
Other(guard, cart drivers,
bicycle renters)
19 1.7
Total 1145 100
Relationships
Father 178 15.5
Mother 256 22.4
Grand father 2 2
Grand mother 22 1.9
Son/daughter 603 52.7
Relative 53 4.6
Other 31 2.7
Total 1145 100
Table2. Categorical Monthly Income of Household
Frequency and percent distribution of average monthly household income.
Monthly income Frequency Percent
<1000 ETB 195 67.5
1000 – 2000 ETB 50 17.3
>2000 ETB 44 15.2
Total 289 100
Electricity, transport, and health institutions are
accessible at 94.1% (272), 87.2 %( 252), and 100
%( 289) respectively.
Fig2. Histogram representation on availability of facilities in kebelle 04, Maichew Town.
Availability of facilities by percent distribution
Death reports
The study showed that there were 6 death reports in the last 12 months of the study period, out of which 3 were males.
The mean age at death was found to be 49.3 years. The causes of death were asthma- 1, chronic illness- 2, labor-1, PUD- 1 and TB - 1.
Environmental conditions
The study showed that 173(59.9%) and 110(38.1%) households were private & rental houses respectively. Regarding the roof
structure of the house, majority of the households 270(93.4%) were covered by corrugated iron sheet. Majority of the HHs
213(73.7%) have walls made of mud whereas, the least household 1(0.3%) has wall made of wood. Regarding the floor of the HHs
majority of them 200(69.2%) have floor made of mud. Our study has also shown that 112(38.8%) HHs have one room only. From a
total of 289 households, the majority 241 (83.4%) have window. Regarding ventilation of the room, more than half of the households
165 (57.1%) have one way ventilation. Good illumination was found in 133 (46%) households. (Table.3)
0
20
40
60
80
100
Electricity Transport Health institution
Yes
No
Table3. Housing conditions
Frequency and percent distribution of households by household ownership and housing characteristics.
Variables Number Percent
Household ownership
Private 173 59.9
Rental 110 38.1
Others 6 2.1
Type of roof
Thatched 10 3.5
CIS 270 93.4
Mud and wood 2 0.7
Others 7 2.4
Wall type
Mud 213 73.7
Brick/concrete 72 24.9
Stone 2 0.7
Wood 1 0.3
Is the wall cracked or plastered?
Yes 100 34.6
No 189 65.4
Type of floor
Mud 200 69.2
Wood 7 2.4
Concrete 82 28.4
Is there any window in each room?
Yes 241 83.4
No 48 16.6
Do you open window?
Sometimes 171 59.13
Always 50 17.3
Occasionally 26 9.03
No 42 14.5
Was there any open window at the time visit?
Yes 68 23.53
No 221 76.47
Ventilation type
One way 168 58.1
Crossed way 75 26
Parallel way 45 15.6
Artificial 1 0.3
Illumination condition of the house
Good 133 46
Fair 142 49.1
Bad 14 4.9
Cleanliness condition of the compound
Good 77 26.6
Fair 204 70.6
Bad 8 2.8
This study also showed that 129(44.6%) HHs have domestic animals. Among these, in 54(41.86%) HHs domestic animals live in the
same house with household members.
Of the total HHs 53(18.3%) have no kitchen. Among the HHs that have kitchen, 220(93.22%) have a kitchen separated from the
house and 16(6.78%) have kitchen in their house. (Table 4)
Table 4. Domestic animals and kitchen in households
Frequency and percent distribution of households by kitchen characteristics and domestic animals living with humans in the same
house.
Variables Frequency Percent
Do you have domestic animals?
Yes 129 44.6
No 160 55.4
Do domestic animals live with humans in the same
house?
Yes 54 41.86
No 75 58.14
Is there kitchen in the house?
Yes 236 81.7
No 53 18.3
Is the kitchen separated from living house?
Yes 220 93.22
No 16 6.78
Does the kitchen have window?
Yes 103 43.64
No 133 56.36
Does the kitchen have chimney?
Yes 86 36.44
No 150 63.56
Regarding waste disposal system 203(70.2%) HHs have no pit. Among the total HHs, 255(88.2%) HHs use latrines, of which
191(74.1%) have private latrine. Out of the HHs that have no latrine, 34(11.76%) HHs use open field. (Table 5)
Table5. Household waste management and latrine condition
Frequency and percent distribution of households by latrine characteristics and presence of pit.
Variables Frequency Percent
Is there pit in the house hold?
Yes 86 29.8
No 203 70.2
Do you use latrine for defecation?
Yes 255 88.2
No 34 11.8
Status of latrine ownership
Private 191 74.9
Communal 48 18.8
Others 16 6.3
What is the type of latrine?
Pit latrine 230 90.2
VIPL 25 9.8
Estimated distance of latrine from living room
<15 meters 195 76.5
>15meters 60 23.5
Estimated distance of latrine from water source
<15 meters 143 61.4
>15meters 90 38.6
Estimated distance of latrine from kitchen
<15 meters 184 81.8
>15meters 41 18.2
Does the latrine have superstructure?
Yes 188 74.3
No 65 25.7
Are there excreta around the latrine?
Yes 49 19.4
No 204 80.6
Is there a hand washing basin with water at the door
step of the latrine?
Yes 53 20.9
No 201 79.1
The study also showed that 234(81%) HHs have water pipe in their compound. The remaining HHs use public stand 53(18.3%),
protected spring (1HH) and covered well (1HH) water supply. 270(93.4%) of the total HHs use jerican for storage. Tasa and joke are
the major equipments used for drawing water from the storage. It takes less than 15 min to fetch water for the majority of HHs
246(85.1%) and 127(43.9%) HHs use more than 30 litres water per capita per day. (Table 6)
Table6. Household water supply and utilization
Frequency and percent distribution of households by average time spent to fetch water, amount of water utilized per capita per day,
methods of water storage and methods to fetch water from storage.
Variables Frequency Percent
Average time spent to fetch water
<15 minutes 246 85.1
15-20 minutes 13 4.5
>20minutes 30 10.4
Amount of water utilized for all purposes per capita
per day in liter
<20 litres 72 24.9
20-30 litres 90 31.1
>30 litres 127 43.9
Methods of water storage
Jerican 270 93.4
Pot 5 1.7
Barrel 8 2.8
Others 6 2.1
What methods do you use to fetch water from
storage?
Pouring 274 94.8
Drawing 15 5.2
89(30.8%) households have vermin of which the majority 65(73.03%) HHs have rats.
Fig3. Household vermin condition
Number of households which have vermin with specific type of vermin
Nutrition
From study undertaken in 289 households 142(49.3%) used to eat with the family members all together, while 39(13.5%) children
used to eat separately from their parents. From 76 potential breast feeders (mothers with a child under the age of 24 months), only
54(71.1%) mothers breast feed their child. From the 22 non breast feeders 7 said their reason is due to their positive HIV status. From
those mothers who were breast feeding about 87(88.8%) said they initiated breast feeding immediately and 9 within a day. Exclusive
breast feeding for 4-6 months was found in 50(69.5%) mothers. Initiation of foods and fluids other than breast milk just after birth was
identified in 26(26.5%) mothers. Mothers who initiated complementary feeding at 6 months were 60(84%). (Table 7)
0
10
20
30
40
50
60
70
Table7. Nutritional status of kebelle 04, Maichew Town
Frequency and percent distribution of eating arrangement and infant and child feeding practices.
Eating arrangement Frequency Percent
All family members together 142 49.3
Separately 99 34.4
Children separately 39 13.5
Others 9 2.8
Total 289 100
Breast feeding baby (<24month)
Yes 54 71.1
No 22 28.9
Total 76 100
Reasonfor Not breast feeding(<24 month)
HIV +ve 7 31.8
Unspecified reason 15 68.2
Total 22 100
Breast feeding initiated(<5 years)
Immediately 87 88.8
Within a day 9 9.2
Other 2 2
Total 98 100
Exclusive breast feeding(<5 years)
Below 4 months 16 22.2
4-6 months 50 69.5
6-11 months 5 6.9
Above 1 year 1 1.4
Total 72 100
Fluid and food other than breast milk just after birth
Yes 26 26.5
No 72 73.5
Total 98 100
Initiation of complementary feeding
At 6 month 60 83.3
At 9 month 11 15.3
Above 12 month 1 1.4
Total 72 100
Type of complementary feeding
Fluid 41 56.9
Semifluid 22 30.6
Family food 9 12.5
Total 72 100
Types of materials used
Bottle 27 37.5
Cup and spoon 43 59.7
Others 2 27.8
Total 72 100
Disease conditions
From the survey conducted, there were 39 sick family members, of those 16 were presented with cough, 10 with fever, 5 with
diarrhoea, 4 with runny nose,2 with vomiting and 2 with others like headache and abdominal pain within two weeks of data
collection.
From those sick members 29 visited health institutions, 3 used holy water, 2 visited pharmacies and the rest 5 gone to traditional
healers.
There were 43 chronic diseases. Of those 5 were Diabetes Mellitus, 6 cases were TB, 13 were cases of HTN, 3 case of epilepsy, 11
cases of disability and 5 were others (asthma, renal disease, chronic migraine ).
Maternal and child health care
The mean age at first marriage was 17.02 years and of the responding mothers 116(41.13%) got married before the age of 18 yrs.
In the last twelve months, 41 pregnant mothers were found in the study area. Of whom 36 were attending at least one ANC visit.
Whereas, 5 mothers were not attending any ANC. The reason given by the mothers for not attending ANC were because they do not
know about it and for undisclosed reason. The ANC follow up showed that there was a decreasing trend in the subsequent visits (Fig.
4). In the last twelve months, there were a total of 32 deliveries, of whom 4 were at home and 28 at health institutions.
Fig4. Trend of ANC visits in Maichew town kebelle 04
In the last 12 months there were 24 spontaneous abortions in the study area.
0
5
10
15
20
25
30
35
40
ANC1 ANC2 ANC3 ANC4 ANC4+
TT vaccination
The table below shows TT vaccination coverage with in 351 women of reproductive age group (15-49 years).
Table8. TT vaccination
Frequency and percent distribution of TT vaccination of mothers of reproductive age group
TT vaccination Number of women currently
taking or completed
Percentage
TT1 201 57.26
TT2 198 56.41
TT3 170 48.43
TT4 127 36.18
TT5 111 31.62
Of the 281 respondent women, 222(79%) know the presence of FP methods, and 59(21%) do not know. Of those who know the
presence of FP methods, 141(63.5%) had ever used FP methods but 81(36.5%) had never tried .Of the family planning methods used
22(15.7%) were pills, 107(75.9%) were injectable, 8(5.6%) were Norplant, 1(0.7%) were condoms and 3(2.1%) were others.
Table9. Reasons for the non-users of contraceptive methods.
Frequency and percent distribution table showing reasons for not using family planning methods.
Currently, 98(44.14%) women of those who know presence of FP methods are using it. Of the current 124(55.86%) non-users
34(15.32) were because they were menopausal, 27(12.16%) were breast feeding mothers,18(8.10%) were widowed, 16(7.21%) for
religious reason, 12(5.41%) were divorced,12(5.41%) were because their husbands were away, 2(0.90%) were infertile, and the rest
3(1.35%) were due to other reasons.
EPI Coverage
Among 119 children below 2 years 102(85.7%) were immunized according to the EPI programme (see the bar graph below the table
10).
Table10. Evidences for immunization
Frequency and percent distribution table for the immunization of infants and children below the age of 5 years.
Evidence Frequency Percent
Card 13 12.74
History 65 63.72
BCG scar 4 3.92
Card plus history 20 19.60
Total 102 100
Reasons Frequency Percent
Need many children 33 31.13
Religion 32 30.19
Fear of side effects 13 12.26
Geographic inaccessibility 15 14.15
Forgetting 9 8.49
Others 4 3.78
Total 106 100
Fig5. Immunization status of children below the age of 2 years
Harmful traditional practice
There were a total of 108 traditional practices in the study area.77 (71.3%) were exercising uvulectomy, 12(11.1%) pulling of the first
teeth, 17(15.7%) female genital mutilation and the rest 2(1.9%) are other practices like tilting around the eyebrow.
0
5
10
15
20
25
30
35
40
polio o polio 1 polio2 polio3 BCG penta1 penta2 penta3
DISCUSSION
Socio-demographic characteristics
Population pyramid of the study area (kebelle 04) indicated that, it is flat at the bottom and narrow at the top. Majority of the female
are between the ages of 15-19, whereas majority of males were found under 15 years of age. Generally, majority of the population
were under 20 years of age. This might imply there is a high rate of dependency level. The finding is found to be in disagreement with
EDHS (Ethiopian demographic health survey of 2011) which shows majority of the population is under 15 years of age. The
discrepancy might be due to residential variation of the population in the EDHS study and our study. In addition our study only
included the urban area; whereas the EDHS study includes both urban and rural areas.
Maternal and child health
The study indicated that mean age of age at first marriage was found to be 17.02 years. The finding is in agreement with EDHS 2011
report, in which the mean age of first marriage was 16.5 years. Of those 41 mothers who were pregnant, 36 were attending at least one
ANC visit which could be due to availability of nearby health centers and Health extension workers. Those who do not attend ANC
could be due to lack of awareness and recklessness in going to health centers.The trend of ANC visit has shown a decrement in the
subsequent visits and this could be explained by problems in health care provision and lack of commitment for attending subsequent
visits.
In the last 12 months 28 of 32 deliveries were at health institution. This is abundantly higher than EDHS 2011 finding which
elaborated that 10% of deliveries are at health facility. This could be due to better institutional coverage in the town and the study
included only the urban area, unlike the EDHS.
Abortion
In the last 12 months there were 24 abortions cases. This might be due to abating the occurrence of unsafe abortions for unwanted
pregnancy.
TT vaccination
Of the reproductive age mothers, 57.26% have taken TT1, 56.41% taken TT2, 48.43% taken TT3, 36.18% taken TT4 and 31.62%
taken TT5.This low TT coverage may possibly be due to lack of awareness. The decrease in subsequent vaccinations can be
explained by decreased motivation of mothers and decreased positive attitudes towards vaccination in families.
Family planning
In our study area 89.8% of mothers in the reproductive age group know the presence of family planning methods, which is lower
compared with the 2011 EDHS which showed it to be 97%. This means there is inadequate awareness creation concerning FP
methods. Currently 44.14% women are using family planning and this is slightly higher than the EDHS 2011 which revealed that 29%
are using contraceptive methods. Most (73.3%) of current contraceptive users use injectable and this is consistent to the EDHS 2011
which showed that injectable are by far the most popular modern methods used ( 21%) . Most non-users are due to religious reasons
and needing many children (22.64% and 21.69% respectively) this means that there is still a misunderstanding of FP and even missing
awareness creation.
Among the children who are less than 2 years of age, 85.7% of them were immunized according to EPI target which shows that there
is effective immunization and this could be due to availability of nearby health services and increased awareness towards child care.
The EDHS 2011revealed the under 2 years immunization coverage to be 24%. And this discrepancy can result from differences in
reporting and population variation. Among the immunized children in 63.7% the evidences for immunization was history, which can
be false reporting or due to carelessness in handling cards.
Harmful traditional practice
In this study uveloectomy was the most common (63 %) harmful traditional practice, which may be due to deficient knowledge
regarding the effects.
Disease conditions
From the total of 39 patients in the past 2 weeks of the study, 41% were presented with cough and 12.8% were presented with
diarrhoea. This can be explained by inadequate personal hygiene and possibly poor environmental and food hygiene.
From those sick members 74.4% visited health institutions.
Environmental
This study has revealed that majority of households are living in their own house. This helps to keep the cleanliness of the house and
the compound. This in turn has a positive effect on the health of the household members.
Although the recommended ventilation type is crossed way ventilation, more than half of the HHs have one way type of ventilation
and 59.13% of the HHs do not open their windows regularly. This may create a conducive environment for the transmission of URTI
and TB.
In our study most walls of the HHs are made up of mud which in turn results in cracking which may create a favourable environment
for breeding of vermin like bed bugs, mosquito and rodents. Exposure to these vermin results in acquisition of diseases like malaria
and typhus.
Our result showed that 41.86% of the HHs who have domestic animals do not have separate house for the animals which may put
these HHs at risk of different zoonotic diseases.
The current study indicated that from those households who have kitchen, more than half of them didn’t have a kitchen with window.
This might expose mothers and children for different kinds of respiratory tract diseases, such as COPD and Asthma. The problem
becomes worse because most of the kitchens also lack chimney.
In our study on solid waste disposal, the result showed that, about 70.2% of the households do not have pit and even 68.96% of them
have no plan to dig. The reason is because they have a municipal waste disposal service.
The coverage of latrine in our study area was found to be 88.23%. The finding is higher than the national coverage of latrine, which is
61.7%. This might be due to the sociodemographic differences. The national figure includes urban, peri-urban and rural areas.
Whereas our study only shows the urban area. Most of the household have latrine for defecation and from this the majority are private
owners. But almost all the households use pit latrine which is substandard and unimproved. The result is a higher than the national
coverage of unimproved sanitation facilities (EDHS 2011). This might be due to that our study only included the urban area, whereas
the EDHS finding includes both the urban and rural parts of Ethiopia. Settings of the latrine also showed that majority of the latrines
were constructed within a distance of less than 15 meters from the living room, water source and kitchen. This might expose the
household members for different kinds of infections, such as cholera, diarrhoea, amoeba, and bad odour. Frequent utilization of latrine
might also be deferred due to the bad odour.
This study showed that majority of the HHs use improved water source. However, some of the HHs (5.2%) use unsanitary practices
like storing water in barrel and using drawing method to fetch water from the storage which may put the household members
susceptible for water born diseases.
Our finding also showed that 30.8% of the households have different kinds of vermin: 73.03%, 34.8%, 20.2% consist rats, flees and
bed bugs respectively. This might put the household members at risk of diseases such as typhus and relapsing fever.
Nutrition
Nutritional status is the result of complex interactions between food consumption and the overall status of health and health care
practices. Numerous socio-economic and cultural factors influence patterns of feeding children and the nutritional status of women
and children. The period from birth to age 2 years is especially important for optimal growth, health and development. Unfortunately
this period is often marked by micro nutrient deficiencies that interfere with optimal growth. Additionally childhood illness such as
diarrhoea and acute respiratory tract infections are common.
From the survey in kebelle 04, from potential mothers who have children under the age of 2 years, which is the recommended duration
of breast feeding, only 71.1%( 54) were found to breast feed their children, the remaining 28%(22) did not breast feed because of
reasons such as sero status of the mother and some unspecified reasons. Same study was undertaken on mothers who have children
under the age of 5 years and 88.8% of them were found to have initiated breast feeding immediately after birth, 69.5% exclusively
breast fed their children from 4-6 months, which is the recommended period. From this data one can say the community has more or
less sufficient information on the advantages of exclusive breast feeding and is also aware of the ideas suggested by health
professionals on the duration. On the same study 83.3 % of the populations were found to have initiated complementary feeding after
6 month, majority 56.9% initiated complementary feeding with fluids and about 59.2% used cup and spoon to feed their children.
Despite what is recommended, 27.1% of mothers started their children with fluids and foods other than breast milk immediately after
birth and 9.5% of the mothers initiated complimentary feeding with family foods. This indicates that, there is still some information
barrier on the feeding practice of children.
In general one may conclude that the community is aware about the importance of breast feeding, advantage of initiation of
complementary feeding, and use of cup and spoon to that of bottle feeding which helps in the reduction of spreading of to the child in
question.
ACTION PLAN
INTRODUTION
Maichew (salty water) is the capital city of southern zone of Tigrai which is found 660 km north of Addis Ababa and 127 km south of
Mekelle. It is surrounded by Endamehoni woreda. DV site, Kebelle 04 is one of the four kebelles in maichew town constituting 4 zones. The
total population of the kebelle 04 is about 5167 with males constituting 2563 and females 2664.From 1358 households, the number of under
five children are around 1027 ( 14.6 %), Mothers ( 14-49) are around 1642 ( 23.48 %) ,70 % of the population are farmers, 20 % are
merchants, and 10% are government employees. Kebelle 04 shares Semere melles health center with that of kebelle 01.
Some of the problems that are identified from study conducted in the catchment area are: early marriage (mean age at marriage 17.5 years),
Poor ANC follow up (ANC follow up show decreasing pattern during subsequent visits), inadequate TT vaccination among the reproductive
age group, Poor breast and complimentary feeding practice, existence of harmful traditional practices, mild vaccination problem, and
Problems with regard to family planning.
The other problems are related to environmental sanitation which includes: gaps in the practice of house and kitchen ventilation, infestation
of households with vermin, poor water handling and storage practice at household, having no separate rooms for domestic animals, and
approximation of distance between latrine, kitchen and water source on majority of the households.
Through analysis of the HC information gathered are: gap in the planned and achieved delivery services, inadequate vaccination practices,
drop out in the subsequent ANC visits, and gaps in the activities that should have been performed by the voluntary community mobilizes
As a result an action plan was devised to create awareness among pregnant mothers and reproductive age group women on the observed
problem areas, motivating the community to avoid harm full traditional practices and allowing good ventilation for the households, and
educating the society on creating clean and healthy living environment and practice of safe water storage that will improve the overall health
status of the community.
Moreover the action plan included another two main sites of intervention, in which the first one is the clinical (static) which would act in
various departments of the health center like Adult OPD, Under 5 OPD, MCH and YFS giving various services and assisting in managing
patients. The second one is the outreach program addressing problems associated with food and drink establishments such as hotels and
restaurants, creating awareness in various issues in prison, colleges, preparatory schools, high schools, elementary schools, and kinder
gardens. The detailed explanations of all the activities that are done and achieved are presented in the subsequent part.
Significance of the project
The project is going to address some of the identified problems through various approaches like giving health education through
training; OPD visits, using “idirs” and religious gatherings, preparing flyers that would improve the awareness of the community in
certain issues. In addition to that, the project would have ways of demonstrating session how to perform activities that would improve
the health status of the community.
The project would also have the plan of communicating with government health officials so as to discuss the ways of improving the
health delivery system benefiting the community at large.
Opportunities
The volunteer community mobilizes who has access to almost every household in our catchment area are considered to be a good
opportunity to work with them.
The health centre is launching a program of community dissection and health education to improve various aspects of health status of
the community in the time range of our intervention plan which would be a greater opportunity for as to give exert opinion and deliver
out messages.
Since we are located near the center of the town we would have a good access to hotels, schools local bear houses, barbers and other
institutions which would have a direct impact on the health status of the community.
The governmental health officials, the kebelle administrators, and the health center administrates are very friendly making it easy to
work with them.
List of the problems identified from the community health survey
• Absence of liquid waste disposal system in 203(70.2%) HHs
• Absence of superstructure for latrine in 65(25.7%)
• Absence of hand washing basins around the latrine in 201 (69.6%) households
• Mothers who breast feed their child <24 month 54 out of 76
• Mothers who start complementary feeding just after birth 26 out of 98
• Absence of ventilation of the kitchens( kitchens without window 133 and without chimney 154)
• Households do not open their window adequately in 239(82.6% )
• Domestic animals living with human in the same house 54(41.86%)
• Spontaneous abortion 24(6.8%)
• In complete TT vaccination practice ( 201(57.26%) have taken TT1 , 198(56.41%) taken TT2, 170(48.43%) taken
TT3, 128(36.18%) taken TT4 and 111(31.62%) taken TT5 )
• Burden of chronic medical illness (3(6.98%) were DM, 5(11.63%) cases were TB, 12(27.91%) were cases of HTN,
1(2.32%) cases of epilepsy, and 8(18.6%) cases of disability.)
• Suboptimal distance of latrine (<15m) from the living room, water source and kitchen are 195(76.5%), 143(61.4%),
184(81.8%) respectively
• Existence of harmful traditional practices (uvulectomy-63%) and mild vaccination problem (14.3%)
• Early marriage (41.13% < 18yrs )
• No ANC follow up ( 12.2%) and decreasing pattern in subsequent visit
Priority
setting
criteria
Identified Health Problems
Absence
of
liquid
waste
disposal
system
Absence
of hand
washing
basins
around the
latrine
Household
s do not
open their
window
adequately
Domestic
animals
living with
human in the
same house
Absence of
ventilation of
the kitchens
Poor breast
and
compliment
ary feeding
practice
Existence of
harmful
traditional
practices
No ANC
follow up
and
decreasing
pattern in
subsequent
visits
Home
delivery
Lack of
awareness of
family
planning
methods
Magnitude
of the
problem
5 5 5 2 4 3 3 2 2 3
Severity of
the
problems
5 4 4 5 3 3 3 4 4 2
Feasibility
of the
problems
4 5 5 3 4 4 4 4 4 4
political
concern
5 5 4 5 4 4 3 3 3 3
Community
concern
5 4 4 5 4 4 4 3 3 3
Total score
(out of 25)
24 23 22 20 19 19 17 16 16 15
According to the priority setting table we arranged the problems identified from high priority to low priority as a follows
List of prioritized problems identified
1) Absence of liquid waste disposal system in 203(70.2%) house holds
2) Absence of hand washing basins around the latrine in 201 (69.6%) households
3) Households do not open their window adequately in 239(82.6% )
4) Domestic animals living with human in the same house 54(41.86%)
5) Absence of ventilation of the kitchens( kitchens without window 133 and without chimney 154
Specific objective regarding the DV site
 To increase awareness towards the importance of pit and risks associated with improper liquid waste disposal system
 To increase awareness towards the importance of constructing hand washing basin around the latrine
 To increase awareness towards adequate opening window
 To increase awareness towards the importance constructing separate room for their animal
 To increase awareness towards constructing ventilation for the kitchen and risks associated with absence of kitchen ventilation
 To increase the awareness of the necessity of breast feeding in all mothers despite the RVI status
 To increase the awareness of the society about the negative impacts of the harmful traditional practices and the risks of
incomplete vaccination
 To increase awareness on the importance of ANC follow up and risks associated with none adherence to the subsequent visits
 To increase the awareness of the adequate delivery service given by the HCs and
 To create awareness regarding risks of home delivery
 To increase awareness of the importance of family planning
Summary of detailed methods and strategies of the intervention (DV Site)
List of
problems
Objectives Strategies Activities Target Responsible
body
Tot
al
plan
Time(week) Total
Achieve
ment
Remark
1st
jan14tojan18
2nd
jan21tojan25
3rd
jan28 to feb1
P A P A P A
1.Absence
of liquid
waste
disposal
system in
203(70.2%
) house
holds
To increase
awareness
towards the
importance
of pit and
risks
associated
with
improper
liquid waste
disposal
system
House to
house visit
Collaborati
ng with
HEWs
Demonstration
Health
information
dissemination
on house to
house visit
visiting model
households
To
dissemin
ate
health
informat
ion in
49% of
HHs of
kebelle
04
Mekelle
university’s
fifth year
medical
students
The
administrato
rs of the
kebelle
VCM
670
hou
seh
olds
200
hou
seh
olds
18
5(9
2.5
%)
260
hou
seh
olds
25
2(9
6.9
%)
210
hou
seh
olds
19
0(9
0.4
7%
)
627 HHs(
93.6%)
No of
households
who dig a pit
after the
demonstration
2.Absence
of hand
washing
basins
around the
latrine in
201
(69.6%)
household
s
To increase
awareness
towards the
importance
of
constructing
hand
washing
basin around
the latrin
Collaboratin
g with HEWs
By visiting
model
households
Health
information
dissemination
Demonstration
of simple hand
washing basin
construction
visiting model
To
dissemin
ate
health
informat
ion in
56.7%
of HHs
of
kebelle
04
Mekelle
university’s
fifth year
medical
students
Volunteer
community
mobilizes
770
hou
seh
olds
280
hou
se
hol
ds
22
6(8
0.7
%)
260
hou
se
hol
ds
25
2(9
6.9
%)
210
hou
se
hol
ds
19
0(9
0.4
7%
)
730
HHs(94.8
%)
Number of
households
who
constructed
simple hand
washing basin
households
3.Househo
lds do not
open their
window
adequately
in
239(82.6%
)
To increase
awareness
towards
adequate
opening
window
Collaboratin
g with HEWs
Using idir
and religious
gathering
Health
information
dissemination
on house to
house visit
To
dissemin
ate
health
informat
ion in
57.8%
of HHs
of
kebelle
04
Mekelle
university’s
5th year
medical
students
Volunteer
community
mobilizers
786
hou
se
hol
ds
per
wee
k
316
hou
seh
olds
28
6(9
0.5
%)
260
hou
seh
olds
25
2(9
6.9
%)
210
hou
seh
olds
19
0(9
0.4
7%
)
762
HHs(96.9
%)
No of
households
started
opening tire
windows
4.
Domestic
animals
living with
human in
the same
house
54(41.86%
)
To increase
awareness
towards the
importance
constructing
separate
room for
their animal
In
collaboration
with HEWs
and VCM
Health
education on
home to home
visit
visiting model
households
To
dissemin
ate
health
informat
ion in
38.3%
of HHs
of
kebelle
Mekelle
university’s
5th year
medical
students
HEWs
Volunteer
community
mobilizes
520
hou
seh
olds
50 21(
42
%)
260 25
2(9
6.9
%)
210 19
0(9
0.4
7%
)
480
HHs(92.3
%)
No of
households
with domestic
animals who
constructed a
separate
house for their
animals
5.Absence
of
ventilation
of the
kitchens(
kitchens
without
To increase
awareness
towards
constructing
ventilation
for the
kitchen and
In
collaboration
with HEWs
and VCM
Demonstration
Health
education in
house to house
visit
To
dissemin
ate
health
informat
ion in
38.3%
Mekelle
university’s
fifth year
medical
students
HEWs
520
hou
seh
olds
50
hou
seh
olds
24(
48
%)
260
hou
seh
olds
25
2(9
6.9
%)
210
hou
seh
olds
19
0(9
0.4
7%
)
494
HHs(95%
)
No of
households
who
constructed
window and
chimney for
window
133 and
without
chimney
154
risks
associated
with absence
of kitchen
ventilation
Visiting model
house holds
of HHs
of
kebelle
04
VCMs
their kitchen
6.Poor
breast
and
complime
ntary
feeding
practice
(29.1%
do not
breast
feed )
To increase
the
awareness of
the necessity
of breast
feeding in all
mothers
despite the
RVI status
In
collaboration
with HEWs
Health
education
dissemination
on house to
house visit
To
dissemin
ate
health
informat
ion in
45.6%
of HHs
of
kebelle
04
Mekelle
university’s
5th year
medical
students
HEWs
Volunteer
community
mobilizes
620
HH
s
240 21
0(8
7.5
%)
200 16
8(8
4%
)
180 16
2(9
0%
)
584
HHs(94.2
%)
No of mothers
involved in
the health
education
7.Existen
ce of
harmful
traditiona
l
practices
(uvulecto
my-63%)
Vaccinati
on
problem
(14.3%)
To increase
the
awareness of
the society
about the
negative
impacts of
the harmful
traditional
practices and
the risks of
incomplete
vaccination
In
collaboration
with HEWs
Health
education
dissemination
on house to
house visit
To
dissemin
ate
health
informat
ion in
47.8%
of HHs
of
kebelle
04
Mekelle
university’s
fifth year
medical
students
The
administrato
rs of the
kebele
Health
bureau
officials
650
HH
s
240 21
0(8
7.5
%)
200 16
8(8
4%
)
210 19
0(9
0.4
7%
)
603
HHs(92.8
%)
No of
participants in
the health
education
8.No
ANC
follow up
( 12.2%)
and
decreasin
g pattern
in
subseque
nt visits
To increase
awareness on
the
importance
of ANC
follow up
and risks
associated
with none
adherence to
the
subsequent
visits
In
collaboration
with HEWs
Health
information
dissemination
in religious
gatherings,
market places
and idir.
To
dissemin
ate
health
informat
ion in
38.8%
of HHs
of
kebelle
04
HEWs
Health
center
administrato
rs
Administrat
ors of the
kebelle
5th year
medical
students
528 214 19
0(8
8.7
%)
184 17
3(9
4.0
2%
)
180 16
2(9
0%
)
525HHs
(90.8%)
Number of
pregnant
mothers
involved in
the HE in the
HC
9.Home
delivery
(19.2.4
%)
To increase
the
awareness of
the adequate
delivery
service given
by the HCs
and
To create
awareness
regarding
risks of home
delivery
In
collaboration
with the HC
administrator
s
In
collaboration
with the
maichew
health office
administrator
s
In
collaboration
HE
dissemination
regarding the
risks of home
delivery
To
dissemin
ate
health
informat
ion in
38.8%
of HHs
of
kebelle
04
Health
center
administrato
rs
5th year
medical
students
HEWs and
VCMs
528 214 19
0(8
8.7
%)
184 17
3(9
4.0
2%
)
180 16
2(9
0%
)
525HHs
(90.8%)
Increment in
HC’s delivery
service
seekers
with HEWs
and VCMs
Lack of
awarenes
s of
family
planning
methods (
10.12 %)
To increase
awareness of
the
importance
of family
planning
In
collaboration
with HEWs
and WDAs
In
collaboration
with michew
health office
HE at the
community idir
and religious
gatherings
Distributing
flyers and
condoms for
free
To
dissemin
ate
health
informat
ion in
38.8%
of HHs
of
kebelle
04
Health
center
administrato
rs
Volunteer
community
mobilizes
528 214 19
0(8
8.7
%)
184 17
3(9
4.0
2%
)
180 16
2(9
0%
)
525HHs
(90.8%)
Number of
peoples
attended the
HE
Number of
flyers &
condoms
distributed
Fig. Bar graph indicating the total plan and achievement of DV site plan
0
100
200
300
400
500
600
700
800
900
Total plan
Achivement
Action plan for static group (HC)
Outpatient department
Services Plan 1st
week 2nd
week 3rd
week 4th
week achievement Explanation
n %
Under 05 OPD 316 79 79 79 79
URTI 80 20 20 20 20
AFI 72 18 18 18 18
Malnutrition 64 16 16 16 16
Pneumonia 36 9 9 9 9
Diarrhoea 40 10 10 10 10
Eye infection 24 6 6 6 6
Adult OPD(Age>24 years) 172 43 43 43 43
URTI 48 12 12 12 12
Gastroenteritis 40 10 10 10 10
AFI 32 8 8 8 8
Skin infection 20 5 5 5 5
LRTI 16 4 4 4 4
Trauma 16 4 4 4 4
B) Expanded programme of immunization
Services Plan 1st
week 2nd
week 3rd
week 4th
week achievement Explanation
No percentage
BCG 48 12 12 12 12
OPV1/Penta1 48 12 12 12 12
OPV2/Penta2 48 12 12 12 12
OPV3/Penta3 48 12 12 12 12
Measles 48 12 12 12 12
C) Maternal health
Services Plan 1st
week 2nd
week 3rd
week 4th
week achievement Explanation
No percentage
FP(Age>24
years)
152 38 38 38 38
PMTCT 40 10 10 10 10
ANC1 48 12 12 12 12
ANC2 60 15 15 15 15
ANC3 60 15 15 15 15
ANC4 60 15 15 15 15
Delivery 40 10 10 10 10
TT 40 10 10 10 10
Safe abortion 8 2 2 2 2
Youth friendly service
Services Plan 1st
2nd
week 3rd
week 4th
week achievement Explanation
No percentage
VCT 32 8 8 8 8
FP(Age 10-24years)
148 37 37 37 37
OPD(Age 5-24years) 124 31 31 31 31
URTI 28 7 7 7 7
Gastroenteritis 24 6 6 6 6
AFI 22 5 5 6 6
Skin infection 20 5 5 5 5
LRTI 16 4 4 4 4
Trauma 14 4 4 3 3
Action plan for outreach program
The aim of the outreach program is to create awareness regarding health & health related problems in food and drink establishments,
schools, colleges, prison and other institutions. In line with this aim information gathered from different stake holder institutions.
Based on the data gathered from these institutions problems were identified and a plan was developed for the intervention in the
outreach program.
Problems identified in outreach programs
1. Unclean foodanddrinkestablishmentsinhotelsandrestaurants(servantsdon’tweargownandcap, have nowashingdish,kitchenutensils
are notclean)
2. Absence of handwashingbasinnearbytoiletsinhotelsandrestaurants
3. The toiletsandkitchens inhotelsandrestaurants are closertoeachother
4. The handwashingwatercontainersinthe restaurantsandhotelsare rustyand dirty
5. The knivesandthe meatcuttingmaterialsinbutcheryare unclean
6. Studentswhoare learninginKGand elementaryschoolsdon’twashtheirclothesproperly.
7. Lowlevel of knowledge regardingreproductivehealth (regardingSTI,familyplanning,HIV) inhighschoolsandcolleges.
8. CrowdedTBpatientslive togetherinasmall room (approximately3by 3) inthe prison
9. Foodhandlersinthe prisondon’tweargownand cap
10. Highprevalence of HIV amongprisoners(32out of 660 prisoners)
Priority setting criteria for outreach programme
Priority
setting
criteria
IdentifiedHealthProblems
TB
patients
live in
crowded
room in
the
prison
food
handlers
inthe
prison
don’t
wear
gowns
and caps
Uncleanfoodand
drink
establishmentsin
hotelsandin
restaurants(don’t
weargownand
cap, have no
washingdish,
kitchenutensils
are notclean)
Students
whoare
learningin
KG and
elementary
schools
don’twash
their
clothes
properly
Low level of
knowledge
regarding
reproductive
health
(regarding
STI, family
planning,HIV)
inhigh
schoolsand
colleges.
Absence of
hand
washing
basin
nearby
toiletsin
hotelsand
restaurants
The toilets
and
kitchensin
hotelsand
restaurants
are closer
to each
other
the hand
washing
water
containers
inthe
restaurants
and hotels
are rusty
and dirty
the knifes
and the
meat
cutting
materials
in
butchery
are
unclean
there is
high
prevalence
of HIV in
the
prison(32
out of 660)
prisoners
Magnitude
of the
problem
5 5 5 5 5 3.5 3 4 4 4
Severityof
the
problems
5 5 5 5 5 4 3 5 5 4
Feasibility
of the
problems
3 5 5 5 5 5 3 5 5 3
political
concern
5 5 5 5 5 5 5 3 3 4
Community
concern
2 4 5 4.5 3 4 3 3 4 3
Total score
(outof 25)
20 24 25 24.5 23 21.5 17 18 21 18
For our outreach programme we have come through the following major problems after
analyzing using the priority setting criteria.
1. Unclean food and drink establishments in hotels and in restaurants(don’t wear gown and
cap, have no washing dish, kitchen utensils are not clean)
2. Students who are learning in KG and elementary schools don’t wash their clothes
properly
3. Food handlers in the prison don’t wear gown and cap.
4. Low level of knowledge regarding reproductive health (regarding STI, family planning)
in high schools and colleges.
5. Absence of hand washing basin nearby toilets in hotels and restaurants.
Problems Objectives Strategy activities Target Responsible
body
Time indicators
1st
wk(jan
14 –jan 18)
2nd
wk(jan
21-jan 25)
3rd
wk(jan
28-feb 1)
Unclean food and
drinkestablishments
in hotels and in
restaurants(don’t
wear gown and cap,
have no washing
dish,kitchenutensils
are not clean)
To Make them
to have clean
food and drink
establishments
In collaboration
with the towns
municipality,
environmental
expert and the
owners of the
hotels and the
restaurants
Health
education
dissemination
inspection
9 hotels
and 7
restaurants
5th yr medical
students,
environmental
expert and the
municipality
3 hotels
and 2
restaurant
2
restaurants
and 3 hotel
3 hotel
and3
restaurant
No of hotels
having clean
food and drink
establishments
Students who are
learning in KG and
elementary schools
don’t wash their
clothes properly
To make them
keep proper
personal
hygiene
In collaboration
with the school
directors,
teachers and
clubs
Health
education
dissemination
Sanitation
campaign
inspection
6 KGs and 4
elementary
schools
Directors of the
school ,
teachers, clubs
and 5th yr
medical
students
2 KG and 1
elementary
school
2 KG and 2
elementary
school
2 KG and 1
elementary
school
No of KGs and
elementary
schoolsstudents
whichkeeptheir
hygiene
foodhandlers in the
prison don’t wear
gown and cap
To Make them
wear proper
clothes
Working in
collaboration
with prison
administrators
and health
workers
Health
information
dissemination
to the food
handlers and
the prisoners
100% 5th yr medical
students
Health worker s
of the prison
and
Prison
administrators
1 No of prisoners
and food
handlers which
have good
hygiene
Low level of To create In collaboration HE 2 high Directors of the 2 high 1 college 1 colleges Pre and post
knowledge regarding
reproductive health
(regardingSTI,family
planning) in high
schoolsandcolleges.
awareness
regarding
reproductive
health
with the school
directors,
teachers and
student clubs
dissemination
in school and
colleges
schools and
2 colleges
school ,
teachers, clubs
and 5th yr
medical student
schools interventiontest
Absence of hand
washing basin
nearby toilets in
hotels and
restaurants
To Make them
to have hand
washing basin
near the toilets
In collaboration
with the towns
municipality,
environmental
expert and the
owners of the
hotels and the
restaurants
Health
education
dissemination
inspection
in 9 hotels
and
7restauran
5th yr medical
students,
environmental
expert and the
municipality
2R and 3 H 3R and 3H 2R and 3 H No of hotels
and r and h
which prepare
hand washing
basin near to
toilet
Barograph Indicating plan and achievement of Out Reach program
0
2
4
6
8
10
Plan
Achievment
Accomplished activities on outreach program
Accordingto the problemsthatwere identified,the followingactivitieswere accomplishedineachsector.
Hotels and Restaurants
Different health related problems were found in different hotels and restaurants and the following health informations were
disseminated accordingly:
• How to keep compound hygiene
• To perform medical checkups for the servants regularly
• How to keep the cleanness of the kitchen and how important is constructing chimney and window for the kitchen
• To establish fire extinguisher and first aid service
• To manage the liquid wastes properly and have accessible Dustin for solid wastes
• Regular insecticide spraying
• Having separate and labeled toilet(for female and male)
• Repairing the cracked walls
• Keeping the pillow sheets clean
• Having sandals and condoms in each bed rooms
• Keeping the shelves clean
• Having hand washing basin near to the toilets
• Having separate fridge for food and drinks
Kindergarten school
 We taught the students about keeping ones personal hygiene and common childhood illnesses prevention.
Primary school
– Awareness creation on personal and environmental hygiene, communicable diseases (scabies, TB.),HIV ,STD and
harmful traditional practices, problems related to early initiation of sex.
Preparatory and High school
– Awareness creation on STI and its prevention mechanisms, HIV, problems related to early initiation of
sex(Unwanted pregnancy and abortion, STD ,HIV, Cervical cancer)
Colleges
◦ Awareness creation on reproductive health in the following topics
• Unwanted pregnancy and its complication
• ST I(syphilis, gonorrhea)
• Family planning using demonstration(condom and COC) and condoms were distributed
• HIV
Prison
 Awareness creation on
• TB including means of transmission, risk factors, signs and symptoms and prevention mechanisms
• TB and HIV co infection
• Keeping personal hygiene for the prisoners.
• Food handling processes for the food handlers
• Additionally we discussed with the administrators the importance of preparing gowns and capes for the
food handlers and reducing the number of TB patient per room
Conclusion
According to this survey and parameters indicated in the study tool, the overall health condition of the population in Kebelle 04 is
good.
Regarding the housing condition, the study reveals that, there were higher numbers(38.1%) of people living in rental houses where
most of the walls(73.7%) are made of mud .Besides this, there are small numbers of windows opened during the data collection time
which resulted in low percentage(46%) of good room illumination. Most of the households (81.7%) have kitchens but small number
of them (36.44%) have chimney.
Concerning hygiene and sanitation, there is high latrine coverage (88.2% HHs have latrine) among which pit latrine is the commonest
(90.2%) but a large number of latrines do not have hand washing basins with water at their door step. There is very low pit coverage
as only 29.8% HHs were having a pit. The study result revealed that most households (81%) have accesses to pipe water and most of
them have pipe water inside their compound.
Regarding child feeding practices, most family members eat together. The study showed that 88.8% of children were breast fed
immediately after delivery but there is high practice of initiation of foods and fluids other than breast milk just after birth. Only 69.5%
of under five children were exclusively breast fed. There is high practice of harmful traditional practice like uvulectomy and FGM.
Recommendation
 Health extension workers and concerned personnel should create awareness about overcrowding , window opening and
ventilation of the room
 Health extension workers and concerned personnel should work closely with community in creating awareness on advantages
of constructing and using hand washing basins at the door steps of their latrines.
 Health extension workers, Kebelle administrators and concerned personnel should work closely in creating awareness on
advantages of constructing and using a pit.
 Health extension workers, non-governmental organizations and other health professionals have to increase their efforts in
creating awareness about benefits of exclusive breast feeding and timing and benefits of initiating complementary feeding.
 Health extension workers and other health professionals should collaborate in creating awareness regarding the benefits of
childhood immunization.
 Health extension workers, religious leaders and Kebelle administrators should strengthen their effort in avoiding harmful
traditional practices
 Health extension workers, other health professionals, and other NGOs should give awareness regarding communicable
diseases and a possible outbreak.
 It is better if the kebelle administrators try to solve problems related with pigs wandering around and destroy things like pit.
 It is better if the prison administrators consider building additional rooms so that the number of prisoners per room can be
reduced.
REFERENCES
1. The participation of NGOs/CSOs in the Health Sector Development Program of Ethiopia
2. Ethiopian Ministry of Health. Health and Health Related Indicators; 2003/04
3. Ethiopian Ministry of Health. Health and Health Related Indicators; 2005/06.
4. UNICEF. Ethiopia’s water and sanitation (WES) programme
5. Federal Democratic Republic of Ethiopia, Ministry of Health (FDRE MOH). Health Sector Development Programme-HSDP-
III, 2005/06-2009/10, A.A.
195765356 final-document-docx

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  • 1. Get Homework/Assignment Done Homeworkping.com Homework Help https://www.homeworkping.com/ Research Paper help https://www.homeworkping.com/ Online Tutoring https://www.homeworkping.com/ click here for freelancing tutoring sites
  • 2. MEKELLE UNIVERSITY COLLEGE OF HEALTH SCIENCES DEPARTMENT OF PUBLIC HEALTH ASSESSMENT OF HEALTH AND HEALTH RELATED PROBLEMS IN MAICHEW TOWN, KEBELLE 04 BY: ROUND ONE 5TH YEAR MEDICAL STUDENTS February 2013
  • 3. Table of contents Acknowledgment List of abbreviation CHAPTER 1: INTRODUCTION 1.1 Background 1.2 Statement of the problem CHAPTER 2: OBJECTIVE OF THE STUDY 2.1 General objective 2.2 Specific objectives CHAPTER 3: METHODOLOGY 3.1 Study area and period 3.2 Study design 3.3 Sample size and sampling techniques 3.4 Sample size 3.5 Sampling technique 3.6 Data collection technique and instruments 3.7 Data processing and analysis 3.8 Quality control
  • 4. 3.9 Ethical consideration CHAPTER 4: RESULTS AND DISCUSSION
  • 5. List of abbreviations ANC: Antenatal care AFI: Acute febrile illness BCG: Bacillus calmette guirine CBE: Community based education CBTP: Community based training program COPD: Chronic obstructive pulmonary disease DV: Demonstration village DM: Diabetes mellitus EDHS: Ethiopian demographic health survey EPI: Expanded program for immunization ETB: Ethiopian birr FGM: Female genital mutilation FP: Family planning HH: Household HIV/AIDS: human immunodeficiency virus/ acquired immune deficiency syndrome HTN: Hypertension KG: Kindergarten
  • 6. LRTI: Lower respiratory tract infection MDG: Millennium development goal OPV: Oral polio vaccine PMTCT: Prevention of mother to child transmission PUD: Peptic ulcer disease SD: Standard deviation SPSS: Statistical program for social sciences STD: Sexually transmitted diseases STI: Sexually transmitted infections TB: Tuberculosis TT: Tetanus toxoid URTI: Upper respiratory tract infection VCT: Voluntary counselling test
  • 7. Acknowledgement It is a pleasure to pass our heartfelt thanks to Mekelle University College of Health Sciences Department of Public Health for arranging this program for us. Our thanks also go to the dean of the college, head of department of medicine, and student service centre. Our special gratitude goes to the community of Maichew town and the residents of kebelle 04 in particular, who were welcoming and for their collaboration during house numbering and survey. We are also highly indebted to the health officials of Maichew town, wereda administrators and municipalities. Our appreciation also goes to deans of Maichew technical college, Hashenge College, Maichew agricultural college, administrators of Maichew central prison, directors of Maichew preparatory school, Tilahun Yigzaw secondary school, and Addisalem, Zelalem Desta and Wefriselam bekalsi primary schools. We would also like to appreciate the collaboration of the administrators and staffs of Ebenezer and Biere Raya KGs. Our gratitude also extends to health extension workers and environmental sanitarians of Maichew town, and in particular, the environmental sanitarians Ato Zinabu and Ato Mesfin who guided us during our outreach program. We also owe a great gratitude to kebelle 04 administrators who provided us all the necessary information regarding the kebelle and helped us during our DV site map sketching. Our greatest thanks go to the administrators and staffs of Maichew health centre who supported us by providing us teaching materials which greatly helped us during our outreach intervention. We also would like to thank each health worker who genuinely shared their clinical knowledge during our static intervention. Last but not least, we would like to express our deepest gratitude to our supervisors for their commitment and genuine comments during our stay. We will also never forget the contributions of Mr Abreha who stood beside us during our difficulties by arranging a temporary cafeteria by discussing with the officials of Maichew agricultural college.
  • 8. CHAPTER 1:INTRODUCTION 1.1 Background information Worldwide, there were 58 million deaths in 2005 of which communicable diseases were estimated to account for 23 million. Communicable diseases remain the most important health problems in Africa. The commonest causes of death and illness in the region are acute respiratory tract infections, TB, HIV/AIDS, STI, diarrhoea disease, malaria and vaccine preventable infection. Epidemic prone diseases such as meningococcal meningitis, cholera, yellow fever, and viral hemorrhagic fevers are prominent health threats in the continent (1). In low income countries like Ethiopia, people predominantly die of infectious diseases: lung infections, diarrhoeal diseases, HIV/AIDS, tuberculosis, and malaria (2) In Ethiopia, Communicable diseases, malnutrition, and HIV/AIDS dominate Ethiopia’s burden of disease. Epidemic-prone diseases such as meningitis, malaria, measles, and shigellosis are also prominent health problems (2). For example the leading cause of outpatient visits includes: Malaria, Helminthiasis, Tuberculosis, Bronchopneumonia, Gastritis and Duodenitis, Acute upper respiratory tract infections, inflammatory diseases of eye (except Trachoma), Infections of skin and subcutaneous tissue respectively. Whereas malaria, pregnancy related problems and respiratory infections are the leading causes of hospital admission (3). Sanitation is fundamental to human development and security. Improper waste management may have health, environmental and economic problems. There are low levels of hygiene awareness, which compound the health risks associated with low water and sanitation coverage levels (4).
  • 9. In Maichew town, lack of proper latrine access and use are still one of the major problems that the community faces. According to woreda health office officials, upper respiratory tract infections and acute febrile illnesses rank the top two diseases in the first quarter of 2005. Currently, the ministry of health targeted in accomplishing the MDG goals by launching various strategies. The health policy of the government focuses primarily on prevention. This implies that focuses should be given to the prevention of all communicable disease that focus should be given to the prevention of all communicable diseases and env’tal factors that predisposes to the occurrence of different disease whereby threatening our citizens. Hence the policy aims at the protection of the environment, the prevention of disease, promotion of health and prolongation of life with the application of science and technology (5). One of the strategies to achieve those goals is by having skilled health professional, from the 33 universities in the country Mekelle University is one of the pioneer in community based education so the approaches to meet the goals are community based training program and developmental team training program. Community based Education (CBE) is a means of achieving educational relevance to community needs and consists of learning activates that use the community -oriented education program. It consists of learning activities that use the community extensively as a learning environment in which not only students but also teacher members of the community and representatives of other sectors are actively engaged throughout the educational experience. The program is of clear benefit to both students and the community. Statement of the problem The commonest causes of death and illness in Africa are acute respiratory tract infections, tuberculosis, HIV/AIDS/STI, diarrheal disease, malaria and vaccine preventable infections. In the past few years the achievements obtained in decreasing infant and child mortality are largely attributable to health and nutrition interventions and improvements. Nevertheless the level of infant mortality in sub-Saharan Africa continues to be among the highest in
  • 10. the world. According to the 2011 EDHS report, for the five years preceding the survey, the level of infant mortality rate was 59 per 1000 live births and under five mortality rate was 88 per 1000 live births. According to the 2011 EDHS report maternal deaths for the seven years preceding the survey were 217 per 1000 women aged 15-49 years. The maternal mortality rate is high due, in part, to food taboos for pregnant women, poverty, early marriage, and birth complications. Harmful traditional practices such as FGM, uvulectomy, milk-teeth extraction, and early child marriage all contribute to short and long term health related problems. Even though the health service coverage of the country and of Tigrai region is said to be growing, communicable diseases attributable to poor sanitation, inappropriate and insufficient latrine utilization, are still major health problems. CHAPTER 2:OBJECTIVE General objective  To assess health and health related problems in Kebele 04 of Maichew town and intervene accordingly from Tahsas 16-Yekatit 1, 4/2005E.C. Specific objectives  To determine latrine coverage of each household.  To determine the practice of infant and child feeding.  To find out coverage of family planning methods.  To determine the level of immunization of children who are below 2 years of age.  To determine the level of TT immunization of mothers within the reproductive age (15-49 years).
  • 11.  To find out harmful traditional practices.  To determine family medical history.  To establish water supply coverage of households.  To determine the practice of waste disposal management.  To determine ANC follow up.  To find out delivery practice. CHAPTER 3:METHODS AND MATERIALS Study area and period Maichew which means “salty water” is the capital city of southern zone of Tigray. It is found 660 km north of Addis Ababa and 127 km south of Mekelle. It is located at an altitude of 12047I north and, longitude of 39032I east. It is found 2479m (8133 ft) above sea level. It has total surface area of 145,568 Hectare of which 868 Hectare is covered by houses. According to the 2003 E.C information the total population of Maichew town is around 25,926, with 13,719 females and 12,207 males. Maichew town has 4 kebelles and 19 zones, and our DV site Kebelle 04 is one of the four kebelles in the town. The total population of the kebelle is about 5167 with males constituting 2563 and females 2664. The number of households in the kebelle is around 1358. The study was conducted from Tahsas 16- Yekatit 1, 2005 E.C. Study design A cross- sectional study design was used
  • 12. Population Sourcepopulation Total households of kebelle 04 in Maichew town. Studypopulation Total households of kebelle 04 in Maichew town. Samplingunit Each household of kebelle 04 in Maichew town. Studyunit Each head of the households (mother, father or any family member whose ages are above 14 years). Mothers in the reproductive age group (15-49 years). Eligibility criteria Inclusioncriteria  All mothers who have children whose age is below 2 years: to determine the level of immunization of children.  All mothers who have children whose age is below 5 years: to determine the practice of infant and child feeding and harmful traditional practice.  All mothers in the reproductive age group (15-49 years): to determine the level of TT immunization and coverage of family planning methods.  All pregnant mothers and all mothers who were pregnant in the past 12 months of the study: to determine ANC follow up. Exclusioncriteria  Those households with absent respondents at 3 visits on 3 different days.  Those rental households which are occupied by students.
  • 13. Sample size determination The sample size was calculated using the formula used to calculate sample size from single proportion: n= z² p (1-q) d² Where: n= sample size for population > 10000 Z= standard normal deviation usually set as 1.96 (which Corresponds to 95 % confidence level) P= the proportion of positive prevalence estimated to be 50% d = marginal error estimated to be= 5% Then the sample size is: n=384 Since the study population is less than 10,000, correction formula was used. Finally, by adding 5% non respondent rate, 324 HHs were included in the study. Sampling technique and sampling procedure  We used systematic sampling method  First we gave unique numbering for each household in the DV site.
  • 14.  We used lottery method to arrange all the unique alphabets used for numbering in order.  we calculated the interval of sampling using the formula: K=Study population /samplesize k=1533/324 k= 4.73~5  We used another lottery method to find our random start.  We identified every study unit using our interval. Data collection techniques and tools  Structured questionnaire which was developed by public health department was used to perform community health surveys.  The questionnaire was prepared in English, and so the interviewer interpreted all the questions in to the language that the respondents would understand.(all the interviewers had a common understanding about all the questions in the questionnaire) Data quality control measures  Detailed explanations of the whole aim of collecting the data was given by the supervisor for the data collectors  Each questions of the whole questionnaire was explained by the supervisor for the data collectors and a brief group discussion was done among the data collectors.  The supervisor took one questionnaire from each data collectors randomly and checked whether the questionnaires were complete and genuine Data quality control  To ensure the quality of the data, adequate discussion was held among students and respective supervisor.  On the spot checking clarification of any missing data and ambiguity was held. Data processing and analysis  Data entry, editing, cleaning and analysis were done on SPSS version 16.0 software.
  • 15.  Descriptive statistics of the data was analyzed and the data was presented in the form of text, tables and graphs or figures. Operational definitions  Proper Utilization of Latrine: -The family members starts to use (under construction latrine or new latrine which does not give service is not rated at all). -The latrine should not be filled with excreta to about at least more than 50 cm space left. -The latrine or drainage system of the toilet shouldn’t have any leakage to the compound or surrounding? -The Slab should not be soiled with excreta.  Protected well: -The well should be constructed with water tight cement wall and slab, not exposed to flood or have diversion ditch, having hand pump or with a system of wind lass having a rope and with clean bucket which has a system of rotating and/ or pauy system. -The slab of the well should have 30-50 cm raised above the ground. -the well should have cover  Protected Spring: -The wall and slab of the spring should be water tight.
  • 16. -The out let should be fitted with pipe. -The surrounding of the spring should not be exposed to animals.  Hand washing basin: the hand washing basin could be made from any local or any other material but should be located adjacent to the latrine.  Artificial ventilation: HH with electrical ventilator.  Illumination:- Good if easy to read a letter written by pencil standing in the house with window open - Fair if we can see letter somewhat - Bad if we cannot read any letter  Cleanliness of the compound:- Good if free of any waste - Fair if with some solid waste - Bad if with both solid and liquid waste  Window opening:- Sometimes is less than or equal to two per week - Occasionally-- less than or equal to one per week - Always-daily
  • 17. Ethical consideration  The study was commenced after official letter of permission was obtained from Mekelle University, CBTP coordinating office.  Official permission letter was sent to Maichew kebelle 04 office and town administration.  Each respondent’s verbal informed consent was obtained and detail purpose of the survey was explained prior to data collection.  Confidentiality of the data was strictly respected. Plan for dissemination of findings  The final report will be presented to the community of Mekelle University.  The finding will be disseminated to CBTP coordinating office.  Final document of the finding will be submitted to the concerned bodies of the kebelle and other stakeholders. Limitations of the study  Due to resource limitation all the study units were not included in this study.  Inferential statistics was not applied to identify explanatory variables for the given outcome variable.
  • 18. CHAPTER 4:RESULTS 5.1 Socioeconomic and demographic characteristics Out of the 289 households all were included in the analysis making a response rate of 100%. The median age of the population was 20 years. There were 497(43.4%) male, and 648(56.6%) females involved in the study. From these there were 361(31.5%) single, and 346(30.2%) were married. The study showed that 1074(93.8%) are Orthodox Christians and 63(5.5%) Muslims.Out of the total population 274(23.9%) were unable to read and write, whereas 155(13.5%) were at college level and above. Most of the study population were students with figure of 421(36.8%), 33(2.9%) were farmers and 108(9.4%) were government employees. 53(4.6%) of the population were found to be living with their relatives. The mean family size of the population was 3.9(SD+ 1.88).The majority of the population 195(67.5%) had a monthly household income of <1,000 ETB. (Table 1)
  • 19. Fig1.Population pyramid of kebelle 04 in Maichew Town. Key: 1=<5years 2=5-9 “ 3=10-14 ” 4=15- 19 ” . . . 16=75-79 “ 17=>80 “
  • 20. Table1 .Sociodemographic characteristics of kebelle 04 Maichew Town. Frequency and percent distribution of sociodemographic data by sex, marital status, religion, educational level and relationships with in the family. Variables Frequency Percent Sex Male 497 43.4 Female 648 56.6 Total 1,145 100 Marital status Single 361 31.5 Married 346 30.2 Divorced 33 2.9 Widowed 83 7.2 Under 15 years of age 322 28.1 Total 1145 100 Religion Orthodox 1074 93.8 Catholic 8 0.7 Muslim 63 5.5 Total 1145 100 Educational status Unable to read and write 274 23.9 Able to read and write 51 4.5 Grade1-4 137 12.6 Grade 5-8 244 21.3 Grade 9-12 284 24.8 College level and above 155 13.5 Total 1145 100 Occupational status Farmer 33 2.9 Merchant 78 6.8 Government employee 117 10.2
  • 21. Personal employee 47 4.1 House wife 161 14.1 Daily labourers 46 4 House maid/servant 15 1.3 Pensioned 12 1 Student 421 36.8 Weaver 2 0.2 Commercial sex worker 4 0.3 Local bear seller 1 0.1 Under age for occupation 189 16.5 Other(guard, cart drivers, bicycle renters) 19 1.7 Total 1145 100 Relationships Father 178 15.5 Mother 256 22.4 Grand father 2 2 Grand mother 22 1.9 Son/daughter 603 52.7 Relative 53 4.6 Other 31 2.7 Total 1145 100 Table2. Categorical Monthly Income of Household Frequency and percent distribution of average monthly household income. Monthly income Frequency Percent <1000 ETB 195 67.5 1000 – 2000 ETB 50 17.3 >2000 ETB 44 15.2 Total 289 100
  • 22. Electricity, transport, and health institutions are accessible at 94.1% (272), 87.2 %( 252), and 100 %( 289) respectively. Fig2. Histogram representation on availability of facilities in kebelle 04, Maichew Town. Availability of facilities by percent distribution Death reports The study showed that there were 6 death reports in the last 12 months of the study period, out of which 3 were males. The mean age at death was found to be 49.3 years. The causes of death were asthma- 1, chronic illness- 2, labor-1, PUD- 1 and TB - 1. Environmental conditions The study showed that 173(59.9%) and 110(38.1%) households were private & rental houses respectively. Regarding the roof structure of the house, majority of the households 270(93.4%) were covered by corrugated iron sheet. Majority of the HHs 213(73.7%) have walls made of mud whereas, the least household 1(0.3%) has wall made of wood. Regarding the floor of the HHs majority of them 200(69.2%) have floor made of mud. Our study has also shown that 112(38.8%) HHs have one room only. From a total of 289 households, the majority 241 (83.4%) have window. Regarding ventilation of the room, more than half of the households 165 (57.1%) have one way ventilation. Good illumination was found in 133 (46%) households. (Table.3) 0 20 40 60 80 100 Electricity Transport Health institution Yes No
  • 23. Table3. Housing conditions Frequency and percent distribution of households by household ownership and housing characteristics. Variables Number Percent Household ownership Private 173 59.9 Rental 110 38.1 Others 6 2.1 Type of roof Thatched 10 3.5 CIS 270 93.4 Mud and wood 2 0.7 Others 7 2.4 Wall type Mud 213 73.7 Brick/concrete 72 24.9 Stone 2 0.7 Wood 1 0.3 Is the wall cracked or plastered? Yes 100 34.6 No 189 65.4 Type of floor Mud 200 69.2 Wood 7 2.4 Concrete 82 28.4 Is there any window in each room? Yes 241 83.4 No 48 16.6 Do you open window? Sometimes 171 59.13 Always 50 17.3 Occasionally 26 9.03 No 42 14.5
  • 24. Was there any open window at the time visit? Yes 68 23.53 No 221 76.47 Ventilation type One way 168 58.1 Crossed way 75 26 Parallel way 45 15.6 Artificial 1 0.3 Illumination condition of the house Good 133 46 Fair 142 49.1 Bad 14 4.9 Cleanliness condition of the compound Good 77 26.6 Fair 204 70.6 Bad 8 2.8 This study also showed that 129(44.6%) HHs have domestic animals. Among these, in 54(41.86%) HHs domestic animals live in the same house with household members. Of the total HHs 53(18.3%) have no kitchen. Among the HHs that have kitchen, 220(93.22%) have a kitchen separated from the house and 16(6.78%) have kitchen in their house. (Table 4)
  • 25. Table 4. Domestic animals and kitchen in households Frequency and percent distribution of households by kitchen characteristics and domestic animals living with humans in the same house. Variables Frequency Percent Do you have domestic animals? Yes 129 44.6 No 160 55.4 Do domestic animals live with humans in the same house? Yes 54 41.86 No 75 58.14 Is there kitchen in the house? Yes 236 81.7 No 53 18.3 Is the kitchen separated from living house? Yes 220 93.22 No 16 6.78 Does the kitchen have window? Yes 103 43.64 No 133 56.36 Does the kitchen have chimney? Yes 86 36.44 No 150 63.56 Regarding waste disposal system 203(70.2%) HHs have no pit. Among the total HHs, 255(88.2%) HHs use latrines, of which 191(74.1%) have private latrine. Out of the HHs that have no latrine, 34(11.76%) HHs use open field. (Table 5) Table5. Household waste management and latrine condition Frequency and percent distribution of households by latrine characteristics and presence of pit.
  • 26. Variables Frequency Percent Is there pit in the house hold? Yes 86 29.8 No 203 70.2 Do you use latrine for defecation? Yes 255 88.2 No 34 11.8 Status of latrine ownership Private 191 74.9 Communal 48 18.8 Others 16 6.3 What is the type of latrine? Pit latrine 230 90.2 VIPL 25 9.8 Estimated distance of latrine from living room <15 meters 195 76.5 >15meters 60 23.5 Estimated distance of latrine from water source <15 meters 143 61.4 >15meters 90 38.6 Estimated distance of latrine from kitchen <15 meters 184 81.8 >15meters 41 18.2 Does the latrine have superstructure? Yes 188 74.3 No 65 25.7 Are there excreta around the latrine? Yes 49 19.4 No 204 80.6 Is there a hand washing basin with water at the door step of the latrine? Yes 53 20.9 No 201 79.1
  • 27. The study also showed that 234(81%) HHs have water pipe in their compound. The remaining HHs use public stand 53(18.3%), protected spring (1HH) and covered well (1HH) water supply. 270(93.4%) of the total HHs use jerican for storage. Tasa and joke are the major equipments used for drawing water from the storage. It takes less than 15 min to fetch water for the majority of HHs 246(85.1%) and 127(43.9%) HHs use more than 30 litres water per capita per day. (Table 6) Table6. Household water supply and utilization Frequency and percent distribution of households by average time spent to fetch water, amount of water utilized per capita per day, methods of water storage and methods to fetch water from storage. Variables Frequency Percent Average time spent to fetch water <15 minutes 246 85.1 15-20 minutes 13 4.5 >20minutes 30 10.4 Amount of water utilized for all purposes per capita per day in liter <20 litres 72 24.9 20-30 litres 90 31.1 >30 litres 127 43.9 Methods of water storage Jerican 270 93.4 Pot 5 1.7 Barrel 8 2.8 Others 6 2.1 What methods do you use to fetch water from storage? Pouring 274 94.8 Drawing 15 5.2
  • 28. 89(30.8%) households have vermin of which the majority 65(73.03%) HHs have rats. Fig3. Household vermin condition Number of households which have vermin with specific type of vermin Nutrition From study undertaken in 289 households 142(49.3%) used to eat with the family members all together, while 39(13.5%) children used to eat separately from their parents. From 76 potential breast feeders (mothers with a child under the age of 24 months), only 54(71.1%) mothers breast feed their child. From the 22 non breast feeders 7 said their reason is due to their positive HIV status. From those mothers who were breast feeding about 87(88.8%) said they initiated breast feeding immediately and 9 within a day. Exclusive breast feeding for 4-6 months was found in 50(69.5%) mothers. Initiation of foods and fluids other than breast milk just after birth was identified in 26(26.5%) mothers. Mothers who initiated complementary feeding at 6 months were 60(84%). (Table 7) 0 10 20 30 40 50 60 70
  • 29. Table7. Nutritional status of kebelle 04, Maichew Town Frequency and percent distribution of eating arrangement and infant and child feeding practices. Eating arrangement Frequency Percent All family members together 142 49.3 Separately 99 34.4 Children separately 39 13.5 Others 9 2.8 Total 289 100 Breast feeding baby (<24month) Yes 54 71.1 No 22 28.9 Total 76 100 Reasonfor Not breast feeding(<24 month) HIV +ve 7 31.8 Unspecified reason 15 68.2 Total 22 100 Breast feeding initiated(<5 years) Immediately 87 88.8 Within a day 9 9.2 Other 2 2 Total 98 100 Exclusive breast feeding(<5 years) Below 4 months 16 22.2 4-6 months 50 69.5 6-11 months 5 6.9 Above 1 year 1 1.4 Total 72 100
  • 30. Fluid and food other than breast milk just after birth Yes 26 26.5 No 72 73.5 Total 98 100 Initiation of complementary feeding At 6 month 60 83.3 At 9 month 11 15.3 Above 12 month 1 1.4 Total 72 100 Type of complementary feeding Fluid 41 56.9 Semifluid 22 30.6 Family food 9 12.5 Total 72 100 Types of materials used Bottle 27 37.5 Cup and spoon 43 59.7 Others 2 27.8 Total 72 100
  • 31. Disease conditions From the survey conducted, there were 39 sick family members, of those 16 were presented with cough, 10 with fever, 5 with diarrhoea, 4 with runny nose,2 with vomiting and 2 with others like headache and abdominal pain within two weeks of data collection. From those sick members 29 visited health institutions, 3 used holy water, 2 visited pharmacies and the rest 5 gone to traditional healers. There were 43 chronic diseases. Of those 5 were Diabetes Mellitus, 6 cases were TB, 13 were cases of HTN, 3 case of epilepsy, 11 cases of disability and 5 were others (asthma, renal disease, chronic migraine ). Maternal and child health care The mean age at first marriage was 17.02 years and of the responding mothers 116(41.13%) got married before the age of 18 yrs. In the last twelve months, 41 pregnant mothers were found in the study area. Of whom 36 were attending at least one ANC visit. Whereas, 5 mothers were not attending any ANC. The reason given by the mothers for not attending ANC were because they do not know about it and for undisclosed reason. The ANC follow up showed that there was a decreasing trend in the subsequent visits (Fig. 4). In the last twelve months, there were a total of 32 deliveries, of whom 4 were at home and 28 at health institutions.
  • 32. Fig4. Trend of ANC visits in Maichew town kebelle 04 In the last 12 months there were 24 spontaneous abortions in the study area. 0 5 10 15 20 25 30 35 40 ANC1 ANC2 ANC3 ANC4 ANC4+
  • 33. TT vaccination The table below shows TT vaccination coverage with in 351 women of reproductive age group (15-49 years). Table8. TT vaccination Frequency and percent distribution of TT vaccination of mothers of reproductive age group TT vaccination Number of women currently taking or completed Percentage TT1 201 57.26 TT2 198 56.41 TT3 170 48.43 TT4 127 36.18 TT5 111 31.62 Of the 281 respondent women, 222(79%) know the presence of FP methods, and 59(21%) do not know. Of those who know the presence of FP methods, 141(63.5%) had ever used FP methods but 81(36.5%) had never tried .Of the family planning methods used 22(15.7%) were pills, 107(75.9%) were injectable, 8(5.6%) were Norplant, 1(0.7%) were condoms and 3(2.1%) were others. Table9. Reasons for the non-users of contraceptive methods. Frequency and percent distribution table showing reasons for not using family planning methods.
  • 34. Currently, 98(44.14%) women of those who know presence of FP methods are using it. Of the current 124(55.86%) non-users 34(15.32) were because they were menopausal, 27(12.16%) were breast feeding mothers,18(8.10%) were widowed, 16(7.21%) for religious reason, 12(5.41%) were divorced,12(5.41%) were because their husbands were away, 2(0.90%) were infertile, and the rest 3(1.35%) were due to other reasons. EPI Coverage Among 119 children below 2 years 102(85.7%) were immunized according to the EPI programme (see the bar graph below the table 10). Table10. Evidences for immunization Frequency and percent distribution table for the immunization of infants and children below the age of 5 years. Evidence Frequency Percent Card 13 12.74 History 65 63.72 BCG scar 4 3.92 Card plus history 20 19.60 Total 102 100 Reasons Frequency Percent Need many children 33 31.13 Religion 32 30.19 Fear of side effects 13 12.26 Geographic inaccessibility 15 14.15 Forgetting 9 8.49 Others 4 3.78 Total 106 100
  • 35. Fig5. Immunization status of children below the age of 2 years Harmful traditional practice There were a total of 108 traditional practices in the study area.77 (71.3%) were exercising uvulectomy, 12(11.1%) pulling of the first teeth, 17(15.7%) female genital mutilation and the rest 2(1.9%) are other practices like tilting around the eyebrow. 0 5 10 15 20 25 30 35 40 polio o polio 1 polio2 polio3 BCG penta1 penta2 penta3
  • 36. DISCUSSION Socio-demographic characteristics Population pyramid of the study area (kebelle 04) indicated that, it is flat at the bottom and narrow at the top. Majority of the female are between the ages of 15-19, whereas majority of males were found under 15 years of age. Generally, majority of the population were under 20 years of age. This might imply there is a high rate of dependency level. The finding is found to be in disagreement with EDHS (Ethiopian demographic health survey of 2011) which shows majority of the population is under 15 years of age. The discrepancy might be due to residential variation of the population in the EDHS study and our study. In addition our study only included the urban area; whereas the EDHS study includes both urban and rural areas. Maternal and child health The study indicated that mean age of age at first marriage was found to be 17.02 years. The finding is in agreement with EDHS 2011 report, in which the mean age of first marriage was 16.5 years. Of those 41 mothers who were pregnant, 36 were attending at least one ANC visit which could be due to availability of nearby health centers and Health extension workers. Those who do not attend ANC could be due to lack of awareness and recklessness in going to health centers.The trend of ANC visit has shown a decrement in the subsequent visits and this could be explained by problems in health care provision and lack of commitment for attending subsequent visits. In the last 12 months 28 of 32 deliveries were at health institution. This is abundantly higher than EDHS 2011 finding which elaborated that 10% of deliveries are at health facility. This could be due to better institutional coverage in the town and the study included only the urban area, unlike the EDHS. Abortion In the last 12 months there were 24 abortions cases. This might be due to abating the occurrence of unsafe abortions for unwanted pregnancy.
  • 37. TT vaccination Of the reproductive age mothers, 57.26% have taken TT1, 56.41% taken TT2, 48.43% taken TT3, 36.18% taken TT4 and 31.62% taken TT5.This low TT coverage may possibly be due to lack of awareness. The decrease in subsequent vaccinations can be explained by decreased motivation of mothers and decreased positive attitudes towards vaccination in families. Family planning In our study area 89.8% of mothers in the reproductive age group know the presence of family planning methods, which is lower compared with the 2011 EDHS which showed it to be 97%. This means there is inadequate awareness creation concerning FP methods. Currently 44.14% women are using family planning and this is slightly higher than the EDHS 2011 which revealed that 29% are using contraceptive methods. Most (73.3%) of current contraceptive users use injectable and this is consistent to the EDHS 2011 which showed that injectable are by far the most popular modern methods used ( 21%) . Most non-users are due to religious reasons and needing many children (22.64% and 21.69% respectively) this means that there is still a misunderstanding of FP and even missing awareness creation. Among the children who are less than 2 years of age, 85.7% of them were immunized according to EPI target which shows that there is effective immunization and this could be due to availability of nearby health services and increased awareness towards child care. The EDHS 2011revealed the under 2 years immunization coverage to be 24%. And this discrepancy can result from differences in reporting and population variation. Among the immunized children in 63.7% the evidences for immunization was history, which can be false reporting or due to carelessness in handling cards. Harmful traditional practice In this study uveloectomy was the most common (63 %) harmful traditional practice, which may be due to deficient knowledge regarding the effects.
  • 38. Disease conditions From the total of 39 patients in the past 2 weeks of the study, 41% were presented with cough and 12.8% were presented with diarrhoea. This can be explained by inadequate personal hygiene and possibly poor environmental and food hygiene. From those sick members 74.4% visited health institutions. Environmental This study has revealed that majority of households are living in their own house. This helps to keep the cleanliness of the house and the compound. This in turn has a positive effect on the health of the household members. Although the recommended ventilation type is crossed way ventilation, more than half of the HHs have one way type of ventilation and 59.13% of the HHs do not open their windows regularly. This may create a conducive environment for the transmission of URTI and TB. In our study most walls of the HHs are made up of mud which in turn results in cracking which may create a favourable environment for breeding of vermin like bed bugs, mosquito and rodents. Exposure to these vermin results in acquisition of diseases like malaria and typhus. Our result showed that 41.86% of the HHs who have domestic animals do not have separate house for the animals which may put these HHs at risk of different zoonotic diseases. The current study indicated that from those households who have kitchen, more than half of them didn’t have a kitchen with window. This might expose mothers and children for different kinds of respiratory tract diseases, such as COPD and Asthma. The problem becomes worse because most of the kitchens also lack chimney. In our study on solid waste disposal, the result showed that, about 70.2% of the households do not have pit and even 68.96% of them have no plan to dig. The reason is because they have a municipal waste disposal service. The coverage of latrine in our study area was found to be 88.23%. The finding is higher than the national coverage of latrine, which is 61.7%. This might be due to the sociodemographic differences. The national figure includes urban, peri-urban and rural areas.
  • 39. Whereas our study only shows the urban area. Most of the household have latrine for defecation and from this the majority are private owners. But almost all the households use pit latrine which is substandard and unimproved. The result is a higher than the national coverage of unimproved sanitation facilities (EDHS 2011). This might be due to that our study only included the urban area, whereas the EDHS finding includes both the urban and rural parts of Ethiopia. Settings of the latrine also showed that majority of the latrines were constructed within a distance of less than 15 meters from the living room, water source and kitchen. This might expose the household members for different kinds of infections, such as cholera, diarrhoea, amoeba, and bad odour. Frequent utilization of latrine might also be deferred due to the bad odour. This study showed that majority of the HHs use improved water source. However, some of the HHs (5.2%) use unsanitary practices like storing water in barrel and using drawing method to fetch water from the storage which may put the household members susceptible for water born diseases. Our finding also showed that 30.8% of the households have different kinds of vermin: 73.03%, 34.8%, 20.2% consist rats, flees and bed bugs respectively. This might put the household members at risk of diseases such as typhus and relapsing fever. Nutrition Nutritional status is the result of complex interactions between food consumption and the overall status of health and health care practices. Numerous socio-economic and cultural factors influence patterns of feeding children and the nutritional status of women and children. The period from birth to age 2 years is especially important for optimal growth, health and development. Unfortunately this period is often marked by micro nutrient deficiencies that interfere with optimal growth. Additionally childhood illness such as diarrhoea and acute respiratory tract infections are common. From the survey in kebelle 04, from potential mothers who have children under the age of 2 years, which is the recommended duration of breast feeding, only 71.1%( 54) were found to breast feed their children, the remaining 28%(22) did not breast feed because of reasons such as sero status of the mother and some unspecified reasons. Same study was undertaken on mothers who have children under the age of 5 years and 88.8% of them were found to have initiated breast feeding immediately after birth, 69.5% exclusively breast fed their children from 4-6 months, which is the recommended period. From this data one can say the community has more or less sufficient information on the advantages of exclusive breast feeding and is also aware of the ideas suggested by health professionals on the duration. On the same study 83.3 % of the populations were found to have initiated complementary feeding after 6 month, majority 56.9% initiated complementary feeding with fluids and about 59.2% used cup and spoon to feed their children.
  • 40. Despite what is recommended, 27.1% of mothers started their children with fluids and foods other than breast milk immediately after birth and 9.5% of the mothers initiated complimentary feeding with family foods. This indicates that, there is still some information barrier on the feeding practice of children. In general one may conclude that the community is aware about the importance of breast feeding, advantage of initiation of complementary feeding, and use of cup and spoon to that of bottle feeding which helps in the reduction of spreading of to the child in question. ACTION PLAN INTRODUTION Maichew (salty water) is the capital city of southern zone of Tigrai which is found 660 km north of Addis Ababa and 127 km south of Mekelle. It is surrounded by Endamehoni woreda. DV site, Kebelle 04 is one of the four kebelles in maichew town constituting 4 zones. The total population of the kebelle 04 is about 5167 with males constituting 2563 and females 2664.From 1358 households, the number of under five children are around 1027 ( 14.6 %), Mothers ( 14-49) are around 1642 ( 23.48 %) ,70 % of the population are farmers, 20 % are merchants, and 10% are government employees. Kebelle 04 shares Semere melles health center with that of kebelle 01. Some of the problems that are identified from study conducted in the catchment area are: early marriage (mean age at marriage 17.5 years), Poor ANC follow up (ANC follow up show decreasing pattern during subsequent visits), inadequate TT vaccination among the reproductive age group, Poor breast and complimentary feeding practice, existence of harmful traditional practices, mild vaccination problem, and Problems with regard to family planning.
  • 41. The other problems are related to environmental sanitation which includes: gaps in the practice of house and kitchen ventilation, infestation of households with vermin, poor water handling and storage practice at household, having no separate rooms for domestic animals, and approximation of distance between latrine, kitchen and water source on majority of the households. Through analysis of the HC information gathered are: gap in the planned and achieved delivery services, inadequate vaccination practices, drop out in the subsequent ANC visits, and gaps in the activities that should have been performed by the voluntary community mobilizes As a result an action plan was devised to create awareness among pregnant mothers and reproductive age group women on the observed problem areas, motivating the community to avoid harm full traditional practices and allowing good ventilation for the households, and educating the society on creating clean and healthy living environment and practice of safe water storage that will improve the overall health status of the community. Moreover the action plan included another two main sites of intervention, in which the first one is the clinical (static) which would act in various departments of the health center like Adult OPD, Under 5 OPD, MCH and YFS giving various services and assisting in managing patients. The second one is the outreach program addressing problems associated with food and drink establishments such as hotels and restaurants, creating awareness in various issues in prison, colleges, preparatory schools, high schools, elementary schools, and kinder gardens. The detailed explanations of all the activities that are done and achieved are presented in the subsequent part.
  • 42. Significance of the project The project is going to address some of the identified problems through various approaches like giving health education through training; OPD visits, using “idirs” and religious gatherings, preparing flyers that would improve the awareness of the community in certain issues. In addition to that, the project would have ways of demonstrating session how to perform activities that would improve the health status of the community. The project would also have the plan of communicating with government health officials so as to discuss the ways of improving the health delivery system benefiting the community at large. Opportunities The volunteer community mobilizes who has access to almost every household in our catchment area are considered to be a good opportunity to work with them. The health centre is launching a program of community dissection and health education to improve various aspects of health status of the community in the time range of our intervention plan which would be a greater opportunity for as to give exert opinion and deliver out messages. Since we are located near the center of the town we would have a good access to hotels, schools local bear houses, barbers and other institutions which would have a direct impact on the health status of the community. The governmental health officials, the kebelle administrators, and the health center administrates are very friendly making it easy to work with them. List of the problems identified from the community health survey • Absence of liquid waste disposal system in 203(70.2%) HHs • Absence of superstructure for latrine in 65(25.7%) • Absence of hand washing basins around the latrine in 201 (69.6%) households • Mothers who breast feed their child <24 month 54 out of 76
  • 43. • Mothers who start complementary feeding just after birth 26 out of 98 • Absence of ventilation of the kitchens( kitchens without window 133 and without chimney 154) • Households do not open their window adequately in 239(82.6% ) • Domestic animals living with human in the same house 54(41.86%) • Spontaneous abortion 24(6.8%) • In complete TT vaccination practice ( 201(57.26%) have taken TT1 , 198(56.41%) taken TT2, 170(48.43%) taken TT3, 128(36.18%) taken TT4 and 111(31.62%) taken TT5 ) • Burden of chronic medical illness (3(6.98%) were DM, 5(11.63%) cases were TB, 12(27.91%) were cases of HTN, 1(2.32%) cases of epilepsy, and 8(18.6%) cases of disability.) • Suboptimal distance of latrine (<15m) from the living room, water source and kitchen are 195(76.5%), 143(61.4%), 184(81.8%) respectively • Existence of harmful traditional practices (uvulectomy-63%) and mild vaccination problem (14.3%) • Early marriage (41.13% < 18yrs ) • No ANC follow up ( 12.2%) and decreasing pattern in subsequent visit
  • 44. Priority setting criteria Identified Health Problems Absence of liquid waste disposal system Absence of hand washing basins around the latrine Household s do not open their window adequately Domestic animals living with human in the same house Absence of ventilation of the kitchens Poor breast and compliment ary feeding practice Existence of harmful traditional practices No ANC follow up and decreasing pattern in subsequent visits Home delivery Lack of awareness of family planning methods Magnitude of the problem 5 5 5 2 4 3 3 2 2 3 Severity of the problems 5 4 4 5 3 3 3 4 4 2 Feasibility of the problems 4 5 5 3 4 4 4 4 4 4 political concern 5 5 4 5 4 4 3 3 3 3 Community concern 5 4 4 5 4 4 4 3 3 3 Total score (out of 25) 24 23 22 20 19 19 17 16 16 15
  • 45. According to the priority setting table we arranged the problems identified from high priority to low priority as a follows List of prioritized problems identified 1) Absence of liquid waste disposal system in 203(70.2%) house holds 2) Absence of hand washing basins around the latrine in 201 (69.6%) households 3) Households do not open their window adequately in 239(82.6% ) 4) Domestic animals living with human in the same house 54(41.86%) 5) Absence of ventilation of the kitchens( kitchens without window 133 and without chimney 154 Specific objective regarding the DV site  To increase awareness towards the importance of pit and risks associated with improper liquid waste disposal system  To increase awareness towards the importance of constructing hand washing basin around the latrine  To increase awareness towards adequate opening window  To increase awareness towards the importance constructing separate room for their animal  To increase awareness towards constructing ventilation for the kitchen and risks associated with absence of kitchen ventilation  To increase the awareness of the necessity of breast feeding in all mothers despite the RVI status  To increase the awareness of the society about the negative impacts of the harmful traditional practices and the risks of incomplete vaccination  To increase awareness on the importance of ANC follow up and risks associated with none adherence to the subsequent visits  To increase the awareness of the adequate delivery service given by the HCs and  To create awareness regarding risks of home delivery  To increase awareness of the importance of family planning
  • 46. Summary of detailed methods and strategies of the intervention (DV Site) List of problems Objectives Strategies Activities Target Responsible body Tot al plan Time(week) Total Achieve ment Remark 1st jan14tojan18 2nd jan21tojan25 3rd jan28 to feb1 P A P A P A 1.Absence of liquid waste disposal system in 203(70.2% ) house holds To increase awareness towards the importance of pit and risks associated with improper liquid waste disposal system House to house visit Collaborati ng with HEWs Demonstration Health information dissemination on house to house visit visiting model households To dissemin ate health informat ion in 49% of HHs of kebelle 04 Mekelle university’s fifth year medical students The administrato rs of the kebelle VCM 670 hou seh olds 200 hou seh olds 18 5(9 2.5 %) 260 hou seh olds 25 2(9 6.9 %) 210 hou seh olds 19 0(9 0.4 7% ) 627 HHs( 93.6%) No of households who dig a pit after the demonstration 2.Absence of hand washing basins around the latrine in 201 (69.6%) household s To increase awareness towards the importance of constructing hand washing basin around the latrin Collaboratin g with HEWs By visiting model households Health information dissemination Demonstration of simple hand washing basin construction visiting model To dissemin ate health informat ion in 56.7% of HHs of kebelle 04 Mekelle university’s fifth year medical students Volunteer community mobilizes 770 hou seh olds 280 hou se hol ds 22 6(8 0.7 %) 260 hou se hol ds 25 2(9 6.9 %) 210 hou se hol ds 19 0(9 0.4 7% ) 730 HHs(94.8 %) Number of households who constructed simple hand washing basin
  • 47. households 3.Househo lds do not open their window adequately in 239(82.6% ) To increase awareness towards adequate opening window Collaboratin g with HEWs Using idir and religious gathering Health information dissemination on house to house visit To dissemin ate health informat ion in 57.8% of HHs of kebelle 04 Mekelle university’s 5th year medical students Volunteer community mobilizers 786 hou se hol ds per wee k 316 hou seh olds 28 6(9 0.5 %) 260 hou seh olds 25 2(9 6.9 %) 210 hou seh olds 19 0(9 0.4 7% ) 762 HHs(96.9 %) No of households started opening tire windows 4. Domestic animals living with human in the same house 54(41.86% ) To increase awareness towards the importance constructing separate room for their animal In collaboration with HEWs and VCM Health education on home to home visit visiting model households To dissemin ate health informat ion in 38.3% of HHs of kebelle Mekelle university’s 5th year medical students HEWs Volunteer community mobilizes 520 hou seh olds 50 21( 42 %) 260 25 2(9 6.9 %) 210 19 0(9 0.4 7% ) 480 HHs(92.3 %) No of households with domestic animals who constructed a separate house for their animals 5.Absence of ventilation of the kitchens( kitchens without To increase awareness towards constructing ventilation for the kitchen and In collaboration with HEWs and VCM Demonstration Health education in house to house visit To dissemin ate health informat ion in 38.3% Mekelle university’s fifth year medical students HEWs 520 hou seh olds 50 hou seh olds 24( 48 %) 260 hou seh olds 25 2(9 6.9 %) 210 hou seh olds 19 0(9 0.4 7% ) 494 HHs(95% ) No of households who constructed window and chimney for
  • 48. window 133 and without chimney 154 risks associated with absence of kitchen ventilation Visiting model house holds of HHs of kebelle 04 VCMs their kitchen 6.Poor breast and complime ntary feeding practice (29.1% do not breast feed ) To increase the awareness of the necessity of breast feeding in all mothers despite the RVI status In collaboration with HEWs Health education dissemination on house to house visit To dissemin ate health informat ion in 45.6% of HHs of kebelle 04 Mekelle university’s 5th year medical students HEWs Volunteer community mobilizes 620 HH s 240 21 0(8 7.5 %) 200 16 8(8 4% ) 180 16 2(9 0% ) 584 HHs(94.2 %) No of mothers involved in the health education 7.Existen ce of harmful traditiona l practices (uvulecto my-63%) Vaccinati on problem (14.3%) To increase the awareness of the society about the negative impacts of the harmful traditional practices and the risks of incomplete vaccination In collaboration with HEWs Health education dissemination on house to house visit To dissemin ate health informat ion in 47.8% of HHs of kebelle 04 Mekelle university’s fifth year medical students The administrato rs of the kebele Health bureau officials 650 HH s 240 21 0(8 7.5 %) 200 16 8(8 4% ) 210 19 0(9 0.4 7% ) 603 HHs(92.8 %) No of participants in the health education
  • 49. 8.No ANC follow up ( 12.2%) and decreasin g pattern in subseque nt visits To increase awareness on the importance of ANC follow up and risks associated with none adherence to the subsequent visits In collaboration with HEWs Health information dissemination in religious gatherings, market places and idir. To dissemin ate health informat ion in 38.8% of HHs of kebelle 04 HEWs Health center administrato rs Administrat ors of the kebelle 5th year medical students 528 214 19 0(8 8.7 %) 184 17 3(9 4.0 2% ) 180 16 2(9 0% ) 525HHs (90.8%) Number of pregnant mothers involved in the HE in the HC 9.Home delivery (19.2.4 %) To increase the awareness of the adequate delivery service given by the HCs and To create awareness regarding risks of home delivery In collaboration with the HC administrator s In collaboration with the maichew health office administrator s In collaboration HE dissemination regarding the risks of home delivery To dissemin ate health informat ion in 38.8% of HHs of kebelle 04 Health center administrato rs 5th year medical students HEWs and VCMs 528 214 19 0(8 8.7 %) 184 17 3(9 4.0 2% ) 180 16 2(9 0% ) 525HHs (90.8%) Increment in HC’s delivery service seekers
  • 50. with HEWs and VCMs Lack of awarenes s of family planning methods ( 10.12 %) To increase awareness of the importance of family planning In collaboration with HEWs and WDAs In collaboration with michew health office HE at the community idir and religious gatherings Distributing flyers and condoms for free To dissemin ate health informat ion in 38.8% of HHs of kebelle 04 Health center administrato rs Volunteer community mobilizes 528 214 19 0(8 8.7 %) 184 17 3(9 4.0 2% ) 180 16 2(9 0% ) 525HHs (90.8%) Number of peoples attended the HE Number of flyers & condoms distributed
  • 51. Fig. Bar graph indicating the total plan and achievement of DV site plan 0 100 200 300 400 500 600 700 800 900 Total plan Achivement
  • 52. Action plan for static group (HC) Outpatient department Services Plan 1st week 2nd week 3rd week 4th week achievement Explanation n % Under 05 OPD 316 79 79 79 79 URTI 80 20 20 20 20 AFI 72 18 18 18 18 Malnutrition 64 16 16 16 16 Pneumonia 36 9 9 9 9 Diarrhoea 40 10 10 10 10 Eye infection 24 6 6 6 6 Adult OPD(Age>24 years) 172 43 43 43 43 URTI 48 12 12 12 12 Gastroenteritis 40 10 10 10 10 AFI 32 8 8 8 8 Skin infection 20 5 5 5 5 LRTI 16 4 4 4 4 Trauma 16 4 4 4 4 B) Expanded programme of immunization Services Plan 1st week 2nd week 3rd week 4th week achievement Explanation No percentage BCG 48 12 12 12 12 OPV1/Penta1 48 12 12 12 12 OPV2/Penta2 48 12 12 12 12 OPV3/Penta3 48 12 12 12 12 Measles 48 12 12 12 12
  • 53. C) Maternal health Services Plan 1st week 2nd week 3rd week 4th week achievement Explanation No percentage FP(Age>24 years) 152 38 38 38 38 PMTCT 40 10 10 10 10 ANC1 48 12 12 12 12 ANC2 60 15 15 15 15 ANC3 60 15 15 15 15 ANC4 60 15 15 15 15 Delivery 40 10 10 10 10 TT 40 10 10 10 10 Safe abortion 8 2 2 2 2 Youth friendly service Services Plan 1st 2nd week 3rd week 4th week achievement Explanation No percentage VCT 32 8 8 8 8 FP(Age 10-24years) 148 37 37 37 37 OPD(Age 5-24years) 124 31 31 31 31 URTI 28 7 7 7 7 Gastroenteritis 24 6 6 6 6 AFI 22 5 5 6 6 Skin infection 20 5 5 5 5 LRTI 16 4 4 4 4 Trauma 14 4 4 3 3
  • 54. Action plan for outreach program The aim of the outreach program is to create awareness regarding health & health related problems in food and drink establishments, schools, colleges, prison and other institutions. In line with this aim information gathered from different stake holder institutions. Based on the data gathered from these institutions problems were identified and a plan was developed for the intervention in the outreach program. Problems identified in outreach programs 1. Unclean foodanddrinkestablishmentsinhotelsandrestaurants(servantsdon’tweargownandcap, have nowashingdish,kitchenutensils are notclean) 2. Absence of handwashingbasinnearbytoiletsinhotelsandrestaurants 3. The toiletsandkitchens inhotelsandrestaurants are closertoeachother 4. The handwashingwatercontainersinthe restaurantsandhotelsare rustyand dirty 5. The knivesandthe meatcuttingmaterialsinbutcheryare unclean 6. Studentswhoare learninginKGand elementaryschoolsdon’twashtheirclothesproperly. 7. Lowlevel of knowledge regardingreproductivehealth (regardingSTI,familyplanning,HIV) inhighschoolsandcolleges. 8. CrowdedTBpatientslive togetherinasmall room (approximately3by 3) inthe prison 9. Foodhandlersinthe prisondon’tweargownand cap 10. Highprevalence of HIV amongprisoners(32out of 660 prisoners)
  • 55.
  • 56. Priority setting criteria for outreach programme Priority setting criteria IdentifiedHealthProblems TB patients live in crowded room in the prison food handlers inthe prison don’t wear gowns and caps Uncleanfoodand drink establishmentsin hotelsandin restaurants(don’t weargownand cap, have no washingdish, kitchenutensils are notclean) Students whoare learningin KG and elementary schools don’twash their clothes properly Low level of knowledge regarding reproductive health (regarding STI, family planning,HIV) inhigh schoolsand colleges. Absence of hand washing basin nearby toiletsin hotelsand restaurants The toilets and kitchensin hotelsand restaurants are closer to each other the hand washing water containers inthe restaurants and hotels are rusty and dirty the knifes and the meat cutting materials in butchery are unclean there is high prevalence of HIV in the prison(32 out of 660) prisoners Magnitude of the problem 5 5 5 5 5 3.5 3 4 4 4 Severityof the problems 5 5 5 5 5 4 3 5 5 4 Feasibility of the problems 3 5 5 5 5 5 3 5 5 3 political concern 5 5 5 5 5 5 5 3 3 4
  • 57. Community concern 2 4 5 4.5 3 4 3 3 4 3 Total score (outof 25) 20 24 25 24.5 23 21.5 17 18 21 18
  • 58. For our outreach programme we have come through the following major problems after analyzing using the priority setting criteria. 1. Unclean food and drink establishments in hotels and in restaurants(don’t wear gown and cap, have no washing dish, kitchen utensils are not clean) 2. Students who are learning in KG and elementary schools don’t wash their clothes properly 3. Food handlers in the prison don’t wear gown and cap. 4. Low level of knowledge regarding reproductive health (regarding STI, family planning) in high schools and colleges. 5. Absence of hand washing basin nearby toilets in hotels and restaurants.
  • 59.
  • 60.
  • 61. Problems Objectives Strategy activities Target Responsible body Time indicators 1st wk(jan 14 –jan 18) 2nd wk(jan 21-jan 25) 3rd wk(jan 28-feb 1) Unclean food and drinkestablishments in hotels and in restaurants(don’t wear gown and cap, have no washing dish,kitchenutensils are not clean) To Make them to have clean food and drink establishments In collaboration with the towns municipality, environmental expert and the owners of the hotels and the restaurants Health education dissemination inspection 9 hotels and 7 restaurants 5th yr medical students, environmental expert and the municipality 3 hotels and 2 restaurant 2 restaurants and 3 hotel 3 hotel and3 restaurant No of hotels having clean food and drink establishments Students who are learning in KG and elementary schools don’t wash their clothes properly To make them keep proper personal hygiene In collaboration with the school directors, teachers and clubs Health education dissemination Sanitation campaign inspection 6 KGs and 4 elementary schools Directors of the school , teachers, clubs and 5th yr medical students 2 KG and 1 elementary school 2 KG and 2 elementary school 2 KG and 1 elementary school No of KGs and elementary schoolsstudents whichkeeptheir hygiene foodhandlers in the prison don’t wear gown and cap To Make them wear proper clothes Working in collaboration with prison administrators and health workers Health information dissemination to the food handlers and the prisoners 100% 5th yr medical students Health worker s of the prison and Prison administrators 1 No of prisoners and food handlers which have good hygiene Low level of To create In collaboration HE 2 high Directors of the 2 high 1 college 1 colleges Pre and post
  • 62. knowledge regarding reproductive health (regardingSTI,family planning) in high schoolsandcolleges. awareness regarding reproductive health with the school directors, teachers and student clubs dissemination in school and colleges schools and 2 colleges school , teachers, clubs and 5th yr medical student schools interventiontest Absence of hand washing basin nearby toilets in hotels and restaurants To Make them to have hand washing basin near the toilets In collaboration with the towns municipality, environmental expert and the owners of the hotels and the restaurants Health education dissemination inspection in 9 hotels and 7restauran 5th yr medical students, environmental expert and the municipality 2R and 3 H 3R and 3H 2R and 3 H No of hotels and r and h which prepare hand washing basin near to toilet
  • 63. Barograph Indicating plan and achievement of Out Reach program 0 2 4 6 8 10 Plan Achievment
  • 64. Accomplished activities on outreach program Accordingto the problemsthatwere identified,the followingactivitieswere accomplishedineachsector. Hotels and Restaurants Different health related problems were found in different hotels and restaurants and the following health informations were disseminated accordingly: • How to keep compound hygiene • To perform medical checkups for the servants regularly • How to keep the cleanness of the kitchen and how important is constructing chimney and window for the kitchen • To establish fire extinguisher and first aid service • To manage the liquid wastes properly and have accessible Dustin for solid wastes • Regular insecticide spraying • Having separate and labeled toilet(for female and male) • Repairing the cracked walls • Keeping the pillow sheets clean • Having sandals and condoms in each bed rooms • Keeping the shelves clean • Having hand washing basin near to the toilets • Having separate fridge for food and drinks
  • 65. Kindergarten school  We taught the students about keeping ones personal hygiene and common childhood illnesses prevention. Primary school – Awareness creation on personal and environmental hygiene, communicable diseases (scabies, TB.),HIV ,STD and harmful traditional practices, problems related to early initiation of sex. Preparatory and High school – Awareness creation on STI and its prevention mechanisms, HIV, problems related to early initiation of sex(Unwanted pregnancy and abortion, STD ,HIV, Cervical cancer) Colleges ◦ Awareness creation on reproductive health in the following topics • Unwanted pregnancy and its complication • ST I(syphilis, gonorrhea) • Family planning using demonstration(condom and COC) and condoms were distributed • HIV
  • 66. Prison  Awareness creation on • TB including means of transmission, risk factors, signs and symptoms and prevention mechanisms • TB and HIV co infection • Keeping personal hygiene for the prisoners. • Food handling processes for the food handlers • Additionally we discussed with the administrators the importance of preparing gowns and capes for the food handlers and reducing the number of TB patient per room
  • 67. Conclusion According to this survey and parameters indicated in the study tool, the overall health condition of the population in Kebelle 04 is good. Regarding the housing condition, the study reveals that, there were higher numbers(38.1%) of people living in rental houses where most of the walls(73.7%) are made of mud .Besides this, there are small numbers of windows opened during the data collection time which resulted in low percentage(46%) of good room illumination. Most of the households (81.7%) have kitchens but small number of them (36.44%) have chimney. Concerning hygiene and sanitation, there is high latrine coverage (88.2% HHs have latrine) among which pit latrine is the commonest (90.2%) but a large number of latrines do not have hand washing basins with water at their door step. There is very low pit coverage as only 29.8% HHs were having a pit. The study result revealed that most households (81%) have accesses to pipe water and most of them have pipe water inside their compound. Regarding child feeding practices, most family members eat together. The study showed that 88.8% of children were breast fed immediately after delivery but there is high practice of initiation of foods and fluids other than breast milk just after birth. Only 69.5% of under five children were exclusively breast fed. There is high practice of harmful traditional practice like uvulectomy and FGM.
  • 68. Recommendation  Health extension workers and concerned personnel should create awareness about overcrowding , window opening and ventilation of the room  Health extension workers and concerned personnel should work closely with community in creating awareness on advantages of constructing and using hand washing basins at the door steps of their latrines.  Health extension workers, Kebelle administrators and concerned personnel should work closely in creating awareness on advantages of constructing and using a pit.  Health extension workers, non-governmental organizations and other health professionals have to increase their efforts in creating awareness about benefits of exclusive breast feeding and timing and benefits of initiating complementary feeding.  Health extension workers and other health professionals should collaborate in creating awareness regarding the benefits of childhood immunization.  Health extension workers, religious leaders and Kebelle administrators should strengthen their effort in avoiding harmful traditional practices  Health extension workers, other health professionals, and other NGOs should give awareness regarding communicable diseases and a possible outbreak.  It is better if the kebelle administrators try to solve problems related with pigs wandering around and destroy things like pit.  It is better if the prison administrators consider building additional rooms so that the number of prisoners per room can be reduced.
  • 69. REFERENCES 1. The participation of NGOs/CSOs in the Health Sector Development Program of Ethiopia 2. Ethiopian Ministry of Health. Health and Health Related Indicators; 2003/04 3. Ethiopian Ministry of Health. Health and Health Related Indicators; 2005/06. 4. UNICEF. Ethiopia’s water and sanitation (WES) programme 5. Federal Democratic Republic of Ethiopia, Ministry of Health (FDRE MOH). Health Sector Development Programme-HSDP- III, 2005/06-2009/10, A.A.