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 Ethiopias 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 envtal 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
Source population

Total households of kebelle 04 in Maichew town.

Study population

Total households of kebelle 04 in Maichew town.

Sampling unit

Each household of kebelle 04 in Maichew town.

Study unit

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
Inclusion criteria

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.

Exclusion criteria

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= z p (1-q) d 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 /sample size 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 shouldnt 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 respondents 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)

Key: 1=<5years 2=5-9 3=10-14 4=15- 19 . . . 16=75-79 17=>80

Fig1.Population pyramid of kebelle 04 in Maichew Town.

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 Sex Male Female Total Marital status Single Married Divorced Widowed Under 15 years of age Total Religion Orthodox Catholic Muslim Total Educational status Unable to read and write Able to read and write Grade1-4 Grade 5-8 Grade 9-12 College level and above Total Occupational status Farmer Merchant Government employee Frequency 497 648 1,145 361 346 33 83 322 1145 1074 8 63 1145 274 51 137 244 284 155 1145 33 78 117 Percent 43.4 56.6 100 31.5 30.2 2.9 7.2 28.1 100 93.8 0.7 5.5 100 23.9 4.5 12.6 21.3 24.8 13.5 100 2.9 6.8 10.2

Personal employee House wife Daily labourers House maid/servant Pensioned Student Weaver Commercial sex worker Local bear seller Under age for occupation Other(guard, cart drivers, bicycle renters) Total Relationships Father Mother Grand father Grand mother Son/daughter Relative Other Total

47 161 46 15 12 421 2 4 1 189 19 1145 178 256 2 22 603 53 31 1145

4.1 14.1 4 1.3 1 36.8 0.2 0.3 0.1 16.5 1.7 100 15.5 22.4 2 1.9 52.7 4.6 2.7 100

Table2. Categorical Monthly Income of Household Frequency and percent distribution of average monthly household income. Monthly income <1000 ETB 1000 2000 ETB >2000 ETB Total Frequency 195 50 44 289 Percent 67.5 17.3 15.2 100

%(
100 80 60 Yes No

Electricity, transport, and health institutions are accessible at 94.1% (272), 87.2 %( 252), and 100 289) respectively.

40
20 0 Electricity Transport Health institution

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)

Table3. Housing conditions Frequency and percent distribution of households by household ownership and housing characteristics. Variables Household ownership Private Rental Others Type of roof Thatched CIS Mud and wood Others Wall type Mud Brick/concrete Stone Wood Is the wall cracked or plastered? Yes No Type of floor Mud Wood Concrete Is there any window in each room? Yes No Do you open window? Sometimes Always Occasionally No Number 173 110 6 10 270 2 7 213 72 2 1 100 189 200 7 82 241 48 171 50 26 42 Percent 59.9 38.1 2.1 3.5 93.4 0.7 2.4 73.7 24.9 0.7 0.3 34.6 65.4 69.2 2.4 28.4 83.4 16.6 59.13 17.3 9.03 14.5

Was there any open window at the time visit? Yes No Ventilation type One way Crossed way Parallel way Artificial Illumination condition of the house Good Fair Bad Cleanliness condition of the compound Good Fair Bad

68 221 168 75 45 1 133 142 14 77 204 8

23.53 76.47 58.1 26 15.6 0.3 46 49.1 4.9 26.6 70.6 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 Do you have domestic animals? Yes No Do domestic animals live with humans in the same house? Yes No Is there kitchen in the house? Yes No Is the kitchen separated from living house? Yes No Does the kitchen have window? Yes No Does the kitchen have chimney? Yes No Frequency 129 160 Percent 44.6 55.4

54 75 236 53 220 16 103 133 86 150

41.86 58.14 81.7 18.3 93.22 6.78 43.64 56.36 36.44 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 Is there pit in the house hold? Yes No Do you use latrine for defecation? Yes No Status of latrine ownership Private Communal Others What is the type of latrine? Pit latrine VIPL Estimated distance of latrine from living room <15 meters >15meters Estimated distance of latrine from water source <15 meters >15meters Estimated distance of latrine from kitchen <15 meters >15meters Does the latrine have superstructure? Yes No Are there excreta around the latrine? Yes No Is there a hand washing basin with water at the door step of the latrine? Yes No

Frequency 86 203 255 34 191 48 16 230 25 195 60 143 90 184 41 188 65 49 204

Percent 29.8 70.2 88.2 11.8 74.9 18.8 6.3 90.2 9.8 76.5 23.5 61.4 38.6 81.8 18.2 74.3 25.7 19.4 80.6

53 201

20.9 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 Average time spent to fetch water <15 minutes 15-20 minutes >20minutes Amount of water utilized for all purposes per capita per day in liter <20 litres 20-30 litres >30 litres Methods of water storage Jerican Pot Barrel Others What methods do you use to fetch water from storage? Pouring Drawing Frequency 246 13 30 Percent 85.1 4.5 10.4

72 90 127 270 5 8 6

24.9 31.1 43.9 93.4 1.7 2.8 2.1

274 15

94.8 5.2

89(30.8%) households have vermin of which the majority 65(73.03%) HHs have rats.

70 60 50 40 30 20 10 0

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)

Table7. Nutritional status of kebelle 04, Maichew Town Frequency and percent distribution of eating arrangement and infant and child feeding practices. Eating arrangement All family members together Separately Children separately Others Total Breast feeding baby (<24month) Yes No Total Reason for Not breast feeding(<24 month) HIV +ve Unspecified reason Total Breast feeding initiated(<5 years) Immediately Within a day Other Total Exclusive breast feeding(<5 years) Below 4 months 4-6 months 6-11 months Above 1 year Total Frequency 142 99 39 9 289 54 22 76 7 15 22 87 9 2 98 16 50 5 1 72 Percent 49.3 34.4 13.5 2.8 100 71.1 28.9 100 31.8 68.2 100 88.8 9.2 2 100 22.2 69.5 6.9 1.4 100

Fluid and food other than breast milk just after birth Yes No Total Initiation of complementary feeding At 6 month At 9 month Above 12 month Total Type of complementary feeding Fluid Semifluid Family food Total Types of materials used Bottle Cup and spoon Others Total

26 72 98 60 11 1 72 41 22 9 72 27 43 2 72

26.5 73.5 100 83.3 15.3 1.4 100 56.9 30.6 12.5 100 37.5 59.7 27.8 100

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.

40 35 30 25 20 15 10 5 0

ANC1

ANC2

ANC3

ANC4

ANC4+

Fig4. Trend of ANC visits in Maichew town kebelle 04 In the last 12 months there were 24 spontaneous abortions in the study area.

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 TT1 TT2 TT3 TT4 TT5 Number of women currently taking or completed 201 198 170 127 111 Percentage 57.26 56.41 48.43 36.18 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.

Reasons Need many children Religion Fear of side effects Geographic inaccessibility Forgetting Others Total

Frequency 33 32 13 15 9 4 106

Percent 31.13 30.19 12.26 14.15 8.49 3.78 100

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 Card History BCG scar Card plus history Total Frequency 13 65 4 20 102 Percent 12.74 63.72 3.92 19.60 100

40
35 30 25

20
15 10 5

0
polio o polio 1 polio2 polio3 BCG penta1 penta2 penta3

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.

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 didnt 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

Absence of liquid waste disposal system 5

Absence of hand washing basins around the latrine 5

Household s do not open their window adequately

Domestic animals living with human in the same house

Identified Health Problems Absence of Poor breast Existence of ventilation of and harmful the kitchens compliment traditional

ary feeding practice

practices

No ANC follow up and decreasing pattern in subsequent visits

2

Home delivery

Lack of awareness of family planning methods

Magnitude of the problem Severity of the problems Feasibility of the problems political concern Community concern Total score (out of 25)

5 5 24

5 4 23

4 4 22

5 5 20

4 4 19

4 4 19

3 4 17

3 3 16

3 3 16

3 3 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) 2) 3) 4) 5) Absence of liquid waste disposal system in 203(70.2%) house holds Absence of hand washing basins around the latrine in 201 (69.6%) households Households do not open their window adequately in 239(82.6% ) Domestic animals living with human in the same house 54(41.86%) 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 Time(week) al 1st 2nd 3rd plan jan14to jan18 jan21to jan25 jan28 to feb1 P
1.Absence of liquid waste disposal system in 203(70.2% ) house holds

Total Achieve ment

Remark

A 18 5(9 2.5 %)

P 260 hou seh olds

A 25 2(9 6.9 %)

P 210 hou seh olds

A 19 627 HHs( 0(9 93.6%) 0.4 7% ) No of households who dig a pit after the demonstration

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 latrin

House to house visit Collaborati ng with HEWs

Demonstration Health information dissemination on house to house visit visiting model households

To Mekelle 670 dissemin universitys hou ate fifth year seh health medical olds informat students ion in 49% of The HHs of administrato kebelle rs of the 04 kebelle VCM

200 hou seh olds

2.Absence of hand washing basins around the latrine in 201 (69.6%) household s

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 universitys 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

19 730 0(9 HHs(94.8 0.4 %) 7% )

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

Health information dissemination on house to house visit

Using idir and religious gathering

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 57.8% of HHs of kebelle 04 To dissemin ate health informat ion in 38.3% of HHs of kebelle

Mekelle universitys 5th year medical students Volunteer community mobilizers

786 hou se hol ds per wee k

316 hou seh olds

28 260 6(9 hou 0.5 seh %) olds

25 2(9 6.9 %)

210 hou seh olds

762 19 0(9 HHs(96.9 %) 0.4 7% )

No of households started opening tire windows

Mekelle universitys 5th year medical students HEWs Volunteer community mobilizes Mekelle universitys fifth year medical students HEWs

520 50 hou seh olds

21( 260 42 %)

25 210 2(9 6.9 %)

19 480 0(9 HHs(92.3 0.4 %) 7% )

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%

520 hou seh olds

50 24( 260 hou 48 hou seh %) seh olds olds

25 2(9 6.9 %)

210 hou seh olds

19 494 0(9 HHs(95% 0.4 ) 7% )

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

their kitchen VCMs

6.Poor breast and complime ntary feeding practice (29.1% do not breast feed ) 7.Existen ce of harmful traditiona l practices (uvulecto my-63%) Vaccinati on problem (14.3%)

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 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 Mekelle dissemin universitys ate 5th year health medical informat students ion in 45.6% HEWs of HHs of Volunteer kebelle community 04 mobilizes To Mekelle dissemin universitys ate fifth year health medical informat students ion in The 47.8% administrato of HHs rs of the of kebele kebelle Health 04 bureau officials

620 HH s

240

21 200 0(8 7.5 %)

16 180 8(8 4% )

16 584 2(9 HHs(94.2 No of mothers 0% %) involved in ) the health education

650 HH s

240

21 200 0(8 7.5 %)

16 210 8(8 4% )

19 603 0(9 HHs(92.8 0.4 %) 7% )

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 To increase the awareness of the adequate delivery service given by the HCs and

In collaboration with HEWs

Health information dissemination in religious gatherings, market places and idir.

To HEWs dissemin Health ate center health informat administrato rs ion in 38.8% Administrat of HHs ors of the of kebelle kebelle 5th year 04 medical students To Health dissemin center ate administrato health rs informat 5th year ion in medical 38.8% students of HHs of HEWs and kebelle VCMs 04

528

214

19 184 0(8 8.7 %)

17 180 3(9 4.0 2% )

16 2(9 0% )

525HHs (90.8%)

Number of pregnant mothers involved in the HE in the HC

9.Home delivery (19.2.4 %)

In collaboration with the HC administrator s

HE dissemination regarding the risks of home delivery

528

214

19 184 0(8 8.7 %)

17 180 3(9 4.0 2% )

16 2(9 0% )

525HHs (90.8%)

Increment in HCs delivery service seekers

In collaboration with the To create maichew awareness health office regarding administrator risks of home s delivery In collaboration

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 To Health community idir dissemin center and religious ate administrato gatherings health rs informat Distributing Volunteer ion in flyers and community 38.8% condoms for mobilizes of HHs free of kebelle 04

528

214

19 184 0(8 8.7 %)

17 180 3(9 4.0 2% )

16 2(9 0% )

525HHs (90.8%)

Number of peoples attended the HE Number of flyers & condoms distributed

900 800 700 600 500 400 300 200 100 0 Total plan Achivement

Fig. Bar graph indicating the total plan and achievement of DV site plan

Action plan for static group (HC)

Outpatient department Services Under 05 OPD URTI AFI Malnutrition Pneumonia Diarrhoea Eye infection Adult OPD(Age>24 years) URTI Gastroenteritis AFI Skin infection LRTI Trauma Plan 1st week 2nd week 3rd week 4th week n 316 80 72 64 36 40 24 172 48 40 32 20 16 16 79 20 18 16 9 10 6 43 12 10 8 5 4 4 79 20 18 16 9 10 6 43 12 10 8 5 4 4 79 20 18 16 9 10 6 43 12 10 8 5 4 4 79 20 18 16 9 10 6 43 12 10 8 5 4 4 achievement Explanation %

B) Expanded programme of immunization Services BCG OPV1/Penta1 OPV2/Penta2 OPV3/Penta3 Measles Plan 48 48 48 48 48 1st week 12 12 12 12 12 2nd week 12 12 12 12 12 3rd week 12 12 12 12 12 4th week No 12 12 12 12 12 achievement percentage Explanation

C) Maternal health Services FP(Age>24 years) PMTCT ANC1 ANC2 ANC3 ANC4 Delivery TT Safe abortion Plan 152 40 48 60 60 60 40 40 8 1st week 38 10 12 15 15 15 10 10 2 2nd week 38 10 12 15 15 15 10 10 2 3rd week 38 10 12 15 15 15 10 10 2 4th week No 38 10 12 15 15 15 10 10 2 achievement percentage Explanation

Youth friendly service Services VCT FP(Age 10-24years) OPD(Age 5-24years) URTI Gastroenteritis AFI Skin infection LRTI Trauma Plan 32 148 124 28 24 22 20 16 14 1st 8 37 31 7 6 5 5 4 4 2nd week 8 37 31 7 6 5 5 4 4 3rd week 8 37 31 7 6 6 5 4 3 4th week No 8 37 31 7 6 6 5 4 3 achievement percentage Explanation

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 food and drink establishments in hotels and restaurants (servants dont wear gown and cap, have no washing dish, kitchen utensils are not clean) 2. Absence of hand washing basin nearby toilets in hotels and restaurants 3. The toilets and kitchens in hotels and restaurants are closer to each other 4. The hand washing water containers in the restaurants and hotels are rusty and dirty 5. The knives and the meat cutting materials in butchery are unclean 6. Students who are learning in KG and elementary schools dont wash their clothes properly. 7. Low level of knowledge regarding reproductive health (regarding STI, family planning, HIV) in high schools and colleges. 8. Crowded TB patients live together in a small room (approximately 3 by 3) in the prison 9. Food handlers in the prison dont wear gown and cap 10. High prevalence of HIV among prisoners (32 out of 660 prisoners)

Priority setting criteria for outreach programme

Priority setting criteria Identified Health Problems TB patients live in crowded room in the prison food handlers in the prison dont wear gowns and caps Unclean food and drink establishments in hotels and in restaurants(dont wear gown and cap, have no washing dish, kitchen utensils are not clean) Students who are learning in KG and elementary schools dont wash their clothes properly Low level of knowledge regarding reproductive health (regarding STI, family planning, HIV) in high schools and colleges. 5 Absence of hand washing basin nearby toilets in hotels and restaurants The toilets and kitchens in hotels and restaurants are closer to each other the hand washing water containers in the 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 Severity of the problems Feasibility of the problems political concern

3.5

Community concern Total score (out of 25)

4.5

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(dont wear gown and cap, have no washing dish, kitchen utensils are not clean) 2. Students who are learning in KG and elementary schools dont wash their clothes properly 3. Food handlers in the prison dont 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 1 wk(jan 2 wk(jan 14 jan 18) 21-jan 25)

st nd

indicators 3 wk(jan 28-feb 1)

rd

Unclean food and drink establishments in hotels and in restaurants(dont wear gown and cap, have no washing dish, kitchen utensils are not clean) Students who are learning in KG and elementary schools dont wash their clothes properly

To Make them In collaboration Health 9 hotels 5th yr medical 3 hotels 2 3 hotel to have clean with the towns education and 7 students, and 2 restaurants and 3 food and drink municipality, dissemination restaurants environmental restaurant and 3 hotel restaurant establishments environmental expert and the expert and the inspection municipality owners of the hotels and the restaurants

No of hotels having clean food and drink establishments

To make them In collaboration Health 6 KGs and 4 Directors of the 2 KG and 1 2 KG and 2 2 KG and 1 No of KGs and keep proper with the school education elementary school , elementary elementary elementary elementary personal directors, dissemination schools teachers, clubs school school school schools students hygiene teachers and Sanitation and 5th yr which keep their clubs campaign medical hygiene inspection students

food handlers in the prison dont 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

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 (regarding STI, family planning) in high schools and colleges. Absence of hand washing basin nearby toilets in hotels and restaurants

awareness regarding reproductive health

with the school dissemination schools and school , directors, in school and 2 colleges teachers, clubs teachers and colleges and 5th yr student clubs medical student

schools

intervention test

To Make them In collaboration Health in 9 hotels 5th yr medical 2R and 3 H 3R and 3H 2R and 3 H No of hotels to have hand with the towns education and students, and r and h washing basin municipality, dissemination 7restauran environmental which prepare near the toilets environmental expert and the hand washing expert and the inspection municipality basin near to owners of the toilet hotels and the restaurants

Barograph Indicating plan and achievement of Out Reach program

10 8 6 4

2
0

Plan Achievment

Accomplished activities on outreach program

According to the problems that were identified, the following activities were accomplished in each sector.

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. Ethiopias water and sanitation (WES) programme 5. Federal Democratic Republic of Ethiopia, Ministry of Health (FDRE MOH). Health Sector Development Programme-HSDPIII, 2005/06-2009/10, A.A.