1.

Introduction
Community based training program attachment enable the students to apply the
knowledge, skill and attitude they have acquired in public health framework of health
promotion ,disease prevention and control at community level .
The main goal of CBTP is to identify common causes of mortality and morbidity and
their determinant in the target community and solve priority of health problem in the
community .The activity of CBTP performed by mobilizing communities and involvement
of the others relevant sectors at all stage (the community diagnosis , priority setting ,action
planning ,implementation of intervention and its evaluation).The student should
communicate effectively with individuals, family , community PHCU staff, local health
department staff, peers and faculty to get a good information and to achieve their target
about communities problem . The major purpose of CBTP are to advise individual and
families to promote health and prevent illness and demonstrate professional value and
behavior in interaction with individual ,families and communities consistent with the future
role of a physician and also demonstrate key public health values ,attitudes and behaviors
such as commitment to equity and social justice, recognition of the important of the health of
the heath of the community as well as individual and respect of diversity

2. SWOT Analysis
.Strength
Positive attitude towards CBTP
Commitment of group members to perform the activities.
Well organized group
Group members have different educational back ground and work experience
Strong relationship with concerning bodies such as Health Center, community leader
Team spirit and good time management
Group members have strong convincing ability
Weakness
Lack of knowledge on SPSS Data analysis
the questionnaire was bulky for respondent and not suitable for working spss

1
 cultural barrier
language barrier
Opportunities
Presence of health extension workers
health center have well organized information system
Availability of organizational arrangement in the community
Cooperativeness of the whole governments offices especially kebele 01 administration
Our instructors encourage and giving us continuous advices
Threats
Shortage of time
Unwillingness of some respondents
Transportation problem
3. Statement of the problem

Ethiopia is the second most-populous country in sub-Saharan Africa, with an estimated

population of 85 million, 85% of whom live in rural areas. With the ninth-highest birth rate
in the world. More than half of households in Ethiopia (54 percent) have access to an
improved source of drinking water. Only 8 percent of households have an improved toilet
facility, not shared with other households. About one household in every four (23 percent) is
electrified. A large proportion of the Ethiopian population (47percent) is under age 15and
more than one household in every four (26 percent) is female-headed.

About half of women 15-49 (51 percent) and one-third of men 15-59 (33 percent) have no
formal education. These proportions have decreased since the 2005 EDHS, when 66 Percent
of women and 43 percent of men had no formal education. Thirty-eight percent of women
15-49 and 65 percent of men 15-59 are literate, an increase from 29 percent and 59 percent,
respectively, in 2005.
Ensuring adequate sanitation facilities is another Millennium Development Goal that
Ethiopia shares with other countries. Thirteen percent of children under age 5 had diarrhea,
and 3 percent had diarrhea with blood, in the two weeks before 2011 EDHS survey.

2
The age at which childbearing commences is an important determinant of the overall level of
fertility as well as of the health and welfare of the mother and the child. Overall, 9 percent of
women age 25-49 have given birth by exact age 15, and 38 percent have given birth by exact
age 18. More than half (58 percent) of women have become mothers by exact age 20.
Twenty-five percent of currently married women have an unmet need for family planning
services; 16 percent have a need for spacing, and 9 percent have a need for limiting. The 12-
month contraceptive discontinuation rate for all methods is 37 percent. The highest
discontinuation rate is for the pill (70 percent), followed by the male condom (62 percent)

One in every 17 Ethiopian children dies before the first birthday, and one in every 11
children dies before the fifth birthday. Infant mortality declined by 39 percent between the
2000 EDHS and the 2011 EDHS, from 97 deaths per 1,000 live births to 59 deaths per 1,000
live births. Under- five mortality is declined by 47 percent over the same period, from 166
deaths per 1,000 live births to 88 deaths per 1,000 live births.
Above half percent follow home delivery ;Around 43 .75% followed untrained birth
attendants.;34% of women who gave birth received antenatal care from a skilled provider,
This is a marked improvement from 28 percent in 2005;19 % made four or more antenatal
care visits during the course of her pregnancy;57 percent did not receive any antenatal care
Table1. Health coverage of melkajebduWoreda in first quarter,
Diredawa,ethiopia,2007E.C
Health center 91.4%
Health post 100%
Fully immunization 88%
Family planning 15%
Institutional delivery 50.9%

3
Table1.1. Top ten Health and health related problems of Adult opd 1st
quarter,DIREDAWA 2007 E.C

Number Ten top disease Frequency Percent(%)

AURTI 517 29.3

1
2 Non bloody diarrhea 352 19.9

3 Dyspepsia 255 14.4

4 UTI 159 9

5 Trauma 129 7.3

6 Disease of musculo 113 6.4

skeletal system
7 Pneumonia 100 5.7

8 Disease of the eye and 50 2.8

adnexia
9 Unspecified disease of the 50 2.8
skin and sub cutaneous
10 Un specified disease of 40 2.3
digestive system

4
Table 1.1.1 Top ten health and health related problems under 5 opd 1st quarter
2007E.C melka jebdu health center.

Number Ten top disease Frequency Percent(%)

1 Non bloody diarrhea 197 37.3
2 AURTI 153 29
3 Pneumonia 94 17.8
4 Skin infection 30 5.7
5 SAM 14 2.7
6 Trauma 13 2.5
7 Disease of eye adnexia 11 2.1
8 Helminthiasis 8 1.5
9 MAM 4 0.76
10 Bloody diarrhea 4 0.76

4.literature review
According to EDHS 2011 report more than half (53 %) of households cook in the housing
unit where they live, while more than one-third (36 %) use a separate building, and about one
household in every ten (9%) cook outdoors. Cooking and heating with solid fuels can lead to
high levels of indoor smoke, which consists of a complex mix of pollutants that could
increase the risk of contracting diseases. Solid fuels include charcoal, wood, straw, shrubs,
grass, agricultural crops, and animal dung. The great majority (95 %) of households
primarily use solid fuel for cooking. The practice is nearly universal around 90(%)with in
rural households and very common in urban households (80%) as well. Wood is the main
type of cooking fuel used by ( 77%) of rural households, (46%) of urban households and 86
of rural households). In addition to wood, charcoal and kerosene are important types of
cooking fuel in urban areas; 30 percent of urban households use charcoal and 10 percent use
kerosene for cooking.

5
About 8 percent of households in Ethiopia use improved toilet facilities that are not shared
with other households, 14 percent in urban areas and 7 percent in rural areas. One in ten
households (32 percent in urban areas and 3 percent in rural areas) use shared toilet facilities.
The large majority of households, 82 percent, use non-improved toilet facilities (91 percent
in rural areas and 54 percent in urban areas). The most common type of non-improved toilet
facility is an open pit latrine or pit latrine without slabs, used by 45 percent of households in
rural areas and 37 percent of households in urban areas. Overall, 38 percent of households
have no toilet facility, 16 percent in urban areas and 45 percent in rural areas.
Households not having water on their premises were asked how long it takes to fetch water.
Only (30 percent in urban areas and 36 percent in rural areas) take less than 30 minutes to
fetch drinking water. More than half of all households (53 percent) travel 30 minutes or more
to fetch their drinking water(19 percent in urban areas and 62 percent in rural areas).
According to EDH 2011, more than half of the households in Ethiopia (54 percent) have
access to an improved source of drinking water, with a much higher proportion among urban
households(95 percent) than rural households (42 percent). The most common source of
improved drinking water in urban households is piped water, used by (87 percent) of urban
households. In contrast, only (19 percent ) of rural households have access to piped water.
Eleven percent of rural households have access to drinking water from a protected spring,
and 8 percent have access to drinking water from a protected well.
Family planning does more than enable women to limit family size. It enables women to
have the number of children they want and subsequently reduces the incidence of maternal
and infant mortality. However, more than 100 million women in the developing world have
unmet needs for family planning (Population Reports 1999, 2001; Ross & Winfrey 2002).
The provision of accurateand relevant information concerning the various types of modern
contraceptive methods that exist, their benefits and low side effects has been considered an
important strategy to address the family planning needs of most women and the subsequent
decrease in fertility rates
Use of any contraceptive methods among currently married women has increased nearly six
fold in the last 20 years, from 5 percent in the 1990 NFFS to 29 percent in the 2011 EDHS.
The increase is especially pronounced for the use of modern methods between 2000 and

6
2011. The increase in modern method use is attributed primarily to the sharp increase in the
use of injectable, from 3 percent in 2000 to 21 percent in 2011.

Thirty-four percent of pregnant mothers who gave birth in the five years preceding the survey
received antenatal care from a skilled provider, that is, from a doctor, nurse, or midwife, for
their mostrecent birth—28 percent from a nurse or midwife and 5 percent from a doctor.
Another 9 percent ofwomen received ANC from a health extension worker (HEW). By
comparison, in 2005 28 percentreceived antenatal care from a skilled provider. This
improvement in the last five years is impressive,particularly since between 2000 and 2005
there was hardly any improvement in antenatal coverage.About six in every ten Ethiopian
women (57 percent) did not receive any antenatal care fortheir last birth in the five years
preceding the survey. While this percentage is still substantial, itrepresents a marked decrease
from 2005, when 72 percent did not receive any antenatal care.
The type of assistance a woman receives during childbirth has important health consequences
for both mother and child. In addition, the proportion of births attended by skilled providers
is a
measure of the health system’s effectiveness, accessibility, and quality of care. Delivery
assisted by skilled providers is the most important proven intervention in reducing maternal
mortality and one of the MDG indicators to track national effort towards safe motherhood.
Ten percent of
births were assisted by a skilled provider—4 percent by a doctor and 7 percent by a nurse or
midwife. Less than 1 percent of births were assisted by a HEW, and 57 percent of births were
assisted by a relative, or some other person. Twenty-eight percent of births were assisted by a
traditional birth attendant, while 4 percent of births were unattended. Skilled assistance at
delivery increased from 6percent to 10 percent in the last six years.

Ten percent of births in Ethiopia are delivered at a health facility—9 percent in a public
facility and 1 percent in a private facility. Nine women in every ten deliver at home. The
percentage of deliveries in a health facility doubled from 5 percent the 2005 EDHS, while
home deliveries decreased slightly from 94 percent to the current level of 90 percent. First
births are much more likely than births orders six or higher to be delivered in a health facility

7
(21 percent versus 4 percent).Delivery in a health facility is more common among births to
mothers age 20-34, births to mothers who had at least four ANC visits, and births to highly
educated mothers and mothers in the highest wealth quintiles. Urban births are notably more
likely than rural births to be delivered in a health

facility (50 percent versus 4 percent). The percentage of births delivered in health facility
ranges from less than 10 percent in SNNP, Affar, Oromiya, Somalia, and Benishangul-
Gumuz regions to82 percent in Addis Ababa. Women who did not deliver at a health facility
were asked the reasons they did not deliver in a health facility. More than six women in ten
(61 percent) stated that a health facility delivery was not necessary, and three in every ten (30
percent) stated that it was not customary. Fourteen percent of women said that the health
facility was either too far or that they did not have transportation.
In Ethiopia marriage marks the point in a woman’s life when childbearing becomes socially
acceptable. Age at first marriage has a major effect on childbearing because women who
marry early have on average a longer period of exposure to the risk of pregnancy and give
birth to a greater number of children over their lifetimes. For women, marriage takes place
relatively early in Ethiopia
Thirty-four percent of women with a birth in the five years preceding the survey received two
or more tetanus toxoid injections during their last pregnancy, and 48 percent of mothers were
protected for their last birth. In the 2011 EDHS mothers age 20-34 were more likely (35
percent) tohave received two or more tetanus injections during their last pregnancy than
mothers under age 20 or35-49 (both 30 percent). Mothers in Addis Ababa were most likely to
have received two or more tetanus toxoid injections (72 percent) and to have had their last
birth protected against neonatal tetanus (82 percent), while mothers in Affar were least likely
(22 and 27 percent, respectively).
UNICEF and WHO recommend that children be exclusively breast fed during the first 6
months of life and that children be given solid or semi-solid complementary food in addition
to continued breast feeding from age 6 months until 24 months or more, when the child is
fully weaned. Exclusive breastfeeding is recommended because breast milk is
uncontaminated and contains all the nutrients necessary in the first few months of life. In
addition, the mother’s antibodies in breast milk provide the infant with immunity to disease.

8
Early supplementation is discouraged for several reasons. First, it exposes infants to
pathogens and thus increases their risk of infection, especially diarrheal disease. Second, it
decreases infants’ intake of breast milk and therefore suckling, which in turn reduces breast
milk production. Third, in lower source settings, supplementary food is often nutritionally
inferior. WHO has established guidelines with respect to IYCF practices for children age 6-
23 months .Breastfeed children 6-23 months should receive animal-source foods and vitamin
A-rich fruits and vegetables daily (PAHO/WHO, 2003). Since first foods almost universally
include a grain- or tuber based staple, it is unlikely that young children who eat two or fewer
food groups will receive both an animal-source food and a vitamin A-rich fruit or vegetable.
Therefore, four food groups are considered the minimum acceptable number of food groups
for breastfed infants (Arimond and Ruel,2003). Breastfed infants 6-8 months should be fed
meals of complementary foods two or three times per day, with one to two snacks as desired;
breastfed children 9-23 months should be fed meals three vaccination coverage among
children age 12-23 months by background characteristics. Female children are slightly more
likely to be fully vaccinated (26 percent) than male children (23 percent). First births are
more likely to be fully immunized (30 percent) than births of order six and higher (20
percent). Urban children are more than two times as likely as rural children to have all basic
vaccinations (48 percent compared with 20 percent). Children whose mothers have secondary
education are more likely to be fully immunized than those born to mothers with no
education (57 and 20 percent, respectively). Similarly, 51 percent of children in the highest
wealth quintile are fully immunized, compared with 17 percent of children in the lowest
wealth quintile. There is a wide variation among regions in full vaccination coverage,
ranging from 79 percent in Addis Ababa to 9 percent in Affar. or four times per day, with one
to two snacks (WHO, 2008).

Nigerian mothers demonstrated good knowledge and positive attitude towards breastfeeding.
Breastfeeding was mostly believed to promote mother-baby bonding. Increasing length of
time for maternity leave and providing designated areas at work places is believed to
facilitate breastfeeding. Most of the mothers practiced advisable .Mbada et al. BMC
Research Notes 2013, 6:552

9
Breastfeeding postures, preferred sitting on a chair to breastfeed and utilized cross-cradle
hold and baby-to breast latch- cording to our survey assessed in Melka Jebdu. From the
result, there was a high awareness of EBF and full breastfeeding among the mothers. This
finding is consistent with previous reports from melka Jebdu that showed high rates of
awareness of EBF among working class mothers and women who have no paid occupation
outside the home and instead focus their lives on motherhood

UNICEF and WHO recommend that children be exclusively breastfed during the first 6
months of life and that children be given solid or semi-solid complementary food in addition
to continued breastfeeding from age 6 months until 24 months or more, when the child is
fully weaned. This survey findings on the practice of the mothers regarding breastfeeding
revealed that majority of the women in this study had good habit about breastfeeding.
According to EDHS Fifty-two percent of infants started breastfeeding within one hour of
birth, and 80 percent, within the first day. But our finding suggest 80% of under 5 children
start whit in one hours . vaccination coverage by comparing similarly collected data in the
2011 EDHS with data from the 2000 and 2005 EDHS. Vaccination coverage in Ethiopia has
increased markedly over the past ten years. The percentage of children age 12-23 months
who were fully vaccinated at the time of the survey increased from 14 percent in 2000 to 20
percent in 2005 and 24 percent in 2011—a 70 percent increase over ten years and a 19
percent increase in the five years
preceding the 2011 survey. The percentage who had received none of the six basic
vaccinations increased from 17 percent to 24 percent between 2000 and 2005 and then
decreased to 15 percent in 2011. With the exception of polio 3, the percentage of children
who received all the other vaccinations has increased in the five years before the 2011
survey.

Exclusive breastfeeding during the first six months after birth is not widely practiced in
Ethiopia .Currently, mothers exclusively breastfeed approximately half of children under six
months (52 percent). Among sub-groups the percentage of young children who are
exclusively breastfed decreases sharply from 70 percent of infants age 0-1 month to 55

10
percent of those age 2-3 months and, further, to 32 percent among infants 4-5 months. The
HSDP IV targets an increase in the proportion of exclusively breastfed infants under age 6
months to 70 percent by 2015.

11
 5. Conceptual framework

Health and health related problems

Environmental personal hygiene Socio- Family health

hygiene demographics

-Waste disposal -religious -Family -Health

system services
-Hand washing -Age -Sex Planning availability
-Gas from industries’ habit
-cultures -Marital status -Nutritional -Taboo
-Open filed -Water availability status
defecation -Illiteracy
-Educational level -Family size
-Population density

Figure.1A:conceptual framework showing factors that causes health and health problems.

6.SIGNIFICANCE OF THE STUDY

The study was designed to investigate and provide relevant information on health and health
related issues currently existing in the melkajebdu community as well as to plan and properly
execute appropriate feasible, timely and cost effective public health interventions in line with
the sectoral guidelines and community expectations. On the other hand it is the strong
conviction of the group members that the findings of this study will provide the platform for
concerned bodies (health center, kebele, HEWs and religious leaders) to intervene, create
awareness and mobilize the community for maximum results. The study will also serve as a

12
 baseline to perform further study on the subject by an individual, governmental and non-
governmental organization in the future.

7. OBJECTIVE
7.1GENERAL OBJECTIVE
To assess health and health related problems in community and implement appropriate
interventions in melka jebdu kebele of dire dawa town from tahisas 20 upto tir 8

7.2 SPECIFIC OBJECTIVE

 To assess the environmental sanitation of the study area from Tahisas 20-Tir 8 ,2007E.C
 To assess the maternal and child health status of melka jebdukebele residents from Tahisas
20-Tir 8 ,2007E.C
 To intervene the prioritized health problems through community involvement from
Tahisas 20-Tir 8 ,2007E.C
 To monitor the efficiency and effectiveness of public health interventions from
Tahisas 20-Tir 8 ,2007E.C
 To participate the community in their own health problems solving from
 To promote sustainability of Health prevention activities

8.Methodology
8.1 study area and period
Dire Dawa city is one of city administration in Ethiopia which is located 526 km from Addis
Ababa to the East. It has 9 urban and 38 Rural Kebeles .
Melka Jebdu is one of the urban Kebeles located 9 km far from the center of the city in West
direction.it was founded in 1930 E.C as Italian basement camp.it is among 9 administrative
kebeles of dire dawa town. It is bordered by Genderigie in the East, Boren in the
North,Genderigi in the south,Goladeg and Gedanser in west.It is devided into six ketena and
different ethnic groups live in this Kebele namely Oromo, Somali,Amhara and many other

13
 ethnic groups. There are different institutions; twelve mosques, one Orthodox Church, one
protestant church, one health center.The town had telephone access, bank, electricity, 2
primary &1 secondary schools, and 21 food and drinking establishments.
Melkajebdu has a total population of 14090 of which, 38,88 are women in the reproductive
age group; 1711 are under five children and 427children are under one year. The study was
conducted from December 20 –January 10/2007 E.C
8.2 Source population
Our source of population was all the households(3131) of Melkajabdu kebele, Dire Dawa
administrative city.
8.3 Study population:
Our study population was systematically and randomly selected 342 households from the
source population
8.4 study design
both quantitative and qualitative cross sectional study design was conducted
8.5 Sample size determination and sampling technique???????????????????????

Sample size was determined using the following simple proportion formula:

(z𝛼/2)2 p(1−p)
𝑛= d2

Where n= sample size

Z (α/2) = 1.96 (95% CI)

p= 0.5=population proportion

d=5%= marginal error

N=3131 house holds

1.962×0.5(1−0.5)
n= 0.052

n=384

14
Since our population size is less than 10,000 we use reduction formula

nf=no/1+no/N

384/1+384/3131

=342 household

8.6 Sampling technique

Systematic random sampling method was used.

K= N/n= 3131 /342=10, Where k=is sampling interval, using lottery method house number 07
was selected and sample collection was carried out at every 9th households interval.

8.7 Measurement (study variables)

• Age

• Sex

• Religion

• Marital status

• Occupational status

• Educational status

• Environmental health condition

• Maternal and Child Health status

• Morbidity and Mortality

15
8.8 Data collection Instrument

Materials used during the study were questionnaire, checklist, Paper, pen, pencil, computer,
map papers, ruler, erasers, Marker, Video camera.

8.9 Data collection technique

Data was collected by face to face interview using structured questionnaire, observation, key
informant interview ,different records were also reviewed

8.10 Data processing, analysis and presentation

After data collection, the data was checked, edited and entered in to the computer and was
analyzed using both Ms excel and SPSS for window version16.0.

Finally, results of the study were presented by using tables, graphs and based on results,
discussion and recommendation was made.

8.11 Quality control

Data quality was assured by pre-testing.

8.12 Inclusion and exclusion criteria

During data collection those who are under eighty are excluded

8.13 Ethical considerations

Before the actual data collection, the letter of permission was obtained from Dire Dawa School
of medicine to dire dawa health office then from Dire dawa health office to Melka jebdu health
office and finally from Melka jebdu health office to kebele administrative and other concerned
bodies. We have also got oral permission from the respondents. we started data collection
process by introducing ourselves and asking their willingness to provide information

16
8.13 Operational definitions

Past 6 month: from July 1,2006E.C_November 30 2007 E.C

Past 12 month: from December 1, 2006E.C_November 30 2007 E.C

Past 18 month: from July 1,2005E.C_November 30 2007 E.C

Good latrine: A latrine without any feces, urine, sewage and any dry waste in addition without
any flies and other insects on the wall and floor

Moderate latrine: A latrine with dry waste and medium moisture on the floor

Bad latrine: feces, urine, sewage, dry waste, flies and other insects seen on the wall and floor of
the toilet

Well lightening house: in the middle of the main house if a person write and read a sentence
which has at least 12 words easily during daylight

Clean compound: there is no any dispersed or any collected dry waste in the house compound

Not clean compound: there is dispersed and compacted dry waste in the house compound

17
 9.RESULT

Part one

1 demographic status

Table1.1Socio-demographic characterMelkajebdukebele Dire Dawa Ethiopia 2007E.C

Measurements
Description Freq. Percentage %
Variables
M 250 81.2
F 58 18.8
head of the
family
Total 308 100.0
<1years 85 4.6
1-4years 121 6.6
5-14years 554 30.2
15-49years 995 54.5
>64years 75 4.1
Age
Total 1830 100
Orthodox 87 6.3
Muslim 1282 93.1
Protestant 7 0.5

Religion Catholic 0 0
Others 1 0.1
Total 1377 100
Somali 130 40

18
 Oromo 157 48.4
Amhara 19 5.8
Ethnicity
Others 19 5.8
Total 325 100

Among the total study subject there were 1908 population in our sample households; out of
these 928(48.6%) were males and 980(51.4%) were females. These shows there are a slight
predominance of females. The majority age group based on our finding was the age between 15
and 49 which accounts 995(54.5%) of the population. While the remaining
554(30.2%),121(6.6%), 85(4.6%) and 75(4.1)% were age between 5 and 14, 1 and 4,under 1 yrs
and above 64yrs respectively with descending order.

This indicates that approximately half of the population of Melkajabdukebele is at reproductive

age group and the rest are dependent groups. Considering the ethnic distribution of the
individuals in the study households, the majority157 (48.4%) of the people are Oromo, followed
by Somali and Amhara which accounts 130(40%) and 19(5.8%) of the community respectively
.Other ethnic groups account about 5.8% of the population.

Majority of the population are Muslims 1282(93.1%) and the other religions are orthodox
87(6.3%), protestant 7(0.5%) and one individual (0.1%) is Jehovah.

19
 160 151
140 130
125
120

100

80 70
64 frequency
60
%
40 26.7
23 25 22.2
20 11.3 12.4
4.4
0
farmers merchants civil servants privet self employed others
organization
workers

Fig1; occupational distribution of Melka jabdu population,DireDawa Ethiopia 2007E.C

Among those who are in the productive age almost half of them are involved in trading and
farming and the rest are engaged in civil service, private organization, and other occupations.

20
 123, 8%
204, 13% 496, 32%
illiterate
236, 15% grade 1-6
grade 7-8
grade 9-12
487, 32% diploma and above

Fig 2. Educational status of Melka jebdu town who are in school age

According to our study almost one third of the population who are above school age are illiterate

and other third are between grade 1 and 6, this implies that more than 2/3 of the population
have

Lower educational level.

21
 frequency percent

477 475

45.1 44.9 38 44
24
3.6 4.2 2.2

married unmarried divorce widow other relations

]

Fig: 3 marital status of Melkajabdu kebele population who are in a reproductive age in Dire
Dawa ,Ethiopia December 2007E.C

Based on our finding the proportion of married and unmarried group of the population who are in
the reproductive age is almost equal and together accounts 90%. The remaining is divorced,
widow and have other relationship.

Table: 1.2 relations of family members with head of family in Melkajebdu Dire Dawa Ethiopia
2007 E.C

Family members Frequency Percent (%)

1 Husband 142 8.6
2 Wife 274 16.6
3 Children 1118 67.9
4 Relatives 89 5.4
5 Friends 0 0
6 Others 24 1.5
Total 1647 100

22
Part two

Environmental health

Table:2.1 housing characteristics in Melka jebdu 01 kebele,Diredawa, Ethiopia 2007 E.C

Frequency Percent
Roofing materials Corrugate tin 302 98.1
Grass 5 1.6
Others 1 .3
Building materials Stone 81 26.3
Woods 76 24.7
Blockets 142 46.1
Others 9 2.9
Wall surfaces Plastered 265 86.0
Cracked 43 14.0

Flooring materials Cement 211 68.5

Soil 97 31.5
Rooms 1-2 210 68.2
3-4 71 23.1
>5 27 8.8
Windows 1-2 228 74.0
3-4 59 19.2
>5 21 6.8
Frequency of Windows every day 152 49.4
opening Occasional 147 47.7
never open at all 9 2.9
Windows alignments Unidirectional 191 62.0
crossed directional 77 25.0
Parallel 40 13.0

23
 Houses with emergence Yes 51 16.6
exits No 257 83.4
Separate cooking unit Yes 227 73.1
No 81 26.9
Cooking fuels fire woods 254 82.5
Kerosene 5 1.6
Charcoal 37 12.0
Electricity 12 3.9

From 308 households around three fourth (73 percent) of households use a separate building
for cooking, while More than one fourth (27 percent) of households have no separate building for
cooking. According to this survey, the great majority (95 percent) of households primarily use
solid fuel for cooking. Wood is the main type of cooking fuel, used by 83 percent of households.
In addition to wood, charcoal and electric are important types of cooking fuel in Melka jabdu 01
kebele; 12 percent of households use charcoal and 4 percent use electric for cooking.

Frequency Percent

254

82.5

37
5 1.6 12 12 3.9

fire woods Kerosene Charcoal Electric

Fig.2:1 sources of cooking fuels in Melka jebdu 01 kebele,Diredawa,Ethiopia2007 EC

24
 45
(14.60%)
yes

263 no

(85.40%)

Figure 2:2-percentage of households/respondents who have toilet at MelkaJebdu,

DireDawa,December, 2007 E.C.

Among 308 households included in this study 263(85.4%) have toilet availability and the
remaining 45 (14.6%) have no toilet at all.

Table 2.2:percentage of households/respondents/ who have no toilet and using other

option,MelkaJebdu, Dire Dawa, December, 2007 E.C.

Other options of defecation Frequency Percent

Open field 24 53.3
Neighbors 21 46.7
Total 45 100

Among the respondents 45(14.6%)who have no toilet; 24(53.3%) of them use in open field and
the remaining 21(46.7%) use in neighbor’s toilet

25
Table2.3:Types of toilet with their quality and hygiene who have toilet, MelkaJebdu, Dire
Dawa,December, 2007 E.C

Types of toilet
Types of toilet Frequency %
Pit latrine 224 85.2

Pit latrine 20 7.6

without slab
VIP 15 5.7
Water flush 4 1.5
total 263 100
Toilet with Lids
Yes 59 22.4
No 204 77.6
Total 263 100
Toilet hygiene
Very good 86 32.7
Good 157 59.7
Poor 20 7.6
Total 263 100

Among respondents having toilet the common is pit latrine which accounts 85.2%, the remaining
are pit latrine without slab, VIP (ventilated improved pit latrine) and water flush which accounts
7.6%, 5.7% and 1.5% respectively. About 92.4% of respondents have improved latrine facility

26
Table 2.4: house holds which have solid waste collection unit inMelkaJebdu, Dire Dawa,
Ethiopia, December, 2007 E.C

solid waste collection unit Frequency Percent

Yes 181 58.8

No 127 41.2

Total 308 100.0

Among the respondents 181(58.8%) have solid waste collection unit and the remaining do not .

Table2.5: toilet with hand washing facility at Melka Jebdu, Dire

Dawa,Ethiopia december, 2007 E.C.

Facility Frequency Percent

Yes 70 22.7

No 238 77.3

Total 308 100.0

Among respondents 70(22.7%) have hand washing facility after toilet.

27
 350
308
300

250

200

145
150

100
48 41
50 25 25
15
6 3
0

Figure 2.3 : frequency of waste disposal site of respondants in MelkaJebdu, Dire Dawa,Ethiopia
December, 2007 E.C.

According to our survey solid waste disposal ways in melkajebedu includes; in the resident
compound 1.9%, in the disposal pit 15.6%, dispersing in the field 13.3%, using as fertilizer
8.1%, open field 8.1%, put in out of compound 1.0%, by municipality 47.1% and others4.9%.

28
Table 2.6 sanitation status of respondent’s compound,MelkaJebdu, Dire
Dawa,Ethiopia,December,2007 E.C

Level Frequency Percent

good sanitation 171 55.5
poor sanitation 137 44.5
Total 308 100.0

About 55.5% of respondents have good sanitation and 44.5% have poor sanitation

Table 2.7 : water source and per capita usage of respondents in Melkajebdu,
Diredawa,Ethiopia2007

Sources Frequency Percent

bono pipe 95 30.8
pipe in the compound 182 59.1
Others 31 10.1
Total 308 100.0
Storage of water
Jurycan 276 89.6
Bucket 8 2.6

29
Barrel 17 5.5
Others 7 2.3
Total 308 100
Containers having lid
Yes 299 97.1
No 9 2.9
Total 308 100
Per capita water consumption
<20 litre 220 71.4
20-50 litres 55 17.9
50 litres 18 5.8
50-100litres 15 4.9
Total 308 100.0
According to our finding the most common source of water is pipe water in the compound which
accounts 59.1% and other sources include bono pipe, others like from neighbor which accounts
30.8% and 10.1% respectively. Based on the survey 89.6% of respondents store water in jurycan
and the remaining store in barrel, bucket and others from 97.1% have lids.The majority of
respondents about 71.1% percapita water consumptions are less than 20litres

Table: 2.8 : number of households who have domestic animals, Dire Dawa,MelkaJebdu, January,
2007 E.C

Domestic animal Frequency Percentage

Yes 152 49.4
No 156 50.6
Total 308 100

Among 308 households included in this study 152(49.4%) of them was found that they have
domestic animals and 156 (50.6%) has been reported that they have no animals. From 152
owners of domestic animals 110 (72.4%) households do have a separate room for their animals

30
where as 24 (15.8%) have no room separately for the animals to live and keep them inside the
compound but not share the same room, where as 18(11.8%) households live together with

animals in the same room.

120
110(72.4%)

100
number of households

80

60

40
24(15.8)
18(11.8%)
20

0
1 2 3 4
Separate room In the main house In the compound

Figure: 2.4- residence of domestic animals in MelkaJebdu , January 2007 E.C

Table: 2.9-House holds with animal waste in their compound in MelkaJebdu, DireDawa
,Ethiopia,December, 2007 E.C

Animals waste
in the compound Frequency Percent
Yes 65 42.7
No 87 57.2.

Total 152 100.0

31
Among the total of 152 study subjects who have domestic animals 65 (42.7%) of households
compound has been found to contain animals waste, and 87 (57.2%) of subjects who do not have
animals was obtained to have a clean compound.

From the total of 308 study population rat, mosquito and bugs was found to cause harmful effect
in 110(36%), 59(19%), 31(10%) of the households respectively and followed by flea and
cockroach which together constitutes 13 (4%). In contrast to this 95 (31%) of the respondents
home was found free of insects.

31%
36% rat
mosquito
bug
others

4% no insect

10%
19%

Figure 2.5: insect and animals that have harmful effect among residents of MelkaJebdu, January
2007 E.C

Among 308 subjects in the study area 291(94.5%) households have electric power supply and
17(5.5%) do not. 294(95.5%) houses have adequate light to make reading possible in the middle
of the house at day time and 14(4.5%) was found without adequate light and there is no light

32
entry at any time of the day.

4.5%
Mornning
Time of light entery

Afternoon
44.5%

Number of house holds

15.6%
Both

3
NO sun light entery at all 5
.
4
%
0 10 20 30 40 50
Perentage

Figure:2.6- Time of sun light entry and adequacy of light among residents of MelkaJebdu, Dire
Dawa,Ethiopia,December , 2007 E.C.

33
PART THREE

6. Maternal and child health condition

Table 3.1: Maternal and child health conditions of Melkajebdu kebele 01, Dire dawa Ethiopia,
December/2007 E.C

Description Measurement

Freq. Percentage

Presence of abortion in the past 18 months Yes 3 4.35

No 66 95.7

Recurrent abortion 1 33.3

Total (15-49yrs) of women reproductive age group 418 100

Number of pregnant mother 13 3.1

Pregnant mothers Had ANC visit 10 76.9

Had No ANC visit 3 23.1

Total 13 100

Maternal death within the past 18 Yes 0 0

months
No 66 100

Total 66 100

Mothers who gave birth within the Yes 50 12

past 18 months
No 368 88

Total 418 100

Among the 418 women of childbearing age on this study population 3(4.35%) had a history
of abortion which is spontaneous and of them one is recurrent in the past 18 months. Out of the
total 13 pregnant mothers during the study period 10(76.9%) of them were visited ANC clinic at

34
least once and 3(23.1) had no ANC visit. There were no maternal mortality, but there were 49
deliveries during the past 18 months.

87.76
90

80

70

60

50 43 frequency

40 percent

30

20 12.24
6
10

0
Home delivery Health
institution
.

Fig 3.1-: Delivery services provided for pregnant women by place (providers) at MelkaJebdu,
Dire dawa, Ethiopia, December. /2007 E.C).

Concerning place of delivery among 49 deliveries in the past 18 months most of them 43
(87.76%) were delivered at health institution and the rest 6(12.24%) were delivered at home.

35
 TBA TTBA Health professional

0%

10% 2%

88%

Fig 3.2-: Birth Attendant in MelkaJebdu,Diredawa, Ethiopia, December 2007 E.C

Among the total 49 deliveries within the past 18 months 43(88%) were delivered in the health
institutions and all were assisted by health professionals the remaining 6(12.2%) delivered at
home, of them 5(10.2%), and 1 (2%) were assisted by trained and untrained traditional birth
attendants respectively.

Table:3.2- Age of women related to marriage and giving birth in MelkaJebdu ,Dire dawa ,
Ethiopia,2007 E.C

Description Frequency Percentag

e

Women in reproductive age (15-49 years) 418 21.9

<15 years 45 13.9

15-18 years 162 50

Age at marriage in years >18 years 117 36.1

Total 324 100

<15 years 18 6.2

15-18 years 127 43.8

36
Age of women at first birth >18 years 145 50
in years

Total 290 100

According to this study 45(13.9%),162 (50%) , and 117(36.1%) of women who are in
reproductive age marriage at the age of ,less than 15years, 15-18 years and greater than 18 years
respectively. Considering age of women at first birth at melkajebdu, 18 ( 6.2%) are below 15
years,127 ( 43.3%) between 15-18 years and 145 (50%) are above 18 years.Concerning family
planning respondent among reproductive age group 19(4.55%) clients were started using family
planning in the past six month, 8(1.9%) clients are discontinue and 18(4.3%) clients are currently
using family planning. Among women respondents of age group 15 to 49 who took TT as
TT1:61, TT2:49,TT3:41, TT4:4 and TT5:12 in the past six, which implies that 25 % of them
have taken TT2 and above in past six month.

37
Part four

Child health

180 170
165
160
160

140

120

100 94 95
90
75 M
80 71 70
F
60
T
40

20

0
started breast exclusively breast fed started
feeding with in 1 hour birth to 6 supplementary 6-9
months

Figure:5.1- Initiation of breast feeding within one hour, Exclusive breast feeding ,and Initiation
of supplementary feeding in MelkaJebdukebele In 2007E.C

There are 85 infants and 206 under 5 year children (socio demographic characteristics are shown
in table) According to this survey ,from a total of 206 under 5 children about 170(82.5%) got
exclusively breast feed up to 6 months ;and of this 165 (80.1%) of them started breast feeding
within one hour of birth. When we see supplementary breast feeding 160 children (77.6%)
started between 6-9 months.

Table 5.1 - type and frequency of harmful practice among under5 children in
Melkajabdukebele,Dire Dawa,Ethiopia,December,2007E.C

HARMFUL TRADITIONAL M F T %
PRACTICES

ovulectomy and tonsillectomy 13 6 19 9.22

milk tooth extraction 10 6 16 7.7

traditional scar On eye lid 1 0 1 0.49

38
female genital mutilation 0 0 0 0

Total 24 12 26 17.41

Among under 5 children 19(9.22%) , 16(7.7%) undergone tonsillectomy /uvullectomy and milk
tooth extraction respectively in the past six months .But there is no FGM practice in the past 6
months

70

60

50

40

30 percent
57.64

20
34.12
29.41 30.59
10

0
have immunization haven’t started have completed
card immunization card immunization immunization

Figure 5;2- Percent of presence of immunization card and initiation and full immunization
status in infants in Melka Jebdu kebele in 2007E.C.

From Eighty five children in 308 households 49(57.64%) of them have immunization card and
25(29.41%) have no cards , at the same time about 26(30.59%) completed immunization in the
past 6months.

39
 70
61.18
60 54.12 52.94
49.41 48.24
47.06 45.88
50
40
percentage

40 36.47 0
1
30
2
20 3

10

0
polio penta valent Rota virus
type of vaccine

Figure 5:3 EPI coverage in melka jebdu kebele in percentage Dire Dawa Ethiopia,
December,2007E.C

More than half of children 52(61.18%) have taken polio 0,46(54.12)polio 1, 42(49.41%) polio 2
and 31(36.47%) polio 3.Forty five (52.94%) of under one children who took BCG vaccine 43
(50.59%) of them have BCG scar.Additionally 45 (52.49%) of under one children took
pentavalent1 ,40 (47.06%) PV2 and 34 (40%) PV3. Rota virus vaccine 1 is given for about 41
(48.24%) and, 39 (45.88%) rotavirus vaccine2 of study children.

Among children aged between 2months – 5 years 58 children (28.16%) took PCV1 ,53
(25.73%) PCV 2 and 46 (22.33%) PCV 3. From the participants children of under one year 26
(30.59%) of them took Measles vaccine.

40
 Part six

Birth and death recording

Table 6.1: Birth and death event in melkajebdukebele Dire Dawa,Ethiopia, 2007 EC

Description

frequency percentage

male 23 1.2%

Number of total death in the family female 16 0.84 %

total 39 2.04%

Male 27 50.9 %

Number of live birth female 23 43.4

Total 50 94.4%

Number of still birth 3 5.6 %

Number of death less than one month 1

male 1.2%

female 1 1.2%

Total 2 2.4%

Number of death between one month up to 1 1.17%

twelve months
male

female 1 1.17%

41
Total 2 2.35%

Number of death between one up to five years 1

male 0.8%

female O 0

Total 1 0.8%

Number death between 6-14 years male

1 0.18 %

female 2 0.36%

Total 3 0.54%

Number 15-49 years 0.9%

male 9

female 6 0.6%

Total 15 1.5 %

Number of death above 50 years Male 8 5.2 %

female 7 4.6%

Total 15 9.8%

From the total of 1908 studied population there are 85 under one year , 121 one up to five years
,995 between 15 up to 49 years and 153 person above fifty years .

From a total 1908 studied population there were 39 deaths male23 (1.2%) and female16 (0.84%).
Among those ,number of still birth were 3 (5.6%) ,number of death below one month 2
(2.4%)male 1(1.2%)and female 1(1.2%),number of deaths from one month up to twelve month
were 2(2.35%) male 1(1.17%) and female1(1.17%),number of death between one up to five
years were 1(0.8%) male, number of death between six up to fourteen years were 3(0.54%) male
1(0.18%) and female 2(0.36%),number of deaths between 15 up to 49 were 15(1.5%) male

42
9(0.9%)and female 6(0.6%),number of deaths above fifty were 15 (9.8%)male8 (5.2%)and
female 7(4.6%).

Part six

Mortality and death event

25
23
21
20

15 14 14
12
11 Male

10 9 9 female

7 total
6
5
5
3

0
Under five between one Between Among adults
children upto tewelve tewelve upto
month fifty nine month

Fig-6:1-Percentage of diarrheal disease within the past two weeks in

melkajebdukebeleDireDawa, Ethiopia, 2007EC.

Out of 308 studied household there were 67 diarrheal cases in past two weeks. Among those
cases 23 (11.1%) were under five, 12 (14.1%) were between one up to twelve months, 11 (9%)
were between twelve months up to fifty nine months and 21 (1.83%) were among adults.

43
 350

308
300
265

250

200
Household response regarding RX
child with diarrhoea in number
150 Frequency

100

50 34

86% 11% 4 1.30% 5 1.60% 100%

0
Health Tradition ORS Religious Total
center

Fig 6.2:Treatment choice of child with diarrheal disease in melka jebdu kebele ,diredawa
,Ethiopia 2007EC.

Among children under age five who had diarrhea in the two weeks preceding the survey, the
percentage for whom advice or treatment was sought from a health facility or provider,
traditional healer, religious, and attempt to treat or manage at home with ORS, 2007 E.C

Mothers of children with diarrhea in the two weeks preceding the survey were asked what was
done to manage or treat the illness .Out the respondents regarding treatment choice of a child
with diarrhoea, majority 265(86%) were go to the health centre followed by traditional
medicine34 (11%), religious 5(1.6%) and attempt to treat at home with ORS 4(1.3%).

44
Table 6.2: Among adults who had diarrhea in the two weeks preceding the survey, the
percentage for whom advice or treatment was sought from a health facility or provider,
traditional healer, religious, and attempt to treat or manage at home with ORS,2007 E.C

Treatment option Number of adult with Frequency

diarrhea

Health centre 265 86%

Tradition 35 11.4%

ORS 8 2.6%

Religious 0 0

Total 308 100%

Out the respondents regarding treatment choice of an adult person with diarrhoea, majority
265(86%) were go to the health centre followed by traditional medicine35 (11.4%), and ORS
8(2.6%)

80
70
70

60

50

40
percent

30
20
20
10
10

0
malaria pnumonia others

F ig 6.3: Among person in the family with other disease in the past two week in
melkajebdukebele Ethiopia 2007EC.

45
From the total studied households there were 40 persons with other disease in the past two
weeks. Among those 8(20%) were malaria, 4 (1o %) pneumonia and others 28(70%).

The number of house hold who has said they have handicap person were 14 and the number of
handicap person was 18.

Table 6.3: Frequency of handicap in melka jebdu kebeledire dawa, Ethiopia 2007EC

description Measurement

Frequency Percentage

Blindness 4 22.2 %

Deafness 4 22.2 %

Both blind and deafness 1 5.6 %

Mental retardation 2 11.1 %

Hand or limb amputation or 2 11.1 %

paralysis

Others 5 27.5 %

Total 18 100 %

From the total studied households there were 18 handicaps .among those blindness and deafness
each were 4 (22.2%), mental retardation were 2 (11.1%), limb amputation 2 (11.1%), both
blindness and deafness were 1(5.6%) and others were 5(27.5%).

Table 6.3: Causes of handicap among melka jebdukebele Dire Dawa Ethiopia 2007EC.

Description Measurement

Frequency Percentage

Accident 6 33.3 %

Conginental 2 11.1%

Idiopathic 10 55.6 %

Total 18

46
Among those handicaps majority 10 (55.6%) were due to idiopathic cause, followed by accident
6(33.3%) and congenital 2 (11.1%)

350
303
300

250

200

frequency
150

100

50
5
0
health facility traditional medicine

Fig 6.4 Treatment choice when people get sick in melkajebdukebele diredawa Ethiopia
2007E.C

Out of the total studied households regarding preference of care or treatment when they got sick,
majority 303 (98.4%) were go to health centre and only 5(1.6%) were go to traditional medicine.

47
10.DISCUSSION
Environmental health

According to EDHS 2011 report on cooking unit of urban area about 49% use separate building
while in Melka Jebdu kebele 73% of households use separate building unit for cooking their
food which is higher than 2011 EDHS report but of 227 households with separate building for
cooking only 35 percent have chimney for exit of smoke.

Cooking and heating with solid fuels can lead to high levels of indoor smoke, which consists of a
complex, mix of pollutants that could increase the risk of contracting diseases. Solid fuels
include charcoal, wood, straw, shrubs, grass, agricultural crops, and animal dung.

According to this survey, the great majority (95 percent) of households in malkajabdu primarily
use solid fuel for cooking which is higher than EDHS 2011 report(85%) in urban area and this
can be result in long term health impacts of forest degradation and flooding. Wood is the main
type of cooking fuel, used by 83 percent of households. In addition to wood, charcoal and
electric are important types of cooking fuel in melkajabdu 01 kebele; 12 percent of households
use charcoal and 4 percent use electric for cooking

In the finding, the availability of toilet in MelkaJebdu 01 kebele is 85.4%. Among those having
toilet, Pit latrine is the most common which accounts 85.2% and the remaining are pit latrine
without slab 7.6%, ventilated improved pit latrine (VIP) accounts 5.7% and Water flush 1.5%.

Of 308 respondents, 45 (14.6%) have no toilet at all and they use other options like open field
and share with neighbors 24(53.3%) and 21 (46.7%) respectively.

Concerning type of toilet facility ,More than 92.4% respondants in melkajebdukebele use
improved toilet facilities that are not shared with others but only about 14 percent of urban
households in Ethiopia use improved toilet facilities that are not shared with other households.
According to EDHS 2011 One in ten households (32 percent in urban areas and 3 percent in rural
areas) use shared toilet facilities, But in our finding only 7 percent of households have shared
toilet facilities. The large majority of households, 82 percent, use non-improved toilet facilities
(91 percent in rural areas and 54 percent in urban areas).

The most common type of non-improved toilet facility is an open pit latrine or pit latrine without
slabs, used by 45 percent of households in rural areas and 37 percent of households in urban
areas. Overall, 38 percent of households have no toilet facility, 16 percent in urban areas and 45
percent in rural areas (1)????

The solid waste disposal way in melka jebedu includes in the resident compound 1.9%, in the
disposal pit 15.6%, dispersing in the field 13.3%, using as fertilizer 8.1%, open field 8.1%, put
in out of compound 1.0%, by municipality 47.1% and others 4.9%.

48
 According to our finding the most common source of water is pipe water in the compound
which accounts 59.1% and other sources include bono pipe, from neighbor which accounts
30.8% and 10.1% respectively

In our finding about 59% of households have water source in their premises which is piped tape
water but nationally only 13 percent of households have water on their premises.

Households not having water on their premises were asked how long it takes to fetch water.
Since they fetch from neighbor and bono, no house hold responded that it takes more than 30
minutes. That is all of our respondents those have no water source intheir premises fetch less
than 30 minutes but nationally only 30% households (30 percent in urban areas and 36 percent
in rural areas) take less than 30 minutes to fetch drinking water.

Concerning maternal and child heath

Among the 418 women of childbearing age on this study population 3(4.55%) had a history of
abortion in the past 18 months. Out of the total 13 pregnant mothers during the study period
10(76.9%) of them were visited ANC clinic at least once. There were no maternal mortality
during the past 18 months, but there were 49 deliveries. According to this finding the ANC
coverage is about 76.9%. This figure showed a much better service utilization as compared with
the national figure, which accounts only 34% of pregnant women who gave birth, received ANC
care from a skilled provider (EDHS, 2011).

Among the total 49 deliveries within the past 18 months 43(88%) were delivered in the
health institutions and all were assisted by health professionals and the remaining 6(12.2%)
delivered at home, of which 5(10.2%), and 1 (2%) of them were assisted by trained and
untrained traditional birth attendants respectively. This figure indicated that there is better
delivery service assisted by health professional (skilled provider) when we compare with
national coverage which account 10% according to EDHS 2011.

According to this finding the delivery coverage were about 43 (87.76%) at health institution
and 6(12.24%) is home delivery. This figure showed a much better service utilization as
compared with the national figure, which accounts only 34% of pregnant women who gave birth,
received ANC care from a skilled provider EDHS, 2011.

The most important nationwide barrier to access to health services that women mention is
taking transport to a facility (71 percent), followed by lack of money (68 percent) and distance to
a health facility (66 percent) as cited by the same study.

According to this study 45(13.9%), 162(50%), and 117(36.1%) of women who are in
reproductive age married at the age of <15years, 15-18 years and >18 years respectively . This
indicates that there were early marriage in Melka jebdukebele 01.Considering age of women at

49
first birth at melka jebdu, 18 (6.2%) are below 15 years, 127 (43.3%) between 15-18 years and
145 (50%) are above 18 years. Whereas according to EDHS 2011,9 percent of women age 25-49
have given birth by exact age 15, and 38 percent have given birth by exact age 18. More than
half (58 percent) of women have become mothers by exact age20. Whereas only 1 percent of
women currently age 15-19 gave birth by exact age 15, the corresponding proportion for women
currently age 45-49 is 12 percent. The percentage of women who gave birth by exact age 18 is
almost half as high for women age 20-24 as for women age 40-49 Age at first marriage has a
major effect on childbearing because women who marry early have on average a longer period of
exposure to the risk of pregnancy and give birth to a greater number of children over their
lifetimes.

According to our surveillance among reproductive age group 19(4.55%) clients were started
using family planning in the past six month, 8(1.9%) clients are discontinue and 18(4.3%) clients
are currently using family planning. When we compare our study with EDHS 2011 regarding
women using family planning, our study shows 18(4.3%), whereas the EDHS 2011 report were
29% nationally.

Concerning tetanous toxoid vaccination among reproductive age group 106(25.4%) were took
TT2+. Whereas according to EDHS report in 2011, the TT2+ coverage national wide was
48%.Therefore there is low TT coverage in melka jebdu kebele.

Concerning child healh

World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) recommend
that all mothers should breastfeed their children exclusively for the first 6 months and thereafter
they should continue to breastfeed for as long as the mother and child wish, and both appropriate
and sufficient weaning food should be added after six months of life.

Initiation of breastfeeding in the first hour and in the first 24 hours after birth varies by
Background characteristics. Breastfeeding within one hour after birth was more common in
urban areas (57 %) than in rural areas (51 %)[Assessment of exclusive breast feeding practice
and

Associated factors in Mecha district, North west Ethiopia Tesfa Getanew Woldie1
AddisuWorkineh Kassa3, Melkie Edris 2014] There was also considerable variation by
region.Initiation of breastfeeding within one hour was lowest in the Amhara and Somali regions
(38 percentand 40 percent, respectively), and highest in the SNNP and Dire Dawa regions (67 %
and66 %, respectively). According to EDHS 2011 Fifty-two percent of infants started
breastfeeding within one hour of birth, and 80 percent,within the first day.Similarly our survey
show 165 (80.1%) of them started breast feeding within one hour of birth.UNICEF and WHO
recommend that children be exclusively breastfed during the first 6 months of life and that
children be given solid or semi-solid complementary food in addition to Continued breast
feeding from age 6 months until 24 months or more, when the child is fully weaned. WHO

50
estimates that worldwide only 35% of children between birth and their fifth month are breastfed
exclusively Exclusive breastfeeding during the first six months after birth is not widely practiced
in Ethiopia.Currently, mothers exclusively breastfeed approximately half of children under six
months (52 percent). But our survey shows about 170(82.5%) exclusively breast feed up to 6
months which is higher than EDHS .

All children age 6-9 months, in contrast, should receive complementary foods. However, only
half of children age 6-9 months (51 percent) received complementary foods the day or night
preceding the survey. 77.6% of under five children started supplementary breast feeding
between the age of 6-9 months in Melkakebele which is higher than national one.

Immunization coverage is one of the indicators used to monitor progress towards the
achievement of MDG4 and the reduction of child morbidity and mortality, as it is one of the
most Cost-effective public health interventions for reaching these goals. According to guidelines
developed by the World Health Organization, children are considered fully vaccinated when they
have received a vaccination against tuberculosis (BCG), three doses each of the DPT and polio
vaccines, and a measles vaccination by the age of 12 months.

Data from the EDHS generally show vaccination coverage to be lower than data in the service
statistics from the Ministry of Health. As for coverage for specific vaccines, 66 percent of
children had received the BCG vaccine, and 56 percent had received the measles vaccine [EDHS
2011]. But in this survey among children of under one year 45(52.94%) took BCG vaccine and
26 (30.59%) of them took Measles vaccine. from children who took BCG vaccine 43 (50.59%)
of them have BCG scar.

A relatively high percentage of children received the first DPT dose (64 percent). However, only
37percent went on to receive the third dose of DPT,reflecting a dropout rate of 43 percent.
Similarly, our survey shows pentavalent dropout rates of 24.4% which is lower than national
dropout rate. More than eight children of every ten (82 percent) received the first dose of polio,
but only about four in ten (44 percent) received the third dose, reflecting a dropout rate of 46
percent [EDHS 2011]t. But our survey shows more than half of children 52(61.18%) have taken
polio 0,46(54.12)polio 1, 42(49.41%) polio 2 and 31(36.47%) polio 3 which indicate relatively
lower coverage and approximately equal dropout rate.

FGM occurs mainly in countries along a belt stretching from Senegal in West Africa, to Egypt in
North Africa, to Somalia in East Africa and the Democratic Republic of Congo (DRC) in Central
Africa. It also occurs in some countries in Asia and the Middle East and among Diaspora
communities in North America, Australasia, the Middle East and Europe. FGM is carried out by
communities as part of a past heritage and is often associated with cultural identity.

The age at which FGM is performed in Ethiopia depends on the ethnic group, type of FGM and
region. More than 52.5% of girls who undergo FGM do so before the age of 1 year. There is a
divergence of practice between the north and the south: in the north, FGM tends to be carried out

51
straight after birth whereas in the south, where FGM is more closely associated with marriage, it
is performed later[EDHS 2011].But in our survey there is no FGM practice in under five children
in the past 6 months. It can be due to regional variation of time of mutilation. Concerning
treatment choice or management of a children with diarrhea

According to our study regarding treatment choice or management of children with diarrhea,
86%were taken for advice or treatment to a health facility or provider but according to EDHS
2011 report 32 percent of the children with diarrhea were taken for advice or treatment to a
health facility or provider. When we compare our result from EDHS 2011 mothers health
seeking behavior for children with diarrhea are increased in our studied population.

According to EDHS2011, Twenty-six percent of children with diarrhea were treated with ORS.
But our result shows that only one point three percent(1.3%) of children were treated with ORS.
So our studied population has less awareness regarding treatment of diarrhea with ORS
compared to EDHS.

According to EDHS 2011 prevalence of diarrhea among under five children in two weeks
preceding the survey in Diredawa were seven point eight(7.8%) but in our study prevalence of
diarrhea among under five children were eleven point one( 11.1%).These shows that in our
studied area there were an increased number of diarrheal cases compared to Diredawa in
general.

52
11.ACTION PLAN

11.1. Problem identification

We identified health problem of the Melkajabdu kebele community using primary and secondary
sources. For primary sources, we use interviewer administered questionnaire, observation and
key informants interviewing; and we collect Secondary data’s from health center, kebele health
office,

Based on our assessment we identified the following health Problem

1. Low family planning usage

2. Low TT coverage

3. Lack of appropriate solid waste disposal system

4. Increased prevalence of diarrheal diseases

5. No separate room for animals

6. Presence of rodent and insect in the house

7. Low per capita water consumption

8. Latrine without cover and hand washing facility

9. Poor housing condition

10. poor personal hygiene

11.2.Problem prioritization
Table11.1 : prioritized problems of MelkaJabdukebele community, December, 2007

S.N Problem Score for criterion

o identified
Magnitud Severit Feasibilit Governmen Communit
e y y t concern y concern Tota Ran
l k

53
1 Lack of 5 3 3 5 5 21 !
appropriate
solid waste
disposal
system

2 Increased 5 3 3 5 4 20 2
prevalence
of diarrheal
diseases

3 Low TT 4 4 2 5 2 17 3
coverage

4 Low family 5 1 2 4 4 16 4
planning
usage

5 Low per 4 2 2 4 3 15 5
capita water
consumptio
n

6 Latrine 4 4 2 2 2 14 6
without
cover and
hand
washing
facility

7 Presence of 3 1 2 4 3 13 7
rodents and
insects

8 Poor 1 2 2 4 2 11 8
housing
condition

9 High 3 2 2 2 1 10 9
dropout rate
of

54
 vaccination

10 No separate 2 1 2 3 1 9 10
room for
animals

55
 11.3 Detailed plan of action

Table 11.2: Action plan to be implemented at MelkaJabdu kebele by CBTP group members fromdec 26_jan5 , 2007E.C

Responsible
body
S. Activities Objectives Strategies Place Resource Indicator
No.

1 To demonstrate hand Working with , kebele From all Ketena Group Man power Demonstration of hand
washing facility and health extention members, , (medical students washing facility and
Training for covering of the toilet workes, DDU cafteria health and HEW) covering of latrine
model family extention
on hand To workers , Jerican ,facet,
washing HEW, model tins,wood,nails
facility ,on To December 26-jan 3
2007E.c family
covering of
toilet and dry
west disposal
system
Group
2 Conducting To conduct three Advocacy and Ketana 1,2,3,4,5 Number of sanitation
members,
sanitation community and campaign
sanitation campaign In community Cleaning materials
campaign participation
Melkajabdukebelefrom 6 members and
dec27-janury5 2007 hygiene Microphone
E.C workers Car

3 Deworming To conduct deworming Using Albendazole At school Group Drug, water and Number of students
and School for 1197 elementary compound members, cup dewormed
based on MOH

56
 health and KG students deworming guide line School staff, Poster Number of students who
education health education participate in Health
session for 1849 health center Leaflet education session
students in Melka No 1 Booklets
elementary&Melka
No2 secondary school Using teaching Chalk and board
from December 28 -- materials and working
with school director microphone
30,2007E.C
and teaching staffs

Responsible
body
S. Activities Objectives Strategies Place Resource Indicator
N

4 Health To conduct 3 health advocacy In each ketene and Group Banners Number of health
education at education session to health center members, education session
community the community in Demonstration community, , marker
and health Melka Jabdu town in Involving community HEW, and booklet
facility level each ketene and health leaders kebele health
center from office
december28– janury 6
2007E.C

5 To construct To construct urinal Coordinate with - Group Observation Number of urinal

urinal latrine latrine and drinking health center and MelkaJabdukebele members checklist latrines constructed
near public establishment in kebele health office
gathering MelkaJabdukebele
site(bus from december -

57
station) 27.janury 5 2007E.C

58
Responsibilities of concerned individuals

table: shows the responsibilities of the concerned bodies

Group Key Woreda Health School

members informants health office center

Effective use of Campaign Community Drugs, Organize

man power and announcement. initiation for Material the students
time. the action. and for
Motivate and resource deworming
Giving health organize Resource supply. and health
education. communities supply. education
for action. follow up
Preparing Follow up of and Arranging
sanitary the coordination classes and
campaign. continuation for the teaching
of the continuation materials
Implement the program.
planned action. of the
program Arranging
Mobilizing the site for
communities taking
for medication
environmental
activities.

Activities to ensure Sustainability

1.Detailed discussion with kebele administration, community leaders and other key informants

2.Meeting with school teachers and director

59
12.Work plan

Table :12.1 Working plan to be implemented at MelkaJabdukebele by group 1 members from

decenber 20-Jan8, 2007E.C

S. December and January (dates)

No.
Activities 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

1 Community
diagnosis

2 prepare
action plan

3 Discussing
with
stakeholder
s and
preparing
necessary
materials
needed for
implementa
tion

4??? Digging
?? common
solid waste
disposal pit

5 Health
education
at health
facility

6 Health
education
at
commmuni
ty

60
7 Deworming
and school
health
education

8 Conducting
sanitation
campaign

9 Urinal
latrine
constructio
n

10 Monitoring
and
evaluation

11 Report
writing and
submission

61
 13. Implementations
After we have done our identification of health and health related problems, we planned to take
actions on the different problems by promising them based on their severity, magnitude,
Governmental and community concerns

Panel discussion with key informants and the kebele leaders

62
For the successful accomplishment of our plan we need the involvement of the different bodies.
To get those bodies we decided as it was expected to communicate with the kebele
Administrative bodies and arrange penal discussions for us with the key informants those that
able to initiate and mobilize the communities. On Tuesday 28/04/2007E.C at 4:00AM we talked
with the Deputy Chief Executive Of the kebele in his Bureau on how to get the different key
informants and we have finished our talk with him by promising as he can get the following
bodies at 9:00PM and as we can discuss with them. The bodies that were expected to attend the
discussion were;

1. The keble health extension workers

2. Religious leaders
3. Chief Executive of the kebele
4. Head of health office of the kebele
5. The kebele youth association representative
6. The kebele sanitary and beauty association representatives
7. “Edir”leaders
8. Trade network representative

According to our appointment we met with the above bodies and present our findings to them,
and discuss with them how to solve the identified problems.

The numbers of participants that attended the panel discussion were 13 males and 10 females.
The participants raise different questions on our findings and we answered their questions.

Finally we have concluded our panel discussion by obtaining different constructive ideas and
comments on our findings and promising them to do with us for the accomplishment of all our
planned activities. We have also arranged three days for sanitary campaign at ketena one on
Friday 01/05/2007, ketena two on Monday 04/05/2007 and at village four on Tuesday
05/05/2007E.C.We also agreed that as they can mobilize the community one day prior to the date
of the sanitary campaign using Mega phone, one to five structures.

63
Sanitary campaign

From the problems that we have obtained solid waste disposal was one.Considering its effect on
health we planned to perform three sanitary campaigns in this kebele and discuss with them on
how, how many times, when and where to do the sanitary campaigns.

First sanitary campaign

64
Our first sanitary campaign was held on 01/05/2007E.C at ketene one by mobilizing the
community. Thenumbers of participant during the sanitary campaign were 14 males and
38females totally 52. This campaign was so good.

65
Second campaign

The second sanitary campaign was held on 04/05,2007E.C at ketena two again by mobilizing the
community and collaborating with the members of Melkajebdu kebele sanitation and beauty
association. A total of 105 people were participated in the campaign of which 70 were females
and 35 were males.

66
Third sanitary campaign

Our final (3rd) sanitary campaign was held on 05/05/2007E.C at village four around the health
center. This was the most successful sanitary campaign from the other two campaigns. The
numbers of participants during this were 141 of which 80 females and 61 were males. Different
governmental bodies were involved during this sanitary campaign like; Keble Deputy Chief

67
Executive, the kebele communication branch,keble health office Executive,kebele health
extension workers and others.

160
141
140

120
105
100
80 male
80 70 female
61
60 52 total

38 35
40

20 14

0
ketena one ketena three ketena four

Figure 13.1: number of participants in the community campaign in melkajebdu kebele

DireDawa,Ethiopia,2007E.C

68
69
Fig:- Third sanitary campaign

School campaign
A) Deworming
According to our finding, observation and secondary data from the health center which shows
helmenthiasis, diarrhea, and malnutrition are among top 10 diseases, and we assured that there
was no deworming campaign done in the past six month. All these things obligated us to
undertake deworming campaign

Based on this, we planned to get medication for deworming from the health center and the health
center promised to give us the medication based on their stock.

Having this in mind we went to the kebele education coordinator to get the number of students
from KG to grade 4 in each school which is around 1300 considering the stock of drug for
deworming.

At the same time, they gave us a letter of permission to communicate with school directors of 3
schools (i.e,Melka No 1 &2 and Getesemani) and arrange time for giving medication.

Accordingly the health center allowed us the medication assigning health extension worker as
responsible body.

70
At the end we under took the deworming based on the scheduled time for 1230 students.

Table13.1 number of students dewormed in melka jebdu kebele schools ,dire

dawa,Ethiopia,2007

Number of students Total Plan Achievement

s.no (%)
School
Male Female
1 MelkaNo’1&KG 260 190 450
2 Melka No’2 365 330 695
3 Getesemani 30 55 85
Total 655 575 1230 1300 94.6%

71
 B) TT vaccinnation
As justified by our research and secondary data from the health center TT vaccination coverage
is much lower than national EDHS 2011.so that after passing through similar procedure as for
deworming we planned to give TT vaccine for female students who are above 15 years old in
Melka No’1 secondary school.

In advance, extensive awareness creation and sensitization about the need of taking vaccine and
its use for about 1032 students while they were on the queue up at the flag ceremony in the
morning session and the TT vaccine was provided for 130 female students who are volunteers.

72
73
74
 Health education
According to our study solid waste disposal, toilet usage, poor personal hygiene, TT vaccination
and family planning are major problem of melka jebdu community. As it is known health
education is key for solving the above problem and bringing behavioral change, we decided to
give health education at schools ,health center and the community.

Strategies used during planning

1. information was gathered on the following issues

1.1. The community and its general physical characteristics
 Localization of existing schools, religious institutions, market places,
recreational facilities, health facilities and other public and private services
were identified
1.2. The communication network
 formal and informal channels, who the participants are in those channels, the
communicators and their effectiveness were identified
 We observed how various leaders communicate their ideas and opinions and
noted to what extent their messages are accepted.
1.3. Religion and its impact on health
 the major religious groups in the community, their leaders & their roles in the
community life were identified
1.4. Health beliefs and practices
 Efforts were made to know how people define good health and disease, and
their
 Methods of waste disposal.
 Their local attitudes and practices regarding personal hygiene and
environmental sanitation were observed
2. Defining and prioritizing problems
 Based on our research
 Secondary data from health center (i.e. top ten diseases….

75
  Key informants(religious leaders, CHEWs, head of health center, kebele
administrators, and focal persons)
 observation
3. Objectives of Health Education
 create awareness on the seriousness of the problem
 creating behavioral change

4. Recourses
 Schools, Health center, Key informant sand social gatherings were identified
and skilled health Extension workers were invited, 25 liter jarycans were given
by Dire Dawa University cafeteria
5. Selecting appropriate Method
 Demonstration, posters, family planning materials(models) ,training
manuals, guidelines.
 Appropriate method in consideration with their culture and languages
(Amharic, somaligna, Affan Oromo) were used depending on the participants
languages to aid on their understanding.
6. Ethical considerations
- Basic ethical principles were followed
 The principle of autonomy
 Beneficence (doing well)
 Non-malfeasance (doing no harm)
 Justice (fairness)
 The principle of truth telling (honesty) and we tried to consider all the Ethical
considerations.

76
1. School health education
 Permission letter given to school director from education coordinator office.
 Communicate the school director and fix appointment date and time toconduct the
health education.
 Select topics depending on top 10diseases at health center and observation during
data collection

First we communicate with school director and talked about our objectives. Then we observed
the general cleanness of the compound, classrooms, latrine, waste disposal area and general
waste management.

To prevent the occurrence of health and health related problems in the school environment we
conducted health education on personal and environmental hygiene and use of TT vaccine for the
students.

77
School health education on use of TT vaccine

Table13:2 school health education at Melka Jebdu primary and secondary school

78
Topics Participants
Material used Students Teachers
Total
M F M F

 Personal hygiene  Microphone,

 Environmental  leaflets, and
Hygiene  posters 578 454 8 7 1047
 TT vaccination

Table 13.3: school health education at Melka Jebdu number two, Getesemane and Toawod
primary schools.

Topics Participants
Method Material used Students
Total
M F

 Personal and Lecture and  posters

environmental demonstration  water and soap
 hygiene and 482 502 944
demonstration of
hand washing

79
 2. Health education at health facility
 Communicate with representative of head of the health centre about the health education
at that facility.
 Assign subgroups
 Select topics depending on top 10 disease and on low coverage activity of the health
center like family planning,TT Vaccination,and hand washing and latrine utilization.

We provided health education in melkajebdu health center for a total of 208 individuals during the
morning for five days. We also recommended the health center personnel to continue morning health
education service in a scheduled manner.

80
: health education at melka jebdu health center

81
Table 13.4 health education in melka jebdu health center diredawa Ethiopia,2007

Topics Method Material Participant

used Male Female Total
Sanitation, personal hygiene and Lecture Poster 22 30 52
waste management discussion
Family planning methods and Lecture Poster 45 79 124
TT vaccination discussion Models

Latrine utilization and hand washing Lecture and 9 23 32

discussion
Total 76 132 208

Community health education

At the end of the campaign the collected dry waste was burned and finally health education
was given on proper use of latrine and dry waste disposal for a total of 298 participants who were
involved in the sanitation campaign, among those 110 were males and 188 were females

82
Table 13:5 community health education at Melka Jebdu in ketenaDire dawa 83Ethiopia,2007

Topic Place Delivered Session Methods Remark

to used
Proper use of Ketena 1 52 Morning Discussion
latrine and Ketena 2 105 4:00am to
dry waste Ketena4 141 4:30am
disposal

83
Total 298

Training
Training on proper use of latrine , presence and use of hand washing facility and solid waste
disposal was given on 04, 05.2007 EC in the afternoon at melkajebdu health center for 51 model
community members selected from each ketena by the ketena health extention workers. Initially
it was planned to train 58 participants from the six ketenas but only 51 were involved because of
being absent to arrive at the site, we lost the rest of the community members.

84
Table 13:6 Number of trainees on proper use of latrine and dry waste disposalDIREDAWA
ETHIOPIA’,2007

Ketenas Participants Total

M F
Ketena 1 1 7 8
Ketena 2 1 8 9
Ketena 3 1 7 8
Ketena 4 0 9 9
Ketena 5 1 7 8
Ketene 6 0 9 9
Total 4 47 51

For demonstration and training we used locally available materials like jerican, syringe, wood,
tin, soap, facet and water. Trainees were well demonstrated and among them selected individuals
were allowed to redemonstrate the activity for the rest of the trainers and each trainee received
one jerican to demonstrate for 5 members under them at home

After two days we visited the trainee’s households with health extension workers and most of
them were participated the hand washing materials and we advised them to transfer the
innovation for at least 5 members.

Home visit

Home visit were conducted in 60 households .A total of 273 individuals participated in the health
education, out of these 71 were males and 202 females. At time visiting health education was
given which focus mainly on:

 Environmental sanitation
 Family planning
 Antenatal care

85
  Exclusive breast feeding and complementary feeding
 Immunization and
 Communicable disease control (like RTI, and diarrheal disease). During health education
we used different teaching methods like counseling, discussion with demonstration.

Inspection of food and drink Establishments

Food and Drinking establishment existed in Malka Jebdu 01 kebele were inspected. Before
inspection was conducted the group members got supporting letter for concerned body from
malkajabdu health center and the food and drinking establishment was assessed according to
standard check list. From 21 food and drinking establishment, 15 (6 bakery, 4restruants and 5tea

86
houses) were inspected. Additionally those establishments which are not licensed by kebele were
also inspected and health education given.

During this time the identified problems and action taken was listed as follow

Common Problems identified in the 1st visit

 Food Handlers have no gown and hair covers while working

 Some FDE have no three dish washing systems
 Some food handlers have no medical check-up certificate
 Some FDE have no Latrine Hand washing facility and latrine cover
 Most FDE were with poor cleanliness of floor and roof
 There is no proper handling of utensils and shelter for storage eating utensils

Action taken during and Post Inspection

 Advice was given for the owners/responsible person of FDE

 Onsite Health education for Food Handlers on identified problems
 Possible suggested solution was given on identified problems

After 5 days of first visits the second visit was conducted for checking up corrected problems.
Accordingly, during the second visit the most FDE have been correcting their problems,
especially like hand wash facility for their toilet, proper handling and management of utensils
and cleanliness of roof and floor were improved. For those still improving their problems
recommendations were given.

87
1. Three dish washing after inspection 2. Making ceiling

88
89
13.1 Strategies
During survey and analysis

We all the group members who are assigned at Melekajebdukebele in order to conduct survey
from December 20/-January10/2007E.C arrived there on Monday morning at 3:00AM.As it is
the first day of our work we introduce ourselves to the head of the health center. Three of our
representatives communicate with the melkajebdukebele administrative and collect data about
the number of households. Then we calculate our sample size to be342 out of 3131 households
and select systematic random sampling methods as our sampling technique. We mark all the
households first then we select the first house hold bylottery method which house number 07 in
every 10 interval we are going to collect the data by dividing our groups in the 10 subgroups
within 6 ketenas.In each subgroup the students were assigned by paired them who speak
oromiffa language with other who can’t. All member of the group are responsible for
interviewing 17 households.

Data analysis was done by manually, Excel and some parts by SPSS software.

To accomplish our action plan we have classified into sub groups and responsibilities were given
accordingly.

Conducting sanitation campaign

- Subgroup which have 5 members.
- Panel discussion with kebele administrative and key informants
- Arrange 3 days program for sanitary campaign
- site selection and community mobilization was performed
- the three sanitary campaigns were successfully done

Deworming and School health education

- Permission letter given to school director from the kebele educational office
- Arrange the date of deworming
- Before deworming education was given about it
- 1230 students were dewormed in 3 schools
-
Health education at school

90
 - Permission letter given to school director.
- Communicate with the school director to fix the date and time to conduct the
health education.
- conducted health education on personal and environmental hygiene and use of
TT vaccine for the students.

Health education for community

- At the end of the campaign health education was given on proper use of latrine
and dry waste disposal for a total of 298 participants who were involved in the
sanitation campaign
Health education at health facility

- Communicate with head of the health centre about the health education at that
facility.
- Assign subgroups
- Select topics depending on top 10 disease and on low coverage activity of the
health center like family planning,TTVaccination,and hand washing and latrine
utilization.
Home visit
- Assigned groups containing 4 members
- Health education focus mainly on:
 Environmental sanitation
 Family planning
 Antenatal care
 Exclusive breast feeding and complementary feeding
 Immunization and
 Communicable disease control (like RTI, and diarrheal disease).
During health education we used different teaching methods like
counseling, discussion with demonstration.

91
 Inspection of food and drink Establishments
- The assigned members prepare checklist
- Took permission paper from the kebele

15 licensed and some non-licensed were inspected

13.2 summary of planned activities with their corresponding achievements

S.N Activities plan Achievem Achievement in Hand over Remark

o ent percent for
sustainability
to
1 Disposing cumulated sold 2 sites 50 Kebeleadmin Diredawa
wastes at the outskirts of istration municipality is
01 kebele - raedy to provide
track as soon as
the loader is found
from promised
organization
(pioneer cement )
2 Sanitation campaign 03 03 100 Kebeie,HEWs Written
,HCs recommendation
given for
responsible bodies
3 Health education 8 session 8 session 100 Hc,HEWs “
4 deworming 1300 1230 94.6 “ “
5 TT vaccination 160 134 83.7 “ “
5 Inspection of Food and 17 15 88 Kebele “
drinking establishment health
coordinator,
HCs ,DDHO
6 Urinal latrine construction 1 60 Kebele -urinal pit prepared
administerati and
on Materials are on
process to be
procured

92
7 Hand washing facility and 51 model 50 100 HEWs recommendation
toilet cover family given for
demonstration for model responsible bodies
family

16.Monitoring and evaluation

MONITORING

 While doing intervention based on our action plan we conduct monitoring through:-
 By asking questions and redemonestration
 Observation using checklist and home visit
 Directly attending interventions
 Meetings held at the end of sessions

Evaluation

 Evaluation was done using activities performed and indicators set in the action plan.
Generally, we can say that our intervention was accomplished as scheduled with
succession rate of 96.6 %

14.STRENGTH AND LIMITATION

Strength
 Commitment of group members to perform the activities.
 Well organized group
 Different educational back ground and work experience of the group members
 Strong relationship with concerning bodies such as Health Center, community leader
 Team spirit and good time management
 Involvement of governmental structures
 Involvement of community leaders, religious leaders and one to five network in
implementation programs

93
  good achievement of activities which are planned

LIMITATION

 Investigator bias
 Shortage of time
 Bulkiness of the questionnaire
 Language barrier
 Deficit financial resource

15.CONCLUSION

According to our study at melka Jebdu kebele, the sex distribution is almost equal in proportion.
As far as religion and ethnicity is concerned majority of the population are Muslims and Oromo/
Somali respectively along with other religions.Majority of the houses are built of corrugated iron
sheet,wall is made of blockets and plastered and cement floured. Most of the households have
one up to two doors, and their windows are single, opened occasionally and arranged
unidirectionally for ventilation. Almost all of the houses visited are without emergency exit
doors and their kitchens are separated from the main rooms, majority using firewood for cooking
purposes.

Greater part of households has latrine facility (85%), but mostly without hand washing
availability (77%). Those without latrine facility (53%) practice open defecation which is an
ideal breeding ground for disease causing microbes.

About 59% of households we visited own solid waste collection unit and disposed off by
municipality workers. The flies,mouse, mosquito and bed bugs are the most widely distributed
insects and rodents. On the basis of MCH about 77% of pregnant women have followed ANC
and around 88% delivered in health institutions with the aid of trained health professionals.
Regarding family planning utilization at the kebele only 4.5% of reproductive age group started
using family planning service in the past six month.

94
Even though there is good coverage of TT1, TT2, and TT3, on the other hand there is very low
coverage of TT4 and TT5. More than 82% of under five children started exclusive breast
feeding upto six month.

16. Recommendation

To Melkajebdu health center:

 Should inspect food and drinking establishments and perform regular medical checkup
for food handlers
 Provide regular health education in their facility
 Conduct regular outreach program on immunization
 Conduct regular supervision and monitoring
 Assist and motivate health extension workers
 Should coordinate and participate in the weekly sanitation campaign conducted by the
community.

To health extension workers:

 Should give regular health education on proper use of latrine and demonstration of hand
washing facility, toilet cover by using locally available materials within the community.
 Mobilize community to conduct sanitation campaign on regular bases
 Should assist and support the households to dig dry waste disposal in their compound
 Should give regular TT vaccination in the community
 Should educate the community members on personal hygiene environmental sanitations

To- Melka jebdu kebele administration:

 Construct communal latrine and create sustainable awareness on proper use of the latrine.
 Integrate with HEWs to Mobilize community to conduct sanitation campaign on regular
bases
 Construct common dry waste disposal sites.
 Provide appropriate and relevant information

95
  Give suitable intervention to the main problem of the community
 Strengthen the structural organization developed in the community
 Protect illegal common sites used by community for dry waste disposal

To -Dire Dawa university:

 Provide stationary materials and other resources to facilitate CBTP activities.

 Prepare temporary resident area for the students at their attachment site.
 Provide standardized and familiarized questionnaire paper relevant to local community.

REFFERENCE

1.

2. Ethiopian demographic and health survey (EDHS), 2011

96