HARAR HEALTH SCIENCE COLLEGE

COMMUNITY BASED TRAINING PROGRAM

ASSESSMENT OF COMMUNITY HEALTH AND HEALTH

RELATEDPROBLEM AND INTERVENTION KEBELE 18, IN NOCK SIT,
HARAR TOW, EASTERN ETHIOPIA, 2024 G.C

SUBMITTED TO HARAR HEALTH SCIENCE COLLEGE COMMUNITY

BASED EDUCATION PROGRAM OFFICE FOR THE PARTIAL FOR
FULLMENT OF COMMUNITY BASED TRAINING PROGRAM (CBTP)
COURSE

HARAR TOWN, EASTERN ETHIOPIA

Dec. 2024

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SUBMITTED TO HARAR HEALTH SCIENCE COLLEGE COMMUNITY
BASED EDUCATION PROGRAM OFFICE FOR THE PARTIAL FOR
FULLMENT OF COMMUNITY BASED TRAINING PROGRAM (CBTP)
COURSE

HARAR, EASTERN ETHIOPIA ,DEC.202

ADVISOR: SIRAJ ADAM (BScMPH)

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NAME OF GROUP MEMBERS (NOC SITE)

1 Abdi Abdulla M/w

2 Aswan Mohammed M/w
3 Hanane Abdi M/w
4 Hidaya Eliyas M/w
5 Nujuma Abdi M/w
6 Remaden Alim M/w
7 Remedan Abduraman M/w
8 Roza Sharaf M/w
9 Shamshe Jemal M/w
10 Sittina Muhammed M/w
11 Tigiet Tasfaye M/w
12 Urji Ubeydi M/w
13 Yoseph Daribe M/w
14 Milkeysa Abdella M/w
15,melat Tilahun Anest
16,meron Tsegaye Anest
17 Mohammed Ame Anest
18 Nabiya Dine Anest
19 Radeit Seifu Anest
20 Radeit Tilahun Anest
21 Selam Mesfin Anest
22 Soziet Ibrahim Anest
23 Tamirat Desalegn Anest
24 Tuji Mahdi Anest
25 Yusufe Ahmed Anest
26 Zelalem Derses Anest

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 Table of Contents
Acknowledgement................................................................................................................................................1
ACRONOMY AND ABREVIATION...........................................................................................................................2
ABSTRACT.............................................................................................................................................................3
INTRODUCTION.................................................................................................................................................... 4
1.1 Background..........................................................................................................................................4
1.2 Statement of the Problem..........................................................................................................................5
2 LITRATURE REVIEW............................................................................................................................................8
2.1 Socio-demographic characteristics............................................................................................................8
1.2 Maternal and child Health...................................................................................................................8
2.3 HIV/AIDS Awareness.................................................................................................................................10
2.4 Drug usage and utilization........................................................................................................................10
2.5 Family planning.........................................................................................................................................11
2.6 Child Health............................................................................................................................................12
2.7 chronic illness...........................................................................................................................................13
2.8 Conceptual framework.............................................................................................................................14
3 OBJECTIVE.....................................................................................................................................................15
3.1 General Objective....................................................................................................................................15
3.2 Specific Objectives...................................................................................................................................15
4 METHODS AND MATERIALS........................................................................................................................16
4.1 Study area and period..........................................................................................................................16
4.2 Study Design.............................................................................................................................................17
4.3 POPULATION.............................................................................................................................................17
4.3.1 Source population.............................................................................................................................17
4.3.2 Study Population..............................................................................................................................17
Study Unit...................................................................................................................................................17
Household..................................................................................................................................................17
4.4 Study Variables.........................................................................................................................................17
Dependent variable....................................................................................................................................17
Independent variables................................................................................................................................17
4.5 Eligibility criteria.......................................................................................................................................18
Inclusion Criteria........................................................................................................................................18

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 Exclusion criteria........................................................................................................................................18
4.6 Sample size determination.......................................................................................................................18
4.7 Sampling Technique.................................................................................................................................19
4.8 Data Collection Technique and Tool.........................................................................................................19
4.9 Data Quality Assurance............................................................................................................................19
4.10 Data Processing and Analysis.................................................................................................................20
4.11 Ethical Consideration..............................................................................................................................20
4.12 Dissemination of Result..........................................................................................................................20
4.13 Operational Definition............................................................................................................................20
RESULT................................................................................................................................................................22
Socio Democratic Status.................................................................................................................................22
Enviromental Health Condition......................................................................................................................23
Maternal and child health situation...............................................................................................................26
Family health conditon...................................................................................................................................27
Family drug condition.....................................................................................................................................28
PRIORITIZED PROBLEM.......................................................................................................................................29
DISCUSSION........................................................................................................................................................34
7.2 Latrine (toilet)...........................................................................................................................................34
7.3 Maternal and child health (MCH).............................................................................................................35
7.4. Environmental Sanitation........................................................................................................................35
7.5. HIV/AIDS..................................................................................................................................................35
7.6. Morbidity and Mortality issue.................................................................................................................36
CONCLUSION AND RECOMMENDATION............................................................................................................36
RECOMMENDATION.......................................................................................................................................37
REFERENCE......................................................................................................................................................... 38

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 LIST OF FIGUR
Figure 1. Conceptual framework, which is selected from different literature to assess the major
healh Related problem hakim woreda ,kebele 18,noc site. Harar Eastern Ethiopia, Dec.2024

FIgure 2;map to show location of Harari region ,hakim woreda kebele 18,Noc site

FIGURE 3;- Pupolational pramid of hakim woreda kebele 18 Noc Site, Harar Eastern Ethiopia
2024 G.C

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 LIST OF TABLE

Table 1 - Educational status of Kebele 18 werwari site in 2024………………………………

Table 2 - Number of rooms and windows of Kebele 18 noc site2024…………………………..

Table 3. Opened window, air flow direction, source of energy and Adequacy of light of
Kebele 18 NOC site
2024…………………………………………………………………………………………

Table 4- Purpose of bed net usage of Kebele 18noc site in 2024………………………………..

Table 5 –is there a kitchen in a Kebele 18 in noc site

2024………………………………………….

Table 6 - Separated kitchen, sufficient air and smoke passage out of kitchen of kebele18
NOCsite in 2024
………………………………………………………………………………………….

Table 7 - Availability of latrine and Type of latrine of kebele18 noc site in 2024……

Table 8- Hygiene condition of the compound of Kebele 18 noc in 2024………………….

Table 9. Showing source of water, storage material, Separated jar and Time taken to fetch
water in minutes of Kebele 18 noc site in 2024………………………………………………….

Table 10 showing pregnant ANC , abortion,related death and delivered women with 12
months of kebele 18 noc site in 2024
…………………………………………………………………..

Table 11 Women vaccinated TT and women stop TT of kebele 18 noc werwari site in
2024……………………………………………………………………………………………

Table 12 childern born within past 12 months of kebele 18 noc site in 2024……………….

Table13 under 1 childeren vaccination status in kebele 18 noc site,2024…………………

Table 14, family health condition of keele 18 noc sit 2024……………………………………..

Table15, family drug condition of kebele 18 noc site 2024…………………………………….

Table 16 death with last 12 months in kebele 18 noc site 2024…………………………

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 Acknowledgement

First We Would Like To Harar Health Science College For Giving Us The Chance To Conduct
And Present This Community Based Training Program. Our Heartfelt Appreciation Also Goes
to Our Advisor Mr. SIRAJ ADEM (BSc, MPH) who gave us valuable scientific guidance and
tireless effort to help us prepare the paper and write this paper correctly. We extend our earnest
gratitude to Hakim woreda officials and our population in live hakim woreda in noc site a place
resting during data collection. Last, but not least we would like to thank the residents of Hakim
woreda kebele 18 noc site and Harar Health Office for their collaboration in giving us the
information we needed.

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 ACRONOMY AND ABREVIATION

AIDS: - Acquired Immune Deficiency Syndrome.

ANC: - Antenatal care

OC:- Oral Contraceptives

BCG: - Bacillus Calmete Guerin.

CBE: - Community Based Education.

CI:- Confidence interval

CBTP: - Community Based Training program

DPT: - Diphtheria pertussis and Tetanus.

EDHS: - Ethiopia Demographic Health survey.

EPI: - Expanded Program for Immunization.

FGM: - Female Genital Mutilation.

FP: - Family Planning.

HIV: - Human Immune Deficiency Virus.

MCH: - Mother and Child Health.

MOH:- minester Of Health

OPV: - Oral Polio Vaccine.

TTP: - Team training program

WHO: - World Health Organization.

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 ABSTRACT

Bacground:- Community based education is concerned with the active creation of positive,
nurturing and intentional community. Students are encouraged to actively participate, apply
academic knowledge, concepts and information during accomplishment of this program.
Community based training program is a branch of community based education which is designed
to understand the real community life, community needs and to practice how to identify the real
world environmental problems and help community to solve environmental problems

Objective:- To assess community health and health related conditions of hakim Woreda, kebele
18 in Noc site Harar, Eastern Ethiopia from, 2024G.C

Method :- A descriptive community based cross sectional study was conducted among
Household residents in Hakim Wareda, 18 kebele in noc site, the study participants were selected
using Systematic random sampling method. The source population was total households of
Hakim Wareda, 18 kebele in noc site .The data were collected by using structured questionnaires
through face-to-face interview and observational method.

RESULT Based on our study the total population was 1800 among them 384 households are
48.5% are female and 51.5 % are male. The higher percentage age group 25-29 and lower
percentage of age group 55-59 , half of the houses (50.7%) have more than 4 rooms and among
of the visited 20.8% have more than 4 window(17.5%) educational status of 51.1% of residents
are Degree and above whereas around 5.8% of them are unable to read and write, under age for
education is 0.9% , 101(18.4%) ,primary education, 101 (18.4 %), education 117 (21.3%), and 7
(1%) Kinder garden.

Conculusion;-Most of the house hold in the the kebele 18, noc site had latrine constructed
but most of them hadn’t Attached Hand washing, not Cleanness Compound and Reproductive
age group Low coverage FP
Recommendation: - We would like to recommend the Hakim Wareda , kebele 18, The Kebele must
work with the community to solve the problem of Hand washing Attaching to
Latrine,cleannesscompound and Coverage FP ,To hakim wareda kebele 18, noc site stakeholders should
work to improve community awareness. should have to minimize the proportion and its complication of
the community health related problems

KEYWORD: Community based Training Program, Noc Kebele 18

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 INTRODUCTION

1.1 Background
Community based education (CBE) is concerned with the active creation of positive, nurturing
and intentional community. Students are encouraged to actively participate, apply academic
knowledge, concepts and information during accomplishment of this program.it is a means of
achieving educational relevance to community needs .It consists of learning programs and
learning activities that use of the community extensively as learning environment(1).

Community based practical education strategy are designed on three main problems; which are
community based training program (CBTP) team training program (TTP) and student research
project(SRP). CBTP is a branch of CBE which is designed to understand the real community
life, community needs and to practice how to identify the real world environmental problems and
help community to solve environmental problems.(2)

Community based education (CBE) is introduced to the world in the late 1970’s as a response to
popular demand that education should give service to the society. In Ethiopia, this program was
first started in Jimma University in 1978. The CBE program was first adopted and implemented
in Ethiopia by Jimma University as part of health science education. Currently the whole
University offer the program. CBTP is also another important community based learning activity
that follows the problem solving approach. The program aims to enable students to work as
members of a health team in solving community health problems by applying the knowledge and
skills of one’s profession and integrating these with the knowledge and skills of other member
team program.(2)

Community based training program (CBTP) is one parts of community based education (CBE)
which is designed to train health science students, about community diagnosis to identify the
problems related to health in the community, it provide health science students to apply the
theoretical knowledge in to practical application (3).

The aim of CBTP is defining and understanding the demographic, socioeconomic, and
environmental aspects of the society which are the main determinant of the community health
status. (3)

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 1.2 Statement of the Problem

The world population is increasing at alarming rate. The large population that cannot match the
available resource causes this leads to poverty and other environmental problem, all these
environmental issues. Globally it is believed that most of the disease are due to lack of sanitation
and inadequate water supply, illiteracy and low health service. This issue is especially higher in
developing countries (4).
Neglected populations living under poverty throughout the developing world are often heavily
burdened by communicable and non-communicable diseases, and are highly marginalized by the
health sector due to their limited access to health and social support services. The population
density and diversity of urban communities offers formidable challenges for healthcare delivery
(5).
Ethiopia is one of the developing country in which most of its population (85%) mainly depends
on agricultures. Different factors like lack of professional commitment, population awareness
about the problems of waste disposal, adequate and necessary medical equipment, in accessible
health facility and low health seek behavior leads to the community to have low health status(6).

Communicable diseases, nutritional problems, maternal and child health problems and
prevalence of HIV/AIDS are the major challenging health care related problems in Ethiopia.
Communicable diseases are considered as major causes of morbidity and mortality, as well as
disability in Ethiopia. The high prevalence of communicable diseases in the country is linked to
the poorly developed socio-economic and environmental factors that have been inherent for
centuries. Seventy five percent up to eighty percent of the disease burdens in Ethiopia are
assumed preventable using measures like improving environmental health status and nutritional
interventions (7-9).

The unsatisfactory housing condition which is one of the basic human right, expose the occupant
to extreme heat and cold, noise and invasion by dust, insects and rodents which are important
criteria for good housing condition and found to be associated with communicable disease,
intestinal parasite, pneumonia, TB and mental illness (10).

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It is reported that up to 60 percent of the current disease burden in Ethiopia is attributable to poor
sanitation where 15 percent of total deaths are from diarrhea, mainly among the large population
of children under five. Some 250,000 children die each year. As well as diarrhea, there is a high
prevalence of worm infestations (causing anemia) which have a synergistic effect on the high
levels of malnutrition. This, in turn, impacts on school attendance and level of education attained
(11).

Improved sanitation and hygiene have been shown to prevent disease transmission. Robust
epidemiological studies by Esrey and others when assuming a critical mass of more than 80
percent of adopters demonstrated that, Pit latrines, when used by adults themselves and for the
disposal of infant’s stools, can reduce diarrhea by 36 percent or more, cholera by 66 percent, and
worm infestations by between 12 and 86 percent. Hand washing with soap (or a substitute) and
water after contact with stools can reduce diarrheal disease by 35 percent or more. Eye and skin
infections can be reduced with more frequent face and body washing. Improved water supply is
generally associated with a 15 percent reduction in diarrhea. A combined safe water supply,
sanitation and hygiene can reduce diarrhea by 65 percent (12).

Impact on disease burden due to inadequate and unsafe water, lack of sanitation and poor
hygiene behavior is a complex issue. The occurrence and severity of Hygiene related outbreaks
in endemic areas is greatly enhanced by human behavior with regards the practice of healthy
hygiene. Improvements in hygiene behavior are the most important barrier to many infectious
diseases, because with safe behavior and appropriate facilities, people reduce their risk of
becoming exposed to diseases

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1.3 Significance of the study

As most of health related problems in Ethiopia are preventable. Community health assessment is
an important tool to identify health status, health related problems and factors that could affect
the society’s health. The result of this survey will serve as to identify and take measure on major
health and health related problem of the community. It gives deep understanding about source of
the problem. Which is usefull HHSC, student research team, community found in hakim
woreda kebele 18, noc site, governmental and nongovernmental organization in planning and
implementing programs to solve community health problem. It also crucial to create awareness
in the community so that they can develop problem-solving capacity and develop healthy
behavior that promotes health. This study can also be used as a base line data for further study in
the area.

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 2 LITRATURE REVIEW

2.1 Socio-demographic characteristics

A community based cross sectional study done in Zimbabwe among 308 households’ shows
that 13% had no latrine facilities, 48% had simple pits and 37% had Blair VIP latrines. Over
all 50% of the population were not satisfied with toilet facilities they were using. All the
respondents expressed dissatisfaction with their domestics waste disposal practices with
46.6% admitting to have indiscriminately dumped waste (12). Six percent of households in
Ethiopia use an improved and not shared toilet or latrine facility. The most common type of
toilet facility in both urban and rural households is a pit latrine without a slab or open pit
(41% in urban areas and 55% in rural areas). Overall, 32 percent of households have no toilet
facility at all; they are almost exclusively rural, accounting for 39 percent of rural households
(6)
From study at hakim woreda kebele 17, in 2024 G.C, of respondents from the total of 384-
targeted households with a total population of 1800, all participants were interviewed in this
study; making response rate 100%. The number of female (204) was greater than that of male
(184). And, regarding religious status of study participant’s majority 59% of them are Muslim
followers followed by 34% Orthodox. Concerning marital status of study participants high
proportion of population were 355(56%) married, 153(24%) of them are single, under age for
marriage 99(16%), 19(3%) divorced, and 12(2%) of them are widowed.(5)

1.2 Maternal and child Health

According the study done in Areka Town, Southern Ethiopia; indicates 187(74.2%) attended
antenatal care and 118(63.1%) of them had four or more visits. Proper care during pregnancy and
delivery is important for the health of both the mother and the baby. Antenatal care (ANC) from
a skilled provider is important to monitor pregnancy and reduce morbidity and mortality risks for
the mother and child during pregnancy, delivery, and the postnatal period (within 42 days after
delivery).(11)

The 2016 EDHS results show that 62% of women who gave birth in the five years preceding the
survey received antenatal care from a skilled provider at least once for their last birth. Three in
10 women (32%) had four or more ANC visits for their most recent live birth. Urban women

8
were more likely than rural women to have received ANC from a skilled provider (90% and
58%, respectively) and to have had four or more ANC visits (63% and 27%, respectively).
Eighty percent of births to urban mothers were assisted by a skilled provider and 79% were
delivered in a health facility, as compared with 21 %and 20 %, respectively, of births to rural
women. Afar has the lowest percentage of women whose births were delivered by a skilled
provider or delivered in a health facility (16 %and 15 %t, respectively), while Addis Ababa has
the highest percentages for both indicators (97 % each) (13).
According to the study done in Debra tabor, among the reproductive age group individual,
5(10%) and 4(8%) were pregnant and gave birth in past 12 months respectively. All of them
gave birth in health institution. All pregnant mothers attained ANC services at least one times. 18
numbers of women used contraceptive, of which 12(85.4%) of them used Depo-Provera (15).

A study done on community health and health related problems in Gursum woreda, Fugnan bira
town kebele 03 in May 2013, show that among 74 under 5 children more half of 40 (54%) under
5 are male & the rest 34(46%) are females.(6)

The 2016 EDHS collected information on the coverage of all vaccines among children born in
the 3 years preceding the survey showed that, 39% of children age 12-23 months have received
all basic vaccinations. Sixteen percent of children in this age group have not received any
vaccinations. 69% of children have received the BCG, 73% the first dose of pentavalent, 81% the
first dose of polio, 67% the first dose of the pneumococcal vaccine, and 64 percent the first dose
of rotavirus vaccine. Fifty-four percent of children have received a measles vaccination.
Coverage rates decline for subsequent doses, with 53% of children receiving the recommended
three doses of the pentavalent, 56% the three doses of polio, 49% the three doses of the
pneumococcal vaccine, and 56% the two doses of the rotavirus vaccine (8).

According to the study done in Harar town, kebele 08 in 2013 show that, From 27 total infants
under 1 year, 20 of them have card and 7 of them have no card in this study area. Out of infants
having card, 18 took BCG& polio 17 infants take penta and 11 infants take measles (7).

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In Ethiopia 13% of children under the age of five were reported to have had diarrhea. 11% of
morbidity of children in Harari region is due to the pre valence of fever among children under
the age of five years (10)

2.3 HIV/AIDS Awareness

According to 2011 EDHS, 97% of women and 99% of men between the age of 15-49 have heard
about HIV/ The level of awareness about AIDS in Harari region is high preceded by Addis
Ababa Dire Dawa and Tigray respectively. Among regions that knowledgeable about HIV
prevention method 79% in Tigray,37% in somnali,40% in Harari.As 2011 DHS survey, Harari
region was the third least next to afar and Somali on having comprehensive knowledge about
HIV/AIDS.(13)

According to EDHS 2016 coverage of HIV testing services among women and men age 15-
49. More than half of women and men (56% and 55%, respectively) had never been tested.
Most respondents who had been tested said that they had received the results of the last test
they took. Overall, 40% of women and 43% of men had ever been tested and had received the
results of their last test. Four percent of women and 3% of men had been tested but did not
receive the test results (10).

According to the study done Meta woreda Chelenko kebele 02 Ketena 03 and 04 from May 6-7,
2014.From the total household that responded to have awareness about VCT 201(81%) says it
benefit it to know oneself while 78 respondent say it is important to care for the future. Out of
total households 200(70.6%) had HIV test but the remaining 8.3(29.4%) where not tested before
(12)

2.4 Drug usage and utilization

A research conduct at Gondar University on student’s shows, among students who practice self-
medication 72% obtained drugs from the pharmacy or drug shop without prescripition, 5.9%
from their friends, 3.6% from drugs leftover from prior use and the remaining 8.5% from plant

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(traditional medicine). Majority of the students 43.2%. Obtained drugs by the physician and
with prescription. A study done on community health and health related problems in Gursum
woreda, Fugnan bira town kebele 03 May 2013 showed that, All study population used modern
medicine 100%, about 133(72.7%), 40(21.9%) were brought drug from some hospital /health
Centre and drug shop respectively, however some people 8(4.4%), 2(1.1%) were brought from
community, pharmacy and rural drug vender respectively (15)

A research conduct at Gondar University on student’s shows, among students who practice self-
medication 72% obtained drugs from the pharmacy or drug shop without prescription, 5.9% from
their friends, 3.6% from drugs leftover from prior use and the remaining 8.5% from plant
(traditional medicine). Majority of the students 43.2%. Obtained drugs by the physician and
with prescription (14)

2.5 Family planning

In Ethiopia Current Use of Family Planning More than one-third (36%) of married women age
15-49 use any method of family planning—35% use a modern method and 1% uses a traditional
method. Injectable are the most popular modern method (23%), followed by implants (8%),
IUCD (2%), and the pill (2%). The use of any method of family planning by married women has
increased more than fourfold from 8% in 2000 to 36% in 2016. Similarly, modern method use
has increased fivefold from 6% to 35% during the same time period. As shown below the percent
of modern family planning in Harari is 29 % (4)

The use of modern family planning methods among reproductive women has increase from 6%
in 2000 to 35% in 2016. Demand for family planning increase from 45% to 58% in the same
period (1)

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 2.6 Child Health

2.6.1 . Breastfeeding and the introduction of complementary food Breastfeeding is very

common

in Ethiopia, with 98% of children ever breastfed. WHO recommends that children receive
nothing but breast milk (exclusive breastfeeding) for the first six months of life? Over half (52%)
of children under six months I n Ethiopia are being exclusively breastfed. Infants should not be
given water, juices, other milks, or complementary foods until six months of age, yet 10% of
Ethiopian infants under six months receive complementary foods. On average, children
breastfeed until the age of 25 months and are exclusively breastfed for 2.3 months.
Complementary foods should be introduced when a child is six months old to reduce the risk of
malnutrition. In Ethiopia, 51% of children ages 6–9 months are eating complementary foods. (5)

According the study done in Areka Town, Southern Ethiopia; shows that proper positioning of
mother and infant during breast feeding was poorer among 38.1% of respondents. Also 29.1%
of them shows poor attachment while breast feeding

In Ethiopia, 58 % of infants under 6 months are exclusively breastfed. Contrary to

recommendation by WHO that children under age 6 months should be exclusively breastfed, 17
% of infants 0-5 months consume plain water, 5 %, each, consume non milk liquids or other
milk, and 11 % consume complementary foods in addition to breast milk. Five percent of infants
under age 6 months are not breastfed at all (10).

According to the study done in Harar town, kebele 16 in 2014 show that, Among the total of 166
under 5 children, 98(59.04%) were exclusive breast feeding up to 6 month and 120(72.29%)
were started complementary feeding at 6 month of age (13).

Among this only there are 7 delivery in the last 12 month with 4 male & 3 females. There is no
any recorded death was occurred in the last 12 month . The Infant and Young Child Feeding
(IYCF) practices recommend that breastfed children age 6–23 months be fed four or more other
food groups daily. Non-breastfed children should be fed milk or milk products, in addition to
four or more food groups. IYCF also recommends that children be fed a minimum number of

12
times per day.* However, only 4% of breastfed children in Ethiopia are receiving four or more
food groups daily and are receiving the minimum number of feedings and just 5% of non-
breastfed children are being fed in accordance with IYCF recommendations.(2)

2.7 chronic illness

A systematic reviews and meta- analysis of evidence was conducted a large population of
women around the world suffer from chronic diseases including mental health diseases. In united
states alone, over 12% of women reproductive age suffer from a chronic medical condition,
especially diabetes and hypertensions. Chronic disease significantly increases the odds for poor
maternal and new born outcomes in pregnant women(5)

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 2.8 Conceptual framework

This conceptual framework developed based up on the literature review above. The arrows in
thediagram show the relationship between Outcome Variable and independent variables as
depicted.
Enviromental condition
Maternal and Child factor factor

Family planning Waste disposal

ANC coverage Laterine coverage

Vaccine coverage Water source

Prevalence of abortion

Community health
and health related
Problem

Socio Demograpic Factor

Age

Sex

Occupation

Marital Status

Educational status

Figure 1. Conceptual framework, which is selected from different literature to assess the major
healh Related problem hakim woreda ,kebele 18,noc site. Harar Eastern Ethiopia, Dec.2024

14
 3 OBJECTIVE

3.1 General Objective

 To assess community health and health related conditions of hakim Woreda, kebele 18 in
Noc site Harar, Eastern Ethiopia from, 2024G.C

3.2 Specific Objectives

 To assess community health problem

 To identify health related condition of hakim woreda

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 4 METHODS AND MATERIALS

4.1 Study area and period

The study was conducted in Harar town which is the Capital City of Harari regional states which
is located in the eastern Ethiopia. Harar town is found 525 km from away Addis Ababa. The total
population of Harari regional state is estimated to be 232,000. From the total population 62.6%
live in Harar town and the rest 37.4 % live in rural area. The regional state has six urban and
three rural Woreda and further the region is sub-divided into 19 urban and 17 rural Kebele’s.
Hakim wereda having 3 kebele’s, with a total population of 28805 (male 14691 and female
14114). There are a total of 1800 households in kebele 18 Noc. Concerning the health facilities,
there is one health center and three health posts. The total population of Hakim woreda was
28805. Hakim has three kebeles 17, 18, 19. Among three kebeles we selected kebele 18.
Kebele18 (NOC) has total population 2300, household 1800. The study was conducted in Hakim
Woreda, kebele 18 from December 3, to dec21, 2024 G.C.

FIgure 2;map to show location of Harari region ,hakim woreda kebele 18,Noc site

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 4.2 Study Design

Community based cross-sectional study will be conducted.

4.3 POPULATION

4.3.1 Source population

All population of Hakim Woreda

4.3.2 Study Population

Randomly selected household in Hakim worada Kebele 18 noc site

Study Unit
Household
4.4 Study Variables

Dependent variable
 Prevalence of community health and health problems

Independent variables
 Socio demographic characteristics:
 Sex and Age
 Marital status
 Occupational status
 Educational status
 Religion
Envaromental Characteristics
o Laterine cover
o Waste disposal
o Water source
Maternal and child Characteristics
o Family planning
o ANC Coverage
o Vaccine covarage
o Prevalence of abortion

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 o Breast feeding

4.5 Eligibility criteria

Inclusion Criteria
All households for our study at the period a survey will be conducted at kebele 18, Nock site

All person found in sampling households at the period of survey will be include The
householders who exit in their residence area for 6 month and above Respondents >18 years age

Exclusion criteria
 Household who are not willing to give information.
 Individual who is seriously ill and unable to response the question.
 Closed house after repeated visit
The household who does not exit in their residence area for < 6 month

4.6 Sample size determination

The sample size will be calculated by using a single population proportion formula considering
the following assumptions.

n=(Zα/2)2p (1-p)

d2

Where,

p= Prevalence = 50%

Zα/2 = confidence levelat95%=1.96

d= marginal erorr =5%

Therefore, to determine the sample size used by this formula,

n= [(1.96)2 (0.50) (0.5)]

(0.05)2

n = 384

18
 4.7 Sampling Technique

Our site was selected with the help of Harar health Science College, SRT coordinator office. To
select the study subject sytamatic random and simple Random technique was conducted was
started by No. all hauseholds found in noc site. Since the total number of households in Hakim
Woreda kebele, 18 in Noc is 1800 HHs and Final sample size is 384.

K=N/n (sampling fraction)

K= 1800/384

=4.68 =5

The first household will be selected by using lottery method

4.8 Data Collection Technique and Tool

Data was collected using well organized questioner, door to door interview and by observation of
relevant information regarding the study population. Data was collected by Kebele 18 noc site
assigned students of M/w and ANEST As tool for data collection we used questionnaires that
were prepared in English version by Harar Health Science College, Konbo collecter software
was used.

4.9 Data Quality Assurance

Before data was collected, all group members discussed with supervisor on the questionnaire to
have common understanding about the intended data to be collected and prepare the sampling
frame. In each group, individuals who speak different language are distributed to avoid language
barrier. Each HHSc are coded after interview to avoid repetition. Then the group members
checked collected data for completeness, accuracy, clarity, and consistency at the end of each
working day. Any confusion on the data collection procedure and/or responses was handled
timely. We used kobo software collecter, Exell 2010 and SPSS

19
 4.10 Data Processing and Analysis

After data will be checked for incompleteness and inconsistency, edited. Checked data also
entered to Excell 2010 software and analyzed. Descriptive statistics was computed manually and
using computer to determine the prevalence of health related problems and other variables. The
findings is presented by text, tables and graphs.

4.11 Ethical Consideration

Official letter was obtained from HHSC community based practice coordinator office and
submitted to Hakim woreda kebele 18, before beginning the study. Verbal consent was obtained
from each respondent or households for participation in the study. Privacy and 16 confidentiality
were insured during the interview, and name of the interviewee were not recorded in the
questionnaire. Clear explanation about the objective of the study was done. During the collection
of data, we students respect the local language, culture, belief, and any aspect of the community
in order to obtain adequate and relevant information about the survey. After the collection was
finished, the questionnaires were structure and handled appropriately.

4.12 Dissemination of Result

The study result will be submitted to Harar health Science College, Hakim Woreda, kebele 18
Administration office. Any other organizations that request the document will be receive a
softcopy kebele Administration as found as necessary.

4.13 Operational Definition

 Closed home: If a house is closed during 3 time visit.

 Traditional birth attendant: birth attendants who attends birth out of health institution.
 Skilled birth attendant: Birth attendants who attend birth in the health institution with
scientific skill and knowledge.

 Solid waste: are all non-liquid wastes of the community surrounding its household sand
agricultural areas.

20
 Environmental sanitation: the control of all, biological, social and physical factors.

 Community diagnosis: It is quantitative and qualitative description of health status of

citizen and the factor which influence the health. It identifies problem in proposes area for
improvement and stimulate action

 . Health status: The health condition of the community, assessed on morbidity, mortality,
disability and utilization of health services.

 4.13 Limitation

Constraint of time

4.14. Problem faced

Respondents home is closed most of the time

Language barrier

4.15. Measures taken to solve the problems

We use the time given effectively

We return back when they return to home

21
 RESULT

Socio Democratic Status

Based on our study the total population who are found in kebele 18,noc site was 1800 among
them 384 households are 48.5% are female and 51.5 % are male. The total population who are
found in the household that have higher percentage age group and lower percentage of age group
range from 25-29 year which accounts 11% and from 55-59 year which accounts 2.5%
respectively.

educational status of Kebele 18 Around 51.1% of residents are Degree and above whereas
around 5.8% of them are unable to read and write According to our study, that under age for
education is 0.9% , 101(18.4%) ,primary education, 101 (18.4 %), secondary

education 117 (21.3%), and 7 (1%) Kinder

FIGURE 3;- Pupolational pramid of hakim woreda kebele 18 Noc Site, Harar Eastern
Ethiopia 2024 G.C

22
Table 1 - Educational status of Kebele 18 noc site in 2024.

Level of education Frequency Percentage %

Under age for education 5 0.9%
Unable to read and write 32 5.8%
KG 7 1%

1-8 101 18.4%

9-12 117 21.3%

DEGREE AND ABOVE 281 51.1%

Fomal education but not 7 1.3%

able to read and write

Enviromental Health Condition

Nearly half of the houses (50.7%) have more than 4 rooms and among of the visited 20.8% of
them also have more than 4 window(17.5%).

Table 2 - Number of rooms and windows of Kebele 18 noc site in 2024

Number of classes frequency percentage

1 49 12.8%
2 60 15.6%
3 80 20.8%
>4 258 50.7%
Window frequency percentage
0 32 8.3%
1 73 19%
2 134 34.9%
3 78 20.3%
>4 67 20.2%

Table 3. Opened window, air flow direction, source of energy and Adequacy of light of
Kebele 18 NOC site in 2024

23
Opened window during Frequency Percentage%
surveying

Yes 245 66.5%

NO 139 36.2%
Air flow direction frequency Percentage
One way 32 8.3%
OPPOSITE direction 352 91.7%
Parallel 0 0%
Other 0 0%
Adequacy of light
Yes 300 78.1%
No 84 21.9%

Table 4- Purpose of bed net usage of Kebele 18noc site in 2024

Majority of family sleep freqeuncy Percentage%

On bed 204 53.1%
On floor 179 46.7%

Table 5 –is there a kitchen in a Kebele 18 in noc site 2024

Kitchen frequency Percentage%

Yes 274 71.3%
No 110 28.6%

Table 6 - Separated kitchen, sufficient air and smoke passage out of kitchen of kebele18
NOCsite in 2024

Kitchen separated from living frequency Percentage%

house
Separated 174 45.3%
Not separated 209 30.2%
Adequate window for air
movement
Yes 290 75.6%
No 94 24.4%
Smoke passage out of kitchen frequency percentage

24
Yes 184 48.3%
No 199 51.8%

. Table 7 - Availability of latrine and Type of latrine of kebele18 noc site in 2024

Availability of latrine cover frequency Percentage%

Yes 90 23.4%
No 294 76.6%

Way of utilized
Common 4 1%
Pyrivate 380 99%

Table 8- Hygiene condition of the compound of Kebele 18 noc in 2022

Hygiene frequency percentage

Clean 180 46.9%

Not clean 204 53.1%

Table 9. Showing source of water, storage material, Separated jar and Time taken to fetch
water in minutes of Kebele 18 noc site in 2024.

Source of water frequency percentage

Tap(bono) water 171 44.5%
In the compound water 213 55.5%
Water storage material
Roto 171 44.5%
Jerican/bido 212 55.2%
Other 1 0.3%
Time taken to fetch water in

25
 minute
<15min 249 64.8%
>15min 135 35.2%
Does the storage material have
cover
Yes 357 93%%
No 27 7.0%

Maternal and child health situation

Table 10 showing pregnant ANC , abortion,related death and delivered women with 12
months of kebele 18 noc site in 2024

Mch Present absent

Pregnant women in the house 53 331%
Pregnant mother who has at 34 19%
least 1 ANC
Delivered women with 12 32 352%
months
Table 11 Women vaccinated TT and women stop TT of kebele 18 noc werwari site in 2024

Who is attending you during Frequency percentage

delivery
TTBA 0 0
Health practitioner 32 100%
women’s stop TT vaccine
before finish
TT1 49 92.5%
TT2 45 84.9%
TT3 24 45.3%
TT4 0 0
TT5 0 0

Women’s stop TT vaccine

before finish
Yes 53 53%
No 0 0
Table 12 childern born within past 12 months of kebele 18 noc site in 2024

26
Is there children Life birth Still birth
born with in past
12 month

Yes 32 0

Table13 under 1 childeren vaccination status in kebele 18 noc site,2024

Under 1 childeren vaccinated Frequency percentage

BCG and having scar
Having scar 12 30.8%
Haven’t scar 20 69.2%
Measles
Vaccinated 15 46.9%
Not vaccinated 17 53.1%

Family health conditon

Table 14, family health condition of keele 18 noc sit 2024

Sick person with in past 14 Frequency Percentage

days in family
Yes 30 7.8%

No 354 92.2%
Place family member go 1st
when they sick
Health center 370 96.4%
Traditional healer 10 2.6%
Religious place 4 1.0%
Disabled family member
Present 5 1.3%
Absent 379 98.7%
HIV awareness
Yes 350 91.1%

27
No 34 8.9%

Family drug condition

Table15, family drug condition of kebele 18 noc site 2024

Way of taking drugs when Frequency Percentage

becoming sick
As doctor order 367 96%
As I need 17 4%
Place of getting drug mostly frequency Percentage
Gov’t health center 150 39.0%
Pharmacy 234 60.9%
Shop 0 0
Finishing ordered drug by
doctor
Yes 360 93.8%
No 24 6.2%

Table 16 death with last 12 months in kebele 18 noc site 2024

Death with in 12 months Frequency Percentage

Yes 30 7.8%
No 354 92.2%

PRIORITIZED PROBLEM

Common problems found in the community

28
1. Lack of latrine cover

2. Lack of hand washing facility near toilet

3. Lack of Water treatment

4. Utilization of TT vaccine

5. Utilization of family planning

6. Closed windows

7. Lack of compound hygiene

8. Low rates of HIV testing

8. Lack of smoke flow in the kitchen

9. Use of charkol inside the house

10. Inappropriate solid waste disposal

11. Early marriage

13. Poor medication use

14. Domestic animals

15. Lack of ANC follow-up

16. Problems linked with insects

Identified health problem and priority settings on a community study ranking health problems.
This can be done by using criteria on five point’s scale.

5-Points = very high

4-Points = high
3-Points = moderate
2-Points = low
1-Point = very

CRITERIA TO PRIORITIZE IDENTIFAYED PROBLEM

Table 21- Criteria to problem prioritize of Hakim woreda kebele 18 Noc village in 2024

29
 Top five prioritize problems
Problems Magnitude Severity Feasibilit Gov't Community Total Runk
y concern concern
Low rate use 2 2 2 4 3 13 8
of modern
contraceptives
Low rates of 4 5 4 4 3 20 2
HIV testing
Lack of 5 4 4 3 2 18 4
latrine cover
Lack of hand 5 4 5 4 3 21 1
wash facility
near toilet
Low rate of 5 3 3 4 2 17 5
utilization of
TT vaccine
Inappropriate 4 3 2 4 3 16 6
Solid waste
disposal
Poor 3 4 3 3 2 15 7
medication
use
Low rate of 3 5 2 5 4 19 3
ANC follow-
up

1.Lack of hand washing facility near toilet

2.Low rate of HIV testing

3.Low rate of ANC follow-up

4.Lack if latrine cover

5.Low rate of utilauzation of TT vaccine

Table 22-Action Plan of Hakim woredakebele 18 Noc village in 2004

Probl Object Activit Strate Target Respo Unit of Pl Ti Achiev Perce Re

ems ive y gy group nsible measur an m ement ntage mar

30
 person ement e k
Lack To Install House House Group Hause 40 D
of increse ation to holeds memb hold ec
hand hand of house which er and getting 12
washi washin hand visit don't comm hand
ng g washi hv unity washin
facilit facility ng hand g
y near from facilit wash
toilet y near facility
toilet
Low To Promo Coffe All Group Individ 50 D
rate increas ting e individ memb ual es
of e aware cerem ual er, who 12
HIV individ ness ony comm particip
testin uals regard unity ated in
g who ing and the
underg import extenti cermon
o HIV ance ons y
testing of
underg
oing
HIV
testing
Low To Educat Coffe Wome Group Womes 40 D
rate increas ing e ns in memb particip ec
of e wome cerem reprod er and ated in 12
ANC wome n's ony uctive comm the
follo ns about age unity, ceremo
w-up numbe benefit group extens ny
r who s of ion's
underg having
o ANC ANC
follow
up
Lack To Contra House All Group House 30 D
of Increas cting to house memb holds ec
latrin e and house holds ers who 12
e latrine attachi visit with and gets
cover cover ng out house latrine

31
 usage latrine latrine holder cover
particu cover cover s
larly
from
Low To Giving Coffe Wome Group Women 40 D
rate increas aware e nse memb who ec
of e TT ness cerem with er and attend 12
utiliz vaccin about ony 15-45 extens the
ation ation import age ions educati
of TT to age ance group on
vacci group of TT
ne 15-49 vaccin
from ation
Blood To Blood Every Group Numbe 40
donat decres donati Prepa individ memb r of
ion e on ring a ual ers individ
deaths progra day who ual
caused m fot full fill who
by around blood the donet
blood the donati criteria blood
loss colleg on and
e blood
bag
Green To Fostin Prepa Harar Group Numbe 50
legac make ga ring a helth memb r of
y the green day scienc ers plantes
college legacy for e and
suitabl at green colleg studen
e for colleg legac e ts in
student e y HHSC
s and
lecture
s
Lack To Educat Going Childr Group Numbe 60
of foster ing to the ens memb r of
aware person childre kg found ers childre
nes al n in and in Hi- n who
on helth kinder teachi tech attend
perso in grante ng kg the

32
nal childre s educati
helth n about on
in person
childr al
en helth

DISCUSSION
7.1 Housing condition
In Ethiopia according to EDHS 2016, 65% had one room, 25% had two room and 9% had more
than 3 room. Out of 384 household 12.8% had 1 room, 15.6% had 2 rooms, 20.8% had 3 rooms,

33
and 18% had 4 rooms and above. Out of 384 household 8.3% had no window, 19.0% had 1
window, 234.9% had 2 window, 20.3% had 3 window, 10.7% had more than 4 window. This
difference might be due to study area, period and difference in Living standard of the
community.
According to the survey conducted by the Ethiopian Federal Ministry of Health (EFMOH), ITN
ownership has risen from 42% to 68% from year 2005 to 2015.(24) The 2011 Ethiopian national
malaria indicator survey indicated that 46.9% of households have their own LLINs and 64.5% of
children and 58.6% of pregnant women slept under ITN.In our study utilization of mosquito nets
at the time of the study was very low 55.7%. However, acceptability and willingness to use ITNs
for malaria prevention was very high. Thus, the expanding ITN implementation and increasing
its coverage for malaria control both in urban and rural malarious areas of the country is crucial.

7.2 Latrine (toilet)

According to EDHS 2011 8% of households in Ethiopia use improved toilet facilities 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. There were also some useful achievement records which included access to toilet
facilities that was increased from 10 % to 29 % in 200

In our study, about latrine Hakim Woreda, kabala 18, Noc site, out of 384 household 100% of
them had latrine ,19.8% had water carrigae and 80.2% had pit . Therefore, the difference might
be due to study area and sample size difference.

7.3 Maternal and child health (MCH)

In our study, of the pregnant women living in Hakim Woreda, among 7 women which is 1.48 %
are pregnant and 100 % women have followed ANC once. ANC is high in Addis Ababa which is
94%, therefore, our result shows a great success because of having knowledge and awareness
and 100% of the delivered mother goes to the health institution at the time of delivery.

34
Neonatal and maternal tetanus is still a major public health problem, especially in developing
countries, which can be easily prevented by immunization of childbearing women with at least
two doses of the tetanus toxoid immunization. This systematic review and meta-analysis was
conducted to show the coverage of two or more doses of tetanus toxoid immunization and
associated factors in Ethiopia.

7.4. Environmental Sanitation

According to the Harari regional state result 67.2%HHs has latrine facilityDepending on our
finding, to the data collected on condition of latrine shows from 384households (100%) were had
latrine, from those 19.8 % have water carriage & 80.2% have pit and 90(23.4%) of them have the
covering material while the rest 290(76.6%) do not have the covering material. The difference
might be due to study area, period and difference in Living standard of the community

Based on EDHS 2016, 13% of households have water in their compound and the rest 87 % of the
households get water from outside of their compound (16). In our study we found that 98.9% of
the households get water supply from the pipe and 1% get water supply from the ground. In
CBTP 2024 Kebele 18, 44.8% of the HH doesn’t use water treatment, only 55,2% of HH uses.
Therefore, the difference might be due to study area and sample size difference.

7.5. HIV/AIDS

According to EDHS in 2016 done in regional level, from the total population who were living in
Harar 99.6 % of women and 99.8 % of men have heard about HIV/AIDS and have awareness
about Our survey which has been done in Hakim woreda Kebele 18 Indicates 100% of the
respondents (384 households) had awareness about HIV/AIDS and factors for transmission. This
shows no significant difference between results to EDHS because the society can get information
about HIV/AIDS from similar sources.

7.6. Morbidity and Mortality issue

According to World Bank report in 2016, the CDR in Ethiopia 2009 was 10 per1000 people. In
our study from the 384 sample households(1542 population), the CDR of Hakim woreda Kebele
18 according to our result the CDR were 5 per 1000 people in Kebele 18 in the past

35
12months .This might be due to unimproved living standard which is related to aging and
chronic diseases

CONCLUSION AND RECOMMENDATION

Conclusion
In general, the survey carried out in Hakiem woreda Noc village Keble 18, includes all aspects of
socio demographic status including educational level, marital status, gender, occupational status
and environmental health status, including housing condition status of the kitchen, source of
energy, latrine usage, solid waste management system, water supply condition, concerning about
the maternal and child health status such as ANC, family planning.

Among 384 households. From the whole community survey major 8 problems are identified and
5 major and critical are prioritized. Then we prepared action plan to intervene the first five
prioritized problems. According to the criteria the problems are improper solid waste disposal,
low covering material of latrine, lack of TT vaccination , lack of Hand washing facilities, poor
usage of bed net, low family planning and poor environmental sanitation, was focused.

According to this survey consults that physical characteristics of household’s environments are
important determinants of health status of the household members. In the study area 99.0% of
households use toilet among which 41.9% of them have no hand washing facilities near toilets.
We have also identified that 44.3% of those who do not have Toilet covering tools, which is
risky for health condition of the population.

RECOMMENDATION
To Harar Health Science College CBTP Coordinator

 To improve the questioner

To Hakiem Woreda Noc site kebele 18 residents
 To improve their sanitation washed their hands after latrine.

36
  To make their use of latrine clean and applies covering material.
 To make their way of living better and keep their environment clean.
 To make window for their homes and awareness of bed net usage.
To Hakiem woreda Noc site kebele 18 administration
 To provide regular waste collection system.

 To educate the community about health and sanitation program and work on.
environmental sanitation campaign.
To health extension workers in Hakiem woreda kebele 18 Noc site
 To create/increase awareness on health status of community.
 To create/increase awareness on TT vaccination
 Health extension workers are expected to work hard to promote health of their community
through education and continual follow up.
 The environmental health workers and municipal waste disposal of Harar City need to
work collaboratively with the urban community on how to improve the environmental sanitation.

 The Health Workers have to do their best to prevent maternal and child morbidity and
mortality rates related to different health problems

REFERENCE

1.Department of community Health (DCH). Community- based Training Program Manual part I
Jimma: Jimma Institute of Health Sciences, 1987; 1- 63.

2.Amare A and Temechegn E. education in Ethiopia. A development perspective. Ethiopian J of

Education 2002; 2: 101-106.

37
3.Measure DHS: DHS surveys and national reports on health situations in different African
countries.

4.Ethiopia health demography survey 2011.

5.Helmut K, Zein AZ (editors). The ecology of health and diseases in Ethiopia. Westview Press,
Boulder, USA, 1993; 29-33, 203-204.

6.Ministry of Health. Planning and Programming Department. Health and health related
indicators, 2001/02 (994 EC).

7.WHO (1997) – Health and environment in sustainable development.

8.World Health Organization: Water, sanitation and hygiene standards for schools in low-cost
settings. Geneva: WHO; 200

9.EDHS 2016 report

10.Worrd Bank Reported Estimation Pop[ulation.

11.Assessment of Community Health and Health Related Problems Meta woreda Chelenko
kebele 02 Ketena 03 and 04 from May 6-7, 2014

12.FDRE Ministry Of Water and Energy Urban Sanitation Universed Access Plan 2011

13.Hareri Reional Health Report 2010.

14.To perform WBC count for 10 patient

15.To provide morning health education on selected d topics daily Arategna health center

38