Community based education for health sciences.ppt

Community based education ppt.

1. COLLEGE OF HEALTH AND MEDICAL SCIENCE Assessment of Health and Health Related Problems and Intervention Plan Development to Improve the Health Status of t he Community in Kebele 18 of Hakim W oreda , Harar Town, Eastern Ethiopia COMMUNITY-BASED TRAINING PROGRAM 1 8/22/2024

2. OUTLINE Introduction Objectives Methodology Results and Discussion Conclusion & Recommendation Acknowledgements References 2 8/22/2024

3. Background Community based education (CBE ): is an approach of teaching and learning that starts with the local and addresses critical gaps in contact with the community . ( Smith & Sobel , 2014 ) CBE has 3 main components: CBTP, TTP & SRP. ( Karunathilake & Kristina, 2022 ) CBTP is designed to train health science students about community diagnosis; to identify the problems related to health in the community to apply the theoretical knowledge into practice ( Tadesse et al ., 2013 ) 3 8/22/2024

4. Statement of the problem Globally, it is believed that most of the disease are due to lack of sanitation and inadequate water supply, illiteracy and low health service ( Wolde et al ., 2019 ) Ethiopia is one of the developing countries, different factors like lack of professional commitment and lack of awareness about problems of improper waste disposal system leads community to have low health status ( Gelaw , 2014 ) 4 8/22/2024

5. Cont’d… Around 80% of disease in Ethiopia are communicable in nature . Among the major sanitation related problems, diarrhoeal disease account 46 % of under-five child mortality ( Begashaw , 2019) Worldwide, 358,000 women die during pregnancy and child birth every year and an estimated 7.6 million children die under the age of five ( Gultie et al ., 2016 ) 5 8/22/2024

6. Cont’d… Most pregnant women in Ethiopia don’t receive ANC . Similarly, children suffer from different diseases inherited from the mother during pregnancy or delivery and low immunization coverage ( Atif et al ., 2016) As estimated by WHO mental health contribute 8.1% in the global burden of disease. Consistent with this finding previous study done in Ethiopia showed that mental illness contributes 12% of burden of disease ( Fekadu et al ., 2019) 6 8/22/2024

7. Cont’d… Available evidence showed that substance use has been dramatically increased, particularly in developing countries. The life time prevalence of substance use is 13.1% for cigarette smoking and 26.7% for chat chewing. ( Aragie et al ., 2021 ) Despite the above facts, there is no similar previous study conducted in the current study area. Thus, this study aimed to assess health and health related problems and set an intervention plan to improve the health status of the community in kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia. 7 8/22/2024

8. Significance of the study It can be used to identify the major health problems of the community, to prioritize the top health problem of the area and intervene accordingly. T his study findings can initiate the population in such away that the community would be able to solve their own problems as well as organizing themselves. For the students: to d evelop team work spirit, tolerance, problem solving ability and helps to learn time and available resource management. 8 8/22/2024

9. Objectives General Objective To assess health and health related problems and to set intervention plan to improve the health status of the community in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. 9 8/22/2024

10. Specific O bjectives To assess socio-demographic status of participants in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess housing condition among HHs in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess kitchen condition among HHs in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess latrine coverage among HHs in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess sanitation practice among HHs in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. 10 8/22/2024

11. Cont’d … To assess solid waste disposal system among HHs in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To identify the form of water supply among HHs in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess the family planning utilization among women aged from 15-49years in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To determine the prevalence of abortion in the past 12 months in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess ANC follow up coverage among pregnant women in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess TT vaccine coverage among women aged from 15-49years in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. 11 8/22/2024

12. Cont’d… To determine the prevalence of morbidity among HHs in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess the awareness of individuals about mental illness in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess the awareness of individuals about epillepsy in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. To assess the practice towards psychoactive substance use among HHs in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. 12 8/22/2024

13. Methodology Study area and period The study was conducted in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia from August 10-11, 2024. Harar is a capital city of Harari regional state & East Hararge zone. It is found at 525km east of Addis Ababa. Harar town has 6woredas. Hakim woreda is one of this town’s woreda & it has 3kebeles. Kebele 18 of hakim woreda possesses 6 menders. For this study, two menders; Werwari & Mekasha were selected purposively based on HEW’s recommendation. 13 8/22/2024

14. Cont’d… Study design A c ommunity-based descriptive cross-sectional study . Source population All households found in Kebele 18, Hakim woreda Study population All households found in Werwari & Mekasha menders, kebele 18, Hakim woreda Study unit Household 14 8/22/2024

15. Cont’d… Inclusion and Exclusion Criteria Inclusion criteria Individuals who were above 18 years and able to provide information. Residents who lived for greater than 6 months in the area Exclusion criteria Respondents who were severely ill. 15 8/22/2024

16. Cont’d… Sample size determination The required sample size was determined using single population proportion formula by considering 95% CI, 5% margin of error, 10% non-response rate & taking proportion (p) from similar previous studies done else where in Ethiopia. After all calculation, the maximum sample size (370) which was obtained from FP utilization with p= 32.4% was used for this study. n = (zα/2) 2 * p (1-p) d 2 16 8/22/2024

17. 17 Area of study Study title Prevalence (p) Reference Sample size(n) Environmental health Percent distribution of households by latrine coverage in eastern Ethiopia 26.9 % Kasahun A, 2022 302 Family planning Use of contraception(any method ) among currently married women age 15-49, Harari region 32.4% Merid K, 2020 336 Child health Prevalence of diarrhoeal disease and associated factors among children aged 6 to 59 months in Oda Bultum District, Eastern Ethiopia 7.4% Zewdalem et al ., 2021 296 Table 1: Sample size determination by taking proportion(p) from similar previous studies done in different parts of Ethiopia 8/22/2024

18. Cont’d… Sampling procedure First, required data was collected from HEWs regarding Kebele 18. Kebele 18 has 6menders & we selected two menders purposively based on HEW’s recommendation. T hese two menders ( Werwari & Mekasha ) have 1094 HHs in total Then to include HHs in the study, we used systematic random sampling technique with K-value of 3 (K=1094/353=3) The first HH was selected randomly by using lottery method and then every three interval, next HHs were included. In case if selected HH was closed, we revisited once again; again if closed after one visit, we used next HH for the sample. 18 8/22/2024

19. Cont’d… Data Collection Method Data collection tool A Semi-structured interviewer administered questionnaire was used. Data collection technique D ata was collected by undergraduate summer students through face to face interview and o bservation . 19 8/22/2024

20. Variables Socio-demographic factors: Age, sex, religion , marital status, occupation, educational status and family monthly income . Env’tal health related conditions : Housing condition, kitchen condition, latrine coverage, sanitation and hygiene practices, solid waste management, & water supply. Maternal health related conditions : FP utilization, abortion , ANC & PNC utilization and TT vaccination . Morbidity and mortality status : Prevalence of diarrhea and etc . Mental health related conditions : Perception about mental illness and epilepsy . 20 8/22/2024

21. Cont’d… Operational Definitions Adequate illumination of the house: is said if when standing in the middle of the room, one can read a pencil written word with at least 12 letters ( Osibona , 2021 ) Good compound cleanness : r elative state the compound with no visible dirt, pleasant for eyes, yard free of any solid and liquid waste, trash and tidy living space and habit of achieving and maintaining that state cleanness . 21 8/22/2024

22. Cont’d… Data quality control Questionnaire was read carefully & understood by all students before data collection was started Collected data were checked immediately after data collection for completeness and consistency there was also close supervision by immediate supervisors. Data processing and analysis Data was coded and tallied manually on tally sheet prepared by team members Then tallied data was counted & changed into frequency Finally, percentage was calculated and results was presented using texts, tables and figures 22 8/22/2024

23. Materials/Instruments used Pen/pencil Staples Ruler Plaster Chalk Marker Graph paper/flip chart Notebook Eraser, Mobile, etc. 8/22/2024 23

24. Cont’d… Ethical consideration Ethical a pproval letter was obtained f rom H U, CHMS and Cooperation letter was written & submitted to respective local administrative offices. D ata were collected under full consent of the community, community leaders and Kebele administrators. Data were collected in accordance with their willingness and the study households were informed clearly during data collection that the information they gave would be kept strictly confidential. All ethical issues were strictly given a great emphasis. The right, privacy, dignity, language and cultural taboos were respected . 24 8/22/2024

25. Cont’d… Dissemination of the results The results obtained from this study will be submitted to HU, CHMS, CBE office and will also be reported to stakeholders to make use for intervention. 25 8/22/2024

26. Results and Discussion Socio-demographic characteristics In this study, a total of 353 HHs were included with response rate of 95.4% Among a total of 1513 participants included in this study, 804(53.1%) were male. The male to female ratio was 1:1.13 The mean age + SD of the participants was 21.1 + 12 years Majority (852(56%)) of participants were orthodox About 71% of participants belonged to literate type of educational status. This finding was in line with previous study conducted in Harari region where 71.2 % of participants were literate. ( Assefa et al., 2021 ). 26 8/22/2024

27. Figure 1. Population pyramid by age & sex of participants in Werwari & Mekasha menders, kebele 18, Hakim woreda , Harar town, Eastern Ethiopia, 2024. 27 8/22/2024

28. Environmental health related conditions 1. Housing condition Out of 353 HHs ; majority (44.3%) have two rooms 237(62 %) have one window per rooms, 82(21.5 %) have two windows per room 329((93.3%) have no mechanical ventilation system other than window 268(75.9%%) have no emergency exit. 28 8/22/2024

29. 2. Kitchen c ondition Out of 353 HHs; 296(83.8%) have kitchen. F rom these kitchen, 185(62.5%) were attached to the main house. Majority, 199(67.3%%) of kitchen have no chimney. From 57(16.2%) HHs which have no kitchen, majority(59.6%) of them cook their food in the open field/outdoor. O ut of 353HHs, 197(55.8%) uses wood as a main source of energy for food preparation . 29 8/22/2024

30. 3. Latrine c overage , sanitation and h ygiene practice In our study, all HHs (100%) have latrine; of which, 83% were private and 326(85.6%) were simple pit type of latrine. From 353HHs, majority (286(81%)) of residents use water & soap for their hand washing. This finding was consistent with previous study done in Jimma t own which reported 95.7% of latrine coverage. ( Legesse et al ., 2016) However, our finding was higher than study conducted in Ambo town which reported 82.3% of latrine coverage. (Samuel et al., 2021 ) The observed difference might be due to t he variation in socio-cultural conditions, educational level and economic status of the residents . 30 8/22/2024

31. 4. Solid waste management From 353HHs; 188(53%) did not have temporary solid waste disposal pit; of which, 117(33%) dispose solid waste openly in the field. 271(77%) did not have segregation/sorting system for d/t types of solid waste. This finding was in line with a study done in Asella town which showed 27.2% of HHs with segregation system ( Lema et al., 2019 ) 31 8/22/2024

32. 5. Water supply Out of 353 HHs; 330(93.5%) use public tap water (bono) 320 (90.6%) store their drinking water in “ Jerican ” Regarding daily water consumption, 271(70.9%) of HHs uses more than 40L/day 280(79.3%) did not use any types of drinking water treatment system Regarding liquid waste disposal system, most (325(92%)) of HHs have no liquid waste disposal system. 32 8/22/2024

33. Maternal health related conditions 1. Family planning O ut of 353HHs, 310(87.8%) RAG women heard about FP; of whom, 31.1% & 28.3% heard from mass media & HEWs, respectively. From 310 women who heard about FP; 255(72.2%) are currently using the service while 50(14.2%) discontinued the service due to they need a child (69.1%). Our finding in this case was comparable with previous study done in Arba Minch town which reported 63.4% of women who used modern contraceptive methods ( Sorato M, et al., 2017 ) 33 8/22/2024

34. 34 Figure 2. Types of FP used by RAG women in werwari & mekasha menders, kebele 18, Hakim woreda , H arar town, Eastern E thiopia, 2024. 8/22/2024

35. Cont’d… 2. Abortion O ut of 353 HHs, only 12(3.3%) RAG women had history of abortion in the last 12months; of whom, 9(75%) followed safe abortion at health institution. 35 8/22/2024 Variables Frequency Percentage History of abortion in the last 12months Yes 12 3.3 No 341 96.7 Place where abortion done Health institution 9 75 Home 3 25

36. 3. ANC and PNC follow up Out of 353HHs, 32(9%) women were currently pregnant in the house. All (100%) of those pregnant women were following their ANC 24 (75%) of women know the danger signs during pregnancy and post-partum period The most stated danger signs during both pregnancy and post-partum were excessive vaginal bleeding/hemorrhage (33%) and severe headache (25 %). 105(18 %) of women had taken TT vaccination. 36 8/22/2024

37. Morbidity status In this study, only 7 individuals diagnosed with diarrhea in the past 2weeks; of whom, 5 of them had taken ORS. In this case, our result was lower than previous diarrhea report from Wolkite town (20.7%) ( Wolde et al., 2022), Nekemte Town ( 28.9%) ( Regassa et al.,2008 ) & Arba -Minch district (30.5 %) ( Mohammed et al.,2013 ) This difference might be due to the variation in the socio-demographic, and environmental factors among the study households. 37 8/22/2024

38. Mental health related conditions From 353HHs, 238 (67.4%) of participants had heard about mental illness; of whom, 106(30%) reported that mental illness is caused by excessive substance use like khat , cigarette, & alcohol 63(18%) reported that mental illness is caused by god punishment. Out of 353HHs; 234(66%) of participants reported that mental illness does not transmit from person to person. 252(71.3%) of respondents were life time psycho-active substance users; of whom, 145(57.5%) were khat chewers. 38 8/22/2024

39. Conclusion Generally, from our study findings we concluded that; Most houses have no mechanical ventilation system other than window and emergency exit Majority of kitchens were found without chimney Majority of HHs dispose both solid and liquid wastes improperly Majority of HHs do not have segregation/sorting system for d/t types of solid wastes There was low coverage of TT vaccine among RAG women Majority of the respondents use psycho-active substance like khat throughout their life. 39 8/22/2024

40. Recommendation Based on our current study findings, we recommend w oreda health office and HEWs: To create awareness regarding possible health effect of disposing both solid and liquid wastes improperly, usage of drinking water with treatment and importance of maternal immunization, and its consequences on their health Recommendation for the community; They should have to adapt themselves/make a habit regarding proper disposal of both solid and liquid wastes and also maternal immunization issue. They should have to implement health and health related advice given by HEWs 40 8/22/2024

41. Challenges faced Local administrative offices closed due to weekend time Shortage of time Rain/weather condition Absence of class/space for data analysis as well as presentation Solution taken We took their phone number from somebody & called them accordingly in order to get required data/information for the study We strict ourselves to the time that we have in order to finish given activities on time We used an umbrella & continued our daily tasks We arranged/made sub-groups in order to do data analysis in the dorm & for presentation, we post-pond our schedule. 8/22/2024 41

42. References Abera , T., Abera , D., & Ayele , D. (2016). Knowledge, attitude, and practice of oral rehydration solution (ORS) use for diarrhea management among mothers of under-five children in Gondar, Ethiopia. Journal of Health Sciences, 26(2), 41-49 Alemayehu , F. B., Belay, D. G., & Fentahun , Y. (2021). Perceived Psychological, Economic, and Social Impact of Khat Chewing among Adolescents and Adults in Nekemte Town, East Welega Zone, West Ethiopia. International Journal of Hematology, Oncology and Clinical Science, 12(3), 1-7. Assefa , Nigatu , et al. " Woldia Town Blood Donor Knowledge, Attitude, and Practice: A Cross-Sectional Study." Journal of Blood Transfusion (2020) Gebremedhin, H., Ayele , D., & Woldeamanuel , D. (2015). Household knowledge and practices towards diarrhea management in rural Ethiopia: a cross-sectional study. BMC research notes, 8(1), 1-6. 42 8/22/2024

43. Problem identification and prioritization List of identified problems: 1. Lack of mechanical ventilation system other than window, 329(93.3%) 2. Lack of emergency exit, 268(75.9%) 3. Lack of chimney attached to kitchen, 199(67.3%) 4. Improper solid waste disposal system, 117(33%) 5. Lack of segregation/sorting system for d/t types of solid wastes, 271(77%) 6. Lack of drinking water treatment system, 280(79.3%) 7. Improper liquid waste disposal system, 325(92%) 8. Low coverage of TT vaccine among RAG women, 105(18%) 9. High prevalence of psycho-active substance usage, 252(71.3%) 8/22/2024 43

44. Cont’d… For intervention purpose, we used below five criteria’s to prioritize those identified problems; Magnitude Severity Feasibility Community concern Government concern 8/22/2024 44

45. Table 3. Prioritization of identified problems in Werwari and Mekasha menders of Kebele 18, Hakim woreda , Harar town, eastern Ethiopia, 2024 No Problems Magnitude Severity feasibility Community concern Government concern Total Rank 1 Improper solid waste disposal system 4 4 5 4 5 22 1 2 Improper liquid waste disposal system 5 4 4 4 4 21 2 2 Low coverage of TT vaccine among RAG women 4 4 3 3 5 19 4 3 Lack of chimney attached to kitchens 3 3 3 2 2 13 8 5 Lack of mechanical ventilation system 5 3 3 2 2 15 7 6 Lack of emergency exit 4 2 3 1 2 12 9 7 Lack of segregation system for d/t solid wastes 4 3 5 2 3 17 6 8 Lack of drinking water treatment system 4 4 5 3 4 20 3 9 High prevalence of psycho-active substance usage 5 4 4 2 3 18 5 8/22/2024 45

46. Cont’d… Top five prioritized problems: Improper solid waste disposal system Improper liquid waste disposal system Lack of drinking water treatment system Low coverage of TT vaccine among RAG women High prevalence of psycho-active substance usage 8/22/2024 46

47. Objectives of community action plan General objective To provide promotive and preventive health services on prioritized health and health related problems in community of Kebele 18, Hakim woreda , Harar town, Eastern Ethiopia on August 25 & 31, 2024. Specific objectives To provide HID on proper solid waste disposal system for 1037HHs of Kebele 18, Hakim woreda , Harar town, Eastern Ethiopia on August 25 & 31, 2024. To provide HID on proper liquid waste disposal system for 2880HHs of Kebele 18, Hakim woreda , Harar town, Eastern Ethiopia on August 25 & 31, 2024. To provide HID on the importance of drinking water treatment for 2482HHs of Kebele 18, Hakim woreda , Harar town, Eastern Ethiopia on August 25 & 31, 2024. To demonstrate on how drinking water can be treated by different methods in 10 sessions for community of Kebele 18, Hakim woreda , Harar town, Eastern Ethiopia on August 25 & 31, 2024. 8/22/2024 47

48. Cont’d… To provide HID on utilization of TT vaccine for 931 RAG women by 20 sessions in Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia on August 25 & 31, 2024. To provide HID on the effect of using psycho-active substances for 2234HHs by 100sessions in community of Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia on August 25 & 31, 2024 . 8/22/2024 48

49. Table 3 : Community action plan for intervention of prioritized problems in community of Kebele 18 of Hakim woreda , Harar town, Eastern Ethiopia on August 25 & 31, 2024 . Prioritized problem Activity Strategy Target population Responsible body Unit of measurement Plan   Achievements N o Percent 1. Improper solid Waste disposal system HID -Community mobilization -Using lesson plan Community of kebele 18 Team members Session 52(1037HHs) 2. Improper liquid waste disposal system HID -Community mobilization -Using lesson plan   >>   Team members   Session 100(2880HHs) 3. Lack of drinking water treatment system HID -Community mobilization -Using lesson plan >> Team members Session 80(2482HHs) Demonstrations Community mobilization Using locally available H2O treatment methods Team members Session 10(100HHs) 4. Low coverage of TT vaccine among RAG women HID     -Mobilization -Using lesson plan RAG women Team members Session 20(931HHs) 5. High Prevalence of using psycho-active substance HID   -Community mobilization -Using lesson plan Community of kebele 18 Team members Session 100(2234HHs) 8/22/2024 49

50. Acknowledgements We would like to thanks; HU, CHMS, CBE office for providing us such practical based learning approach Our immediate supervisors for their consistent guidance, comments and support during this program 8/22/2024 50

51. THANK YOU!!! 8/22/2024 51