DTTP result power point presentation off

DTTP result

1. Salale University College of Health Science ASSESSMENT OF HEALTH AND HEALTH RELATED PROBLEMS IN DIDA HETO KEBELE, FITCHE TOWN, NORTH SHOA, OROMIA, ETHIOPIA, 2023 By: Group 4 JAN ,2024 Fitche, Ethiopia 1/12/2024 1 community practice in Dida Heto Kebele

2. List of participants sn Name Specialty Sn Name Specialty 1 Nesru ame abdulla Pchn 20 Mesfin abebe welde PH nutrition 2 Rahel reta teferra Pchn 21 Shukuri kedir itaye PH nutrition 3 Regatu bekele tafa Pchn 22 Yirgalem zeleke hailu PH nutrition 4 Shimelis alemayehu Pchn 23 Mitiku terfasa raga Epidemiology 5 Tamene zegeye benti Pchn 24 Shimelis ayele jira Epidemiology 6 Tamirat mogasa chalchisa Pchn 25 Tahir kedir bekeru Epidemiology 7 Tolossa negussie worku Ahn 26 Usman abdela usman Epidemiology 8 Worku daba bali Ahn 27 Waktola aga yemo Epidemiology 9 Yadeta kebede ayana Ahn 28 Mesfin jimma wayesa Reproductive health 10 Yordanos lemma adefris Ahn 29 Mohammed jima tura Reproductive health 11 Milki girma tafa M/microbiology 30 Mustefa kedir gelgelu Reproductive health 12 Muhammednur gebi asaba M/microbiology 31 Samuel melaku gurmessa Reproductive health 13 Rundase gebeyehu feyissa M/microbiology 32 Zinash tamiru keno Reproductive health 14 Tofik adem ahimed M/microbiology 33 Kidist million assefa Mnh 15 Abonesh belay adefris Gmph 34 Mudesir ebrahim kumbi Mnh 16 Adnan yusuf adem Gmph 35 Zinash tadese Mnh 17 Ali lemessa hunde Gmph 36 Marema abe Gmph 18 Aschalew tilahun Gmph 37 Biranu aredo   Mnh 19 Mama amiyo bedaso PH nutrition       1/12/2024 2 community practice in Dida Heto Kebele

3. Outline of presentation Introduction Objectives Methods Results and Discussion Conclusion and Recommendation Limitation of the study Prioritized Problem References Acknowledgment 1/12/2024 3 community practice in Dida Heto Kebele

4. Introduction Background of the study World Health Organization defined health as : “ a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity which include physical fitness, emotional well-being, social relationships, and the ability to cope with daily life stresses.” Community health is also defined as : “ environmental, social, and economic resources to sustain emotional and physical wellbeing. It comprises environmental, mental, maternal, child ,communicable , non-communicable, and nutritional health problems .” ( Svalastog et al., 2017; Holst, 2020 ) 1/12/2024 4 community practice in Dida Heto Kebele

5. Introduction….. Health and health related problems are : a disease or medical illness or an environmental condition that poses the risk of disease or medical ailment or any health problems that occur from a variety of preventable and non-preventable sources which includes physiological, psychological disease and environmental factors. Communicable disease, nutritional problems, maternal and child health problems are the major challenging health care related problems in Ethiopia ( Eshete , Desalegn and Tigu , 2023) 1/12/2024 5 community practice in Dida Heto Kebele

6. Introduction…. A global assessment by the World Health WHO estimated that 24% of the global disease burden and 23% of all deaths were attributed to modifiable environmental factors, including physical, chemical, and biological hazards to human health . The highest number of deaths per capita attributable to the environment was reported for sub-Saharan Africa, primarily reflecting infectious diseases, non-communicable diseases and injuries . (Peters , Nawrot and Baccarelli , 2021 ) 1/12/2024 6 community practice in Dida Heto Kebele

7. Cont.. Globally, 2.3 billion people lack basic sanitation, 892 million people practiced open defecation, 844 million people lack basic drinking water, and 2.5 million people lack improved sanitation ( Berhe et al., 2020 ) Lack of sanitation contributes to about 10% of the global disease burden, causing mainly diarrheal diseases. Improved sanitation has significant impacts not only on health, but on social and economic development, particularly in developing countries (O, 2014). 1/12/2024 7 community practice in Dida Heto Kebele

8. Cont.… Shortage of storage materials, lack of alternative waste disposal options, household attitudes, poor housing condition and lack of awareness were the challenges for low performance of solid waste management practices of the local government and households in many parts of Ethiopia ( Abegaz , no date; Gizaw et al., 2019 ) Majority of the above-mentioned health and health related problems are evident in Fiche town. However , assessment, identification, prioritization of health challenges & well-articulated comprehensive health and health related study is limited in study area. 1/12/2024 8 community practice in Dida Heto Kebele

9. Cont.… This DTTP is designed to systematically and scientifically assess, identify gaps, analyze and prioritize community health needs for further intervention in the area. T he findings obtained from this study guide community directed interventions to solve the identified health and health related problems in the community. 1/12/2024 9 community practice in Dida Heto Kebele

10. Objectives General Objective To assess community’s health and health related problems in Dida- H eto Kebele, Fitche town, north Showa, Oromia, Ethiopia, 2023 Specific Objectives To identify maternal and child health related problems in Dida- H eto Kebele, Fitche town, north Showa, Oromia, Ethiopia, 2023. To identify communicable diseases problems in Dida- H eto Kebele, Fitche town, north Showa, Oromia, Ethiopia, 2023 To identify non-communicable disease problems in Dida- H eto kebele , Fitche town, north Showa, Oromia, Ethiopia, 2023. 1/12/2024 10 community practice in Dida Heto Kebele

11. Cont.…. To determine environmental health related problems in Dida- H eto Kebele, Fitche town, north Showa, Oromia, Ethiopia, 2023 To identify nutrition related problems in n Dida- H eto Kebele, Fitche town, north Showa, Oromia, Ethiopia, 2023. To prioritize health and health related problems in n Dida- H eto Kebele, Fitche town, north Showa, Oromia, Ethiopia, 2023 1/12/2024 11 community practice in Dida Heto Kebele

12. Methods Study area and period The study was conducted in Dida Heto Kebele of Fitche town, from December 13-16/2023 The Kebele is sub-divided into 11 Gott with an estimated total population of 20,328 and 4235 households Geographically Dida Heto Kebele is bounded by D ire D oyo, Torban Ashe, Ganda Cafe, Ganda koticha sefane, north, east &west part respectively. 1/12/2024 12 Figure 1: The map of study area extracted using ArcGIS 10.8 Software, Fitche town ,Oromia, Ethiopia 2023 community practice in Dida Heto Kebele

13. Cont.. Study design A community based descriptive cross sectional survey with mixed method approach was employed . Population Source population All community and organizational stake holders in Fitche town's Dida Heto (04) Kebele. 1/12/2024 13 community practice in Dida Heto Kebele

14. Cont.… Study population Quantitative : All House Holds living in Dida Heto Kebele of Fitche town . Qualitative: All purposely selected key informants like a religious leader, Kebele administration, Urban health extension professionals and other stakeholders. Study unit Quantitative : The representatives of household in Dida Heto Kebele Qualitative: Participants (selected individuals for key informants, FGD, interview) and Institutions 1/12/2024 14 community practice in Dida Heto Kebele

15. Inclusion and Exclusion criteria Inclusion criteria Q uantitative - Households head who are residents in the Kebele for more than 6 months and > 18 years old. Q ualitative - Individuals/groups who are residents for more than 6 months in the town/institution and > 18 years old, and those people with good understanding of the study area. Exclusion criteria Household head who were m entally ill or unable to hear and communicate at time of data collection 1/12/2024 15 community practice in Dida Heto Kebele

16. Sample size determination For quantitative Sample size is determined by using single population proportion formula. Sample size is calculated by using 48% (Illegal solid waste disposal) which is taken to acquire a maximum number of sample size with 95% confidence level and 5% margin of error when compared to other factors ( Town and Gojjam, 2014) = = 384 By adding 10% Non-response rate, the final sample size = 423   1/12/2024 community practice in Dida Heto Kebele 16

17. Sample size determination…… For qualitative 8 key-informants with different community members such as: Religious leaders Community elders Urban health extension worker Health development army School representatives Fitche town a dministration were independently interviewed A total of 36 respondents have been participated in FGD in 3 groups. 1/12/2024 17 community practice in Dida Heto Kebele

18. Sampling technique and procedure For Qualitative The sampling technique was purposive sampling method for 8 key informant interview and 3 FGDs Key informant interviews participants was those who have information about health from the community. 1/12/2024 18 community practice in Dida Heto Kebele

19. Sampling technique and procedure…. For Quantitative Systematic random sampling technique for quantitative data were used. Proportional allocation was done according to the number of households there in each gotts. K=No of households/sample size=4235/423=10 The first household was selected by taking specific references in each gott . 1/12/2024 19 community practice in Dida Heto Kebele

20. Cont.… Starting from the reference point, every K th household was included in the study until the proportionally allocated sample size is reached. For households which doesn’t fulfill inclusion criteria the next household were selected . 1/12/2024 20 Figure 2 : Proportional sample sizes determined for gote , Fitche, Oromia, Ethiopia, Dec,2023 community practice in Dida Heto Kebele

21. Data collection procedures Data was collected by using face to face interviewer administered semi-structured questionnaire that includes both closed ended and open ended questions for household survey . FGD Was conducted by representing the Kebele. In each FGD, 8 individuals were involved. Age, sex and education level specific homogenous groups were formed. Twelve key informants were interviewed. Observation was conducted across the different areas of the Kebele (School, FDEs and Health Facilities) 1/12/2024 21 community practice in Dida Heto Kebele

22. Study variables 1/12/2024 22 community practice in Dida Heto Kebele

23. Operational definitions Health problem : the factors which directly affects individual’s health: - infectious disease (respiratory diseases, diarrhea), non-communicable diseases (heart diseases, hypertension and diabetes mellitus), mental diseases Waste : anything that is discharged from human activities and, animal products that is disposed to environment . Latrine utilization is the reported use of the latrine, verified physically by footprints and fresh excreta inside the pit; and an absence of feces around the home . Fully immunized: infant who received fully recommended doses of vaccine Key informants : key or essential persons for whom to contact for data collection and who can give necessary information 1/12/2024 23 community practice in Dida Heto Kebele

24. Data quality assurance The questionnaire was pretested on 10% of the total sample size All the group members discussed on the questionnaire and acquired the same understand before data collection The collected data was checked for completeness and consistency on daily basis by assigned group members Team and sub group leaders strictly monitored data collection procedure 1/12/2024 24 community practice in Dida Heto Kebele

25. Data processing and analysis Data entry were done by using Epi-Data 4.6 version and exported to SPSS version 26.0 for analyses. Frequency tables, graphs, and descriptive summaries were used to describe the study variables . For qualitative data analysis, notes taken and voice recorded during FGD and KII and it was transcribed and translated by group members to English language and coded, categorized, thematically synthesized and finally, the result of qualitative was presented by narration. 1/12/2024 25 community practice in Dida Heto Kebele

26. Ethical consideration letter of permission and cooperation was obtained from Salale University College of health science (CP Coordinator). Oral consent and written consent was obtained from the local administration and each household in the survey area. The participants of the survey were given adequate explanation about the purpose of the study and their Voluntariness was confirmed. 1/12/2024 26 community practice in Dida Heto Kebele

27. Result and Discussion Situational analysis result S ituational analysis of health and health related problem of in Dida Heto Kebele was done for two consecutive days by SU, College of health sciences, regular m asters students using different methods approach such as; KII, FGD, observation The summary of situational is presented as follows : 1/12/2024 27 community practice in Dida Heto Kebele

28. Cont.… During observation of health institutions Unclean compound (i.e. hospital ) Lack patient waiting area No regular health education provided Un cleaned latrine (i.e. hospital ) No septic tank ( i.e. both HC and hospital) During school visit Ventilation of class room is good Nonfunctional MHM room Presence of Open field waste disposal Poor latrine utilization Shortage of hand washing facilities lack of first aid service 1/12/2024 community practice in Dida Heto Kebele 28

29. Cont.. During food and drinking houses observation Food handlers personal hygiene were well protected No separated shower room for most of hotel servant Some room has no adequate ventilation Shortage of hand washing facilities around the toilet No proper waste disposal system followed During environmental scanning The main finding : Poor sewerage system in the Kebele Open field liquid waste disposal Improper solid waste disposal system 1/12/2024 community practice in Dida Heto Kebele 29

30. Result Socio-demographic Characteristics of Respondent Among 423 households head interviewed, Majority 221(52.2%) of participants were female. The mean age of the respondent was 39.6 The marital status of respondent‘s shows that out 423 respondents 350(82.7 %) are married, while only 58(13.7%) were single 1/12/2024 30 community practice in Dida Heto Kebele

31. Cont.. From those 423 house hold, 266 (62.9%) were headed by male. Concerning educational status of the respondents around 59(13.9%) unable to read and write. Among the studied participants, 146(34.5%) government employment and 129 (30.5%) were daily labor. 1/12/2024 31 Figure 24: Educational status of the respondent in Dida Heto Kebele Fiche town, north Shoa, Oromia, Ethiopia, December 2023 community practice in Dida Heto Kebele

32. Cont.…. 1/12/2024 32 Figure 25: Source of information on health and health related problem Dida Heto Kebele Fiche town, north Shoa, Oromia, Ethiopia, December 2023 community practice in Dida Heto Kebele

33. Housing condition of the house hold Among all respondents 168(39.7%) live in house which has more than two rooms. The status of housing conditions of households, 7(1.7%) and 9(1.9%) have no good ventilation and illumination status respectively. 56.5% of material of floor, majority of them was cemented 221(52.2%) material of roof was corrugated iron/metal 170(40.2%) material of exterior wall was made of wood with mud 1/12/2024 33 community practice in Dida Heto Kebele

34. Cont.. 1/12/2024 34 Figure 26: The main material of the room or the floor made in Dida Heto Kebele, Fiche town, North Shoa, Oromia, Ethiopia 2023 community practice in Dida Heto Kebele

35. Cont.. Among all respondents 410(97%) of them have separate kitchen room 188(44.4%) of them have separate kitchen room but attached to the main house. 140(33.1%) of households replied that they have livestock’s present around their house 32(22.8%) livestock’s were live together . 1/12/2024 35 community practice in Dida Heto Kebele

36. Cont.. 1/12/2024 36 Figure 28: Type of energy source the house hold use for cooking in Dida Heto Kebele, Fiche town, North Shoa, Oromia, Ethiopia 2023 community practice in Dida Heto Kebele

37. Cont.… From the total house hold visited 400(94.6%) and 382(90.3%) they had clean house and compound respectively . 83.7% the house hold clean there house on daily base and 3.5% weekly base Water supply and usage 97.6% of the HH has access to water supply Majority 90.31% of Dida Heto Kebele residents use pipe water as a source of drinking water while 7.8% and 0.5% of them use well and spring respectively. 1/12/2024 37 community practice in Dida Heto Kebele

38. Cont.. More people, or 93.4% are aware of how to make drinking water safer 43.8 % use boiling method,36.7 % chemical treatment and 17.5 % use filtration Common problems relating water the house hold faced the highest percent goes to scarcity 67.1% followed by absence 19.6 % Problem related to water supply shortage of water accounts 69.6% and sanitation problem 21 % 1/12/2024 38 community practice in Dida Heto Kebele

39. Cont.. 1/12/2024 39 Figure 28: Type of container HH use to store drinking water in Did Heto Kebele, Fiche town, North Shoa, Oromia, Ethiopia 2023 community practice in Dida Heto Kebele

40. Waste disposal Management system About 258 (61%) of the people in the Dida Heto Kebele have temporary solid waste storage, while 165(39%) of them do not. 135(31.9%) use private, 112(26.5%) use communal, for temporary solid waste disposal. Most of the house hold 169 (40%) and 237(56%) dispose of solid waste and liquid waste on the field respectively 1/12/2024 40 Figure 30: Ways of disposing liquid waste in Dida Heto Kebele, Fiche town, North Shoa, Oromia, Ethiopia 2023 community practice in Dida Heto Kebele

41. Cont.. 1/12/2024 41 Figure 29: Ways of disposing solid waste at HH level in Dida Heto Kebele, Fiche town, North Shoa, Oromia, Ethiopia 2023 community practice in Dida Heto Kebele

42. Latrine facility & hand washing condition Among all participants 266(93%) of households have latrine 89.4 % of resident’s toilet was pit latrine 184 (64.3%) of them have hand washing facility. 46.6 % and 0.5% use soap and ash to wash their hands respectively. 19 (6.6%) of the respondents use latrine of the neighbors only (0.7%) use open defecation 1/12/2024 42 community practice in Dida Heto Kebele

43. Cont..   variable Frequency Percent Latrine presence Yes 393 92.9% No 30 7.1% Type of latrine Pit latrine 378 89.4% VIP 14 3.3% Water carriage 25 5.9% Pour flush latrine 6 1.4% Is it functional Yes 383 90.5% No 8 1.9% latrine has hand washing facility Yes 279 66.0% No 144 34.0% What do you use to wash your hand after toilet Water only 76 18.0% Soap and water 197 46.6% Ash and water 2 0.5% 1/12/2024 43 Table 9. Latrine presence and hand washing facility in Dida Heto Kebele, Fiche town, Oromia, Ethiopia December 2023 community practice in Dida Heto Kebele

44. Maternal and Child Health at House Hold level Among households included in the study 334(79 %) have a women in reproductive age. Only 61(14.4%) of HH have pregnant women in the last 12 months 56 (91.8%) of them got ANC services while 5(8.2%) did not. 80% of them fail to follow antenatal care due to a lack of awareness From pregnant women who have ANC follow up : 11(19.6 %) contact once 17(30.4 %) of them attend follow up four times and above 1/12/2024 44 community practice in Dida Heto Kebele

45. Cont.. 18(29.5%) and 11(18%) of them started ANC follow up at gestational age of 12Wks and after 16Wks respectively A total of 84 women delivered in the last 12 months 78(92.8 %) were gave birth at health facility ,while 6(7.2%) gave birth at home. 69(82%) of them had postnatal visits, while 17(18%) did not. 221(66%) were using family planning. 137(62 %) of them used short acting family planning 84(38 %) used long acting. 1/12/2024 45 community practice in Dida Heto Kebele

46. Cont.…. There are 140(33%) households with under-two children in the Kebele. 136 (97%)of them are vaccinated: 80(58.8%) are fully immunized 53(38.9 %) are up to date 3(2.2%) were defaulted because mother forgot schedule. 1/12/2024 46 community practice in Dida Heto Kebele

47. Cont.. 1/12/2024 47 Figure 32: Family planning method used by respondents in Dida Heto Kebele, Fiche town, North Shoa, Oromia, Ethiopia 2023 community practice in Dida Heto Kebele

48. Maternal and child nutritional status at household level There were 98(23.2%) PLW in the past 12 month the Kebele. 81(82.7 %) had counseled on nutritional related issues . 17(17.3%) of PLW were not access to the care due to not attending health institution 10(58.8%). 12(19.6 %)PLW did not take Iron folate tablet supplementation during their last pregnancy. 66.7% reason was due to n o access iron /folate tablet. 1/12/2024 48 community practice in Dida Heto Kebele

49. Cont.. From a total of 84 delivered women in last 12 months Out of which 34(40.5%) initiate breast feeding within 1hr 41(48.8 %) initiate breast feeding within a day 9(10.7%)initiate breast feeding after one day. 57(67.9 %) were on exclusive breast feeding ,22(26 %) on mixed feeding and 5(5.9 %) gave only powder milk for first six months. 1/12/2024 49 community practice in Dida Heto Kebele

50. Cont.. From a total of 204 under 5 children’s found in the selected HH 171(83.8%) had taken vitamin A 120(58.8%) dewormed in the past 6 months . lack of awareness and inaccessibility of the service accounts 11.8% and 5.7% for the reason not received Vit . A and deworming respectively 1/12/2024 50 community practice in Dida Heto Kebele

51. Cont.. Concerning time of initiation to complementary feeding for their last child 95(26.2%) started before 6 months 163(44.9%) at 6 month and 105(28.9%) after 6 months 1/12/2024 51 Figure 33: Time to initiate complementary feeding of children in Dida Heto Kebele, Fitche Town, North Shoa Zone, Oromia, Ethiopia 2023 community practice in Dida Heto Kebele

52. Food and water borne disease Majority of the respondents 382(90.3%) were know about disease transmitted by contaminated food and water. 219(51.8 %) mention diarrheal disease 128(30.3 %) typhoid fever 32(7.6 %) helminthes 3(0.7 %) both diarrheal disease and typhoid fever. 1/12/2024 52 community practice in Dida Heto Kebele

53. Cont.. 418(98.8%) know prevention methods of food and water borne disease. 197(46.6%)by frequent hand washing with soap 48(11.3%) latrine utilization 33(7.8%) keeping utensils clean 128(30.6%) environmental and personal hygiene . A total of 78(18.4%) under 5 children develop diarrheal disease in the last 2 weeks in the house hold. 1/12/2024 53 community practice in Dida Heto Kebele

54. C ommunicable Disease Majority of the respondents 402( 95%)were heard about communicable disease T heir major source of information were media ( 211(49.9%) from radio/TV) Among the respondents 388(96.5 %) know ways of diseases transmission. 181(46.8%) through person to person 70(18.1 %) contaminated food 82(21.2 %) contaminated water . 55(14 %) of them said through fly 1/12/2024 54 community practice in Dida Heto Kebele

55. Cont.… Among of respondents 402(95%) knew how to prevent CD 204(50.7%) by frequent hand washing with soap 129(32%) Environmental and personal hygiene 41(10.2%) latrine utilization 28(7 %) keeping house cleaning, 1/12/2024 55 community practice in Dida Heto Kebele

56. Cont.. 93.7% of the respondents have heard about STD including HIV/AIDS 96.5 % Know transmission & prevention methods STD&HIV/AIDS From a total of 104 HHs who developed illness in the last 3month 42(40.4 %) was diarrhea 27(26 %) AFI 35(33.7 %) respiratory disease 1/12/2024 56 community practice in Dida Heto Kebele

57. Non communicable Disease(NCD) 331(78.3%)respondents were heard about NCD. Of them 290(87.9%) know prevention methods of NCD 98(33.7%) regular physical exercise 77(26.5%) dietary modification 56(19.2 %) a void smoking and 54(18.6 %) decreasing alcohol consumption . 1/12/2024 57 community practice in Dida Heto Kebele

58. Cont.. 143(43.2%)of the respondents not e ver Practiced NCD Prevention Methods Concerning NCD predisposing factors: 226(54.3 %) respondents said obesity 102(24.5 %) physical inactivity 88(21.2 %) for others such as smoking cigarettes and alcohol consumption 1/12/2024 58 community practice in Dida Heto Kebele

59. Cont.… 1/12/2024 59 Figure 34: NCD prevention method practiced by the respondent in Dida Heto Kebele, Fiche town, North Shoa, Oromia, Ethiopia 2023 community practice in Dida Heto Kebele

60. Prevalence of NCD variable Response Frequency   Number Percent Is there any family members who have been diagnosed HTN? Yes 70 16.6% No 353 83.4% Total 423 100%   Is there any family members who have been diagnosed DM? Yes 64 15.1% No 359 84.9% Total 423 100%   Is there any family members who have been diagnosed Cancer? Yes 38 9% No 372 91% Total 410 100% Is there any family members who have been diagnosed CVD? Yes 53 12% No 370 88% 1/12/2024 60 Table 16: Family Member Having or Diagnosed with NCD in Dida Heto, Fitche Town, Oromia, Ethiopia, December, 2023 community practice in Dida Heto Kebele

61. Discussion This survey aimed to assess health and health related problem of community in Dida Heto Kebele Among all participants 266(93%) of households have latrine which is similar with Bahirdar city, 333(93.8%) (W. and S., 2013) . Nineteen (6.6%) of the respondents use latrine of the neighbors and only (0.7%) use open defecation which is almost good when we compare this with EDHS 2019, more than one in four households (27%) in Ethiopia have no toilet facility (35% in rural areas and 10% in urban areas) (EPHI), 2019 ). 1/12/2024 61 community practice in Dida Heto Kebele

62. Cont.. The study revealed that 165(39%) of them dispose their solid waste on open field and 80 (18.9%) burn, 94(22.2%) garbage container, and 72(17%) in pit. This is much lower than the study conducted in Asella town (82.8%) (Bereda and Bereda, 2021) In Dilla town (58.3 %) ( Fereja and Chemeda , 2023) and Woldia town (50.8 %) ( Abegaz , no date) Of them dispose their solid waste on open field respectively. Therefore the difference of this finding could be due to Socio-demographic characteristics and Household lifestyles 1/12/2024 62 community practice in Dida Heto Kebele

63. Cont.. Surprisingly, as one of the key informants interview, said ; ‘‘disposing of solid wastes in open places and drainage systems is a common practice in the town’’. There is punishment on individuals who get rid of waste in unauthorized areas but there is lack of implementation. As a result, regulations do not seem to be obeyed by the households as desired. 1/12/2024 63 community practice in Dida Heto Kebele

64. Cont.. From a total of 423HHs, 237(56%), dispose their liquid waste on the open field, 91(21.5%) in sewage pits; 84(19.9 %) in toilets; and 11(2.6%) in other or specified places. This is slightly lower than the study conducted in Bahir Dar 64% ( W . and S., 2013 ). A 78 years old woman in the Kebele said that “there were no solid and liquid waste disposals,…… sewerage systems were closed due to solid waste accumulation finally she summarized the questions raised from us by saying it’s better to clean (remove) both solid and liquids wastes from ditch and close the upper parts of the ditch. … 1/12/2024 64 community practice in Dida Heto Kebele

65. Cont.… Of 69.6 % of the women who had pregnant utilized ANC service below WHO’s recommendation, and 30.4 % of the women used the service as recommended by WHO (at least four and above ANC visits). But this results lower than study conduct in Southwestern Ethiopia which 548 (56%) women used the ANC service for at least four times (Belay et al., 2022) . 1/12/2024 community practice in Dida Heto Kebele 65

66. Cont.. T he study showed that 78(92.8%) were gave birth at health facility and the rest 6(7.2%) gave birth at home. This study supported by study done in Amhara region east Gojjam zone in 2020 show that, 609(47.5%) were gave birth either at hospitals or health centers and 395(53.5%) of those women who gave birth outside the health institutions ( Emiru , Alene and Debelew , 2020 ) . Therefore the study shows poor performance it might due to lack of transportation for getting service to health facilities 1/12/2024 66 community practice in Dida Heto Kebele

67. Cont.. From a total of 334 non pregnant women of reproductive age group 221(66%) is using modern contraceptive family planning. Out of which 137(62%) of them used short acting and 84(38%) of them used long acting. As compare to the study conducted in Bodit town, Walayita on modern contraceptive utilization, by 2017 show that 48.2% women utilized any modern contraceptive ( Gebremeskel , 2017 ). Therefore , utilization of family planning in study area is high because it has been conducted in Town where there is high accessibility of public and privet Health facility. 1/12/2024 67 community practice in Dida Heto Kebele

68. Cont.. Form a total of 140 under two years children, 80(58.8%) are fully immunized, 53(38.9%) are up to date and 3(2.2%) is defaulted because mother forgot schedule. This result was greater than EDHS-19, which may be progression of expanded program of immunization however there was defaulter around 12.2 % in community revealed by survey (EPHI) and ICF, 2021 )). 1/12/2024 68 community practice in Dida Heto Kebele

69. Cont.. Concerning time of initiation to complementary feeding for their last child was, 95(26.2%) started before 6 months, 163(44.9%) at 6 month and 105(28.9%) after 6 months. Time of starting complimentary feeding were categorized as whom started <6months 8.13%, started at 6months 81.39% and started >6months 10.4 %. This result indicates discrepancy when compared with EDHS-19, and poor improvement may be due low community awareness (EPHI) and ICF, 2021)). 1/12/2024 69 community practice in Dida Heto Kebele

70. Cont.… From the present survey show that 34(40.5%) initiate breast feeding within 1hr, 41(48.8%) initiate breast feeding within a day and 9(10.7%) after one day this result of early initiation of breast feeding practice is lower than the study conducted in Debre Tabor (76.8 %) ( Abie and Goshu , 2019). 1/12/2024 70 community practice in Dida Heto Kebele

71. Cont.. Majority of the respondents have heard about TB (90.8%) and said that TB transmitted through the air airborne 92.2%. S tudy finding was higher than study conducted in Tepi, Southern Ethiopia 83%(54), Jordan 52.9%(55), Northeast Tanzania 44%(56), Nigeria 80%(57) but lower than Ethiopia at national level conducted study 95%(58). T he sociocultural, socioeconomic, and behavioral characteristics of the study participants may play a great role in the variation observed. 1/12/2024 71 community practice in Dida Heto Kebele

72. Cont.. According to the survey 78.3% were heard about NCD and from those who heard 87.9% know prevention methods . Concerning its predisposing factors 54.3% respondents said obesity, 24.5% respondents said physical inactivity and 21.2% for others such as smoking cigarettes and alcohol consumption This result is lower than study conducted in urban area of Negeri Sembilan, Malaysia 81.2% ( Sahar et al., 2018) , but higher than study conducted in Ghana 44% ( Asante, Dai and Walker, 2023). This difference may be due to community education level, socioeconomic and behavioral difference between countries. 1/12/2024 72 community practice in Dida Heto Kebele

73. Cont.. Among participant who has heard about NCD 16.6%, 15.1%, 9% and 12% has member of family having or diagnosed with HTN, DM and CVD respectively. A study conducted in an urban settlement in Pakistan indicates that 40.1% had hypertension, 15.8% had diabetes and 17.0% had ischemic heart disease (Bray et al., 2021 ). The may due to sociocultural and socioeconomic variations 1/12/2024 73 community practice in Dida Heto Kebele

74. Conclusion and Recommendation From the finding of this study we can conclude that there is problem in Environmental Sanitation and hygiene in the community. Lack of liquid and solid waste management There were also lack of awareness on how to prevent non communicable disease and inadequate source of health and health related information. Regarding Maternal and Child health care there were good institutional delivery and ANC service utilization. But there were low coverage of long acting family planning and late initiation of complementary feeding. 1/12/2024 74 community practice in Dida Heto Kebele

75. Cont.. On the other hand, regardless of adequate information regarding communicable and non-communicable diseases, significant prevalence of NCD was assessed. The town administration and Woreda health office with concerned stakeholders should work to improve the awareness of the community about proper placement and utilization of liquid and solid waste burning materials and latrine utilization . The health office stake holder should work to create awareness about Non communicable disease prevention practice Health professionals and HEWs have to create community sensitization programs on maternal and child issues , including FP,ANC ,Delivery , PNC service and child vaccinations 1/12/2024 75 community practice in Dida Heto Kebele

76. Limitation of the study It is impossible to generalize to other Kebeles, Study design can’t show cause and effect relationship 1/12/2024 76 community practice in Dida Heto Kebele

77. List of prioritized problems Sno List of problems Criteria for prioritization Total Rank Magnitude Severity Feasibility Community concern Gov’t concern 1 Poor sewerage system in the area 5 5 4 5 5 24 1 2 Improper solid waste disposal system 4 3 3 5 5 20 2 3 Open field liquid waste disposal 4 3 2 4 4 17 4 4 Poor NCD prevention practice 4 4 3 5 2 18 3 5 Low Coverage of long acting FP 4 3 3 3 4 17 5 6 Poor coverage of PNC service 4 3 2 3 3 15 6 7 late initiation of breast feeding after birth 4 3 2 3 2 14 7 8 Poorly functioning of school clubs on health and health related aspects 3 2 3 2 4 14 8 9 Nonfunctional menstrual hygiene management room in the school 3 3 2 2 3 13 9 10 Shortage of hand washing facilities in the School 3 2 3 2 3 13 10 11 Poor Solid/liquid waste management in hotels, restaurants 3 3 2 3 2 13 11 12 Poor cleanliness of the school compound 2 2 3 2 3 12 12 13 Shortage of first aid kit in the school 2 2 3 1 3 11 13 1/12/2024 77 Table 17: Prioritization of health and health related problems, in Dida Heto Kebele, Fiche town, North Shoa, Oromia, Ethiopia, December 2023 community practice in Dida Heto Kebele

78. Reference Holst J. Global Health - Emergence, hegemonic trends and biomedical reductionism. Global Health. 2020;16(1):1–11 . Joubert BR, Mantooth SN, McAllister KA. Environmental Health Research in Africa: Important Progress and Promising Opportunities. Front Genet. 2020;10(January):1–29. Ababa A, Hailu K, Alemu ZA, Id MA. Barriers to cleaning of shared latrines in slums. 2022;1–14 . Mohammed SH, Habtewold TD, Arero AG, Esmaillzadeh A. The state of child nutrition in Ethiopia : an umbrella review of systematic review and meta-analysis reports. 2020;1–10 . Usman MA, Gerber N, Pangaribowo EH. ZEF-Discussion Papers on Development Policy No . 220 Determinants of Household Drinking Water Quality in Rural Ethiopia. 2016;(220). 1/12/2024 78 community practice in Dida Heto Kebele

79. Acknowledgement We would like to thank Salale University College of health sciences , for arranging this practical field training program and giving us the opportunity to go through identification of the major community health problems and take part in problem-solving activities of the community. Also We would like to acknowledge our respected instructors and supervisors : Mr. Tadesse Nugussie , Mihret Zerihun , Mr. Abdi Negash , Mr.Tinsae Abeya , Mr. Kumera Bekele, Mr. Adugna Alemu for providing us with valuable support & assistance throughout the preparation of this project. A s well as all administers of Dida Heto kebele , town health office, Fitche health centre number 2 and HEW for providing us information about kebele and community 1/12/2024 79 community practice in Dida Heto Kebele

80. Thank You 1/12/2024 community practice in Dida Heto Kebele 80