Jimma university area

1. WELCOME TO
PHASE II CBTP
SYMPOSIUM
1

2. 2
COLLEGE OF HEALTH SCIENCES DEPARTMENT
OF MEDICAL SCIENCE AND PATHOLOGY
CBTP PHASE-II presentation prepared by 2nd
year Medical. Lab students
Jimma university
By: BABO KABELE TEAM

3. Team members
S.n
o
Name ID.NO S.no Name ID.NO
1 Misganaw Desta 4664/07 17 Shemima Herato 2176/07
2 Fikadu Balcha 2045/07 18 Yamral Firew 2228/07
3 Issa Haji 01448/06 19 Mahamed Abdulahi 2102/07
4 Oumer Ahmed 02849/06 20 Mastawasha Birhanu 2104/07
5 Ermias Yonas 2038/07 21 Yakobe G/mariam 02383/06
6 Alan Abdulahi 1930/07
7 Mihiret Shiferaw 2114/07
8 Uki Aliyi 2219/07
9 Etaferahu Mesfin 4643/07
10 Gebre Ljalem 2053/07
11 Aragaw Fiseha 1950/07
12 Mulunesh Ganasha 2132/07
13 Sewda Herato 2173/07
14 Minale Endalew 2118/07
15 Yohanis Solde 2233/07
16 Asna Said 1956/07
3

4. Topic of study
Survey on Prevalence of intestinal
parasites in Babo kebele.
4

5. Outline
• Introduction
• Background
• Objective
• Methodology and Material
• Operational definition
• Result & Discussion
• Problem identification & prioritization
• Action plan
• Conclusion
• Recommendation
• Acknowledgement
• Reference
5

6. Introduction
• Jimma University is Ethiopia’s first
innovative community oriented educational
institute of higher learning.
• Community based Education (CBE) is a
program through which students get
practical problem solving skills.
6

7. General overview of CBE
➢CBE : is a means of achieving educational relevant to community need.
➢ Community oriented program education
➢ CBE is designed on three main programs
1.CBTP 2.TTP/DTTP 3.SRP
CBTP : is an integrated institutional programs run in phase from first year to pre
graduation student In each phase students group are designed to urban, semi-
urban and rural communities.
Phase two CBTP is used:
 To know determinant factor those enhance morbidity of the community.
 Prevalence rates of intestinal parasite
 Mode of transmission of intestinal parasite
7

8. Significance of CBE
1. For the community
• Identifying the health problems of the community
• Identifying the morbidity causes of the community
• Identifying the health status of the community
• To get awareness about how to prevent and control community health
problem
2. For the students
• Challenge, fear and worry in the future to give value for the social
problem
• To be active learners
• To implement the theoretical knowledge in solving community problem. It
is important for the competency
• Practicing the habit of team work.
• Learning how to collect the data and processing it and analyzing it
• Helps for higher research program
8

9. BACKGROUND
 Babo kabele is one of the kabele found under Kersa woreda .
 It is 20Km away from Jimma University on the way to Addis Abeba.
 It is bounded by -Tekur Balto and Sarbo kebele in East
-Girma kebele in north
-Ankeso kebele in south
-Merewa kebele in West
 This kebele lies at 1500-1800 meter above sea level.
 The kebele has two streams named as Kalacha and Birbirsa.
 The total population of Babo kebele is 2315 out of this 1178 are male where
as 1137 are female.
 Educational facilities in Babo kebele is as follows.
 Two kindergarten and two elementary school.
 There are 5 mosques with no other religious institution.
 In the kebele 78 hectares has been irrigated.
9

10. Statement of the problem
Parasitic infection has world wide distribution and considerable public
health problem
Globally two billion people are infected with IP
Majority of them were children in resource poor setting.
Intestinal parasites cause significant morbidity and mortality to
children
Particularly the major public health problem of sub -Saharan Africa.
The most common IP infections in the world are; Amebiasis,
Ascariasis, Trichiuriasis and Hookworm infection
In Ethiopia parasites are widely distributed most of them are :
A.lumbricoids, T.trichuria,Hookworm, shows wider distribution
10

11. Cont’d….
Global prevalence:
➢ A.lumbricoides 1.2 billion
➢Hook worm 740 million
➢T.trichiura 795 million
➢Amoeba 300 million
➢ In Africa the distribution prevalent among children
Nigeria:-A.lumbricoides=
-Hook worm= 30.1%
-E.histolytica=9.3%
➢In Ethiopia among pre school children :-
-A.lumbricoides=7.2%-12.17%
-T.trichiuria=2.6%
-Hook worm=9.7%
11

12. OBJECTIVES
General Objective
To assess the prevalence of intestinal parasite & risk factor
among children under 15 age in Babo kebele
Specific objectives
• To determine the prevalent intestinal parasites in the study
community
• To determine risk factors for intestinal parasites
• To assess the sanitary level of the community
• To determine waste disposal of Babo kebele community
• To identify source of water supply in Babo kebele
• To determine latrine availability in Babo kebele
• To prepare the action plan for the prioritized problem of the
community and solve the problem of the community in the
next phase.
12

13. METHODOLOGY
Study area: Babo kebele in jimma zone
 Kebele is bounded by ;-Tekur Balto and Sarbo kebele in East
-Girma kebele in north
-Ankeso kebele in south
-Merewa kebele in West
Study period: June 19-22, 2016
Study design: cross-sectional study
Source population:-children of Babo kebele
Study population:- selected children of Babo kebele
Inclusion criteria-all children of babo residents who won the
chance to be examined
Exclusion criteria-individual who are seriously ill and children
that are unable to give their specimen at a time
13

14. Cont’d….
Sampling technique:- Random sampling method was conducted Study
community (Sample size) by using the formula
where
n=Sample size
p=prevalence(environmental) =0.5
d=margin of error= (5% ) ,0.05
Z=95% confidence interval=1.96
n=384
 When we replace the values in the formula we get
n= (1.96)2 0.5(1-0.5)
(0.05)2
n = 384
Since the total house hold is less than 10,000 we use the correction formula
14

15. Cont’d….
Where, Nf is corrected sample size
n is calculated sample size
N is total household
When we repeal the values in the formula
• we get the corrected sample size to be 204
• And also the sampling interval is calculated using:
k =N
n
where, K is sampling interval
N is total no of household
n is sample size
Kth =436= 2
204
15
Nf = __n___
1+n/N
Nf = 384/(1+384/436)

16. Cont’d….
 Data collection technique
 Face to face interview through presented questionnaire.
 Laboratory data
 Macroscopic stool examination
 Direct wet mount were used
 One gram of stool was used per child.
 Data processing & analysis
 Data checked for completeness
 Tallied manually
 Data checked for completeness
 Tallied manually
 Chi –square used to determine risk factors
 P<0.05 – considered significant
 Data Presentation
o Finding was presented by frequency distribution table ,percentage, Pie chart
and diagrams.
16

17. Data quality control
Pre analytical
➢Discussed on the questionnaires.
➢Appropriate specimen collected
➢Labeling of sample as soon as received
➢-SOP is used
Analytical
➢No too thick or thin smear was done
 Examination cross checked before reporting as negative result.
Post analytical
 Results properly recorded, interpreted by using standard reporting system
 Processed specimen properly discarded
 Children with positive result informed to go to near by health institution
17

18. MATERIALS USED
 Pencil
 pen
 Sharpener & ruler
 Computers
White paper
Ruler
Questionnaire
Applicator stick
Pasture pipette
18
 Microscope
 Microscopic slide
 Cover slide
 Glove
 Gown
 Disposal container
 0.85% normal
saline
 Scientific calculator

19. Measurement of Study Variables
Dependent variables
 Prevalence of intestinal parasite
Independent variables
 Age
 Waste disposal
 Hand washing before meal
 Trimming finger nail
 Latrine availability
 and usage
19
 Eating raw meat
 Water source for
drinking
 Shoe wearing habit
 Hand washing habit

20. Problem encountered
Language barrier
Shortage of materials.
Involuntariness to give sample
Some systematically selected house hold
were closed
Rainy weather condition & muddy road.
Lake of electricity supply
20

21. Solution for encountered problems
• Overcome shortage of material by buying from students’ cash
• Closed houses were visited repeatedly
• Umbrella used
• Health information is given to involutes to convince them
• Using solar mirror for microscopic examination
Limitation
• Unwillingness of respondents to provide certain information.
• Community frustration
• Low sensitivity of direct wet mount
21

22. Ethical consideration
Official letter from CBE office
Permission from kebele officials
Verbal consent from family/guardian
Confidentiality of results maintained
Processed specimen discarded appropriately
Children with positive result were informed to go
health post

22

23. Operational Definitions
• Frequency- total number of individual variable that present in tables
studied population.
• House hold- all people living in a house
• Pit latrine- a latrine with a deep hole and simple wall
• Data- raw material of statistics
• Percent- per hundred
• Prevalence rate- number of cases
• Rate- collections that imply the probability of the occurrence of some
event
• Ratio- the fraction of the form where some bases already defined
• Sample-part of population
• Systemic sampling- individuals are chosen at regular interval from
the sampling frame.
• Variable- something that can change
23

24. 24

25. Cont’d….
From 204 households 125 participated children in
the study giving a response rate of 61.27%.
The prevalence of intestinal parasites was 40.8%.
Four species of parasites identified:
 A. lumbricoids 37 (72.5%)
 T. Trichuria 5(9.8%)
 Hook worm 8(15.7%)
 Taenia spps 1(2.0%)
25

26. Prevalence of intestinal parasite
26
*
sex Parasitic infection
Positive Negative
No % No % No %
Male 27 38.6% 43 61.4% 70 56%
Female 24 43.7% 31 44.3% 55 44%
Total 51 40.8% 74 59.2% 125 100%
Table 1:- distribution of IP children and sex at Babo kebele and
association with Ip June19-21 2016
Chi-square=0.327,DF=1 and p=0.567 ;p>0.05 sex is not significantly
associated with IP

27. Source of water supply
27
Public pipe water; in
rural Ethiopia-15.6%
Protected Well in
rural Ethiopia-16%
Figure 1- sources of drinking water in Babo Kebele from June 19-21, 2016
21.43%
63.60%
48.30%
52.50%
78.57%
36.40%
51.70%
47.50%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
pipe spring well river
positive
negative
There is no association between water sources and intestinal parasitic
infection (p=0.096>0.05, df = 3 x2 =6.35) due to its statistical significance of
the value.

28. Table 2:- Habit of eating raw meat and stool examination results Babo
kebele June 19-21,2016
28
Habit of eating
raw meat
Parasites infection
+ Ve - Ve Total
No % No % No %
Yes 24 53.3% 21 46.7% 45 36%
No 27 33.75% 53 66.25% 80 64%
Total 51 40.8% 74 59.2% 125 100%
*
Eating raw meat is no associated with intestinal parasite infection.
There is statistically insignificant association (X2 = 4.57, DF = 1,
p=0.062< 0.05).

29. Table 3:-Habit of shoe wearing and result of stool examination for
intestinal parasitic infection in Babo kebele June 19-21, 2016.
29
Habit of shoe
wearing
Parasitic infection
+ Ve -Ve Total
Number % Number % Number %
Always 5 26.32% 14 73.68% 19 15.2%
Some times 40 42.5% 54 57.4% 94 75.2%
Not at all 6 50% 6 50% 12 9.6%
Total 52 41.6% 73 58.4% 125 100%
*
Wearing a shoe and prevalence of intestinal parasite has
association as the chi-square value is low. P=0.034 <0.05 , DF = 2,
x2 = 2.19 and the calculation is statistically significant.

30. Table 4:- Habit of hand washing before meal and result of stool
examination in Babo kebele June 19-21,2016
30
Habit of hand
washing before
meal
Parasitic infection
+ Ve - Ve Total
Number % Number % Number %
Always 12 33.33% 24 66.66% 36 28.8%
Sometimes 34 44.7% 42 55.3% 76 60.8%
Not at all 5 38.46% 8 61.54% 13 10.4%
Total 50 40% 75 60% 125 100%
*The prevalence of parasitic infection has significant association with
hand washing before meal. This association is significant which is
(p=0.041<0.05, DF=2 ,X2 = 1.35).

31. Table5:-Habit of fruit washing before eating and stool
examination in Babo kebele June 19-21,2016
31
Habit of fruit
washing before
eating
Parasitic infection
+ Ve -Ve Total
Number % Number % Number %
Always 8 29.6% 19 70.4% 27 21.6%
Sometimes 23 36.5% 40 63.5% 63 50.4%
Not at all 20 57.1% 15 42.9% 35 28.0%
Total 51 40.8% 74 59.2% 125 100%
*There is no association between habit of fruit washing before eating
and intestinal parasite infection (p=0.057>0.05, DF = 2 x2 = 5.75 )
which is statistically insignificant.

32. Table 6:-Habit of hand washing after defecation and stool examination
in Babo kebele June19-21, 2016.
32
Habit of hand
washing after
defecation
Parasitic infection
+ Ve - Ve Total
Number % Number % Number %
Always 12 40.0% 18 60.0% 30
24%
Sometimes 30 39.47% 46 60.53% 76 60.8%
Not at all 9 47.37% 10 52.63% 19 25.2%
Total 51 40.8% 74 59.2% 125 100%
*
This associations not statistically significant. (p= 0.818 and 0.818>0.05,DF=2
X2 = 0.403).

33. Table 7:-Habit of availability latrine and stool examination results in
Babo kebele June 19-21,2016.
33
Habit of latrine
availability
Parasitic infection
+ Ve - Ve Total
Number % Number % Number %
Yes 34 40.5% 40 59.5% 84 67.2%
No 17 41.46% 24 58.54% 41 32.8%
Total 51 40.8% 74 59.2% 125 100%
*
There is no association between latrine availability and infection of
intestinal parasite. Because, (p= 0.643>0.05, DF = 1, x2 = 0.215). Which
is statistically insignificant.

34. Table 8:-Habit of trimming finger nail and stool examination
results in Babo kebele June 19-21,2016.
34
Habit of trimming
fingers nail
Parasitic infection
+ Ve -Ve Total
Number % Number % Number %
Yes 18 32.1% 38 67.9% 56 44.8%
No 33 47.82% 36 52.17% 69 55.2%
Total 51 40.8% 74 59.2% 125 100%
*
This association is statically significant b/c (p=0.036>0.05,DF=1, x2 = 3.15)

35. Table 9:-Usage of wasted disposal pit and stool examination
result in Babo kebele June19-21, 2016.
35
Usage of
wasted
disposal pit
Parasitic infection
+ Ve - Ve Total
Number % Number % Number %
Yes 22 34.37% 42 65.63% 64 51.2%
No 29 47.54% 32 52.46% 61 48.8%
Total 51 40.8% 74 59.2% 125 100%
*This association is statistically not significant. (p=0.043<0.05, DF,=1 x2 = 2.24).

36. Table 10:-Habit of using river or lake or stream and stool examination
results in Babo kebele June19-21, 2016.
36
Habit of usage of
river or stream
Parasitic infection
+ Ve - Ve Total
Number % Number % Number %
Yes
Drinking 25 45.45% 30 54.55% 55 23.0%
Bathing 25 48.08% 27 51.92% 52 21.8%%
Washing 44 50.57% 43 49.43% 87 36.4%
Swimming 23 51.11% 22 48.89% 45 18.8%
Total 117 49.0% 122 51.0% 239 100
No 4 20% 16 80% 20 100
*
The prevalence of parasitic infection and habit of using river, stream or lake
has not association which was statistically significant.(p=0.154>
0.05,DF=4,x2 =6.68).

37. Habit of latrine Usage
Figure 3:- Habit of latrine Usage in babo kebla from June 19-21, 2016
37
*
always sometimes not at all
28.57%
55.38%
33.36%
71.43%
44.62%
63.64%
postive
negative
Therefore ,chi square=8.42,DF=2, P=0.015<0.246 and latrine usage has
association with intestinal parasite.

38. Parasitological survey result
38
Figure 4:- parasitological stool examination results in Babo Kebele from June19-
21, 2016
9.80%
72.50%
15.70%
2.00%
percent
T.trichuria
A.lumbricoides
Hookworm
other(Taenia spp)

39. Problems Identified
• Prevalence of intestinal parasite
• Lack of shoe wearing habit
• Poor waste disposal pit
• Lack of trimming finger nail
• Lack of hand washing before meal.
• Unwise usage of latrine
• Usage of river or lake or stream for washing,swimming and
bathing
39

40. Prioritization of problems
NO Problem Priority setting criteria Total Rank
Magnitude severity Feasibility Government
concern
1 Prevalence of intestinal
parasite infection
5 3 4 5 17 1
2 Lack of hand washing before
meal.
5 4 4 4 17 2
3 Poor waste disposal pit 5 4 3 5 17 3
4 Lack of trimming finger nail 3 2 3 3 11 4
5 Lack of shoe wearing habit 4 2 3 3 12 5
6 Unwise usage of latrine
40

41. 41
Action plan
Problem
identified
Objective strategy Target activity Responsible body Monitoring and
activity
1.prevalence of
intestinal parasite
To reduce
parentage of
intestinal
parasite
Educating the
community
Decreasing the
prevalence of IP
Reminding
government, awaring
about IP
Student, CBE office
,government
Monitoring
activity to evaluate
the prevalence
rate of IP
2 Lack of shoe
wearing habit
To overcome
prevalence of
parasite
Educating the
community
transmission of
IP
Decreasing the
prevalence of IP
Reminding
government, awaring
about IP
Government,
CBE office, student
Pure water
supply
3. Habit of hand
washing before
meal
To overcome
prevalence of
parasite
Educating the
community
transmission of
IP
Decreasing the
prevalence of IP
Giving awareness for
community
Community, CBE
office
To assess the habit
of hand washing
4.Lack of waste
disposal pit
To overcome
of parasite
infection
Educating the
community
transmission of
IP
Decreasing the
prevalence of IP
Educating
The community
Community,
Students, CBE office
To assess the habit
of toward eating
raw meat.
5.Lack of
trimming finger
nail
To overcome
prevalence of
parasite
Dissemination
of health
information to
the community
Decrease the
prevalence of
intestinal
parasite
Giving awareness to
the community to trim
their finger nail
Community, student To assess the habit
of trimming
finger nail
6 Unwise usage of
latrine
To overcome
prevalence of
parasite
Giving of health
information to
the community
Decrease the
prevalence of
intestinal
parasite
Giving awareness to
the community to use
latrine
Community, CBE
office, student
To assess the habit
of proper latrine
usage

42. Conclusion
• In our study we have identified that intestinal parasites were the major
health problem of the community.
• According to our parasitological survey 40.8% were positive for different
intestinal parasites, the most prevalent was found to be
A.lumbriciods(72.5%) followed by Hookworm(15.7%) ,T.trichuria(9.8% )
and other ( T.spp 2% )were the least prevalent parasite in babo kebele.
• A.lumbricoides is the most prevalent intestinal parasite
• This study showed that there is significant relation b/n intestinal
parasite infection and:
– Water source
– Hand washing before meal
– latrine availability
– Trimming finger
– Habit Wearing shoe in the Babo Kebele
42

43. Recommendations
To the community
• Management of pipe water should be encouraged
• Regular shoe wearing habit should be enhanced
• Habit of washing hand before eating and after defection
To health extension workers
• Creating awareness about water borne diseases in the community
• Creating awareness about standard water purification method
• Health education on etiology, prevention and control of intestinal
parasites has to be provided for the community
• Creating awareness should be given to the community on usage of
river, stream and lake water and avoiding eating raw meat.
• Further study should be made, so that the appropriate action
should be taken.
43

44. Cont’d….
To the students
• Providing health education concerning personal
hygiene to the community
To the kebele administrators
• Awareness of the community about environmental
health should be improved to decrease the
prevalence of diseases due to intestinal parasite.
• Sanitation of the community should be improved.
44

45. Acknowledgment
•First of all we will like to express our deepest gratitude for JU
who prepare such programs
• we would like to express our deepest appreciation and heart full
thanks to our supervisors for their valuable contribution
•We also give a great thanks for Babo kebele community who
accepted us with out any hesitation
•I have special thanks for our adviser Miteku Bajiro for his
advice
•Lastly but not the least we would like to thank Babo kebele
leaders for their cooperation in our work by giving place for work
and permitting us to move with in the community
45

46. Reference
Manuals of previous surveys in CBE office
WHO, UNAIDS (2009). FACT SHEET, Sub-Saharan Africa,
Latest epidemiological trends.
Intestinal nematodes; Harrison’s principle of internal medicine,
17th edition, 2008, chap 210.
De Silva NR, Brooker S, Hotez PJ, Montresor A, Engels D,
Savioli L. Soil transmitted helminth infections: updating the
global picture. Trends Parasitol. 2003; 19:547–551(Medline).
Evans AC, Stephenson LS. Not by drugs alone: the fight
against parasitic helminths.World Health Forum 1995;16:258
261 (Medline).
Tesfamichael T, Kloos H. Intestinal Prasitism, In: Zein AZ and
Kloos H. (Eds). The Ecology of Health and Disease in Ethiopia,
Addis Ababa: Ministry of Health, 1988:214.
WHO Technical Report Series 749. Prevention and control of
intestinal parasitic infections. WHO, Geneva, 1987.
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