community based education phase 3

JIMMA UNIVERSITY
COLLEGE OF PUBLIC HEALTH AND MEDICAL
SCIENCES
DEPARTMENT OF NURSING
CBTP Phase 3 in Seto Semero kebele, Jimma Town,
2015
By : Year III Nursing students
7/8/2015
1

GROUP MEMBERS
❖ Amare Kume
❖ Antsokia Nigusie
❖ Dori Berhe
❖ Eyerus Nigusie
❖ Ermias Samuel
❖ Lemane Tesema
❖ Mahlet Temesgen
❖ Makida Hadis
❖ Megersa Alene
❖ Meheret Woema
❖ Medanit Endale
❖ Samira Awel
❖ Sani Musa
❖ Seman Sherif
❖ Sena Dadi
❖ Shanbal Ketela
❖ Zamzam Roble
❖ Zebiba Edio
❖ Zewde Teshome
❖ Bezunesh Woldie
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2

PRESENTATION OUTLINE
• Introduction
• Statement of the problem
• Significant of study
• Objectives
• Methods and materials
• Result & Discussion
• Conclusion and Recommendation
• Acknowledgment
• Reference
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3

INTRODUCTION
❑ Jimma University is
❑ the first higher institution in Ethiopia with community-
oriented curricula.
❑ a public higher educational institution established in
December 1999 by the amalgamation of Jimma College of
Agriculture (founded in 1952), and Jimma Institute of Health
Sciences (established in 1983).
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4

CON’T…
❖ CBE is a means of achieving educational relevance to community needs
and consists of learning activities that use the community oriented
education program.
❖ It consists of learning activities that use the community extensively as a
learning environment in which:
❖ Students, Teachers, Members of the community and
❖ Representatives of other sectors are actively engaged through out the
educational experience
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5

Strategies of CBE
DTTP/TTP
CBTP
SRP CBE
3C’s
Competent,
Committed and
Confident Professionals
6
7/8/2015

STATEMENT OF THE PROBLEM
❖ Maternal and child health are the most important problem of our
community that should be solved because these two are the
most important determinants of the community health and
future competent health generation of the society.
❖ ANC service is the provision of advice and medical service to a
pregnant woman by health professionals from the time of conception to
delivery.
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7

CONT’D…
❖ National EPI coverage survey(2014), shows that
Ethiopia has made notable progress in routine
immunization coverage with an increasing in
Penta coverage above 80% coverage in 2014
compared to 29% in 2013.
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8

CONT’D…
❖ Family planning is considered as one of the strategies to
reduce population growth as well as maternal and child
mortality.
➢ Only 29% of women of reproductive age group use
contraceptive (EDHS ,2011)
❖ About 52% of infants can breast feed within 1hr and
80% of infant breast feed within one day; exclusive
breast feeding approximately(57%) (EDHS,2011).
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9

CONT’D…
❑ Harmful traditional practice is common in Ethiopia:
+ uvula cutting 80% and 25% in Ethiopia and Oromia
respectively .
+ extraction of milk teeth 84% and 27% in Ethiopia and
Oromia respectively.
+ female genital mutilation 72% and 28% in Ethiopia
and Oromia respectively (EDHS,2011)
❑ At national level the knowledge of HIV/AIDS is almost universal
(97% of the women, 15-49 ages have heard about HIV/AIDS)
(EDHS,2011
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10

SIGNIFICANCE OF STUDY
➢ It helps the student to understand and know about the society
better.
➢ It helps the student to know the existing social problem and think
possible solution to solve this problem.
➢ It promotes mutual understanding, team sprit among the group
members .
➢ It equips the students with the knowledge of how to collect,
analyze and interpret.
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11

CONT’D…
❑ Problems related with family planning, antenatal care
follow up, child health care practice and awareness of
HIV/AIDS are common in Ethiopia.
❑ Therefore this study will provide detail information
about the situation of the problem in the study area.
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12

OBJECTIVES
General objectives
❑ To assess RH ,FP awareness & use, pregnancy
status & ANC ,HIV awareness ,child health &
immunization status in seto semero kebele.
Specific objectives
✓ To asses the reproductive health status of women in
the community
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13

CONT’D…
✓ To identify the contraceptive prevalence in the
community.
✓ To identify harmful traditional practices that affect the
children.
✓ To identify common children problems in the community.
✓ To assess the HIV/AIDS awareness and test among
reproductive age women.
✓ To assess the immunization status of children.
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14

METHODS AND MATERIALS
➲ Study area and period
➲ The study was conducted in Seto-semero Kebele, from June 27-29/2015
➲ Located in Oromia Region, Jimma Zone, Jimma Town.
➲ It is 2.5km away from Jimma University Main Campus to the North
west.
➲ Total population: 10,310 ; Male= 4984, Female= 5326
➲ Total House holds= 2204
➲ Climatic condition : Woina-dega
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15

CONT’D…
❖ Geographical boundaries :
❖ East: Mendera Kochi
(Debela)
❖ West: Bosa Addis
❖ North: Somodo
❖ South: Awitu Mendera
❖ The kebele has plain and forested
features with an altitude of 1200-
1800m above sea level.
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16

CONT’D…
➲ Study Design
➲ Community based Cross sectional study design
➲ Population
Source Population
➲ All reproductive age & children under two age found in Seto
Semero kebele.
Study Population
➲ All selected reproductive age women & under two found in
Seto Semero kebele .
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17

• Sample Size Determination & Sampling Technique
Sample Size Determination
• Sample size was calculated using single population proportion formula.
= 384
Where:
• Zα/2
= Confidence level at 95% CI (1.96)
• P = population proportion taken as 0.5
• d = margin of error of (5%)
• n = minimum possible sample size
18
7/8/2015
CONT’D

▪ Sample Size Determination of reproductive age women(15-49)
▪ Since the source population is <10,000 we used correction formula to
determine final sample size as:
= 330
▪ Where, n = Minimum (calculated) sample size
N=2341(Total reproductive age women in Seto-Semero
Kebele)
nf
= Final (adjusted) sample size
nf = 330households + 10% contingency of 330 (33) = 363
CONT’D…
19
7/8/2015

CONT’D…
Sampling Technique
❖ Systematic sampling technique.
❖ Households were selected by systematic sampling
technique
❖ Every 6 household (k=2341/384) was included.
❖ Where, N=total number of reproductive age women
n=minimum sample size
❖ The first house was selected by lottery method.
20
7/8/2015

▪ Sample Size Determination of child under 2
▪ Since the source population is <10,000 we used correction
formula to determine final sample size as:
= 234
▪ Where, n = Minimum (calculated) sample size
N=604(Total under 2 age children in Seto-Semero
Kebele)
nf
= Final (adjusted) sample size
▪ nf = 234+ 10% contingency of 234 (24) = 258
CONT’
D…
21
7/8/2015

STUDY VARIABLES
+ Age
+ Religion
+ Marital status
+ Ethnicity
+ Literacy
+ Occupation
+ ANC
+ FP
+ HIV/AIDS awareness
+ Child care practice
+ EPI
+ Sex
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22

DATA COLLECTION INSTRUMENT & PROCEDURE
Data collection instrument
➢ Semi-structured question was developed & given by CBE
office.
Data collection procedure
➢ General orientation was given by CBE office coordinators
and supervisors provided orientation before data collection.
➢ Data was collected by face to face interview
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23

CONT’D…
Data quality assurance
➢ Data completeness and accuracy were checked by the leader each day after
data collection.
➢ Definitions of terms were discussed to have common understanding.
➢ All students have been oriented to have common consensus.
➢ Questions were asked the same way for all respondent.
Data analysis procedure
➢ The collected data was tallied, analyzed manually by using scientific calculator
and presented by using tables, figures and statement as necessarily.
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24

ETHICAL CONSIDERATION
• Letters of permission from Jimma University CBE office
submitted to the administrators of Seto-Semero kebele.
• Consent was granted from Kebele leaders and respondent.
• Data was collected after getting consent from each
respondents.
• The information provided by each household was kept strictly
confidential.
25
7/8/2015

DISSEMINATION OF FINDING
• The finding will be presented to Jimma university CBE office in
hard copy & it will be presented for students & other concerning
body in soft copy form.
26
7/8/2015

RESULT
Part 1: Sociodemographic characteristics
Table 1: Distribution of women age class in study population in Seto
semero kebele , Jimma town, Oromia region, south west of Ethiopia ,from
June 27-29,2015.
Age group Frequency %
15-19 18 4.95
20-24 75 20.66
25-29 70 19.3
30-34 74 20.46
35-39 64 17.63
40-44 39 10.7
45-49 23 6.3
Total 363 100
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27

CONT’D…
7/8/2015
28
Religion Frequency %
Muslim 178 49
Orthodox 109 30
Protestant 64 17.6
Catholic 12 3.3
Total 363 100
Table 2: Distribution of religion in study population in seto semero kebele ,
Jimma town,Oromia region, south west of Ethiopia, from June 27-29,2015.

CONT’D…
7/8/2015
29
Marital status Frequency %
Married 304 83.74
Single 41 11.29
Divorced 9 2.48
widowed 9 2.48
total 363 100
EDHS 2014
married 60.3%
Widowed 2.6%
Table 3: Distribution of marital status in study population in Seto semero
kebele , Jimma town, Oromia region, south west of Ethiopia ,from June 27-
29,2015.

CONT’D…
Ethnicity Women Husband
Frequency % Frequency %
Oromo 219 60.33 184 60.52
Amhara 72 19.83 51 16.77
Kefa 24 6.61 23 7.56
Dawro 21 5.78 10 3.28
Yem 14 3.85 21 6.92
Other 13 3.6 15 4.95
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30
Table 4: Distribution of ethnicity in study population in seto semero kebele,
Jimma town, Oromia region, south west of Ethiopia from June 27-29,2015.

CONT’D…
Literacy Women Husband
Illiterate 34 9.36 11 3.62
Read and
write
85 24.42 36 11.84
1-6 56 15.43 39 12.82
7-12 132 36.36 84 27.63
>12 56 15.42 133 43.75
Total 363 100 304 100
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31
Table 5: Distribution of literacy status in study population in seto semero
kebele, Jimma town,Oromia region, south west of Ethiopia from June 27-
29,2015.

CONT’D…
Occupation Women Husband
Government
employer
83 22.86 171 56.25
Student 23 6.33 - -
Merchant 58 15.97 83 27.30
House wife 172 47.38 - -
Farmer 3 0.82 10 3.28
Daily
laborer
4 6.61 25 8.2
Other - - 15 4.9
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32
Table 6: Distribution of occupation in study population in seto semero kebele,
Jimma town,Oromia region, south west of Ethiopia from June 27-29,2015.

CONT’D…
No. of wife husband
have
Frequency %
1 291 95.72
2 7 2.33
3 5 1.64
7/8/2015
33
Table 7: Distribution of number of wife in study population in Seto semero
Kebele, Jimma town, Oromia region, south west of Ethiopia from June 27-
29,2015.

CONT’D…
7/8/2015
34
Figure 1: Distribution of knowledge of family planning study population in seto semero
kebele , Jimma town, Oromia region, south west of Ethiopia from June 27-29,2015.
Part 2 :Family planning

CONT’D…
.
7/8/2015
35
Types of FP
knowledge
Frequency %
Pills 333 100
Injection (depo) 300 90
Loop 121 36.3
Implant 84 25
Condom 162 48.65
Other 15 4.5
Table 8: Distribution of type of FP knowledge in study population in Seto
semero kebele, Jimma town, Oromia region, south west of Ethiopia from
June 27-29,2015.
EDHS(2001)=
10.4% pills
37% injectable

CONT’D…
.
7/8/2015
36
FP in use
Types frequency %
Pills 57 20
Injection
(depo )
182 64
Loop 14 4.9
Implant 25 8.95
Other 6 2.2
Total 284 100
Table 9: Distribution of FP in use in study population in seto semero kebele,
EDHS 2014
Injectable
93.4%

CONT’D…
Reason for FP use Frequency %
For spacing 264 92.9
Financial problem 58 20.4
Other 8 2.8
7/8/2015
37
Table 10: Distribution of reason for FP to use in study population in seto semero
kebele, Jimma town, Oromia region, south west of Ethiopia from June 27-
29,2015.

CONT’D…
Reason for FP not to
use
Frequency %
Fear of side effect 11 13.9
Not knowing source 10 12.6
Lack of husband
consent
53 67
Not available 5 6.3
Other 2 0.2
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38
Table 10: Distribution of reason for FP not to use in study population in seto
semero kebele, Jimma town ,Oromia region, south west of Ethiopia from June 27-
29,2015.

.
Age Age at marriage Age at first pregnancy Age at last pregnancy
Frequency % Frequency % Frequency %
<=18 58 18 44 13.6 6 1.8
>18 261 81 275 85 316 98.2
Total 322 322 322 100
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39
Table 11: Distribution of age at marriage,first pregnancy & last pregnancy in
study population in Seto semero kebele, Jimma town, Oromia region, south west
of Ethiopia from June 27-29,2015.

CONT’D…
Variables Response Frequency %
Number of
pregnancy
1 18 5.59
2-4 207 64.28
>4 31 9.62
Total 322 100
Out come
of
pregnancy
Live birth 579 90.9
Still birth 29 4.55
Abortion 29 4.55
Total 679
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40
•Part 3: ANC
Table 12: Distribution of number of pregnancy & out come of pregnancy in study
population in seto semero kebele, Jimma town, Oromia region, south west of
Ethiopia from June 27-29,2015.

CONT’D…
Variables Responses Frequency %
Place of
delivery
At home 42 13.04
Health station 7 2.17
Health center 227 70.5
Hospital 46 12.28
Total 322 100
If at home
attendant
Trained 28 66.67
Untrained 10 23.8
Neighborhood 4 9.53
Total 42 100
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41
Table 13: Distribution place of delivery & attendant in study population in seto semero
kebele, Jimma town, Oromia region, south west of Ethiopia from June 27-29,2015.
EDHS 2014
In Ethiopia
Home 84%
Health facility
16%
In Oromia
Home 86%
Health facility 14

CONT’D…
Variable Response Frequency %
Problem
during
pregnancy
Yes 90 27.95
No 232 72.05
Total 322 100
Type Vaginal Bleeding 30 33.33
Fever 18 20
Body swelling 13 14.4
Abortion 29 32.2
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42
Table 14: Distribution of problem during pregnancy in study population in seto semero
kebele, Jimma town, Oromia region, south west of Ethiopia,from June 27-29,2015.
EDHS 2014
Vaginal bleeding
22%
Fever 21%

CONT’D…
Problem
during labor
and delivery
Yes 76 23.60
no 246 76.40
Types Still birth 9 11.84
Prolonged
labor
28 36.84
Excessive
bleeding
39 51.32
7/8/2015
43
Table 15: Distribution of problem during labor & delivery in study population in seto
semero kebele, Jimma town , Oromia region, south west of Ethiopia from June 27-
29,2015.

CONT’D…
Problem
during
puerperium
Classification Frequency %
Yes 43 13.40
no 279 86.60
Types Excessive
bleeding
8 18.60
Fever 29 67.40
Breast problem 6 14
7/8/2015
44
Table 14: Distribution of problem during purperum in study population in Seto semero

CONT’D…
Precaution
during
pregnancy
Precaution
taken
Frequency %
Work 173 53.73
Hygiene 195 60.60
Nutrition 170 52.8
Birth preparedness
before pain starts
Yes 28 8.70
no 294 91.30
7/8/2015
45
Table 15: Distribution of precaution during pregnancy in study population in seto semero

CONT’D…
Number of
ANC follow
up
yes 233 72.40
no 89 27.60
Reason for
follow up
Getting sick 70 30.05
Regular
checkup
161 69.95
Check up
interval
1 month 60 36.8
2 month 103 63.20
7/8/2015
46
Table 16: Distribution of ANC follow up ,reason & check up interval in study population
in Seto semero kebele, Jimma town, Oromia region, south west of Ethiopia from June 27-
29,2015.
EDHS 2014
ANC FOLLOW UP
Not received 41%
Received 59%

CONT’D…
✕ There are 2% prohibited food and 15.50%
recommended food during pregnancy.
✕ Full coverage of weaning starting gradually.
✕ 10(22.2%) forbidden & 20(44.4%) recommended
food for infant.
7/8/2015
47

TABLE 17: DISTRIBUTION OF CHILD CARE,WASH,BREAST FEEDING & COLLOSTRUM IN STUDY
POPULATION IN SETO SEMERO KEBELE, JIMMA TOWN, OROMIA REGION, SOUTH WEST OF
ETHIOPIA,FROM JUNE 27-29,2015.
Variable Classification Frequency %
Child care age in
year
<1 45 13.98
1-2 70 21.74
3-5 133 41.33
>5 74 22.98
Sex M 135 41.9
F 187 58.07
Child wash With in 1 hr 27 8.4
With in 24 hr 115 35.7
>24 hr 180 55.9
Breast feeding
starts
Immediately 267 82.9
With in 1 hr 43 13.4
After 1 hr 12 3.7
Collostrum Yes 301 93.5
No 21 6.5
7/8/2015
48
EDHS(2011)=52%
with in 1 hr
=80% with in 24
hr

CONT’D…
Other food after
birth
Yes 26 8.1
No 296 91.9
Type Water 3 11.5
Butter & water 7 26.9
Butter 16 61.6
How long breast
feeding
Still breast feeding 25 6.5
3-4 10 3.1
6 month 89 27.64
<3 month 10 3.10
5 month 15 4.50
>6 month 173 53.70
7/8/2015
49
Table 18: Distribution of other food after birth,type & how long brest feeding in study
population in seto semero kebele,Jimma town,Oromia region, south west of Ethiopia,from
june 27-29,2015.
EDHS(2011)=52%
=6 month
,32%=<5 month

CONT’D…
Age for
additional food
(in month)
<4 24 7.5
4-6 68 21.1
7-12 160 49.7
>12 70 21.67
First additional
food
Milk & milk product 271 84.2
Egg 25 7.8
Potato 10 3.1
Fruit % vegetable 12 3.7
7/8/2015
50
Table 19: Distribution of age for additional food & first additional food in study population
in Seto semero kebele, Jimma town, Oromia region, south west of Ethiopia from June 27-
29,2015.
EDHS(2011)=5.
5%<4 month,
18.9%=4-6 month

CONT’D…
7/8/2015
51
Figur 2: Distribution of bottle feeding in study population in Seto semero kebele, Jimma
town, Oromia region, south west of Ethiopia from June 27-29,2015.

CONT’D…
7/8/2015
52
Figur 3: Distribution of under five check up in study population in seto semero kebele,

CONT’D…
Harmful
traditional
practice
Frequency %
Uvula cutting 35 61.4
Female
circumcision
11 19.2
Extraction of milk 8 14.2
Other 3 5.2
Total 57 100
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53
Table 20: Distribution of harmful traditional practice in study population in Seto semero
kebele,Jimma town, Oromia region, south west of Ethiopia from June 27-29,2015.
EDHS(2011)
=uvula
cutting=80% in
ethiopa
25% in oromia

CONT’D…
Under 5 health
problem
Yes 10 4
No 248 96
Ailments Fever 5 50
Diarrhea 5 50
Cough 4 40
7/8/2015
54
EDHS 2011
in Ethiopia
Diarrhea 26.8%
Cough 14%
In Oromia
Diarrhea 11.3%
Cough 7%
Table 21: Distribution of under 5 health problem,age & ailments in study population in Seto
semero kebele,Jimma town, Oromia region, south west of Ethiopia from June 27-29,2015.

PART 4; HIV/AIDS STATUS
TABLE 22: DISTRIBUTION OF HIV AWERNESS,WAYS TO
KNOW,PREVENTION IN STUDY POPULATION IN SETO
SEMERO KEBELE, JIMMA TOWN,OROMIA REGION,
SOUTH WEST OF ETHIOPIA,FROM JUNE 27-29,2015.
HIV
awareness
Yes 363 100
Ways of
transmission
to know
Mother to child 226 62.3
Sexual intercourse 346 67.8
Blood contact 231 63.6
Other 199 54.8
Prevention abstinence 322 88.7
being faithful 348 95.6
Safe sex 205 56.5
STI 140 38.7
Safe transfusion 62 17.1
Safe infant feeding 39 10.7
7/8/2015
55
EDHS(2011)
=97% HIV
awaerness

CONT’D…
HIV tested Yes 307 84.6
No 56 15.4
Reason for not
tested
Sure of -ve 344 60.7
Fear of +ve 7 12.5
Don’t know where
to get service
2 3.8
Couldn’t afford 13 23
7/8/2015
56
Table 23: Distribution of HIV tested & reason for not tested in study population in seto
semero kebele,Jimma town, Oromia region, south west of Ethiopia from June 27-29,2015.
EDHS (2011)=
61% not tested

Immunization at
least once
Yes 103 89.56
No 12 10.44
Vaccine card
Immunized
Yes 56 54.3
No 47 45.7
Vaccination BCG 103 100
Polio 1,DPT 1 101 98
Polio 2,DPT 2 101 98
Polio 3 ,DPT 3 85 82.5
Measle 75 72.8
7/8/2015
57
EDHS 2011
Fully immunized
24%
No vaccination
15%
Part 5:EPI
Table 24 : Distribution of immunization & vaccine card in study population in seto semero
kebele,Jimma town, Oromia region, south west of Ethiopia from June 27-29,2015.

CONT’D…
Variable Reason Frequency %
Reason for
immunization
failure
Unaware of
immunization
2 1o
Fear of side effect 4 2o
Un aware of to return
2 & 3 round
5 25
Wrong idea of
contraindication
1 5
Rumors about side
effect
3 15
Family problem 3 15
Mother ill 3 15
Total failure 20 100
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58
Table 25 : Distribution of immunization failure & reason for failure in study population in
seto semero kebele,Jimma town, Oromia region, south west of Ethiopia from June 27-
29,2015.

CONT’D…
TT at least
once
Yes 296 81.5
No 67 19.5
TT TT1 296 100
TT2 296 100
TT3 183 61
TT4 57 19.2
TT5 - -
7/8/2015
59
EDHS 2011
Mothers receiving ≥
2 TT dose
In Ethiopia 32%
In Oromia 32.9%
Table 26: Distribution of TT status of mothers in study population in seto semero kebele,

CONCLUSION
• Most of women were house wife.
• Almost all women knew FP method & use.
• Significant number of women are married at the age
<18.
• Majority of women had <4 number of pregnancy.
• Majority of the women had visited health facility
during their pregnancy. Majority of home delivery
were attended by trained TBA.
• Majority the mother were washing their child after
24hrs.
• Most of mother use harmful traditional practice.
7/8/2015
60

CONT’D…
• Most mothers start breastfeeding immediately.
• About half of mothers started complementary feeding for their
child at age of greater than 6 months.
• Most of the study participant vaccinated their last child.
• Majority households did not practice harmful traditional
practice on their child.
• All of the study participants heard about HIV/AIDS.
• Most of the last child of households in the study area were
fully vaccinated.
7/8/2015
61

PROBLEM IDENTIFIED
✕ EPI failure.
✕ Early marriage.
✕ Home delivery.
✕ Infant additional food before 6 month.
✕ Lack of husband consent for FP usage.
✕ Lack of full coverage of ANC follow up.
✕ Lack of knowledge when to wash child after birth.
✕ Harmful traditional practice of infant.
7/8/2015
62

RECOMMENDATIONS
Depending on the study we would like to give the following
recommendation.
✕ Health extension workers, community, chairman of the
kebele, the government, and non- governments should:
✕ Health extension worker should aware the husband to
integrate for FP service & knowledge with their wife.
✕ The community To reduce harmful traditional practice on
children.
✕ Health extension worker should aware the community
about early marriage .
63
7/8/2015

CONT’D…
▪ To attain full coverage of delivery at health facility to
minimize pregnancy related problems.
▪ To create better understanding when to wash child after
birth.
▪ To decrease early marriage .
▪ To attain full coverage of TT up to TT5.
64
7/8/2015

LIMITATIONS
✗ Lack of background documented material about their age
✗ Refusal to tell about case like abortion
65
7/8/2015

PROBLEMS ENCOUNTERED
✗ Some houses were closed
✗ Community fatigued due to repeated
interviews
✗ Language barrier
✗ The weather condition.
✗ Lack of vaccination card for some children
66
7/8/2015

ACKNOWLEDGMENT
We would like to thank
✕ The CBE office of Jimma university
✕ The residents and administration of Seto-Semero
kebele
✕ Our supervisors & each group members
For their unreserved and continuous support
67
7/8/2015

REFERENCES
● Getu Degu,Biostatistics for health science
students,2003.
● EDHS,2011
● EDHS,2014
● Ethiopian narrative health survey.
7/8/2015
68

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