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description
Rapid Assessment of Health, Water and
Sanitation Status
for
Butajira: The Case of Ziway, South East
Oromiya, Ethiopia
Baseline Review
Report for Ag Consult PLC
Prepared by : Fikru Tessema
Position : Public Health Expert
June 2005
Addis Ababa
1
1 Introduction
1.1 Aim of the Report
This report is for the project: Rapid Assessment of the Status of
Health, Water and Sanitation for Butajira – Ziway Water Develpmnet
Project in Gurage Zone of SNNP Region and East Shoa Zone of
Oromiya Region of Ethiopia.
The objective of this report is to present a summary of current
situation of health service, water supply and sanitation coverage,
hygiene practice of the community and existing health, water and
sanitation facilities.
This report is, therefore, more of overview of the status of
health, water and sanitation services rather than a detailed
review.
1.2 Methods and approach of the assessment
Methods employed to collect data are: structured questionnaire and
formats was used to collect data from households and secondary
data from health and water desks; purposive sampling technique was
also employed to select sample areas and limit sample size.
Three woredas were included in the assessment and field
observation has also been fully employed to see the real
situation.
1.3 Sample size
The assessment was conducted in 2 kebeles from each woreda and two
villages were also selected from each kebele. A total of 10
households were interviewed from each village for this assessment
(Table 2.5).
2
Table 1.3 No of sampled kebeles, villages and households by
woreda, June 2005.
Se.
No.
Woreda
Number of
Kebele Village Houesholds
1 Meskan 2 2 20
2 Mareko 2 2 20
3 Adamitulu 2 2 20
Total 6 6 60
1.4 Layout of this report
This report is divided into seven sections:
Section 1 provides an introduction to this report and the
purpose of the report;
Section 2 provides the background information of the
assessment areas and woredas’ administrative structure;
Section 3 presents current situation of health problems and
service coverage and existing health facilities;
Section 4 summarises water supply and sanitation service
coverages;
Section 5 contains environmental and personal hygiene
practice of the community and diarrhoea episodes;
Section 7 summarises conclusion and recommendations based on
the findings;
3
2 Background of the assessment areas
The assessment areas are two woredas from Gurage Zone, namely:
Mesekan and Mareko of SNNP Region and one woreda from East Shoa
Zone, Adami Tulu of Oromiya Region.
2.1 Meskan Woreda
It is located in Gurage Zone in Southern Nations, Nationalities
and People Region. Meskan woreda is divided in to 43 kebeles of
which 2 kebeles are urban centres. The capital town of Meskan
woreda is Butajira with municipal administration.
Meskan has 240,373 population and different agro-ecological
zones with average wet weather, Dega and Winaadega, and
altitude ranges from 1800-3200m above sea level1.
2.2 Mareko Woreda
It is located in Gurage Zone in Southern Nations, Nationalities
and People Region. Mareko woreda is divided in to 24 kebeles of
which 1 kebele is urban centre. The capital town of Mareko
woreda is Koshe with municipal administration.
Mareko has 64,000 population and different agro-ecological
zones with dry weather, Winaadega and Kolla, and altitude
ranges from 1600-2200m above sea level2.
2.3 Adanitulu Woreda
It is located in East Shoa Zone in Oromiya Region. Adamitulu
woreda is divided in to 38 kebeles of which 5 kebeles are urban
centres. Adamitulu Woreda Administration is based in Ziawy
Town.
1 Meskan Woreda Rural Development Office 2 Mareko Woreda Rural Development Office
4
Adamitulu has 151,793 population and different agro-ecological
zones with dry weather and Kolla, and altitude ranges from
1600-1900m above sea level3.
2.4 Family Sizes
The number of people per household is 6.85, 6.65 and 7.00 for
Meskan, Mareko and Adami Tulu woredas respectively. The average
household size for the three woredas is 6.83 people per
household.
Table 2.4 Number of people per household, June 20054
Se. No. Woreda Total No. of People in a
House
Total No. people
per HH
Male Female
1 Meskan 76 61 137 6.85
2 Mareko 68 65 133 6.65
3 Adamitulu 74 66 140 7.00
Total 218 192 410 6.83
3 Adamitulu Woreda Rural Development Office 4 Survey Results
5
2.5 Woredas’ administrative structure5
Figure 2.4 Woredas’ administrative structure of the study areas
5 Woreda Rural Development Office
Federal Government
Region (SNNPR)
Region (Oromiya)
Other 7 Regions &
2 City Councils
Zone
(Misrak Shoa)
Zone
(Gurage)
Woreda Woreda
Mareko (Semene Koshe, Elala
Jireno) 2 Villages
Meskan (Misrak Imbor, Enseno)
2 Villages
Adami Tulu (Gerbi Wudina, Abenie
Germame) 2 Villages
6
3 Health services
3.1 Health Facilities
The health facilities in the study area are health posts (HP),
health stations (HS) (private clinics), health centres (HC)
and hospitals. There are a total of 29 HPs, 6 HSs, 4 HCs and 1
hospital in the project area.
According to the definition of Ministry of Health for services
catchments area for HP is 5,000 population; for HC 25,000
population and for hospital is 100,000 population.
Based on the referral system of Ministry of Health, one HC
will have 5 satellites HP. HC is also under the district
hospital in the referral system.
The manning system of the health facilities is based on the
type of the facility. HPs are operated by health extension
workers. HCs have physicians, health officers, nurses,
sanitarians and medical laboratory technicians (Table 3.1).
Table 3.1 Number of Health Facilities by Woreda and Type,
June 2005
Se.
No.
Woreda No. and type of health facilities
Health Post Health Station Health Centre Hospital
1 Meskan 14 2 1 1
2 Mareko 6 2 2
3 Adamitulu 9 2 1
Total 29 6 4 1
7
3.2 Major health problems
The major leading causes of morbidity and mortality in the
study area are malaria, pneumonia, dysentery, intestinal
parasites, diarrhoea, respiratory and skin infections.
Malaria, dysentery, diarrhoea and respiratory infections are
also the major leading causes of deaths. Dysenteries,
diarrhoea and respiratory infections are the diseases
following malaria with high morbidity and mortality rate
(Table 3.2.1 and 3.2.2).
Table 3.2.1 Five top causes of outpatient visits, June 20056
Meskan Woreda
Se. No.
Disease
Percentage
(%)
1 Malaria 23.0
2 Pneumonia 16.0
3 Dysenteries 12.0
4 Eye diseases 9.0
5 Upper respiratory infections 8.0
Mareko Woreda
Se. No.
Disease
Percentage
(%)
1 Respiratory infections 16.0
2 Intestinal parasites 11.0
3 Diarrhea 8.3
4 Malaria 6.5
5 Gastritis 6.0
Adami Tulu Woreda
Se. No.
Disease
Percentage
(%)
1 Malaria 32.80
2 Intestinal parasites 8.65
3 Upper respiratory infection 8.55
4 Pneumonia 8.02
5 Skin infections 5.52
6 Woreda Health Offices
8
Table 3.2.2 Some top causes of deaths, June 20057
Meskan Woreda
Se. No.
Disease
Percentage
(%)
1 Malaria NA
2 Pneumonia NA
3 Dysenteries NA
Mareko Woreda
Se. No.
Disease
Percentage
(%)
1 Malaria NA
2 Lower respiratory infections NA
3 Common diarrhea NA
4 Upper respiratory infections NA
Adami Tulu Woreda
Se. No.
Disease
Percentage
(%)
1 Malaria NA
2 Lower respiratory infection NA
3 Diarrhea NA
4 Upper respiratory infections NA
3.3 Health services coverage
The health service is able to reach half of the population of
the most woredas. Meskan woreda has 56.2%, Mareko 54.0% and
Adami Tulu 43.0% health service coverage (Table 3.3.1).
Table 3.3.1 Health services coverage by woreda, June 20058
Se.
No.
Woreda
Services coverage
(%)
1 Meskan 56.2
2 Mareko 54.0
7 Woreda Health Offices 8 Woreda Health Offices
9
3 Adamitulu 43.0
4 Water supply and sanitation
4.1 Water supply coverage
Safe water supply service coverage is low in all woredas.
Meskan woreda has 37.6%, Mareko 32.0% and Adami Tulu 34.0%
safe water supply service coverage (Table 4.1.1).
Table 4.1.1 Safe water supply coverage by woreda, June 20059
Se. No. Woreda Services coverage (%)
1 Meskan 37.6
2 Mareko 32.0
3 Adamitulu 34.0
Overall most sources of water are unsafe. Most households,
65%, get water from traditional well in Meskan, 50% from pond
in Mareko and 100% from traditional well in Adamitulu woredas.
The only major sources of safe water in each woreda mainly
(21.7%) are from water well with hand pumps and few portions
(3.3%) are from protected springs. Significant number of
households is using ponds (16.7%) and river (11.7%) as sources
of water (Table 4.1.2).
Table 4.1.2 Sources of water by type, June 2005
Se.
No. Type of source Meskan % Mareko % Adamitulu % No of HHs No of HHs No of HHs
1 Spring:
Protected 2 10.0
Unprotected
2 River 3 15.0 4 20.0
3 Well:
With hand pump 13 65.0
Traditional 2 10.0 6 30.0 20 100.0
9 Woreda Water Desk Offices
10
Motorized
4 Pond 10 50.0
Total 20 100.0 20 100.0 20 100.0
Most households, 60.0%, can reach water sources within 30
minutes in Meskan, in 1 hour in Mareko and in 30 minutes in
Adamitulu woreds. More than half of the population is
expected to travel more than an hour to fetch water.
Significant number of households, 25.0%, reaches water
sources in 2 hours and 15% in 4 hours walking distances in
Mareko woreda. 15% of the households in Adamitulu woreda can
reach water points in 2 hours and 15% in more than 4 hours.
Some times it may take the whole day to get back to home. A
population with in 1-2 hours walking distances from water
sources are also accounts for 38.3%.
In most cases elder children and women are the one who fetch
water for households. For households with in 30 minutes
walking distances from water sources the children and women
themselves are carrying water. But for households within more
than one hour walking distances from water sources, they use
donkey for fetching and carrying water (Table 4.1.3).
Table 4.1.3 Time taken for a single travel to fetch water, June 2005
Se.
No. Time taken Meskan % Mareko % Adamitulu %
No of HHs No of HHs No of HHs
1
Less than 30
minutes 12 60.0 3 15.0 12 60.0
2 1 hr 7 35.0 7 35.0
3 2 hrs 1 5.0 5 25.0 3 15.0
4 3 hrs 2 10.0
5 4hrs 3 15.0 2 10.0
6 More than 4hrs 3 15.0
Total 20 100.0 20 100.0 20 100.0
11
60% of the households’ water consumption rate is more than 50
litters per day per household for the whole purposes like for
drinking both for family and animals, preparing food,
washing, etc in Meskan, 65% consume 40 litters per day per
household in Mareko and 70% consume 40 litters per day per
household in Adamitulu woredas. Most households consuming
less than 40L of water per day per household fetch water one
time in a day by using different type and size of containers
(20L or 25L size).
Households with water consumption rate at more than 50
litters per day are those using averagely six containers of
10L size per day. These households are the one who have their
own traditional type of well and nearby water sources (Table
4.1.4).
Table 4.1.4 Water management and usage, June 2005
Se.
No. Litters Meskan % Mareko % Adamitulu % No of HHs No of HHs No of HHs
1 20 L/day 7 35.0 1 5.0
2 40 L/day 8 40.0 13 65.0 14 70.0
3 50 L/day 3 15.0
4 More than 50 L/day
12 60.0 2 10.0
Total 20 100.0 20 100.0 20 100.0
Based on focus group discussion, one of the most influencing
factors for per capita water consumption rate in this area
is that most households fetch water for drinking of their
cattle because cattle cannot get water from any where.
Averagely the number of cattle per household is not more
than seven. The per capita water consumption rate is,
therefore, less than 1 litre per day.
4.2 Sanitation services
12
4.2.1 Sanitation facilities
Most households, 70.0%, have traditional pit latrine in
Meskan, 60% in Mareko and 40% in Adamitulu woredas.
Households with out latrine and use open spaces accounts for
30% in Meskan, 40% in Mareko and 60% in Adamitulu woredas.
All households construct new one when the old toilets get
filled. The depth of the most households (85.3%) is about 2-3
meter deep.
Since the water table of the area too deep, there is no
chance for ground water pollution from the depth of the
toilets. The only important aspect to be checked during
construction to avoid infiltration is the position of the
ground water source and toilet (Table 4.2.1 – 4.2.3).
Table 4.2.1 Availability of latrine by households, June 2005
Se.
No.
Availability &
type Meskan % Mareko % Adamitulu %
No of HHs No of HHs No of HHs
1 Latrine available 14 70.0 12 60.0 8 40.0
2 Latrine not
available 6 30.0 8 40.0 12 60.0
3 Traditional pit
latrine (TPL) 14 70.0 10 50.0 6 30.0
4 Improved TPL 2 10.0 2 10.0
5 VIP latrine
6 Open space 6 30.0 8 40.0 12 60.0
Table 4.2.2 Emptying of filled sanitation facility by households, June 2005
Se. No. Practices Meskan % Mareko % Adamitulu % No of HHs No of HHs No of HHs
1 Dis-sludge the toilet 0 0.0 0 0.0 0 0.0
2 Construct new one 14 70.0 12 60.0 8 40.0
Table 4.2.3 Latrine depth by households, June 2005
13
Se. No. Depth (in M) No. of
Households
%
1 2 meters 15 44.1
2 3 meters 14 41.2
3 More than 3 meters 5 14.7
Total 34 100.0
4.2.2 Sanitation coverage
Of the total visited households, 56.7% have latrine. A
significant number of households, 43.3%, have no latrine.
This implies that the surface water/run-off harvesting is not
safe for drinking unless open field defecation practice will
be improved.
4.3 Personal Hygiene
Of the total visited households, 60.0% have a shower every
week in Meskan, 40.0% have a shower once in a month in Mareko
and 55.0% have a shower every week in Adamitulu woredas (Table
4.3.1-1).
Table 4.3.1 Personal hygiene practice by households, June 2005
1. Shower
Hygiene
practice
Meskan
%
Mareko
%
Adamitulu
% No of HHs No of HHs No of HHs
- Twice a
week 1 5.0 0.0 4 20.0
- Every day
- Every week 12 60.0 7 35.0 11 55.0
- Twice a
week
- Twice a
month
7
35.0 5 25.0 5 25.0
- Once a
month
8 40.0
Total 20 100 20 100 20 100
14
Of the total visited houesholdes, 50% are practicing cloth
washing weekly in Meskan, 45% once in a month in Mareko and
55% weekly in Adamitulu woredas (Table 4.3.1-2).
2. Cloth washing
Hygiene practice
Meskan % Mareko % Adamitulu %
No of HHs No of HHs No of HHs
- Every week
10 50.0 5 25.0 11 55.0
- Twice a week
- Twice a month
10 50.0 6 30.0 9 45.0
- Once a month
9 45.0
Total 20 100 20 100 20 100
The majority of the households, 90.0% have hand washing
practice during critical times before eating/feeding and
preparing their food in Meskan, 75% in Mareko and 75% in
Adamitulu woredas. But significant number of households, 45%
has no hand washing practice after visiting toilet, defecating
or cleaning children’s faeces in Meskan, 55% in Mareko and 30%
in Adamitulu woredas (Table 4.3.1-3).
3. Hand washing
Hygiene practice
Meskan % of HHs with hand
washing practice
Mareko % of HHs with hand
washing practice
Adamitulu % of HHs with hand
washing practice
No of HHs No of HHs No of HHs
Yes No Yes No Yes No
- Before eating/
feeding 18 2 90.0 15 5 75.0 15 5 75.0
- Before
preparing food 18 2 90.0 15
5 75.0 15 5 75.0
- After toilet
visiting/defecating 11 9 55.0 9 11 45.0 14 6 70.0
15
4.4 Environmental Hygiene
Most refuse disposal methods (71.7%) are open space and refuse
pit 23.3%. Some households are also using river (3.3%) and
composting (1.7%).
The majority of the households (8.1.7%) also use open space
for wastewater disposal and seepage pit and river 15.0% and
3.3% respectively. The open space disposal method is one of
the main contributors to surface waster/run-off pollution
(Table 4.4).
Table 4.4 Waste disposal practices by households, June 2005
Se.
No.
Waste disposal No. of
Households
practicing
%
1 Garbage/refuse
- Open space 43 71.7
- In pit 14 23.3
- In river 2 3.3
- Make compost 1 1.7
2 Wastewater
- Open space 49 81.7
- Seepage pit 9 15.0
- In river 2 3.3
4.5 Diarrhoea episode
Diarrhoea is highly prevalent in children under five years of
age. Children with diarrhoea two times in the last year
account for 29.0%, three times 33.9% and five times 9.7%. A
significant number of children (27.4%) have diarrhoea more
than five times in a year (Table 4.5.1).
16
The rates of using ORS, antibiotics, traditional medicine and
no treatment are 30.6%, 24.2%, 16.1% and 29.0% respectively
(Table 4.5.2).
Table 4.5.1 Diarrhoea episode in under 5 years children, June 2005
Se.
No.
Frequency of getting
diarrhoea
Number of
children
%
1 2 times 18 29.0
2 3 times 21 33.9 3 5 times 6 9.7
4 More than 5 times 17 27.4 Total 62 100.0
Table 4.5.2 Treatment for diarrhoea by type of medicine, June 2005
Se.
No.
Treatment Number of
children
%
1 ORS 19 30.6
2 Antibiotics 15 24.2 3 Traditional medicine 10 16.1
4 No treatment 18 29.0 Total 62 100.0
5 Conclusions
The over all health service coverage is very low, because the
distribution of health facilities in the study area is not
sufficient.
Because of low level of preventive health services, like safe
and adequate water supply, basic sanitation, personal and
environmental hygiene, most preventable diseases are the major
causes of morbidity and mortality in the area. Most prevalent
health problems are malaria, dysentery, diarrhoea, intestinal
parasites, skin, eye and respiratory infections.
This survey has come up with findings of the most important
and major problems. These are:
17
Low level of preventive and curative health service,
i.e., more than 50% of the population has no access to
health facilities.
High morbidity and mortality rate because of malaria,
dysentery, diarrhoea and respiratory infections.
Lack of safe and adequate water supply, i.e., most
households has no access to safe water supply schemes
(46% from traditional well and more than 16% from
ponds).
Lack of basic sanitation facilities, i.e., more than 43%
of the population has no access to basic sanitation
facilities.
Poor hand washing and environmental hygiene practices,
i.e., more than 43% of the population has no hand
washing practice after toilet visiting/defecating or
cleaning children and use of waste disposal pit.
High rate of diarrhoea episodes among children under 5
years of age, i.e., more than 5 times in a year accounts
for 27%, which is far from 5 times in a year for
national.
6 Recommendations
Recommendations based on the findings:
o Increase numbers of health facilities especially the
health posts that can serve the grassroots level
population.
o Provide safe and adequate water supply schemes and basic
sanitation facilities to reduce the prevalence of water
and sanitation related diseases like malaria, dysentery,
diarrhoea and intestinal parasites.
18
o Raise awareness of the population on good personal hygiene
to control water washed related diseases like skin
infections and eye diseases.
o Raise awareness of the population on good environmental
hygiene practices like proper waste disposal to control
the pollution of man made pond from polluted run-off.
o Encourage households practicing proper waste disposal in a
pit and use of latrines to discourage open filed waste
disposal and defecation.