The ethiopian

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Alemu Mekonnen, MD, Dennis Carlson, MD

Department of Community Health, Faculty of Medicine, Addis Ababa University
A randomized field trial involving two modes of contraceptive distribution, clinical and community-based, which were again divided into "free" and "paying" subgroups was carried out in four rural service cooperatives (S.c.)( consisting of 4-6 Farmers Associations) of Sululta, Oromia Region, from Octl92 -Feb/93. The baseline survey revealed no important differences in potential confounders among the selected 8 Farmers Associations (FA) ( 2 FAs from each S.C.). Of the total 110 clients, 75 (68.2%) were females while 35(31.8%) were males. After 17 weeks of program intervention the contraceptive prevalence rate was 5.8% at Community Based Distribution (CBD), while 2.6% at clinics. There was a significant difference (p= .043) between paying and free groups in continuation rates. The main reasons for not starting oral pills was lack of knowledge while those in favour of starting were to prevent pregnancy, already having enough children and the need for birth spacing. The majority (80.0% ) of male clients started using condoms to prevent STDs and AIDs. The high attendance rate of women at CBD sites may be due to easier accessibility of many CBD programs sites and the fact that these programmes reach a large majority of the rural population. The increasing trend of continuation, which may be due to value given to paid items, might also help broaden the acceptance of family planning services.

Fertility preferences among currently married women in Addis Ababa

Yared Mekonnen; BSc, Tekabe Ayalew; BA, Amare Dejene; BSc, MSc

National Research Institute of Health

In this study fertility rate of married women, desire for additional children, preferred birth intervals and ideal family size were addressed. Of 1000 women who were included in the survey, 699 (69.9%) were in union and the analyses were made on this group. The Marital Fertility Rate (MFR), Fertility Rate of Spacers (FS) and Fertility Rate of Limiters (FL) were found to be 4955,2739 and 5273 births per 100 women, respectively. About 53% of the married women want to stop child bearing and 14% want to delay for at least two years suggesting that 67% of the women are potential contraceptive users either for the purpose of spacing or limiting birth. The Contraceptive Prevalence Rate of spacers (45.9%) is higher than that of limiters (34.4%) and it is 31.6% for the population of married women. These women were asked what they think would be the ideal family size and about 40% said four children although some said family size is determined by God.

Contraceptive, demographic and sexual behaviours or high school students in Jimma, southwestern

Ethiopia.

Tesfaye Shiferaw, BSc, MPH, DrPH¹ Sileshy Demaissie, BSc, Messeret Shiferaw, BSc, MD2

¹Department of Community Health, Jimma Institute of Health Sciences, 2Department of Training,

Ministry of Health

There is scarce information about the levels of sexuality and fertility among students in Ethiopia. The purpose of this study was to explore the pattern of contraceptive, demographic and sexual behaviours of high school students in Jimma, southwestern Ethiopia. A total of 535 randomly selected subjects responded to self administered questionnaires. Over 65% of students reported to have knowledge on modern contraceptive methods while only 20% currently make use. Nearly 40% of the students reported unprotected sexual encounters during the past four weeks with one or more partners. Males showed a significantly higher preponderance of sexual practice and earlier encounter. The mean desired family sizes were 6.1 and 6.4 for males and females respectively which was not statistically significant (P > 0.05). The mean desired number of sons (3.01 and 3.8) by males and females respectively was found to be statistically significant (P < 0.05). The mean desired number of daughters (3.2 and 3.9) by males and females was found to be statistically significant (P < 0.05). The gap between contraceptive knowledge and actual use; and the prevalence of high-risk sexual encounters seemed high. Moreover, students awareness on population issues seemed low. School-based surveys that periodically measure the prevalence of priority health-risk behaviours among students at national, regional or zonal levels are suggested in order to plan interventions.

Drug use and purchasing determinants in an Addis Ababa district

Alemeyehu Belayneh, MD, David Zakus, PhD

Department of Community Health, Faculty of Medicine, Addis Ababa University

This study assesses the overall drug use pattern (with and without prescription) in an Addis Ababa community , potential drug sources, factors associated with increased drug consumption and purchasing following an illness episode. It employed a cross-sectional community-based survey of a sample of 1185 households, selected randomly from the source population of all 23 kebeles of the previous Yeka District of Addis Ababa. A structured questionnaire was developed, pretested and implemented for the purpose of the survey. The study showed that 85.2 % of the studied sample population took some kind of drug (prescribed or non-prescribed) and 14.8% did nothing following an illness during the four week study period. Drug users and nonusers were compared with respect to demographic and socio-economic variables. The use was higher among children less than 5 years of age, in high income groups, and among those with higher average health care expenditure per episode. There was no sex difference observed in relation to drug taking with or without prescription. 86.9% and 84.1% of males and females, respectively, took drugs. Of these drug users, 95.5% took them with prescription and 4.5% without. It is believed that the high use rate of drug taking and specifically drugs with prescription following an illness in the district might be explained with the burden of morbidity in the district.
Assessment or the user characteristics or the out patient service or Jimma hospital.

Ferew Lemma, MD, MPH, Abebe G!Mariam BSc, MPH and Mebrat Kebede

Department of Community Health, Jimma Institute of Health Sciences
A cross- sectional survey to assess the users characteristics of the out patient service (OPD) of Jimma Hospital (South-West Ethiopia) was undertaken between 1-15 August 1993. All patients (n = 1256) who reported to OPD services were interviewed using a structured questionnaire to examine socio-demographic factors, reasons for hospital visit and other variables. Data was collected by 10 senior medical students, who were superyised by investigators. Among 1256 OPD service consumers 76.6% were from Jimma. 9.8% out of Jimma but with in Jimma Zone. 13.6% out side Jimma Zone 12.7% patients were referred from other health institutions 52.9% are females, 63.5% were married, 7.3% have a family size of > 10. The majority (58.7% ) are christians by religion. 36% are free patients. Occupationally 32.7% are students, 8.4% farmers and 40.5% are either children or others without occupation. Travelling distance of patient to hospital was determined: 74.5% have travelled less than one hour, 2.6% travelled 712 hours, 11.8% sought medical help 1-7 weeks and 12 weeks respectively. 69.3% and 7.8% had received treatment from health institutions, and other sources respectively prior to arrival to the hospital .
Evaluation or district health management teams in Addis Ababa Mahdi Bekri, M.D, David Z8kus,

PhD

Department of Community Health, Faculty of Medicine, Addis Ababa University

This study, a cross-sectional census survey with a case control analysis, assesses various determinants of functionality of District Health Management Teams (DHMTs) in Addis Ababa. The questionnaire survey component was carried out among 16 DHMTs from December, 1992 to February, 1993. The objectives of the study were to describe the work of the various heal~ teams and classify them as functional or nonfunctional. The findings revealed that eight of the DHMTs were performing 60% or more of the ctivities mentioned in their job description, this being the cut-<>ff point for determining functionality. The criterion for functionality was then further strengthened, limiting functionality to those teams who performed 64 % of their required activities, leaving seven in this category .Comparing these with the five nonfunctional teams 56% of their required activities) various associations between structural team characteristics and internal team interaction processes were found. DHMT functionality was positively associated with the academic qualifications of the team leader (OR= 14.1 with 95% CI 14-259), with the presence of job descriptions for the team members (OR=4.0 with 95% CI 3.8-57.3), with the size of the team (OR= 10 with 95% CI 9.98-128.82), and with the presence of research activities (OR=5 with 95% CI4.1-106.4). Among the team interaction process that were found to be important to functionality (at P < 0.05) were the clarity of objectives, knowledge of each others roles, analysis of experience, good communications, a feeling of belonging, and respect for differences. These findings demonstrate the importance of structural and interaction processes for the appropriate development of health management teams and the further strengthening of the district health care system.
Utilization of traditional medicine among inpatients in Jimma hospital Abebe G.Mariam, BSc., MPH,

Frew Lemma, MD., MPH, Yilikal Alemu

Department of Community Health, Jimma Institute of Health Sciences
A cross-sectional survey to determine the utilization of Traditional Medicine (I'M) and its relation with cultural, educational and socio-economic aspects was carried out in july 1992 in surgical and medical inpatients in Jimma Hospital (South -west Ethiopia). All patients were studied using a pre-tested and structured questionnaire. Data was collected by 3 senior medical student, who were supervised by investigators. A total of 113 patients in the age group 14 -18 were identified by the survey. The majority (69% ) are males, 67% were from rural areas, 57.5% were muslim by religion, 64.6% are illiterate, 67.2% are either unemployed or farmers by occupation and only 25.7% have an average income of 500 Birr and above. Results indicated that 26.9% of rural and 12.3% of urban admitted patients were found to use TM. 43.3% are in the age group 40 and above, 28.3% illiterates, 25.7% farmers, 4.4% unemployed patients, 22.2% muslims, 15.9% christians and 9.7% of patients with income less that 500 Birr were found to utilize TM. Symptoms for which TM was utilized included 13.6%, 6.8%, 4.5% and 2.5% for Mitch (acute febrile illness), Entil (tonsillitis), and for combination of the above symptoms and others respectively. 52.6% of the TM users received treatment from traditional 1iealers. Easy accessibility was reported to be the main reason to use TM (47.7%). 36.6% reported to have had symptomatic relief after using TM, while only 6.8% said the symptoms were aggravated after the use of TM.18.2% reported to the hospital because of TM failure. 95.6% of the study subjects preferred to use modern medicine in future rather that TM. Based on the findings of the study recommendations are given.
Knowledge, attitude and practice (KAP) towards harmful traditional practices among high school

students in Addis Ababa.

Amare Dejene Haregewoin Cherinet, Fisseha Haile Meskal, Abate Gudunffa and Ayalnesh Mekonnen

National Committee on Harmful Traditional Practices

KAP study on Harmful Traditional Practies (HTP) with special emphasis on female circumcision has been conducted among 1722 students (45.7% male, 54.3% female) in 5 high schools in May 1993 in Addis Ababa. The majority of the respondents, 77.2 % believe that female circumcision is a harmful traditional practices. Mainly the mother decides for a daughter to be circumcised in the family followed by grandmothers and fathers. Most of the student (greater than 85%) support eradication of major harmful traditional practices. 67.9% of the respondents have suggested different means and ways of eradicating female circumcision. Among the study population 40% of the girls are circumcised. The study identifies mothers as the most important target groups to be sensitized during the implementation program. It is also recommended to consider suggestions of the students during the campaign.

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