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Butajira hdss, ethiopia

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Addis Ababa University Butajira Rural Health Program

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Background of Butajira HDSS

The Butajira Rural Health Program was initiated in 1986 by performing a census of the population of randomly selected (using the probability proportionate to size technique) nine peasants association (rural communities) and one urban dwellers association (urban village). The initial census was used to obtain the baseline population and to establish a system of demographic surveillance with continuous registration of vital and migratory events (birth, death, marriage, new household, out-migration, in-migration and internal move) at the household level.  Initially data was collected every month.  This was recently changed to be every three months.  In addition, censuses were conducted every 3-5 years to update the baseline.  Undertaking population census has been changed to annual housing, individual and family reconciliation since 2003.


The BRHP was established as a collaborative program between the Department of Community Health, Faculty of Medicine, Addis Ababa University and the Division of Epidemiology, Department of Epidemiology and Public Health, Umea University (Sweden). 


BRHP is located in one of the most densely populated parts of Ethiopia, Meskan and Mareko district, Guraghe Zone. The district is part of the Southern Nations Nationalities and People’s Region (SNNPR). The estimated size of the District is 797 km2, of which Butajira town covers approximately 9 km2.   The district lies at an average of 2100 m above sea level ranging from 1750 to 3400 meters above sea level, from 1750 m in lowlands to 3400 m in mountainous areas, which are sparsely inhabited.  Annual rainfall ranges between 900 and 1,400 mm. The main rainy season is from June to September, with “small rains” common around March and April. The area has rich soil and farming is the main mode of living for the rural population and the staple food is Enset (false banana). Teff (a cereal staple), maize, millet, barley and legumes are the main crops. Pepper, coffee and khat (a mild stimulant drug) are also grown as cash crops. Enset (false banana) cultivation is very common and gives the main staple food in the area.


The population of the district is estimated at 259,689 with the majority (87%) residing in rural areas. The vast majority of the district population follows the Islamic religion.  The district has 82 villages but the HDSS site was established in ten randomly sampled villages, with an initial estimated population of 30,000. Currently there are 12798 households with an estimated population of 54,096 as of January 1, 2007.

The population structure shows typical developing country pattern whereby the proportion of children under 14 years is 38% and that of older people 65 years and over is 3%. There are one technical, one high school, and 14 junior secondary and 14 primary schools in the district. The number of private clinics and drug vendors are also increasing in the district.
The BRHP has been the basis for research capacity building both locally and in Sweden and other European countries as evidenced by 10 completed and 5 ongoing in PhD works in Swedish, Norway and in-house. More than 35 MPH theses were done in BRH (See Appendix I for list of PhD and MPH theses and publications from BRHP). A number of staff from the Faculty of Medicine have attended summer courses on epidemiology and field research methods in Umea, Sweden. BRHP is also one of the field training sites for mid-level health professionals training within the Faculty of Medicine.
The local people are also believed to have benefited from the existence of the base in various ways. The base has created jobs for about 40 local residents for the last 20 years. The enumerators of the study base were recruited from the respective villages in consultation with the local people.

Many of the epidemiologic surveys conducted in the base had treatment packages for endemic diseases on site. Intervention studies, for example the ARI study. Infectious disease study and Indoor air pollution study, provided treatments for targeted diseases during the study periods. These projects also support the establishment and maintenance of nine health posts in all rural villages and the training of the community health workers locally recruited.

The health posts are being utilized by other sectors like agriculture extension workers and health extension workers providing education and vaccinations.

The ARI study has reduced childhood mortality through the introduction of appropriate case management protocol for cases of pneumonia at grass root levels.

The mental health study has also established a psychiatric clinic in Butajira Health Centre and assisted in the training of psychiatric nurses. With the continuation of the study base more benefits are incorporated in the planned intervention studies.

The study base has also contributed to the establishment of a hospital in the town of Butajira. To date the base supports the electronic recording system of the entire activities of the hospital including Internet use.


The main aim of the program is to establish a field epidemiologic laboratory that will help in tracking changes in health outcomes and behaviour through continuous registration of vital events. In addition, causes of death will be established by employing the verbal autopsy procedure in BRHP and provide information for informed decision. The specific objectives of the program are to:

Priority Research Areas

  • Reproductive health


  • Domestic violence

  • Mortality patterns in different gender and age groups;

  • Malaria Prediction

  • Health Systems and Financing:

  • Epidemiology of Cardiovascular Disease Risk Factors

  • Study of in-door air pollution and its association with respiratory tract infection in children;

  • Mental Health studies

  • AIDS Mortality surveillance

  • A verbal autopsy cause of death study

Completed Key Projects (Up to 10)

Project Name


Grant Period

Mortality and Survival from Childhood to Old Age in Rural in Ethiopia



Study of mechanisms and rate of spread of HIV from rural to urban areas



Studies of mortality patterns in different gender and age groups



Study of in-door air pollution and its association with respiratory tract infection in children; and



Mental health studies



Epidemiology of Cardiovascular Disease Risk Factors in Ethiopia




Studies of domestic violence




Transmission Patterns of Measles, Rubella and Hepatitis B viruses

Welcome Trust


Ongoing Key Projects (Up to 10)

Project Name


Grant Period

The trivalent Meningitis Vaccine Trial



AIDS Mortality surveillance



Establishing HIS and its management that links the research base with the local health system (Hospital)



Study on perinatal maternal disorders in Ethiopia

Wellcome Trust


Validation of the IUALDT bronchial symptoms questionnaire to enhance asthma diagnosis and treatment in an Ethiopian population

Association of Physicians, UK and Northern Ireland


Study of in-door air pollution



Malaria Prediction system



A verbal autopsy cause of death study



Planned Projects (Up to 5)
Project Name:

  • The new-born study

  • The assessment of the interrelationship between population dynamics and health in Butajira

Human Resource at the site (Grouped by Major Categories)



Research Scientists


Clinical Staff


Statisticians / Bio-Statisticians


Field Supervisors


Database and ICT


Field Workers


Administrative staff



Main funding sources for the program currently are Sida/GLOBFORSK, CDC/EPHA, NUFU and WHO.


The major collaborators for the program are the Division of Epidemiology, Department of Epidemiology and Public Health, Umea University and the local Ministry of Health (regional, zonal and district health offices), WHO, USAID, NUFU


PhD Theses

  1. Mesganaw Fanrtahun (2008). Mortality and Survival from Childhood to Old Age in Rural in Ethiopia; Umeå University , Sweden

  2. Fikru Tesfaye (2008). Epidemiology of Cardiovascular Disease Risk Factors in Ethiopia; Umeå University , Sweden

Published Articles in peer reviewed Journals

  1. Duncan P, Aref-Adib G, Venn A,Britton J, Davey G. Use and misuse of paracetamol and aspirin in rural Ethiopia: study with qualitative and quantitative components. East African Medical Journal.2006;83:31-36.

  1. Fantahun M, Fortell E, Berhane Y, Wall S, Hognerg U, Byass P. Assessing new approach to verbal autopsy interpretation in rural Ethiopia: the interVA model. Bull World Health Organization. 2006; 84:204-210.

  2. Fantahun M,Berhane Y, Wall S, Byass P,Hogberg U. Women’s involvement in household decision-making and strengthening social capital—crucial factors for child survival in Ethiopia . Acta Pædiatrica 2007; 96: 582–589

  3. Berhane Y, Wall S, Fantahun M, Emmelin A, Mekonnen W, Hogberg U, Worku A, Tesfaye F, Molla M, Deyessa N, Kumie A, Hailemariam D, Enqueselassie F & Byass P. A rural Ethiopian population undergoing epidemiological transition. over a generation: Butajira from 1987 to 2004. Scandinavian Journal of Public Health, 2008; 36: 436–441

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Site Contact Details

Dr Fikre Enquselassie

Head, School of Public Health

Addis Ababa University, Ethiopia

Tel: + 251 11 507549


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