Chapter 5: Health status
1. BSF/IFAD project
2. General situation of the project area
3. Anthropomethry
4. Nutrition status
26
Chapter 5: Health status
27
5. Health status
Within the framework of the BSF/IFAD project, preventive health care will be emphasised.
‘Health’ and ‘health status’ will therefore be considered from this viewpoint.
If we mention woredas, we actually refer to the catchment area of the woredas since the
questionnaires are limited to the catchment areas of the different woredas.
Suggestions for possible interventions will be written in italic and all variables mentioned are
summarised in Chapter 7.
5.1. Causal model
The health status is influenced by many determinants. All possible determinants of relevance
to the target group were identified and linked in a causal model during a comprehensive and
participatory workshop in Awassa (June 1997). Figure 5.1. shows a simplified model of the
model composed during the workshop. Only elements of importance for this study were
restrained. This model will be used as starting point to determine the health status. Health
determinants considered as important in the literature but not taken up in this model such as
breast feeding and weaning foods will therefore also be discussed.
5.2. Results
5.2.1. Sanitary environment and facilities
5.2.1.1. Housing
Houses are very primitive: floors are mostly made from mud and walls from wood and mud.
Most houses have roofs of grass and straw, only a few houses have corrugated iron as a roof
like 40.4% in Goffa Zuria which is the highest percentage.
These primitive living conditions make a hygienic environment impossible. It can be
concluded that the situation is more favourable in Konso S.W. compared to other woredas
since this woreda counts the highest percentage of households with a separate kitchen and
households where the animals are not sleeping in the house.
5.2.1.2. Household waste
The majority of the households dump their waste in the open field. More than 70% of the
households is doing so except for Konso S.W. (58.7%), Damot Galle (62.0%) and Tellocheta
(63.9%). This situation is not favourable for a hygienic environment and should be changed
especially in woredas with a high population density like Damot Galle, Sodo Zuria and Goffa
Zuria.
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The percentage of households dumping their waste in the open field should decrease through
the intervention and the percentage of households digging their waste in a pit should
increase.
5.2.1.3. Human waste
Only a few households have a latrine: the lowest percentage can be found in Chena (8.0%)
and the highest in Sodo Zuria (53.3%) like seen in Figure 5.2. More than 80% of the
households use their latrine except for Chencha Zuria were only 72.7% of the households
does so. The use of a latrine is fewer in the rural areas compared to the urban areas. Latrines
become often too dirty to use because of bad maintenance.
The percentage of households having a latrine should increase through the intervention. The
intervention can only called successful if the new latrines are also used and this on a long
term base.
5.2.1.4. Water
Figure 5.3. shows households having access to safe water. Water is considered as safe if it is
coming from a tap, a protected spring or a well with a hand pump. It is clear that Goffa Zuria
has the highest percentage (67.3%) of households with access to safe water. In all other
woredas these percentages are lower than 35%. The very low percentages of Tellocheta and
Chena could be explained by the occurrence of many natural springs with fairly clean water.
In these woredas the intervention could and should be limited to the protection of these
springs.
It could be said generally that the percentages of households with access to safe water should
increase a lot through the intervention, especially in the rural areas where access is very low.
Increasing the number of safe water points should provide more water for household
activities (see Figure 5.4.) and the time for collecting water should decrease (see Table 5.1.).
The intervention could be completed with health education on the importance of hygiene.
Indicators for health education could be for example the percentages of households storing
their water in a proper way (see Figure 5.5.), percentages of households where mother and
children take a bath at least once in 2 weeks (see Table 5.2.), and the percentage of
households where the mother could show a piece of soap to the interviewer (see Table 5.2.).
Possession of soap but it is a necessary condition for its use but does not guarantee the use of
it. It could also indicate poverty as a lot of households said they were not able to buy soap
because it is too expensive.
The frequency of bathing is very low, especially in Offa, Konso S.W. and Tellocheta. In these
woredas there should be paid attention on this custom during health education.
Very few households in Chencha Zuria (18.0%) store their water properly covered. Only in
Tellocheta, Chena en Goffa Zuria are these percentages higher than 70.0%. People should be
made aware of this topic.
The situation in rural areas is generally worse than the one of urban areas which confirms that
it was a good choice to take rural people as target group. Of all woredas the situation of
Chapter 5: Health status
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Konso S.W. seems worst since this woreda has the worst score on all variables except for the
percentage of safe water points. Chencha Zuria also scores very bad.
The percentages of this section are an important indication for the present situation since the
BSF interventions will enhance the number of safe water points. By doing so more households
should use safe water in the future and more water should be available for households
activities. Time spent on water collection should also decrease. Through health education, the
percentage of households storing their water in a proper way should increase as bad storage
can undo the effect of safe water at the source.
5.2.1.5. Recommendations of the population itself for sanitation and a hygienic
environment
During the interview, people were asked about the major problems considering sanitation and
hygiene of the environment. Table 5.3. shows the answers of the respondents. It is clear that
safe water is the major problem in 5 of the 8 woredas. Latrines are most important in Goffa
Zuria and second in Damot Galle, Sodo Zuria, Offa, Chena and Tellocheta.
Education is also mentioned a lot, which means people are interested in information. It can be
concluded that education is wanted and necessary during an intervention. The frequency of
people mentioning not having enough money to buy soap is an indication for the economic
situation.
Interventions preferred by the population correspond with the problems mentioned in Table
5.3.
5.2.2. Health facilities
5.2.2.1. Family planning
Family planning is a very important topic since Ethiopia has a fast population growth which
causes shortage of fertile land in an lot of woredas. When looking at Figure 5.6. which shows
the percentage of women knowing how to prevent a pregnancy, it can be concluded that there
is still a lot to do about family planning, especially in Chencha Zuria. Most women, knowing
how to prevent pregnancies, are to be found in Konso S.W. but these women are using a non
safe method. Condoms are used very rarely.
The percentages of unwanted pregnancies is an indication of the demand for family
planning. This demand is highest in Chencha Zuria (54.5%) were also most women do not
know how to prevent a pregnancy. Also in Offa (46.0%) and Damot Galle (41.8%) there are a
lot of unwanted pregnancies.
5.2.2.2. Vaccinations
The percentage of vaccinated children is shown in Figure 5.7. and is higher than the
percentage of vaccinated women. Only in Konso S.W. there are a lot of mothers (66.7%) who
took care to vaccinate their youngest child. This percentage is a lot lower in all other woredas.
Chapter 5: Health status
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5.2.2.3. Antenatal care
The majority of women delivers at home, especially the rural women. Most women are
assisted by family. The second major part delivers alone and a third part with the assistance of
a traditional healer. TBA’s seem only important in Konso S.W.
The majority of women do not seem to seek antenatal care. Only in Konso S.W. this custom
seems to exist because 86.4% of the women had antenatal care during their last pregnancy
while the other percentages are around 20 to 30%.
The number of deliveries with assistance of TBAs should increase through the BSF
intervention since new TBAs will be trained and present TBAs will be given extra training
during this intervention. They will also be given a complete delivery set. From the supply side
questionnaire it is known that present TBA’s do not report their performances in the health
station or centre. The BSF intervention should also pay attention to this topic.
5.2.3. Breast feeding and weaning foods
The percentage of mothers who gave breast feeding to their youngest child is very low
compared to other developing countries (see Figure 5.8.). The lowest percentage of women
giving breast feeding is found in Konso S.W. This is in contradiction to the fact that Konso
S.W. has the most women seeking antenatal care where the importance of breast feeding
should be emphasised.
When dividing women into 2 age classes (women above 25 and women of 25 and younger), it
becomes clear that it are mainly the elder women who do not give breast feeding (see Table
5.8). These results should be interpreted carefully as the number of elderly women is low or
zero like in Offa.
It could be that elder women do not give breast feeding anymore because they are exhausted.
The anthropometric results showed that mainly elder (pregnant) women had a BMI below
18.5 so they could be considered as malnourished. This could be caused by pregnancies with
short birth intervals so mothers can not recover from their pregnancies. This may be
especially true if they have not the possibility to rest and eat enough.
It might be recommended to involve elder women in education on breast feeding and to
encourage them to beer give breast feeding as long as they feel themselves physically capable
to do so. These results are a stimulus for family planing as they indicate that is better for the
health of mothers to bear children at a younger age and to be able to spread the births so they
can recover more easily from their pregnancies.
Most women start breast feeding their child within 2 hours after birth so the child gets the
colostrum with the antibodies. Breast feeding is almost always given on demand of the baby.
The duration of breast feeding varies along the woredas (see Figure 5.8.) but most mothers
sustain breast feeding for at least 6 months.
The percentages of women, giving their children (between the age of 4 and 6 months)
supplementary liquids, is very high. The lowest percentage is found in Chena and is still
52.2%. Through nutrition education these percentages should decrease as supplementary
liquids nullify the effect of breast feeding because those liquids are often made with unsafe
and unboiled water which can cause diarrhoea.
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Only a few mothers seem to know that breast feeding only is sufficient for babies up till 6
months. A lot of mothers starts too early or too late with giving weaning foods as seen in
Figure 5.9. It is clear that effective education on weaning foods can ameliorate this situation.
Moreover most mothers are very interested in information about breast feeding and weaning
foods: the lowest percentage of mothers asking for this information can be found in Chencha
Zuria (53.0%), all other woredas have percentages above 72.2%.
5.2.4. Recommendations by mothers to have healthy babies
The majority of mothers considers a good and balanced diet as most important to have
healthy babies (see Table 5.6). Mothers seem to know what the important topics are, but do
not know how to realise them since there are still a lot of malnourished children. This would
suggest that a lack of knowledge is not the reason but a lack of means or a combination of
both.
5.2.5. Mortality and morbidity
Figure 5.10. shows the percentage of households where at least one child died before it
reached the age of 1 year. These percentages are the highest for Chena, Konso S.W. and Offa.
This result is strange for Konso S.W. since it had the best score for vaccinated children and
antenatal care. The low percentage of mothers giving breast feeding could be a possible
explanation.
Figure 5.11. shows the percentages of households where the mother considers her children to
have a bad health status. These percentages are relatively low compared to the number of
households where a child died. These percentages should decrease to have a successful
intervention.
When considering the behaviour of households with an ill child, it becomes clear that a lot of
households want to come to the health centre if they had enough money available to do so: the
percentages of these households are lying between 54.5% (Offa) and 91.4% (Konso S.W.).
Chencha Zuria is the only exception with the majority of households (36.9%) seeking help by
a traditional healer. Chencha Zuria has also the highest percentage of households, who do
nothing but wait when their child is ill.
People are very interested in obtaining information about how to treat diarrhoea at home: the
lowest percentage of interested households is hound in Chencha Zuria which is 68.0%. All
other percentage are higher than 80.0%. This information seems necessary since almost no
one uses oral rehydration solutions (highest percentage of households using it is 8.4% in Sodo
Zuria) and local medicines and drinks are preferred to medicines of the health centre. There
are also a lot of mothers who do not know that diarrhoea is caused by unhygienic living
conditions, contaminated food and bad weaning practices. A lot of mothers also do not know
that a child with diarrhoea needs more liquids (see Figure 5.12.).
This perception should be drastically changed by an intervention.
Chapter 5: Health status
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5.3. Conclusion
From the previous considerations, it can be concluded that the health status of the BSF
woredas is vulnerable. Sanitary facilities for human and household waste are rare and only a
few households have access to safe water or have enough water for household activities.
Besides the lack of facilities there is also a lack of basic knowledge of hygiene, diarrhoea,
breast feeding, family planning and related topics.
Health care should be extended by equipment, staff and activities. Health care seems also very
expensive to the people surveyed.
The BSF intervention should take into account the needs and preferences of the population
from the catchment area. The baseline study showed that different woredas have different
needs and that not every intervention is as much important in all woredas. This conclusion
justifies the fact that the baseline study was carried out in all the 8 woredas.
Suggestions for interventions based on results of this chapter are given in Chapter 7.