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.