The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

The Ministry of Health (MOH) and its partners are determined to prevent and manage preventable causes of morbidity and mortality in mothers, neonates and children. In the last decade, special emphasis has been given to increasing the number of health facilities that provide maternal and child health services (MNCH), huge production of skilled birth attendants (SBAs), and equipping the health facilities to improve the utilisation of quality services. This study investigated the community perspectives of health service utilisation and proposes a framework for improving the utilisation of the available SBA and postnatal care (PNC).The purpose of this study was to develop a framework for the utilisation of skilled care for delivery and postnatal care by women of childbearing age (15-45). The study used a Sequential explanatory Mixed Methods Approach to investigate the utilisation of SBA and PNC in a district in Ethiopia. The Delphi Technique helped to solicit input from maternal health care experts on the development of a Framework for utilisation of SBA and PNC. This study utilised the Anderson Health Utilisation Model. In the study, 79.8% and 248 (71.5%) of the women who delivered within 12 months prior to this study received ANC and skilled birth attendance respectively from SBA. Fifty five (15.8%) mothers and 131 (38%) babies received Postnatal care from SBA with in 45 days after delivery. The study further found that women who can read and write and were educated are more likely to utilise SBA and receive quality health care services. The study showed that certain factors such as disrespecting service users, abusing service users’ lack of trust on the SBA by service users, religion and superstition contribute negatively to the use of SBAs. None of the predisposing, enabling and need factors predicted the use of SBA for PNC by the mothers. Nevertheless, through the focus group discussions (FGDs) and individual interviews (IDI), it was revealed that there was a widespread knowledge and perception gaps in the community related to the importance of postnatal period and PNC. Religious sanctification also have imperative role in hampering PNC service use by the mothers. The Health care workers (HCWs) also lacked the keenness and orientation to provide the service. Babies born from families with monthly income equal to 500 or above USD were more likely to use PNC within 45 days. There was a widespread misconception in the community that Babies do not need PNC before 45 days of birth except for vaccination purpose. To examine their role in health service utilisation for SBA and PNC, researches can integrate social support and social network to the Andersen’s health- ervice utilisation model. A framework for utilisation of SBA and PNC is proposed. The researcher recommends developing an utilisation tool kit that specifies the detail operationalisation of the framework. / Health Studies / D. Litt. et Phil. (Health Studies)

Cervical cancer is the second most commonly diagnosed cancer and the third leading cause of cancer death among women in less developed countries. Screening for cervical cancer is the most accepted and successful strategy for cervical cancer control. The purpose of the study was to investigate factors that determine cervical cancer screening practice among women in Addis Ababa, Ethiopia and develop guidelines to improve the utilisation of cervical cancer screening services. The researcher used the health belief model (HMB) as the theoretical foundation of the study and a convergent parallel mixed methods design. Quantitative data was obtained from screened and not screened women attending maternal health services at selected public health centres. Statistical Package for Social Sciences (SPSS) Version 23 was used for entry and analysis of data Qualitative data was obtained in key informant interviews from health service professionals on their perceptions of women‟s cervical cancer screening uptake at the health centres. The study found that higher age >35 years category (X2 =33.618 and p-value <0.001), contraceptive use (X2 value=20.7 and p-value <0.001), having two or more children, and knowledge of cervical cancer and screening (chi-value X2 =51.649, p-value=0.001) were strongly associated with screening practice. In addition, women‟s perception of susceptibility (t-test=3.42 and 3.432, p-value=0.001) was a predictor of screening. Lack of awareness was a serious barrier to cervical cancer screening and health service providers‟ information was a strong promoter of screening. The study recommends promoting and facilitating health education on cervical cancer at all health facilities; organising awareness campaigns, education programmes, and community mobilisation to raise awareness of cervical cancer screening; integrating cervical cancer screening with other reproductive health services, and capacitating the health professionals in order to increase utilisation of cervical cancer screening services. Consequently, the researcher used the findings of the study to develop guidelines to improve the uptake and quality of cervical cancer screening services. / Health Studies / D. Litt. et Phil. (Public Health)

The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)

This qualitative research investigated the implementation problems of apprenticeship training program in the Addis Ababa TVET colleges and enterprises. The research looked into the training program conducted by TVET Colleges and enterprises. Relevant literature on the nature of apprenticeship training and the factors that could affect its implementation were also reviewed. The research applied the theoretical statement of Bandura’s (1977) theory of observation /imitation/, Vygotsky’s theory of ZPD, contextual or the situated learning (Lave and Wenger, 1991), the constructivist view of learning and career theory as the main theoretical frameworks to describe the apprenticeship training process. The theories, however, do not mention the factors that can hamper the implementation of apprenticeship training in a specific social context. The theory of observation was preferred since it can describe the apprentice’s effort to master the skill of an occupation by observing the craftsman at the enterprises. The situated learning was preferred as it gives value to practice as a condition for the effectiveness of learning. Similarly, the research considered Vygotsky’s theory of the ZPD. The application of ZPD indicates the difference between what the apprentice can accomplish independently and what he/she can do with the close assistance of supervisor on a given task. Holland’s career theory (as cited in De lary, Duncan & Swarth, 2006) is also considered to describe the apprenticeship training in relation with an occupation. The current research has enabled to consider context specific conditions by focusing on the investigation of the causes of the implementation challenges of the apprenticeship training. The researcher collected data from Addis Ababa TVET Agency experts, deans of one private and another public TVET Colleges, college apprenticeship training coordinators, trainers, trainees, supervisors and enterprises by employing unstructured and structured interviews, observation and Focus Group Discussion tools. The analysis was made by making the data pass through three successive steps: data reduction, data display and interpretation, and conclusion. The findings showed that the implementation of the apprenticeship training program had challenges that could be shared among its actors; Trade Unions had no involvement in the implementation of the apprenticeship training program; the selected colleges and enterprises addressed their challenges by using limited strategies and without regular and systematic way; the presence of some less motivating factors for the participation of the apprentices in the apprenticeship training was reported; the presence of conditions that could adversely affect the apprentices’ acquisition of occupational skills was reported; the provision of apprenticeship training at the enterprises lack, either facilities or training services, in order to arrange the apprenticeship training program for TVET college trainees; and there were some indications for the presence of some weak professional qualities of supervisors that have implications for the apprentices’ training. Eventually, it was concluded that the implementation of apprenticeship training program in the Addis Ababa TVET Colleges and enterprises had challenges that require the consideration of both institutional and human conditions. / Curriculum and Instructional Studies / D. Ed. (Curriculum Studies)

This thesis examines marginality as a regime of interconnectedness. Drawing on the ethnographic material from a 16-month-fieldwork between October 2009 and December 2010 on the street economy and streetlife in Arada, the old city centre of Addis Ababa’s inner city, I argue that marginalized subjects are not to be seen as social actors that inhabit and create alternative and parallel social, political and economic realities away from the mainstream society. Rather, the way the urban poor are connected and integrated in the broader political economy of the Ethiopian urban society frames and defines modalities, forms and experiences of marginality. From this perspective, this thesis focuses on the on-going reconfiguration of the street economy in Addis Ababa’s inner city. Since the early 2000s, the increasing concern with poverty reduction and good governance in the development agenda has concurred with the attempts of the ruling party to expand its machinery of political control and mobilization at the grassroots of urban society. In this context, under the impact of development programs promoting the establishment of small-scale enterprises, the street economy has undergone a pervasive process of formalization and politicization that has come to advance the realization of an authoritarian form of developmental state, while imposing a regime of unskilled and badly paid labour on the street. This thesis examines this process by looking at the history of streetlife in Arada, as a terrain of social, economic and political practice, and it recounts the everyday life and life trajectories of those involved in the street economy. In particular, I look at how the political reconfiguration of the street economy has come to intertwine with the way living through marginality and dealing with forms of social inequality on the street have been historically conceptualized and experienced in Addis Ababa’s inner city.

Rural-urban differentials in fertility behaviour are neither new nor surprising, but a difference of over four children per woman as observed between rural Ethiopia and the country's national capital, Addis Ababa, in 1990 is rare, possibly unique. Reported fertility in Addis Ababa in 1990 was about 2.6 children per woman. By the mid-1990s, it declined further to 1.8 children per woman. This study investigates the dimensions, components and causes of this remarkable reproductive change. ¶ The study specifically asks and seeks to answer the following questions. Is the decline real, or is it merely an illusion created by faulty reporting? If it is real, how has it come about? Did it result from a change in the onset of reproduction or a decline in the proportion of women reaching high parities or both? And in what context has such a fundamental, even revolutionary, change taken place in a country and a continent that are mostly yet to join the global transition to a small family-size norm. ¶ Data for the study were drawn from two national population censuses, undertaken in 1984 and 1994, two fertility surveys, conducted in 1990 and 1995, and a number of supplementary sources, including a qualitative study conducted by the investigator. Results from the study confirm that the trend of declining fertility and the recent fall to below-replacement-level are indeed real. As the analysis shows the decline was largely driven by changes in the marriage pattern, and supplemented by the increased propensity of fertility control observed across all birth orders and age groups. All socio-economic groups in the city have had a decline in cohort fertility and this was brought about both by shifts in population composition (a composition effect) and increased intensity of fertility control within each group (a rate effect). The institutional and cultural factors that are believed to have prompted these changes are discussed in the thesis in some detail.

In Addis Ababa, Ethiopia, open reservoirs provide the majority of the drinking water. In the study present and future condition of these water sources and supplies were systematically assessed regarding water quantities. The study was done by reviewing municipal documents and accessing meteorological, hydrological and demographical data in Addis Ababa. 0%, 5% and 10% change in reservoir inflow/rainfall were used and projections for 2020 and 2030 were used to estimate future temperature and population sizes. The result indicated that supplied water quantity per capita from surface sources in Addis Ababa is likely to be reduced. Both climate and socio-economic related vulnerabilities were identified and the four following got the highest risk score: Increases in population, increased per capita water demand, overexploited land and increased distribution losses.At present the annual increase in population in Ethiopia is 4.4% and annual GDP increase is 7%, leading to a growing water demand in Addis Ababa. If the water supplies are not substantially increased the situation will lead to water scarcity. By 2020 water demand coverage will be 34% and by 2030 22%, compared with the current 50% coverage.Overexploited land was also identified as a major vulnerability due to the impact on catchment hydrology and distribution losses, caused by insufficient maintenance and replacement of aged pipes. At present 20% of the treated water is lost and it is likely to increase during the coming decades. However, the climate change induced rainfall variability is unlikely to cause large problems within the observed timeframe. Even with a 100 year drought 14% of the available water would be spill due to the limited reservoir capacity.To secure future water distribution Addis Ababa Water and Sewerage Authority (AAWSA) should build dams north of the Entoto ridge. They should also gain further understanding about and find appropriate measures for, highlighted vulnerabilities. A full vulnerability assessment should be done by AAWSA and they should consider implementing a „Water Safety Plan‟ for the whole water supply system.

The present study focuses on the analysis of physico-chemical parameters: electrical conductivity, nitrate and phosphate in the Akaki River basin of Addis Ababa, Ethiopia. These secondary water quality parameters were obtained from two different sources: the surface water quality data both for Little and Great Akaki were retrieved from Addis Ababa Environmental Protection Agency (AAEPA). Whereas, the groundwater quality data for four water wells were obtained from Addis Ababa Water and Sewerage Authority (AAWSA). These water quality parameters have been determined in order to assess the pollution levels of Akaki River basin. The values of the parameters have been evaluated with respect to the maximum acceptable standard level of WHO (World Health Organization) for surface and drinking water. The outcome of the study observed absence of spatial and temporal pattern both on surface and groundwater but displayed a huge variation. The result also showed increasing concentration and variation of all parameters inside and outside the city of Addis Ababa with increasing industrialization and urbanization. Comparison also showed that the little Akaki is highly polluted as compared to Great Akaki River. The ground water chemistry also showed a high phosphate load in all of the productive wells. On the contrary, all the wells displayed nitrate level below WHO standard and they are free from Nitrate. KEY WORDS: Addis Ababa, Ethiopia, Physico-chemical, Little and Great Akaki, AAEPA, AAWSA, Spatial, temporal.