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.

Surface water is globally becoming more and more a scarce resource, and in Addis Ababa the capital of Ethiopia, river water quality has been degraded due to anthropological forcing for many years. Therefore, the study objective was to investigate causes and impact of surface water pollution in Kebena and Great Akaki rivers. The technical aspect of the study focused on analysing the parameters E. coli, phosphate, nitrate and total ammonia nitrogen in 34 different sampling sites in the western part of the Great Akaki catchment. The other aspect was to evaluate authorities’ and companies’ perspective on the water quality, usage and future plans to mitigate further pollution of rivers. Another perspective was to interview households and farmers regarding their view on usage, water quality and health risks. The main finding was a high surface water contamination in both Kebena and Akaki river, throughout the city, mostly from domestic, municipality and industrial wastewater and solid waste. E. coli concentrations exceeded thresholds given by WHO. Concentrations of phosphate and total ammonia nitrogen strongly indicated eutrophication. Nitrate values were lower than expected with no perceived healthrisk. The interview study with authorities, households and farmers indicated irrigation as the main usage. Little to moderate health risks perceived by farm users and high health risks perceived by authorities for farmers were found. Therefore, addressing a stronger collaboration between authorities and the local community is important. In addition, the implementation of mitigation strategies should be strengthened and the stakeholders need to be accountable for their actions. A continued monitoring of pollutants as well as a multi-sectoral approach to solidwaste and wastewater management will help improve the river water quality. / Ytvatten blir globalt allt mer en knapp resurs och i Addis Abeba, huvudstaden i Etiopien, har flodernas vattenkvalitet under många år försämrats på grund av antropogen påverkan. Denna studie syftar till att undersöka orsaker och påverkan på ytvattenföroreningar i floderna Kebena och Akaki. Den tekniska aspekten av studien inkluderar vattenanalyser av parametrarna E.coli, fosfat, nitrat och totalt ammonium kväve som utfördes på 34 olika provtagningsplatser i västra delen av Great Akakis avrinningsområde. Den andra aspekten var att utvärdera myndigheters och företags perspektiv på vattenkvalité, flodvattnets användningsområden och framtida planer för förbättring av föroreningsgraden i floderna. Ett annat perspektiv var att intervjua hushåll och lantbrukare angående deras bild av ytvattenanvändning, om vattenkvaliteten och hälsorisker. Studiens huvudsakliga upptäckt är en genomgående hög föroreningsgrad i stadens flodvatten. Föroreningen består till största del av avlopp och avfall från hushåll, kommuner och industrier. Koncentrationerna av E.coli överskred WHO:s gränsvärden. Halterna av fosfat och totalt ammoniumkväve indikerade övergödning. Nitratvärdena visade lägre halter än förväntat och därmed ingen påvisad hälsorisk. Intervjustudien med myndigheter, hushåll och lantbrukare påvisade att ytvattnet mest används för bevattning av åkermark. Lantbrukarna uppfattade en liten till medelhög hälsorisk med denna användning, medan myndigheter ansåg att lantbrukarna utsattes för en hög risk. Därför är ett starkare samarbete mellan myndigheter och samhället viktigt. Dessutom behöver implementationen av förbättringsåtgärder förbättras och alla aktörer måste göras ansvariga för sina handlingar. En fortsatt övervakning av föroreningar och ett multi-disciplinärt arbetssätt vid avfall- och avloppshantering kommer att vara till hjälp vid förbättring av vattenkvaliteten i floden.

Master of Public Health - MPH / The Health Extension Program (HEP) is an innovative, community based comprehensive primary health care program that Ethiopia introduced in 2003. It gives special emphasis to the provision of preventive and promotive services at community and household level. However, utilization of the HEP packages is low and reasons for this underutilization are not well known. The aim of this study is to assess the availability and utilization of the Health Extension Program Service in Akaki District of Oromia Region, Ethiopia. Quantitative study using a cross-sectional survey design. The study was conducted in Akaki District of Oromia Regional State in Ethiopia with 79,162 inhabitants. Random sampling was used to select 355 households. A structured data collection tool/ questionnaire was employed to collect data from the study participants. Data were analyzed using SPSS for Windows version 19. Descriptive statistics were used to analyze socio demographic characteristics of the study participants and to assess the availability and utilization of each service component. The response rate of the study was 100% with complete data obtained from 335 (94.4%) of the households. The majority (93.1%) of respondents were women. The availability of HEP services as described by the household visit of Health Extension Workers (HEWs) is very high with 86.6% visiting at least monthly and 11.3% visited sometimes. There was a highly significant association between the health extension workers’ visit to households and health extension service utilization during pregnancy (OR=16.913, 95% CI 8.074-35.427 at p<0.001). HIV testing utilization showed a tenfold increase among households who received education. Participation of households in the Model family initiative was another key factor associated with high levels of HEP services utilization. Though HEP services are available for most households, the frequency of household visits by HEWs and the involvement of Households in model family training greatly influenced service utilization. Improving frequency of services availability at household level and consistent health education will greatly improve services utilization.