TITLE: TYPHOID FEVER PREVENTION PRACTICE AND

ASSOCIATED FACTORS IN CHICHU KEBELE, DILLA ZURIA

WOREDA, GEDIO ZONE, SOUTHERN ETHIOPIA, 2024

SUBMITTED BY: GROUP I, 2NDYEAR MEDICINE

STUDENTS

SUPERVISOR: ELSHADY (BSC, MSC)

SUBMITTED TO: CBE OFFICE

DILLA, ETHIOPIA

JUNE, 2024
 ACKNOWLEDGEMENT
First, we would like to thank the Almighty God. Then, our deepest
gratitude to the CBE coordinate office of Dilla University for organizing
this opportunity to practice our theoretical knowledge and help the
society, for it gives us better perspective and more experience dealing
with the community and its problems. We would also like to thank our
resident advisor for guiding us through constructive comments, assistance
and encouragement.

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 ABSTRACT
This study purposed on was conducted on typhoid fever prevention practice and
associated factors in Chichu kebele, Dilla zuria woreda, gedio zone, Southern
Ethiopia Regional State, 2024.

INTRODUCTION: Typhoid fever (TF) is a febrile life-threatening disease that

affects millions annually. It is mainly transmitted through the fecal-oral route.
Typhoid fever can be prevented by maintaining food safety, safe water supply, proper
sanitation, vaccination, and health education to create public awareness and induce
behavioral change after identifying knowledge, risk perception, and prevention
practice gaps and by adapting it to local conditions.

OBJECTIVE: To assess the prevention practice of typhoid fever and its

associated factors in Chichu kebele, Dilla Zuria, Gedeo zone, May, 2024.

METHODOLOGY: A community based cross-sectional study was conducted

among selected households by using systematic random sampling technique in Chichu
kebele. A questionnaire was developed referencing previous literature. Data collection
was conducted by using structured questionnaire. Data was entered and analyzed by
using software called SPSS v. 27.

RESULT: Finding of the study showed that Age, risk Prevention and knowledge
towards typhoid fever are associated factors that are identified as potential factors of
typhoid fever.

CONCLUSION: the study concluded that majority of the studied subjects had an
unsatisfactory knowledge level about typhoid fever and less risk perception and more
of less rare typhoid prevention practice was observed. In recent studies, the relative
risk perception of typhoid fever has been found to be relatively high when compared
to other similar infectious diseases.

RECOMMENDATION: Health extension workers and local authorities must

provide health education about TF and preventive mechanisms. In adtion Kebele

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Administrators should work in collaboration with health extension workers and
community elders to prepare meetings on health information about TF

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 TABLE OF CONTENTS
ACKNOWLEDGEMENT..............................................................................................i
ABSTRACT...................................................................................................................ii
TABLE OF CONTENTS..............................................................................................iv
CONTENT OF FIGURE.............................................................................................vii
CONTENTS OF TABLES.........................................................................................viii
CHAPTER ONE: INTRODUCTION............................................................................1
1.1. Background.....................................................................................................1
1.2.Statement of The Problem................................................................................3
1.3. Significant of the Study...................................................................................3
1.4. General Objective:...........................................................................................6
1.4.1 Specific Objective:................................................................................6
CHAPTER 2:..................................................................................................................7
LITERATURE REVIEW...............................................................................................7
2.1 typhoid Fever As A Disease.............................................................................7
2.1.1. Methods of Transmission..................................................................7
2.1.2. Mechanism f Typhoid Fever.............................................................7
2.1.3. SYMPTOMS & DIAGNOSIS OF TYPHOID FEVER...................8
2.2.FACTORS ASSOCIATED WITH TYPHOID FEVER................................10
2.2.1. FOOD borne Illness........................................................................10
2.2.2. Water, Sanitation And Hygiene......................................................11
2.2.3. Latrine............................................................................................11
2.2.4. Healthcare Associated Factors........................................................12
2.2.5. Socio-Economic Status And Knowledge Level..............................12
2.3.Conceptual Framework..................................................................................13
CHAPTER 3: METHODS AND MATERIALS..........................................................16
3.1.Study Design..................................................................................................16
3.2.Study Area and Period....................................................................................16

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 3.3.Population.......................................................................................................16
3.3.1. study Population..............................................................................16
3.3.2. Study Unit.......................................................................................17
3.3.3. Sample Size Determination.............................................................17
3.3.4. sampling technique and sampling procedure..................................18
3.4.Eligibility Criteria..........................................................................................18
3.4.1. Inclusion Criteria............................................................................18
3.4.2. Exclusion Criteria...........................................................................18
3.5.Data Collection Procedure.............................................................................19
3.5.1. Instruments......................................................................................19
3.5.2. Data Collectors................................................................................19
3.5.3. Data Quality Control.......................................................................19
3.6.Variables.........................................................................................................19
3.7.Operational Definition....................................................................................20
3.8.Data Management And Analysis....................................................................20
3.9.Ethical Considerations....................................................................................20
3.10.Dissemination of the Result.........................................................................21
CHAPTER FOUR........................................................................................................22
RESULT AND PRESENTATION..............................................................................22
4.1. Socio-demographic characteristics of participants........................................22
4.2. Perceived Prevalence of Typhoid Fever in Chichu kebele...........................24
4.3. Kowledge of Respondents towards Typhoid Fever......................................25
4.4 Risk perception towards Typhoid fever.........................................................27
4.5. Typhoid prevention practice..........................................................................29
4.6. Factors associated with Typhoid Fever prevention practice.........................31
4.7. Discussion.....................................................................................................33
4.8. Strength and limitation of the study..............................................................35
CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATIONS.......................36
5.1. Conclusion.....................................................................................................36

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 5.2. Recommendation.....................................................................................37
Reference......................................................................................................................38
Annex-I: Informed consent..........................................................................44
Annex-II: Assessment of perceived prevalence and associated factors of
typhoid fever................................................................................................45

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CONTENT OF FIGURE
Figure1: Typhoid fever and its factors Conceptual Framework..................................13
Figure 2: pie-chart of respondents on knowledge Typhoid fever................................27
Figure 3: pie chart- Risk Perception towards Typhoid fever.......................................28
Figure 4: Pie chart on prevention practice question.....................................................31

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CONTENTS OF TABLES
Table 1: Proportionality of distribution of Sample in Chichu kebele ketenes’............18
Table 2: Socio-demographic characteristics of participant(n=359).............................23
Table 3: prevalence of typhoid fever in Chichu kebele (n=359)..................................24
Table 4: Knowledge of Respondents towards Typhoid Fever (n=359).......................26
Table 5: Attitude towards Typhoid fever of respondents (n=359)...............................28
Table 6: Typhoid prevention practice related questioner (n=359)...............................30
Table 7: The Model fitness test in Hosmer and Lemeshow Test (n=359).............32
Table 8: Factors on prevention of typhoid fever (n=359)............................................32

CHAPTER ONE: INTRODUCTION

1.1. BACKGROUND
Typhoid fever is a global health problem causing great suffering in developing
countries where unhealthy living conditions prevail. Also known as enteric fever, this
potentially fatal multi- systemic disease is caused by several serotypes of Salmonella
Enterica including S. Typhi and S. Paratyphoid. Untreated or sub optimally treated
typhoid fever may lead to perforation of the terminal ileum. The complication
requires surgical management and is still associated with considerable morbidity and
mortality [1].

Enteric fever also known as typhoid fever is a water borne disease transmitted via the
fecal- oral route and is contracted by the consumption of water or food stuffs
contaminated by salmonella typhi or typhi bacillus or by urine from an infected
person or carrier[2]. Typhoid fever is an illness caused by bacterium Salmonella.

Food borne gastroenteritis caused by enteric bacterial pathogens like Salmonella and
Shigella species in human beings remains a major public health problem around the
world (1). Salmonella is the most frequently reported cause of food borne illness,

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worldwide. Salmonella infection most commonly occurs in countries with poor
standards of hygiene in food preparation and handling and where sanitary disposal of
sewage is lacking. It mainly occurs in the tropics and sub tropics in Africa, India,
Pakistan South East Asia and South America (2).

Typhoid fever, also known simply as typhoid, is a disease caused by Salmonella

enterica serotype Typhi, also called Salmonella Typhi (3). Typhoid fever is a
significant global health concern, particularly in developing regions such as Ethiopia,
where access to clean water and adequate sanitation is limited (4).

Typhoid fever is a life-threatening disease typically spread through contaminated food

or water (5).The disease is associated with symptoms such as prolonged fever,
fatigue, headache, nausea, abdominal pain, and constipation or diarrhea. In severe
cases, typhoid fever can lead to complications or even death (6). Typhoid fever has
been a known health threat for centuries, with some historical suggestions that it was
responsible for a plague in Athens in 430 B.C (7). The bacteria responsible for
typhoid fever, Salmonella typhi, was first described in the late 19th century (8). Once
ingested, the bacteria multiply and spread into the bloodstream, leading to the
symptoms associated with the disease (9).

Despite improvements in living conditions and antibiotics, typhoid fever remains a

public health problem in many developing areas, particularly in regions lacking access
to safe water and adequate sanitation (10).

As of 2019, there are an estimated 9 million cases of typhoid fever annually, resulting
in about 110,000 deaths per year. Children are at the highest risk, and the disease's
prevalence is influenced by factors such as urbanization and climate change (8).

Similarly, TF, one of the major public health problems, showed 5%-56.2% S. Typhi
prevalence at different times and geographical areas of Ethiopia [6]. The burden of S.
Typhi is affected by different geographical areas, times, persons, and places [8].
Besides lack of access to safe water, poor sanitation, poor hand washing practices
(after using toilet, before eating food, and before preparing food), eating raw foods
(milk, vegetables, and meat), improper disposal of human and other wastes, close

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contact with TF cases or carriers, and low level of education increased the risk of
acquiring S. Typhi [8].

As indicated by World Health Organization (WHO) [9] and other studies [2,6], TF
can be prevented by maintaining food safety, safe water supply, proper sanitation,
vaccination, and health education to create public awareness and induce behavioral
change after identifying knowledge, attitude, and practice (KAP) gaps and by
adapting it to local conditions in the study area.

Knowledge is necessary to acquire optimum health. Attitude development is not

essentially a function of the amount of information one receives but a function of how
that information was acquired. Furthermore, advancing the knowledge of
communities towards TF is a powerful means to foster favorable attitude and
exercising preventive practices among the population. Therefore, a clear
understanding about the knowledge, attitude, and practices (KAPs) among any
community is required to interrupt and prevent the transmission of TF. Determining
the prevalence of S. Typhi, KAPs of the community towards TF, and identifying
associated factors on TF will have paramount importance to implement proper TF
prevention and control strategies. Thus, the present study was intended to determine
the sero prevalence of S. Typhi and KAP offebrile patients towards TF in Chichu
general hospital, Northwest Ethiopia

1.2. STATEMENT OF THE PROBLEM

Typhoid fever is a significant public health concern in Chichu kebele,Dilla Zuria. The
prevalence of this infectious disease has raised serious health issues among the local
population. The lack of access to clean water, poor sanitation, and limited healthcare
facilities have contributed to the high incidence of typhoid fever in the area.
Furthermore, the community’s limited awareness of preventive measures and the
absence of effective public health interventions have exacerbated the problem. As a
result, there is an urgent need to comprehensively understand the impact of typhoid
fever in Chichu kebele to develop targeted strategies for prevention and control.

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In this analytical research, we delved into the multifaceted challenges posed by
typhoid fever in Chichu kebele. By examining the socio-economic factors,
environmental conditions, and healthcare infrastructure, we aim to identify the root
causes of the high prevalence of typhoid fever. Additionally, we explored the existing
knowledge and practices related to hygiene and sanitation within the community to
assess the gaps that contribute to the spread of the disease. Through this
comprehensive analysis, we intend to provide valuable insights that can inform
evidence-based interventions to mitigate the burden of typhoid fever in Chichu
kebele.

Overall, this research seeks to shed light on the pressing issue of typhoid fever in
Chichu kebele, emphasizing the need for targeted interventions and community
engagement to effectively combat the disease and improve the overall health
outcomes of the local population.

1.3. SIGNIFICANT OF THE STUDY

Furthermore, the findings of this study could help health authorities and organizations
develop targeted interventions and education programs to prevent and control typhoid
fever in the community. By understanding the knowledge levels and practices of the
residents towards typhoid fever, effective measures can be implemented to improve
public health outcomes and reduce the burden of this disease in Chichu kebele.
Ultimately, this study has the potential to positively impact the health and well-being
of the community members and contribute to overall improvements in the quality of
life in the area.

In conducting our study, it is important to consider the history of previous

exposure to typhoid among respondents in the study area. Understanding the
prevalence of previous cases can provide valuable insights into the current risk
factors and potential for future outbreaks. Additionally, exploring the risk
perception towards typhoid fever among respondents is crucial in assessing the
level of awareness and preparedness within the community. By examining both
historical exposure and risk perception, we can better strategize and implement

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effective prevention and control measures to mitigate the spread of typhoid in
the study area.

The current status assessment of perceived prevalence and associated factors of

typhoid in Chichu Woreda is a crucial endeavor aimed at understanding and
mitigating the impact of this infectious disease within the community. By
conducting a comprehensive evaluation of the prevalence of typhoid and its
related factors, valuable insights can be gained to inform prevention strategies
and public health interventions. This assessment serves as a foundation for
evidence-based decision-making, enabling stakeholders to prioritize resources
effectively and implement targeted measures to reduce the burden of typhoid in
the region. Through a systematic analysis of data and collaboration with local
health authorities, this assessment will contribute to the development of
sustainable prevention practices that safeguard the health and well-being of the
population in Chichu Woreda.

The majority of cases and deaths occurring in Asia and sub-Saharan Africa largely
driven by lack of access to clean water and poor sanitation (11). Moreover, recent
studies done on the burden of TF in low- and middle-income countries revealed an
increasing trend of TF in Africa(12). Though different laboratory test methods and
clinical specimens are used, the prevalence of S. Typhi is variable among different
countries in Africa and among different geographical locations in Ethiopia. Previous
studies done showed a heterogeneous prevalence of S. Typhi in African countries
ranging from 5%–69.6% (13).

As indicated by World Health Organization (WHO) and other studies, TF can be

prevented by maintaining food safety (Shahbaz, 2022), safe water supply, proper
sanitation (Immurana, 2022), vaccination (Dagan, 2021), and health education to
create public awareness and induce behavioral change after identifying knowledge,
attitude, and practice (KAP) gaps and by adapting it to local conditions in the study
area (Salata, 2020).

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Knowledge is necessary to acquire optimum health. Attitude development is not
essentially a function of the amount of information one receives but a function of how
that information was acquired (18). Furthermore, advancing the knowledge of
communities towards TF is a powerful means to foster favorable attitude and
exercising preventive practices among the population. Therefore, a clear
understanding about the knowledge, attitude, and practices (KAPs) among any
community is required to interrupt and prevent the transmission of TF. Determining
the prevalence of S. Typhi, KAPs of the community towards TF, and identifying
associated factors on TF will have paramount importance to implement proper TF
prevention and control strategies (19).

Thus far, the FMOH has established different intervention strategies for the
community to improve awareness and risk perception of infectious diseases including
typhoid fever through health extension workers. However, the burden of typhoid fever
has not been reduced to an acceptable rate (10). Bearing in mind, in Ethiopia, typhoid
fever is an endemic disease, and the burden and consequence of the disease vary with
different ecology, climate, and population groups. So, communicating the latest new
information concerning the distribution of typhoid fever in the catchment area will
have valuable significance for early and prioritized interventions (20).

Typhoid fever is most common among individuals who work in food handling and
preparation activities and overcrowding slums and low-economic-status people
because of poor hygiene and waste disposal system. Unless protective and control
measures are taken appropriately, the occurrence of typhoid fever outbreaks would be
higher (10). Thus, the study attempted to survey on the typhoid fever prevention
practice and associated factors in Chichu kebele, Dilla zuria woreda, Gedio zone,
southern Ethiopia regional State.

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 CHAPTER TWO: OBJECTIVE
1.1. GENERAL OBJECTIVE:
To assess typhoid fever prevention practice and associated factors in Chichu kebele,
Gedeo zone, Southern Ethiopia, May,2024

1.2. SPECIFIC OBJECTIVE:

o To determine typhoid prevention practice in Chichu kebele, Southern
Ethiopia, 2024

o To identify factors associated with typhoid prevention practice in Chichu

kebele, Gedeo zone, Southern Ethiopia, 2024

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 CHAPTER THREE: LITERATURE REVIEW
1.1. TYPHOID FEVER AS A DISEASE
1.1.1. METHODS OF TRANSMISSION

Water is a source of diseases of typhoid and paratyphoid which affect the alimentary canal. In
home and school, it is essential that hands should be washed after defecating or urinating, for
infection can be transferred in unclean hands used to prepare food or handle eating pots (21).

Unwashed hands, exposed septic sores, contaminated water and flies can also spread infection to
food during its preparation. In areas where drainage and sanitation are poor, water runs over the
ground during rainstorms, picks up feces and contaminates water sources. This contributes
significantly to the spread of diseases such as typhoid (4).

Other ways typhoid fever can be contracted include using a toilet contaminated with bacteria,
eating seafood from a water source contaminated by infected remains, eating raw vegetables that
have been fertilized by human waste, contaminated milk and poultry products and oral or anal
sexual practices with a person who’s a carrier of Salmonella typhi bacteria (10)

1.1.1. MECHANISM F TYPHOID FEVER

After ingestion in food or water, typhoid organisms pass through the pylorus and reach the small
intestine. They rapidly penetrate the mucosal epithelium via either micro fold cells or enterocytes
and arrive in the lamina propria, where they rapidly elicit an influx of macrophages that ingest
the bacilli but do not generally kill them (22). Some bacilli remain within macrophage of the
small intestinal lymph nodes. Typhoid bacilli are drained into mesenteric lymph nodes where
there is further multiplication and ingestion by macrophages. It is believed that typhoid bacilli
reach the bloodstream principally by lymph drainage from mesenteric nodes, after which they
enter the thoracic duct and then the general circulation (23).

As a result of this silent primary bacteremia the pathogen reaches an intracellular haven within
24 hours after ingestion throughout the organs of the reticulo-endothelial system (spleen, liver
and bone marrow), where it resides during the incubation period, usually of 8 to 14 days (24).
The incubation period in a particular individual depends on the quantity of inoculums (the

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introduction of pathogenic organisms into body to produce immunity to the specific diseases),
i.e., it decreases as the quantity of inoculum increases, and on host factors. The incubation
periods ranging from 3 days to more than 60 days have been reported (25). Typhoid begins like a
cold. Temperature goes up a little more each day. Pulse rate relatively slow and sometimes
diarrhea and dehydration, trembling or delirium (mind wanders) and person very ill.

The clinical presentation of typhoid fever varies from a mild illness with low-grade fever,
malaise, and slight dry cough to a severe clinical picture with abdominal discomfort and multiple
complications (26). Many factors influence the severity and overall clinical outcome of the
infection. They include the duration of illness before the initiation of appropriate therapy, the
choice of antimicrobial treatment, age, the previous exposure or vaccination history, the
virulence of the bacterial strain, the quantity of inoculums ingested, host factors (e.g., HLA type,
AIDS or other immunosuppression) and whether the individual was taking other medications
such as H2 blockers or antacids to diminish gastric acid (27). Patients who are infected with HIV
are at significantly increased risk of clinical infection with S. typhi and S. paratyphi (28). Acute
non-complicated disease: Acute typhoid fever is characterized by prolonged fever, disturbances
of bowel function (constipation in adults, diarrhea in children), headache, malaise and anorexia.
Bronchitis cough is common in the early stage of the illness. During the period of fever up to
25% of patients show exanthema (rose spots), on the chest, abdomen and back (29).

1.1.2. SYMPTOMS & DIAGNOSIS OF TYPHOID FEVER

Abdominal discomfort develops and increases. It is often restricted to the right lower quadrant
but may be diffuse. The symptoms and signs of intestinal perforation and peritonitis sometimes
follow, accompanied by a sudden rise in pulse rate, hypotension, marked abdominal tenderness,
rebound tenderness and guarding, and subsequent abdominal rigidity. A rising white blood cell
count with a left shift and free air on abdominal radiographs are usually seen. Altered mental
status in typhoid patients has been associated with a high case-fatality rate. Such patients
generally have delirium, rarely with coma. The gold standard for typhoid diagnosis is isolation
and identification of Typhi from culture of blood, stool, or bone marrow; however, healthcare
facilities in LMIC often lack capacity for performing bacterial culture. Thus, many typhoid cases
are diagnosed clinically or with unreliable serologic tests, whereas others remain undiagnosed

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and inappropriately treated. Following infection, patients may shed Typhi in their stool or urine
for 1–12 months, and up to 5% of patients was come asymptomatic chronic carriers, potentially
excreting the bacteria for many years (30).

Given the fecal–oral transmission route and persistent shedding by asymptomatic carriers in
endemic populations, WASH, and food-handling interventions are critical control measures to
interrupt typhoid transmission (31). Water interventions improve the quality, quantity, or
management of water.

Sanitation interventions separate feces from human contact (15). Hygiene interventions refer to
the conditions and practices that remove pathogens from the surfaces of an individual (hand
washing, bathing, etc.) or the home environment (cleaning or disinfection). Food-handling
interventions (food interventions) refer to the safe production, processing, and storage of foods,
with a focus on high-risk foods commonly associated with transmission risk (32).

For a definitive diagnosis of typhoid fever, the World Health Organization (WHO) recommends
bacterial isolation from blood or bone marrow. The gold standard is bone marrow culture,
obtained through aspiration of the iliac crest or sternum and has a suggested sensitivity of 90%
after 4 days of culture. However, due to the invasive nature of bone marrow biopsies, the
diagnosis typically depends on blood culture or the Widal test (10).

According to the WHO, the criteria for establishing a diagnosis of Typhoid Fever have three
modalities: Suspected Case, Confirmed Carrier and Chronic Carrier. A suspected patient has a
fever for at least three successive days in an endemic region or after travelling from an endemic
zone. During this timescale, the acute phase of the infection is detectable with rapid tests such as
TUBEX and Typhi dot, and serological testing such as the Widal test, albeit the Widal test is
currently not clinically accepted (33).

A confirmed case is a patient whose laboratory findings or molecular techniques for recognizing
S. typhi confirm the bacterial presence. In this phase, the patient presents with compatible
typhoid-like symptoms such as persistent high-grade fever, fatigue, headache, nausea, abdominal
pain, and diarrhea or constipation. At this stage of the disease, a blood culture or bone marrow
culture is used to confirm the diagnosis. Thus, it has been recommended to have clinicians with a
firm grasp on the clinical presentation of typhoid fever, laboratory testing, and ruling out other
causes of fever to suspect and confirm typhoid fever cases in Africa (34).
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Lastly, a chronic carrier is a person who still excretes the bacteria causing typhoid for up to 12
months or more. The patient here presents gall bladder pathology in conjunction with
cholecystitis, cholelithiasis, gall bladder cancer and other pathologies at anatomical sites where
the bacteria localize and grow. A fecal specimen for microbiological culture investigations is the
best to identify the disease status at this stage of the disease. Although the polymerase chain
reaction (PCR) was adopted to diagnose the chronic carrier status in Africa, still stool culture is
the investigation of choice during this stage (35). Diagnosing Typhoid fever in Africa is hindered
by the resource and personnel limitations within the continent.

When developed nations had adopted blood or bone marrow culture as the diagnostic
investigations of choice when trying to confirm the enteric fever, almost all of the countries in
Africa were still reliant upon serology or agglutination tests especially the Widal test as the
investigation of choice. Other investigations for diagnosing typhoid fever include stool culture,
urine culture, and other laboratory tests (36).

2.2. FACTORS ASSOCIATED WITH TYPHOID FEVER

1.1.1. FOOD BORNE ILLNESS

Contaminated food is a major cause of Salmonellosis worldwide. Foodborne illness is a

common, costly, sometimes life threatening – yet largely preventable – public health problem.
Many outbreaks and individual cases of foodborne illness result from consuming the two most
common types of foodborne pathogens; bacteria, like Salmonella, Listeria, or E. coli and
Viruses, such as norovirus or hepatitis A. Anyone could get a foodborne illness. But some people
have a higher risk, such as pregnant women, young children, older people, and those with weak
immune systems (37).

Foodborne salmonella causes two kinds of illnesses. The first is Salmonellosis – usually
characterized by nausea, vomiting, diarrhea, cramps, and fever, with symptoms generally lasting
a couple of days and tapering off within a week. The other kind of illness is Enteric Fever – high
fever, diarrhea or constipation, aches, headache, and drowsiness. Enteric fever includes typhoid
fever and paratyphoid fever. Up to 10% of people with enteric fever who do not get treatment
may die. Enteric fever is usually associated with sewage-contaminated drinking water (38).

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 1.1.2. WATER, SANITATION AND HYGIENE

Typhoid is transmitted via the fecal-oral route, which means that the typhoid-causing bacteria
can pass into people’s mouths through food, water, hands, or objects that have been
contaminated with fecal matter. Globally, 2 billion people lack access to safely managed
drinking water services and 3.6 billion people lack access to safely managed sanitation services
(e.g., toilets). These communities are at higher risk for typhoid and other waterborne diseases
such as diarrheal infections, polio, and hepatitis A. By safely separating waste from water
sources used for drinking, cooking, washing, cleaning, or swimming, and ensuring that water is
treated and free of contamination, we can help prevent the spread of typhoid along with many
other diseases (39).

In a study done on household water treatment practices in Burie Zuria Woreda, Northwest
Ethiopia, the finding shows that, among the total study participants, 357 (44.8%) of them treated
water at their home. More than half, 213 (59.7%), boil water, 74 (20.7%) settle and stand and 70
(19.6 %) have used chlorine chemicals (“Wuha-Agar” and “Bishan-Gaari”) (40)and in a study
done in some rural areas of Ogun State, Nigeria on 250 rural households, out of these about
households 20%, 36%, 12%, 9.2% and 14.4% of them use borehole (hand dug well), pipe borne
water, river and streams respectively (41).

1.1.3. LATRINE

Around 2.3 billion people do not have access to any basic sanitation facilities, and 892 million
people still defecate in the open. Everyone deserves a safe place to go, not only for the privacy
and dignity it provides but also for the health of our communities (42).

When human excretions get loose and contaminate water, food, hands, or objects that can make
their way into people’s mouths, it spreads deadly enteric illnesses like diarrhea and typhoid (43).
All enteric illnesses are spread via the fecal-oral route, so improvements in water, sanitation, and
hygiene can dramatically decrease the risk of both diarrhea and typhoid (44). In Jakarta,
Indonesia, one study found that households with a toilet were half as likely to get typhoid as
households without a toilet (45). But toilets themselves are only half the equation.

A family with a toilet can still be at risk of contracting diseases like typhoid if the water they use
for drinking, cooking, bathing, or washing is contaminated by fecal matter from elsewhere in the

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community—open drains, lakes and rivers, surface or floodwaters, public latrines, or fecal sludge
in the soil (46). Human excreta and its pathogens spread easily without a safe sanitation system,
so we also need to make sure that the waste is properly captured, stored, transported, treated, and
disposed or recycled (46)

1.1.4. HEALTHCARE ASSOCIATED FACTORS

Individuals with enteric fever are managed as outpatients in Africa, a continent where typhoid
fever is widespread, and are consequently treated with oral antibiotics, whereas hospitalization
remains a necessity in the most severe or complicated cases. Relapse and fecal carriage have
received a lot of attention in typhoid patients, and both of these factors can enhance the illness
severity and chronicity, which in turn has the potential to raise the disease transmission rates
(18).

1.1.5. SOCIO-ECONOMIC STATUS AND KNOWLEDGE LEVEL

Other factors that have significant roles in the prevalence of typhoid fever are socio-economic
factors and the knowledge of community on modes of transmission. Many qualitative and
quantitative researchers sought to point out that African countries or the individuals in those
areas have limited knowledge on the burden of typhoid fever risk factors and relate it to their
behaviors, hygienic practices, and the prevention of the disease (49).

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 1.2. Conceptual Framework

The study conducted a survey on the prevalence of typhoid fever among respondents in Chichu
Woreda, focusing on socio-demographic characteristics association with the disease. The
variables studied included sex, age of the respondents, religion, educational status, marital status
of the household head, occupation of the household members, number of individuals in the
house, and average monthly income.

DEPENDENT VARIABLE
Typhoid Fever Prevention Practice
And Associated Factors

Figure1: Typhoid fever and its factors Conceptual Framework

This comprehensive approach aimed to gather a holistic understanding of the factors that may
contribute to the spread and prevalence of typhoid fever within the community. By examining
these various socio-demographic factors, the study sought to identify potential risk factors and

22
patterns that could be instrumental in developing targeted interventions and strategies for
prevention and control of the disease. The findings from this survey are expected to provide
valuable insights for healthcare providers, policymakers, and other stakeholders involved in
public health efforts to reduce the burden of typhoid fever in Chichu Woreda.

As part of our research, we are interested in the history of previous exposure to typhoid among
respondents. We would like to inquire if any family members have been admitted to a healthcare
center within the last six months, specifically for a case of typhoid fever. Additionally, we are
curious if you personally have ever been infected with typhoid fever and sought treatment at a
healthcare center. If so, we are interested to know if you used any medications and for how long.
Furthermore, we would like to inquire if there has been a typhoid fever vaccination campaign in
your area within the past six months. Lastly, we are interested to know if you often travel, as this
may play a role in your risk of exposure to typhoid fever. Your responses will help us better
understand the prevalence and risk factors of typhoid fever in different populations.

Knowledge of the respondents towards typhoid fever is essential in preventing its transmission
and managing its symptoms. Typhoid fever is caused by germs and can be transmitted through
drinking contaminated water or eating contaminated food. Symptoms of typhoid fever include
headache, loss of appetite, fever, and diarrhea. Risk factors for typhoid fever include poverty,
consumption of dairy, poultry, and fish products. Prevention measures such as hand washing,
drinking boiled or treated water, and proper waste disposal can help reduce the risk of typhoid
fever infection. It is important for individuals to receive health education on typhoid fever to
effectively differentiate its symptoms from other diseases.

Effective prevention and management of typhoid fever requires a comprehensive understanding

of risk perceptions among individuals. The transmission of this serious disease occurs when
infected persons come into contact with healthy individuals. Factors such as inadequate access to
clean and reliable water sources, poor sanitation practices, and the absence of proper waste
disposal facilities like pit latrines in homes all contribute to the spread of typhoid fever.
Additionally, consuming unwashed raw vegetables can also increase the risk of infection. By
conducting thorough studies to investigate and address these risk factors, strategies can be
implemented to combat the prevalence of typhoid fever in communities. It is imperative to

23
educate the public on the importance of practicing good hygiene and utilizing clean water
sources to reduce the risk of contracting this debilitating illness.

In preventive mechanism this study it was important in considering the main source of drinking
water is crucial for maintaining good hygiene practices. Water treatment is essential to ensure the
water is safe for consumption. It is important to use soap when washing hands, especially before
preparing meals, after using the toilet, and after changing diapers. Having a private latrine
facility and proper waste storage at the household level also contributes to maintaining
cleanliness. It is important to have separate containers for different types of waste and ensure
they are covered. Sanitary conditions where children play, as well as clean drinking water
provided at food stalls and restaurants, are also key factors in preventing the spread of diseases.
It is recommended to consume food at home more frequently than at food stalls, restaurants, or
local food shops. Additionally, it is vital to be mindful of the cleanliness of raw vegetables and
fruits consumed outside the home. By practicing these prevention measures, we can help protect
ourselves and others from potential health risks.

24
 CHAPTER FOUR: METHODS AND MATERIALS
3.1. STUDY DESIGN
A community-based cross-sectional study was implemented to evaluate the awareness of typhoid
fever and its related determinants in Chichu kebele. The community-based cross-sectional study
that was conducted in Chichu kebele aimed to assess the level of awareness among its residents
regarding typhoid fever and its associated determinants. The study utilized a sample of
individuals selected randomly from the community, with data collected through interviews and
questionnaires. Findings from the study indicated varying levels of awareness among the
residents, with some demonstrating a good understanding of the disease and its risk factors,
while others lacked crucial knowledge. Factors such as education level, access to healthcare
services, and socioeconomic status were identified as key determinants influencing awareness
levels. These results highlight the importance of targeted health education programs and outreach
initiatives to improve knowledge and prevention efforts related to typhoid fever within the
community. Overall, the study provides valuable insights for policymakers and healthcare
providers to address gaps in awareness and promote better health outcomes in Chichu kebele.

3.2. STUDY AREA AND PERIOD

The research was undertaken in the Chichu kebele, a community with a total population of
80,000 residents. The study spanned from May 20 to May 23, 2024 G.C., focusing on specific
aspects within this local area. By examining the dynamics and characteristics of Chichu kebele
within this timeframe, valuable insights were gained regarding various socio-economic factors
and community needs. The findings from this study aim to contribute to the broader
understanding of the region and potentially inform future development initiatives.

3.3. POPULATION
3.3.1. STUDY POPULATION

As far as the study conducted in Chichu kebele, all residents comprised the total population
under consideration. Through the application of systematic random sampling, a specific target
population was selected from the households within the community. This method ensured a fair

25
and unbiased representation of the residents of Chichu kebele, in the study, allowing for accurate
and reliable results to be obtained. By focusing on a specific subset of the population, researchers
were able to gather valuable data and insights that can contribute to a better understanding of the
community and inform decision-making processes in the future.

3.3.2. STUDY UNIT

Heads of households in Chichu kebele using systematic random sampling.

3.3.3. SAMPLE SIZE DETERMINATION

Single population proportion formula was used to determine the required sample size
2
z ∗q∗p∗N
n= 2 2
d ( N−1 )+ z ∗p∗q

Where,

n= Sample size.

P= sample Proportion, P = 50% value is taken and q = 1-p= 1-0.5=0.5

Z= Confidence interval (95%) in significance of α= 0.05

Zα /2 = the standard score for 95% confidence level is 1.96

d= Margin of error (0.05)

( 1.96 )2∗0.5∗0.5∗2434
n= 2 2
( 0.5 ) ( 2433 )+ (1.96 ) ∗0.5∗0.5

2336.64
n=
5.8392

n= 400

The sample size gives 400

26
 3.3.4. SAMPLING TECHNIQUE AND SAMPLING
PROCEDURE

Chichu kebele has 2434 households. The households in each sub-kebele were selected by
systematic random sampling method. The first households were determined by lottery method
and the rest are selected every 9th value until total sample size was achieved.

N 2434
K= = = 8.57 ≈9 and we made proportionality of n/N = 0.164
n 384

Table 1: Proportionality of distribution of Sample in Chichu kebele ketenes’

No Chichu Kebele ketena Group population Proportionate sample

1 Ketena 1 1052 172

2 Ketena 2 734 121

3 Ketene 3 650 107

Total 2434 400

3.4. ELIGIBILITY CRITERIA

3.4.1. INCLUSION CRITERIA

All households with heads that are resident in the kebele who have stayed for more than 6
months. Any responsive body above 18 years old in the absence of household head.

3.4.2. EXCLUSION CRITERIA

Households with respondents whom are chronically ill and unable to respond.

27
3.5. DATA COLLECTION PROCEDURE
3.5.1. INSTRUMENTS

The data was collected using structured and pretested questionnaire adapted and modified from
different literature to fit the situation at hand and the objective of the research. It was made sure
that the data collection groups discussed the questions and understood them well before taking
them to the community.

3.5.2. DATA COLLECTORS

The data was collected by second year medical students.

3.5.3. DATA QUALITY CONTROL

The structured questionnaire was adapted from different literature and used to collect data. The
objective of study was elaborated to participants. The pretest was on 5% of sample size which
was performed second week prior to study. All data was checked for completeness, clarity and
consistency by the group members. The questions were translated to questioner to local language
and training was given for data collectors.

3.6. VARIABLES
 DEPENDENT VARIABLE:
o Prevalence of typhoid fever
o Typhoid prevention practice

 INDEPENDENT VARIABLES:
o Socio-demographic: Age, Sex, Education status, Marital Status, family size
o Usage of safe water for cooking and drinking
o cleaning hands
o avoidance of contaminated foods like raw vegetables and fruits.
o Knowledge
o Attitude
o Previous typhoid infection

28
 o Usage of latrine

3.7. OPERATIONAL DEFINITION

 GOOD KNOWLEDGE: - participant score mean and above regarding

knowledge question among the total knowledge related questions was classified as
having a good knowledge

 POOR KNOWLEDGE:- participant score below mean regarding knowledge

question was classified as having poor knowledge.

 RISK PERCEPTION:- as a measurable construct representing an individual's overall

evaluation, feeling, or disposition toward a particular object, person, group, idea, or
situation. Risk perception refers to the way individuals assess and interpret the
likelihood and consequences of potential hazards.

 POSITIVE ATTITUDE:- participant score mean and above regarding

knowledge question among the total attitude related questions was classified as
having a positive attitude.

 NEGATIVE ATTITUDE:- participant score mean and above regarding

Risk perception question was classified as having negative attitude.

3.8. DATA MANAGEMENT AND ANALYSIS

The collected data underwent a thorough manual review to ensure its completeness and
consistency before being entered into the SPSS software version 27 for analysis. In the bi-variate
analysis, variables with a P-value of less than 0.25 were identified as candidates for further
exploration in the multivariate analysis. Subsequently, in the multivariate analysis, variables with
p-values lower than 0.05 were deemed statistically significant in association with typhoid fever.
This rigorous analytical approach helped in identifying key factors potentially linked to the
incidence of typhoid fever, thereby contributing valuable insights to the study.

29
3.9. ETHICAL CONSIDERATIONS
The data collection methods utilized were conducted in a manner that adhered to professional
values and ethical standards. Prior to the commencement of the study, a formal letter was
obtained from the Dilla University College of Medicine and Health Sciences CBE office,
ensuring institutional support and approval for the research. Additionally, verbal consent was
obtained from all participants involved in the study. Throughout the data collection process,
strict measures were implemented to ensure the confidentiality of respondents, thereby
safeguarding their privacy and personal information.

3.10. DISSEMINATION OF THE RESULT

The findings were presented to the Dilla University College of Medicine and Health Sciences
CBE Office.

30
 CHAPTER FIVE: RESULT AND PRESENTATION
In this study, data were disseminated to 400 participants, leading to a response rate of 89.75%,
with 359 fully completed and returned surveys. The non-response rate accounted for 10.25%,
with 41 surveys not returned.

1.1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF

PARTICIPANTS

The survey data reveals a gender distribution of 57.9% males and 42.1% females. The age
groups with the highest representation were 25-35 (35.4%) and 36-45 (25.3%). A significant
majority of respondents were married couples (75.8%). Regarding religious affiliations, the
breakdown was as follows: Protestant (49.2%), Orthodox (35.8%), Muslim (13.9%), and other
(0.8%). In terms of income, the majority fell within the income brackets of 1000-2500 (38.4%)
and 2500-5000 (47.1%). Educational attainment levels varied from uneducated (25.1%) to
holding a diploma or higher degree (12.8%). This disparity in education levels could impact the
prevention of typhoid due to lack of awareness. Family sizes ranged from 1-3 members (20.6%)
to 4-7 members (60.4%), which may contribute to increased vulnerability to typhoid fever.

Analyzing the demographic status of households in Chichu, Dilla Zuriya Woreda reveals a
diverse occupational distribution, with farmers comprising 11.4%, merchants 18.9%, government
employees 20.9%, labor workers 12.0%, unemployed individuals 22.0%, and others 14.8%. The
notable increase in population and higher prevalence of less educated individuals pose a
significant challenge in combating typhoid fever and providing effective treatment in the area.
Addressing these factors is crucial for successful disease prevention and management efforts in
the community.

31
Table 2: Socio-demographic characteristics of participant(n=359)
Variable Categories Frequency Percent (%)
Gender Male 208 57.9
Female 151 42.1
Age 18 – 24 71 19.8
25 – 35 127 35.4
36 – 45 91 25.3
>45 70 19.5
Marital Status Single 52 14.5
Married 272 75.8
Divorced 19 5.3
Widowed 16 4.5
Religion Protestant 177 49.2
Orthodox 129 35.8
Muslim 50 13.9
Other 3 0.8
Average Monthly <1000 17 4.7
Income 1000 – 2500 138 38.4
2500 – 5000 169 47.1
5000 – 10,000 33 9.2
>10,000 2 0.6
Educational Status Uneducated 90 25.1
Able to read and write 110 30.6
Completed Elementary 53 14.8
Completed High school 60 16.7
Diploma and above 46 12.8
Number of family 1–3 74 20.6
members 4–7 217 60.4
>7 68 18.9
Occupation Farmer 41 11.4
Merchant 68 18.9
Government Employee 75 20.9
Labor Worker 43 12.0
Unemployed 79 22.0
Other 53 14.8

32
 1.1.PERCEIVED PREVALENCE OF TYPHOID FEVER IN CHICHU
KEBELE

According to the data presented, a significant portion of family members, specifically 90%,
sought admission to a healthcare facility within the past 6 months. Out of these cases, a
staggering 75.5% were diagnosed with typhoid fever, indicating a prevalent health issue within
the community. Furthermore, a majority of respondents, approximately 62.1%, shared that they
had experienced an infection of typhoid fever at some stage, highlighting the widespread nature
of the illness. On the other hand, 37.9% of participants reported no history of being infected with
typhoid fever.

Table 3: prevalence of typhoid fever in Chichu kebele (n=359)

Variable Frequency Percent (%)

Any family member admitted to healthcare center in the last 6 months?

Yes 269 90

No 25.1 74.9

If yes, was the case typhoid fever?

Yes 271 75.5

No 88 24.5

Have you ever been infected by typhoid fever?

Yes 223 62.1

No 136 37.9

33
 4.1.KNOWLEDGE OF RESPONDENTS TOWARDS TYPHOID FEVER

The findings reveal a stark divide in knowledge about typhoid fever, with only 4.74%
demonstrating a good understanding while a striking 95.26% displayed poor knowledge on the
subject. This disparity is of utmost significance as ignorance about typhoid fever can lead to a
higher transmission rate of the disease. It underscores the critical need for increased education
and awareness initiatives to tackle this public health issue effectively. Consequently, efforts must
be made to bridge this knowledge gap and empower individuals with accurate information to
prevent the spread of typhoid fever in communities.

Typhoid fever, a bacterial infection caused by germs, is widely recognized as a serious health
concern, with 80.2% of respondents attributing its onset to these microbial agents. The ingestion
of contaminated water and food stands out prominently as key contributing factors to the spread
of this disease, identified by 8.1% and 8.4% of participants, respectively. Manifesting in a range
of symptoms, including headache, loss of appetite, fever, and diarrhea, typhoid fever presents a
significant health challenge to affected individuals, as evidenced by varying percentages of
respondents reporting the occurrence of these distressing signs. Efforts to educate communities
about the transmission and symptoms of this illness are crucial in combating its prevalence and
ensuring prompt diagnosis and treatment.

Typhoid fever remains a significant public health concern, with poverty and certain dietary
habits such as dairy, poultry, and fish consumption identified as risk factors for the disease. It is
crucial for individuals to practice good hygiene by washing hands regularly, consuming treated
water, and disposing of waste properly in order to prevent the spread of typhoid fever. Despite
the fact that many respondents have not received prior health education on the topic, they express
confidence in their ability to recognize the symptoms of typhoid fever and differentiate them
from other illnesses. Continued efforts to educate the public on preventive measures and
symptoms of typhoid fever are essential to reducing its incidence and ensuring prompt treatment.

34
Table 4: Knowledge of Respondents towards Typhoid Fever (n=359)
Variables Categories Frequency Percent
Typhoid fever is caused by germs. Yes 288 80.2
No 71 19.8
Typhoid Fever is caused by drinking Yes 29 8.1
contaminated water. No 330 91.9
Typhoid Fever is caused by eating Yes 30 8.4
contaminated food. No 329 91.6
Headache is a symptom of typhoid fever. Yes 48 13.4
No 311 86.6
Loss of appetite is a symptom of typhoid Yes 56 15.6
fever. No 303 84.4
Fever is a symptom of typhoid fever. Yes 49 13.6
No 310 86.4
Diarrhea is a symptom of typhoid fever. Yes 38 10.6
No 321 89.4
Poverty is a risk factor for typhoid fever. Yes 237 66.0
No 122 34.0
Dairy Consumption is a risk factor for Yes 87 24.2
typhoid fever. No 272 75.8
Poultry Consumption is a risk factor for Yes 88 24.5
typhoid fever. No 271 75.5
Fish product consumption is a risk factor for Yes 202 56.3
typhoid fever.
No 157 43.7
Hand washing prevents typhoid fever Yes 84 23.4
infection. No 275 76.6
Drinking treated water prevents typhoid Yes 87 24.2
fever. No 272 75.8
Proper disposal of waste prevents typhoid Yes 93 25.9
fever. No 266 74.1
Have you ever had previous health education Yes 82 22.8
related to typhoid fever? No 277 77.2
Can you effectively differentiate symptoms Yes 100 27.9
of typhoid fever from other diseases? No 259 72.1

35
 Goog Knowledge
4.74%

Poor Knowledge
95.26%

Figure 2: pie-chart of respondents on knowledge Typhoid fever

4.1. RISK PERCEPTION TOWARDS TYPHOID FEVER

Typhoid fever is a highly concerning illness with significant implications for public health. A
considerable percentage of individuals, approximately 15.9%, are cognizant of the severity of
this disease. Moreover, a substantial portion of the population, roughly 70.2%, recognize the
potential for individuals with typhoid fever to transmit the illness to others. There is also an
awareness among about 21.2% of the public that inadequate access to clean water sources may
contribute to the prevalence of typhoid fever. Poor sanitation practices have been identified as a
factor by 22.6% of respondents, highlighting the multifaceted nature of the issue.

In addition, 21.7% of surveyed individuals believe that the absence of proper toilet facilities in
households can significantly impact the spread of typhoid fever. Furthermore, a notable 24.0% of
the population acknowledges the risk of contracting typhoid fever through the consumption of
unwashed raw vegetables. These findings underscore the importance of education and public
health initiatives aimed at addressing the various factors associated with the transmission and
prevalence of typhoid fever.

36
Table 5: Attitude towards Typhoid fever of respondents (n=359)
No. Variables Categories frequency Percentage (%)
1 Typhoid fever is a serious disease. Yes 57 15.9
No 302 84.1
2 Infected person transmits the Yes 252 70.2
diseases to health person. No 107 29.8
3 Lack of enough and reliable water Yes 76 21.2
sources contribute to typhoid fever. No 283 78.8
4 Poor sanitation practices contribute Yes 81 22.6
to typhoid fever infections. No 278 77.4
5 Lack of pit latrines in each home Yes 78 21.7
contributes to typhoid fever. No 281 78.3
6 Eating unwashed raw vegetables Yes 86 24.0
contribute to typhoid fever. No 273 76.0

Good Risk Percep-

tion
21.17%

Poor Risk
Perception
78.83%

Figure 3: pie chart- Risk Perception towards Typhoid fever

37
 4.1.TYPHOID PREVENTION PRACTICE

According to the data collected from the questionnaire survey, it has been revealed that only
20.89% of the respondents exhibited good typhoid prevention practices, while the majority,
accounting for 79.11%, displayed poor adherence to typhoid prevention measures. This disparity
in prevention practices has had a significant impact on the residents, as those with low
prevention practices were more susceptible to contracting typhoid fever. These findings suggest
that residents of Chichu Kebele are at risk of exposure to typhoid fever due to suboptimal
prevention practices. Addressing this issue through education and interventions could help
improve the community's overall health outcomes.

The analysis of the data sheds light on troubling issues surrounding water usage, hygiene
practices, sanitation, and food consumption habits within the surveyed population. It is alarming
to note that a considerable number of individuals are dependent on contaminated surface water
sources, without proper treatment measures in place, which poses serious health hazards.
Furthermore, the findings indicate a lack of adherence to basic hand hygiene protocols, with a
significant portion neglecting to use soap regularly, particularly before handling food and after
visiting the restroom. This non-compliance significantly heightens the likelihood of infectious
disease transmission within the community. It is imperative that these concerning trends are
addressed promptly through targeted interventions and education initiatives to safeguard public
health and well-being.

Ensuring adequate sanitation facilities is crucial for maintaining public health

and preventing the spread of diseases. Despite efforts to improve sanitation
infrastructure, there are still gaps that need to be addressed, particularly in
providing private latrines and proper waste management practices for all
individuals. The lack of adequate waste containers can result in exposure to
pests and diseases, posing significant risks to the community's health.
Moreover, the unsanitary conditions in areas where children play can lead to
health issues and illnesses among the younger population. It is imperative
that steps be taken to address these shortcomings and promote a clean and
hygienic environment for all individuals.

38
Food consumption habits raise further concerns, with varied exposure to food safety standards.
Many believe that water at food stalls and restaurants is not clean, posing health risks. The
reliance on local water sources and consumption of raw vegetables and fruits from food stalls
without proper washing also contribute to potential health hazards.

Table 6: Typhoid prevention practice related questioner (n=359)

No variables categories Frequency Percent
(%)
1. Main source of drinking water surface water 164 45.7
ground water 195 54.3
2. Do you use water treatment? No 197 54.9
Yes 162 45.1
3. How often do you use soap when you Always 117 32.6
wash your hands? Sometime 242 67.4
4. Do you wash your hands by soap and No 198 55.2
water before preparing a meal? Yes 161 44.8
5. Do you wash your hands by soap and No 337 93.9
water before meal?
Yes 22 6.1
6. Do you wash hands by soap and water No 340 94.7
after using the toilet?
Yes 19 5.3
7. Do you wash hands by soap and water No 348 96.9
after changing diapers?
Yes 11 3.1
8. Do you wash hands by soap and water No 350 97.5
when coming home?
Yes 9 2.5
9. Is there private latrine facility for the No 86 24
family? Yes 273 76
10. Do you have place to store wastes at No 193 53.8
household level? Yes 166 46.2
11. Is there a separate container for different No 232 64.6
types of waste? Yes 127 35.4
12. Is the container covered? No 279 77.7
Yes 80 22.3
13. Is the area children play in sanitary? No 225 62.7
Yes 134 37.3
14. How often do you take your food at Always 290 80.8
home? Sometimes 69 19.2

39
 15. How often do you take your food at food Always 74 20.6
stalls, restaurants or local food shops? Sometimes 285 79.4
16. Is the drinking water provided at the food No 219 61
stalls, restaurants or food shops clean? Yes 140 39
17. What is your main source of drinking Local water 359 100
water when you are not at home? from the shop
Bottled water 0 0
18. How often do you eat raw vegetables or Always 314 87.5
fruits from a food stall or restaurant? Sometimes 45 12.5

Good Practice
20.89%

Poor Practice
79.11%

Good Practice Poor Practice

Figure 4: Pie chart on prevention practice question

1.1.FACTORS ASSOCIATED WITH TYPHOID FEVER PREVENTION

PRACTICE

After analyzing the data using bivariate logistic analysis methods, we had acquired 11 significant
variables. As we proceeded to the multivariate logistic analysis, only 3 factors were found to be
statistically significant, namely; hand washing practices, knowledge level of the community, and
attitude of the community towards typhoid fever.

40
 Table 7: The Model fitness test in Hosmer and Lemeshow Test (n=359)
Hosmer and Lemeshow Test

Step Chi-square df Sig.

1 11.682 8 .166

The results from the analysis of the table clearly suggest that the model is well-suited and has a
strong association with the dependent variable, which in this case is the prevention of typhoid
fever. The independent variables that were selected for this study were found to be significant in
their relationship with the dependent variable. This conclusion is supported by the chi-square
value of 11.682 from the Hosmer and Lemeshow test, which further solidifies the findings. The
calculated p-value of 0.1666 is greater than the conventional significance level of 0.05,
indicating that there is no significant difference between the observed and expected values in the
model. This level of confidence, at 95%, further reinforces the validity of the results obtained
from this analysis.

Table 8: Factors on prevention of typhoid fever (n=359)

Preventi
on
Variable practice
Response Fre (%) Poor Goo AOR (95% Cl)
q. d COR
Knowledge Poor 342 95.3 272 70 0.618(0.211-1.811) 1.472(0.468-4.634)
Good 17 4.7 12 5 1
Risk Poor 283 78.8 234 49 0.403(0.229-0.709)* 2.474(13.48-4.543)*
Perception Good 76 21.2 50 26 1
Educational Uneducated 90 25.1 75 15 0.508(0.217-1.186) 0.593(0.258-1.364)
status
Able to read 110 30.6 94 16 0.432 (0.188-0.993)* 1.120(0.445-2.822)
and write
Completed 53 14.8 39 14 0.911(0..376-2.210) 1.530(0.620-3.773)
Elementary
Completed 60 16.7 43 17 1.004(0.428-2.355) 1.501(0.591-3.812)
High school
Diploma and 46 12.8 33 13 1
above

41
 18-24 71 19.8 48 23 16.292(3.667-72.389)* 0.546(0.274-1.088)
Age group 25-35 127 35.4 102 25 8.333(1.911-36.338)* 0.863(.411-1.813)
36-45 91 25.3 66 2 12.879(2.933-56.551)* 0.073(0.015-0.345)*

1.1. DISCUSSION
Typhoid fever is a life-threatening infection caused by the bacterium Salmonella Typhi. It is
usually spread through contaminated food or water. Once Salmonella Typhi bacteria are
ingested, they multiply and spread into the bloodstream. Urbanization and climate change have
the potential to increase the global burden of typhoid. In addition, increasing resistance to
antibiotic treatment is making it easier for typhoid to spread in communities that lack access to
safe drinking water or adequate sanitation.

As of 2019, an estimated 9 million people get sick from typhoid and 110 000 people die from it
every year. Symptoms include prolonged fever, fatigue, headache, nausea, abdominal pain, and
constipation or diarrhea. Some patients may have a rash. Severe cases may lead to serious
complications or even death. Typhoid fever can be treated with antibiotics although increasing
resistance to different types of antibiotics is making treatment more complicated. The typhoid
conjugate vaccine is recommended for use in children from 6 months of age and in adults up to
45 years or 65 years (depending on the vaccine). Two typhoid conjugate vaccines have been
prequalified by WHO since December 2017 and are being introduced into childhood
immunization programmes in typhoid endemic countries. This vaccine is very important in
places like the study area to be in programme.

In accordance to the study findings concerning on the transmission majority 8.4% and 8.1% of
the respondents know that typhoid fever is transmitted by eating contaminated food and drinking
contaminated water respectively. The result of this study is less than the study done in Tanzania
which is 42.5% [51]. The difference is might be due to implementation of health extension
worker in the area.

Regarding the causes of typhoid fever about 80.1 % of the respondents knew that typhoid fever
is caused by germ. The result of this study is higher than the study done in Elmina in the Central
Region of Ghana 49.2% [52]. The difference is might be due to the socio demographic
characteristic.

42
Concerning the sign and symptom of typhoid fever about 15.6% were answered loss of appetite.
The findings of this study are slightly higher than the study done in Nigeria 6.3% [53]. The
difference is might be due socio demographic characteristic.

Regarding perception on hygiene majority 22.6% of the respondents agree that poor sanitation
practices among households in the community contribute to the spread of typhoid fever. The
result of this study is slightly lower than the study done in Kenya which was 48% [54]. The
difference is may be due to the socio demographic characteristic of the respondents.

Concerning the risk perception towards typhoid fever. The study showed that majority 15.9% of
the respondent perceived typhoid fever as serious diseases. The result of this study is lower than
the study done in Zimbabwe which were 70% [55]. The difference is may be due to effort of the
health extension worker in the area.

Regarding water supply and toilet facility in the study area the result of the study showed that
majority 54.3% of the respondents obtained drinking water from ground water and also about
76% of the respondents used pit latrine type of toilet. The result of this study is different from the
study done in Kenya 54.6% ground water for drinking water and 83% used pit latrine [56]. The
difference is may be due to the study area.

Regarding treatment of drinking water and the means of treatment the study revealed that only
45.1% treat their drinking water. The result of this study is slightly greater than the study done in
Tanzania 42.5% [57]. The difference is may be due to the difference in the study area and period.

Concerning hygiene the study result showed that majority 5.3% washed their hand by soap and
water after using toilet facility. The result of this study is lower than with the study done in
Nigeria 221 (94.0%) [58].

This community-based cross-sectional study has attempted to assess typhoid fever prevention
practice and associated factors in Chichukebele. The current study shows that Age, risk
Prevention and knowledge towards typhoid fever are associated factors that are identified as
potential factors of typhoid fever (P < 0.05).

The most of study findings are similar to the others finding because the majority of the problems
are related to knowledge to typhoid fever that high expose to the typhoid fever and then risk
perception ;and poor practice of prevention of thyroid fever is highly related finding others.

43
 1.2.STRENGTH AND LIMITATION OF THE STUDY

The study conducted exhibited notable strength in its ability to adapt a customized questionnaire
that closely aligned with the socio-cultural practices of the Chichu Kebele community. By
incorporating observations of typhoid transmission and identifying the factors that influence
typhoid fever prevention practices, the study was able to provide valuable insights into the
dynamics of disease prevention within this specific demographic. However, it is imperative to
acknowledge the weaknesses inherent in this approach. One major drawback is the potential for
respondents to misunderstand or provide inaccurate information, which could compromise the
reliability of the study results. While clinical examination reports were not utilized in this
context, the study findings were largely dependent on the perceptions and responses of the
participants. Moving forward, it will be essential to address these limitations and consider
additional measures to enhance the accuracy and validity of the research outcomes.

44
 CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS

1.3. CONCLUSION
Based on the findings of the present study, it can be concluded that majority of the studied
subjects had an unsatisfactory knowledge level about typhoid fever and less risk perception and
more of less rare typhoid prevention practice was observed. In recent studies, the relative risk
perception of typhoid fever has been found to be relatively high when compared to other similar
infectious diseases. This heightened perception may be due to the severe symptoms and potential
complications associated with the illness. Additionally, the odds of infection were found to be
higher among individuals who had less awareness and a negative attitude towards the modes of
transmission and risk factors of typhoid fever. It is evident that education and awareness
campaigns are crucial in reducing the spread of this infectious disease. Furthermore, regular hand
washing practices were identified as poor among the community, which is a key factor in
preventing the transmission of typhoid. These findings suggest that targeted interventions
focused on improving hygiene practices and increasing knowledge about the disease are essential
in preventing and controlling typhoid outbreaks within communities.

Typhoid fever, a bacterial infection caused by Salmonella enterica serotype Typhi, remains a
major public health concern in many parts of the world, including the Chichu Keble of Dilla
Zuriya Woreda. One of the key factors contributing to the prevalence of typhoid fever in this
region is the lack of utilization of water treatment methods. This lack of access to clean and safe
drinking water puts individuals at a higher risk of contracting the disease. Furthermore, the
practice of not washing hands with soap before meals and upon returning home also plays a
significant role in the spread of typhoid fever. Proper hand hygiene is crucial in preventing the
transmission of pathogens, including those responsible for typhoid fever. Additionally, the
absence of proper environmental sanitation practices further exacerbates the situation.
Inadequate waste disposal and poor sanitation contribute to the contamination of water sources,
increasing the likelihood of typhoid fever outbreaks. Addressing these issues through education
and community-wide interventions is essential in improving typhoid fever prevention practices
in Chichu Keble. By promoting water treatment, encouraging proper hand washing habits, and

45
emphasizing the importance of environmental sanitation, we can work towards reducing the
burden of typhoid fever in this region and safeguarding the health of the community.

5.2. RECOMMENDATION
The following recommendations were forward to the stake holders

 TO HEALTH EXTENSION WORKERS

Health extension workers and local authorities must provide health education about TF and
preventive mechanisms.

 TO HEALTH CARE PROVIDERS

To avert the burden and consequences of the disease, they should deliver intensive health
promotion programs such as safe hygienic conditions particularly hand washing related to
cooking, eating and toilet.

 TO KEBELE ADMINISTRATORS
Kebele Administrators should work in collaboration with health extension workers and
community elders to prepare meetings on health information about TF,

 TO NON-GOVERNMENT ORGANIZATION
The organizations should promote safe hygienic practices like hand washing and they should
also apply these hygienic practices in their organizational activities. They also should support
government efforts in taking action to prevent TF.

 TO CHICHU HEALTH CENTER

As one of the health centers in Chichu kebele, the organization should take action in providing
intensive health information sessions about TF to avert the burden of the disease.

46
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ANNEX-I: INFORMED CONSENT

Good morning/afternoon Sir/Madam! We are medicine students from Dilla University. As part
of our academic requirements, we are conducting a research on the prevention of typhoid fever
and associated factors in Chichu kebele. Thus we would like to request for your perspective
about the issue in your area.

The information that we will obtain from you will be used only for research purpose and also we
need to assure you that your confidentiality is respected. The study has no risk to you and your
organization. Therefore we politely request your cooperation to respond to our checklist. You
do have the right not to respond at all or to withdraw in the meantime, but your input
has great value for the success of our objective .

Do you agree?

 Yes, continue
 No, thank you and good bye!

Thank you for your cooperation!!!

53
ANNEX-II: ASSESSMENT OF PERCEIVED
PREVALENCE AND ASSOCIATED FACTORS OF
TYPHOID FEVER
Part I: Socio-demographic characteristics of the respondents

No. Variables Response options Remark

1 sex 1. Male
2. Female
2 Age of respondent _____________

3 Religion 1. Protestant
2. Orthodox
3. Muslim
4. Others

4 Educational status 1. Uneducated

2. Able to Read and write
3. Completed elementary
4. Completed high school
5. Diploma and above
5 Marital status of the house hold head 1. Single
2. Married
3. Divorced
4. Widowed
6 Occupation of the household 1. Farmer
2. Merchant
3. Government employee
4. labor worker
5. Unemployed
6. Other
7 Number of individuals in the house
______________

8 Average monthly income

______________

54
Part II: History of previous exposure of typhoid among respondents

No. Variables Response options Remark

1 Any family member admitted to 1. Yes 2. No

healthcare center in the last 6 months?

2 If yes, was the case typhoid fever? 1. Yes 2. No

3 Have you ever been infected by typhoid 1. Yes 2. No

fever?

4 Did you visit a healthcare center? 1. Yes 2. No

5 Did you use any medications? 1. Yes 2. No

6 How long did you take the medications? 1. ____ days

2. I don’t remember

7 Has there been a typhoid fever 1. Yes 2. No

vaccination in your area in the past 6
months?

8 Do you often travel? 1. Yes 2. No

Part III: Knowledge of the respondents towards typhoid fever

No. Variables Response options Remark

1 Typhoid fever caused by germs. 1.Yes

2. No

2 Typhoid fever transmitted by drinking contaminated water. 1.Yes

2. No
3 Typhoid fever transmitted by Eating contaminated food. 1.Yes

2. No
55
4 Head ache is the symptom of typhoid fever. 1.Yes

2. No
5 Loss of appetite is the symptom of typhoid fever. 1.Yes

2. No
6 Fever is the symptom of typhoid fever. 1.Yes

2. No
7 Diarrhea is a symptom of typhoid fever. 1. Yes

2. No
8 Poverty is a risk factor for typhoid fever. 1. Yes

2. No
9 Dairy consumption is a risk factor for typhoid fever. 1. Yes

2. No
10 Poultry consumption is a risk factor for typhoid fever. 1. Yes

2. No
11 Consuming fish products is a risk factor for typhoid fever. 1. Yes

2. No
12 Hand washing prevent typhoid fever infection. 1. Yes

2. No
13 Drinking boiled or treated water prevent typhoid fever 1. Yes
infection.
2. No
14 Proper disposal of waste prevent typhoid fever infection. 1. Yes

56
 2. No
15 Have you ever had previous health education related to 1. Yes
typhoid fever? 2. No

16 Can you effectively differentiate symptoms of typhoid fever 1. Yes

from other diseases? 2. No

Part IV: Risk perception towards typhoid fever among respondents

No. Variables Response options Remark

1. Yes
1 Typhoid fever is a serious disease.
2. No

1.Yes
2 Infected person transmit the diseases to health person.
2. No

Lack of enough and reliable water sources contribute to 1.Yes

3
typhoid fever. 2. No

Poor sanitation practices contribute to typhoid fever 1.Yes

4
infections. 2. No

Lack of pit latrines in each home contributes to typhoid 1.Yes

5
fever. 2. No

Eating unwashed raw vegetables contribute to typhoid 1. Yes

6
fever. 2. No

Part v: prevention practice related questions

57
No. Variables Response options Remark

1. Surface water
Main source of drinking water 2. Ground water
1.

2. Do you use water treatment? 1. Yes

2. No
1. Always
How often do you use soap when you wash
2. Sometime
3.
your hands?

Do you wash your hands by soap and 1. Yes

4.
water before preparing a meal? 2. No

Do you wash your hands by soap and 1. Yes

5.
water before meal? 2. No

Do you wash hands by soap and water

1. Yes
6.
after using the toilet?
2. No

Do you wash hands by soap and water

1. Yes
7.
after changing diapers?
2. No

Do you wash hands by soap and water

1. Yes
8.
when coming home?
2. No

Is there private latrine facility for the

1. Yes
9.
family?
2. No

Do you have place to store wastes at 1. Yes

10.
household level? 2. No

11. Is there a separate container for different 1. Yes

58
 types of waste?
2. No

Is the container covered? 1. Yes

12.
2. No

Is the area children play in sanitary? 1. Yes

13.
2. No
1. Always
2. Often
How often do you take your food at home? 3. Sometimes
14.

How often do you take your food at food 1. Always

2. Often
stalls, restaurants or local food shops?
15. 3. Sometimes

Is the drinking water provided at the food

1. Yes
16. stalls, restaurants or food shops clean?
2. No

What is your main source of drinking water 1. Local water from the
17. when you are not at home? shop
2. Bottled water
1. Always
How often do you eat raw vegetables or fruits 2. Often
18. 3. Sometimes
from a food stall or restaurant?

ዲላ ዩኒቨርሲቲ የሕክምና እና ጤና ሳይንስ ኮሌጅ

59
 የማኅበረሰብ አቀፍ ስልጠና ፕሮግራም (CBTP)

በጌዴኦ ዞን በዲላ ዙሪያ በጪጩ ቀበሌ በታይፎይድ በሽታ መከላከል ዙሪያ ለማጥናት የተዘጋጀ ቃለ መጠይ።

ውድ ተሳታፊ:

ስሜ_______________________

! እኛ የዲላ ዩኒቨርሲቲ የህክምና ተማሪዎች ነን። እንደ የትምህርት መስፈርታችን የታይፎይድ ትኩሳት እና ተያያዥ
ምክንያቶች በጪጩ ቀበሌ በመከላከል ላይ ጥናት ለማድረግ አቅደናል። የጥናት ቡድኑ አባላት በታይፎይድ በሽታ ያሉ
ችግሮችን ለመቅረፍ የጣልቃ ገብነት ስልቶችን በመንደፍ ጥናት ሊያደርጉ ነው። በመሆኑም ይህ ቃለ ምልልስ የተዘጋጀው
በዚህ በጪጩ ቀበሌ ስላለው ዋና ዋና የታይፎይድ በሽታ መከላከል ዙሪያ መረጃ ለማግኘት ነው።

ይህን ቃለ ምልልስ ተጠቅመን የምናገኘው መረጃ ለምርምር ዓላማ ብቻ የሚያገለግል ሲሆን እንዲሁም ከእርስዎ የምናገኘው
መረጃ በሙሉ በምስጢር የሚያዝ መሆኑን ልናረጋግጥሎት እንወዳለን። ጥናቱ ለእርስዎ ና ለቤተሰብዎ አባላት ምንም ስጋት
የለውም።

ስለዚህ በዚህ ቃለ መጠይቅ ለመሳተፍ ትብብርዎን በትኅትና እንጠይቃለን።በጥናቱ ቃለ መጠይቅ ምላሽ ያለመስጠት ወይም
የመውጣት መብትዎ የተጠበቀ ነው። ነገርግን የእርስዎ የመረጃ ግብአት ለዓላማችን ስኬት ትልቅ ጠቀሜታ አለው።

ስምምነት

እኔ ምላሽ የጥናቱ አግባብ,አላማው,ሊኖሩ የሚችሉ ጥቅሞች ና በዚህ ጥናት ውስጥ ከመሳተፍ ጋር ተያይዘው ሊከሰቱ የሚችሉ
ስጋቶች እንደተገለጹልኝ አረጋግጣለሁ። በእነዚህ እውነታዎች ላይ በመመስረት ለመሳተፍ እወስናለሁ።
ፊርማ_______________

ስለዚህ በአካባቢያችሁ ስላለው ጉዳይ ያለዎትን አመለካከት እንዲሰጡን እንጠይቃለን።

ለትብብርዎ እናመሰግናለን!!!

አባሪ-II: ስለታይፎይድ ትኩሳት የማህበረሰብ የግንዛቤ ጥያቄዎች

ክፍል አንድ፡ የመላሾች ማህበራዊ-ስነ-ሕዝብ ባህሪያት

አይ. ተለዋዋጮች የምላሽ አማራጮች አስተያየት

60
1 ፆታ ወንድ

ሴት

2 የምላሽ ሰጪ ዕድሜ ____________

3 ሃይማኖት ፕሮቴስታንት

ኦርቶዶክስ

ሙስሊም

ሌሎች

4 የትምህርት ደረጃ ያልተማረ

ማንበብ እና መጻፍ የሚችል

የመጀመሪያ ደረጃ ትምህርት

ያጠናቀቀ

ሁለተኛ ደረጃ ትምህርት ተጠናቀቀ

ዲፕሎማ እና ከዚያ በላይ

5 የቤቱ ባለቤት የጋብቻ ሁኔታ ነጠላ

ያገባ

የተፋታ
የትዳር አጋር ያረፈበት

6 የቤት ውስጥ ሥራ ገበሬ

ነጋዴ

የመንግስት ሰራተኛ

የጉልበት ሰራተኛ

ሥራ አጥ

ሌላ

7 በቤቱ ውስጥ ያሉ ግለሰቦች ብዛት

______________

61
8 አማካይ ወርሃዊ ገቢ
______________

ክፍል II፡ ስለታይፎይድ ተጋላጭነት የምላሽ ሰጪዎች ታሪክ

አይ. ተለዋዋጮች የምላሽ አማራጮች አስተያየት

1 ባለፉት 6 ወራት ውስጥ ወደ ጤና ጥበቃ ጣቢያ አዎ

የገባ ማንኛውም የቤተሰብ አባል አለ?
አይደለም

2 አዎ ከሆነ፣ ጉዳዩ የታይፎይድ ትኩሳት ነበር? አዎ

አይደለም

3 በታይፎይድ ትኩሳት ተይዘው ያውቃሉ? አዎ

አይደለም

4 የጤና ተቋም ማእከልን ጎብኝተዋል? አዎ

አይደለም

5 ማንኛውንም መድሃኒት ተጠቅመዋል? አዎ

አይደለም

6 መድሃኒቶቹን ለምን ያህል ጊዜ ወስደዋል? ____ ቀናት

አላስታውስም።

7 በአከባቢዎ ላለፉት 6 ወራት የታይፎይድ ትኩሳት አዎ

62
 ክትባት ተሰጥቷል?

አይደለም

8 ብዙ ጊዜ ትጓዛለህ? አዎ

አይደለም

ክፍል III፡ ስለ ታይፎይድ ትኩሳት ምላሽ ሰጪዎች እውቀት

አይ. ተለዋዋጮች የምላሽ አማራጮች አስተያየት

1 ታይፎይድ ትኩሳት የሚመጣው በጀርሞች ነው። አዎ

አይ

2 የተበከለ ውሃ በመጠጣት ታይፎይድ ትኩሳት ይተላለፋል። አዎ

አይ

3 የተበከለ ምግብ በመመገብ ታይፎይድ ትኩሳት ይተላለፋል። አዎ

አይ

4 የራስ ምታት የታይፎይድ ትኩሳት ምልክት ነው። አዎ

አይ

5 የምግብ ፍላጎት ማጣት የታይፎይድ ትኩሳት ምልክት ነው። አዎ

አይ

6 ትኩሳት የታይፎይድ ትኩሳት ምልክት ነው። አዎ

63
 አይ

7 ተቅማጥ የታይፎይድ ትኩሳት ምልክት ነው። አዎ

አይ

8 ድህነት ለታይፎይድ ትኩሳት የሚያጋልጥ ነው። አዎ

አይ

9 የወተት ተዋጽኦ መጠቀም ለታይፎይድ ትኩሳት ይበልጥ ተጋላጭ ያደርጋል። አዎ

አይ

10 የዶሮ እርባታ ለታይፎይድ ትኩሳት ይበልጥ ተጋላጭ ያደርጋል። አዎ

አይ

11 የዓሣ ምርቶችን መጠቀም ለታይፎይድ ትኩሳት ይበልጥ ተጋላጭ ያደርጋል። አዎ

አይ

12 እጅን መታጠብ የታይፎይድ ትኩሳትን ይከላከላል። አዎ

አይ

13 የተቀቀለ ወይም የታከመ ውሃ መጠጣት የታይፎይድ ትኩሳትን ይከላከላል። አዎ

አይ

14 ቆሻሻን በትክክል ማስወገድ የታይፎይድ ትኩሳትን ይከላከላል. አዎ

አይ

64
15 ከዚህ ቀደም ከታይፎይድ ትኩሳት ጋር የተያያዘ የጤና ትምህርት ወስደህ አዎ
ታውቃለህ? አይ

16 የታይፎይድ ትኩሳት ምልክቶችን ከሌሎች በሽታዎች በትክክል መለየት አዎ

ይችላሉ? አይ

ክፍል IV፡ በተመልካቾች መካከል ስለ ታይፎይድ ትኩሳት ስጋት ያለው ግንዛቤ

አይ. ተለዋዋጮች የምላሽ አማራጮች አስተያየት

አዎ
1 ታይፎይድ ትኩሳት ከባድ በሽታ ነው.
አይ

አዎ
2 የታመመ ሰው በሽታውን ወደ ጤና ሰው ማስተላለፍ ይችላል።.
አይ

በቂ እና አስተማማኝ የውሃ ምንጭ እጥረት ለታይፎይድ ትኩሳት አስተዋጽኦ አዎ

3
ያደርጋል. አይ

ደካማ የንፅህና አጠባበቅ ልምዶች ለታይፎይድ ትኩሳት ኢንፌክሽን አዎ

4
አስተዋጽኦ ያደርጋል። አይ

በእያንዳንዱ ቤት ውስጥ የጉድጓድ መጸዳጃ ቤቶች እጥረት ለታይፎይድ አዎ

5
ትኩሳት አስተዋጽኦ ያደርጋል። አይ

6 ያልታጠበ ጥሬ አትክልት መመገብ ለታይፎይድ በሽታ አስተዋጽኦ አዎ

ያደርጋል።

65
 አይ

ክፍል v፡ ከመከላከል ልምምድ ጋር የተያያዙ ጥያቄዎች

አስተያየ
አይ. ተለዋዋጮች የምላሽ አማራጮች
ት

የከርሰ ምድር ውሃ
1 ዋናው የመጠጥ ውሃ ምንጭ የከርሰ ምድር ውሃ

አዎ
2 የውሃ ህክምና ትጠቀማለህ?
አይ

ሁሌም
3 እጅዎን ሲታጠቡ ምን ያህል ጊዜ ሳሙና ይጠቀማሉ? አንዳንድ ጊዜ

አዎ
ምግብ ከማዘጋጀትዎ በፊት እጅዎን በሳሙና እና በውሃ
4
ይታጠባሉ? አይ

66
 አዎ
5 ከምግብ በፊት እጅዎን በሳሙና እና በውሃ ይታጠባሉ?
አይ

ከመጸዳጃ ቤት በኋላ እጅን በሳሙና እና በውሃ አዎ

6
ይታጠባሉ?
አይ

ዳይፐር ከቀየሩ በኋላ እጅን በሳሙና እና በውሃ አዎ

7
ይታጠባሉ?
አይ

አዎ
8 ወደ ቤት ሲመለሱ እጅን በሳሙና እና በውሃ ይታጠባሉ?
አይ

አዎ
9 ለቤተሰቡ የግል መጸዳጃ ቤት አለ?
አይ

አዎ
10 በቤተሰብ ደረጃ ቆሻሻን ለማከማቸት ቦታ አለህ?
አይ

አዎ
11 ለተለያዩ ቆሻሻዎች የተለየ መያዣ አለ?
አይ

አዎ
12 መያዣው የተሸፈነ ነው?
አይ

አዎ
13 ልጆች የሚጫወቱበት ቦታ በንፅህና ውስጥ ነው?
አይ

14 ምግብዎን በቤት ውስጥ ምን ያህል ጊዜ ይወስዳሉ? ሁሌም

ብዙ ጊዜ

67
 አንዳንዴ

ምግብዎን በምግብ መሸጫ ድንኳኖች፣ ሬስቶራንቶች ሁሌም

ወይም በአካባቢው የምግብ ቤቶች ምን ያህል ጊዜ ብዙ ጊዜ
15
ትወስዳለህ? አንዳንዴ

በምግብ ድንኳኖች፣ ሬስቶራንቶች ወይም የምግብ ቤቶች አዎ

16
የሚቀርበው የመጠጥ ውሃ ንጹህ ነው?
አይ

ቤት ውስጥ በማይኖሩበት ጊዜ ዋናው የመጠጥ ውሃ ምንጭ የአካባቢው ውሃ ከሱቅ

17
ምንድነው? የታሸገ ውሃ

ሁሌም

ጥሬ አትክልቶችን ወይም ፍራፍሬዎችን ከምግብ ቤቶች ወይም ብዙ ጊዜ

18
ሬስቶራንት ስንት ጊዜ ይበላሉ? አንዳንዴ

68