Browsing by Author "Mesganaw Fantahun"

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    Assessment of the Implementation of Focused Antenatal Care in Public Health Centers in Addis Ababa, Ethiopia
    (Addis Abeba University, 2014-06) Aster Berhe; Mesganaw Fantahun
    Background- Antenatal care (ANC) is a widely used strategy to improve the health of pregnant women and to encourage skilled care during childbirth. In 2007, the Ministry of Health of Ethiopia developed a national adaptation plan based on the new model (Focused Antenatal care) of the World Health Organization (WHO). Although antenatal services are well utilized in Addis Ababa (100% first visit coverage), there are gaps in full implementation of all components of Focused antenatal care. Currently, there are limited studies on the implementation of Focused antenatal care in Ethiopia including in the study area. Objective-To assess the implementation of Focused Antenatal Care in public health centers of Addis Ababa. Methodology- Facility based cross sectional study using quantitative supplemented with qualitative data collection methods were conducted from July to August 2013. Eight hundred Sixteen sessions of Antenatal care were observed in ten health centers. Simple random and purposive sampling techniques were used for quantitative and qualitative components of the study respectively. A pretested semi structured interview guide and structured checklist was used to collect data. Data were entered with EPI-info version 3.5.1 and cleaned with, analyzed by SPSS version 20. Data was analyzed using descriptive and bivariate statistics and thematic analysis for in-depth interview. Results- The study revealed that the health care providers’ performance by five FANC components was as follows, on average comprehensive history taking had the highest performance (92%) and lowest performance was in clinical examination (54%). There was statistically significant difference (p<0.05) on the performance of health care providers where health officer and diploma midwives total average percentage performance scores were 79% and 75% respectively, while nurses scored 67%. Practice compared by visit and time spent showed that health care provider perform better in visit one (78%) and worse in visit three (62%). The average duration was 19 minutes for visit one and the time reduced during subsequent visits and was lower than WHO/National protocol. The qualitative data analysis revealed that there is variation among health care providers experience in implementing FANC and this may depend on their knowledge on FANC and work collaboration from their colleagues. Besides, Health care providers performed most of the procedures but also omitted certain procedures developed in the WHO / National protocol in all assessed health centers. Most of the assessed health centers have basic equipment’s and supplies while the National protocol on selected obstetrics topic including FANC was not found in all health centers and some procedures were not included in ANC card. Conclusion and recommendations- Health care providers did not spend adequate time as per the WHO/National protocol for each visit and their practice was not uniform. This affects the implementation of all components of Focused ANC and the desired outcome, it is especially prone to shallow health information and counseling which is at the center of Focused ANC. There were adequate equipment and supply to provide FANC in most of the assessed health center except few gaps. Implementation of Focused ANC may require assigning adequate staff and providing training, updating and disseminating the 2010 National Management Protocol on Selected Obstetric Guidelines for Antenatal Care to be in line with the new PMTCT guideline then revise FANC card accordingly.
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    Birth Preparedness, Complication Readiness, Neonatal Care Practices and Their Effect on Neonatal Health Status in Jimma Zone, Southwest Ethiopia.
    (Addis Abeba University, 2015-02) Gurmesa Tura; Mesganaw Fantahun
    Background: In spite of global efforts for many decades, saving the lives and improving the wellbeing of neonates have been global challenges. Recent estimate shows that about 3 million neonates die each year globally. The greatest burden (98%) of this neonatal death is shouldered by the low and middle-income countries. In Ethiopia, despite promising achievement in under-five mortality reduction, the rate of decline in neonatal mortality remained very slow, with recent status of 37 deaths per 1000 live births. Birth preparedness and complication readiness and the minimum neonatal care package along the continuum of care starting form pregnancy, during labour and delivery and the immediate postpartum period have been identified as comprehensive strategies to address the high neonatal mortality. However, the status of birth preparedness and complication readiness, the provisions of the minimum neonatal care package, their determinants and effects on neonatal health status have not been well investigated at the local context. Moreover, studies on the causes and determinants of the high neonatal mortality in Ethiopia in general and in Jimma Zone in particular are very scarce. Thus, there is a need to conduct a study and identify gaps for policy and program improvement. Objectives: The objectives of the study were to assess the status of birth preparedness, complication readiness, neonatal care practices and their effect on neonatal health status in Jimma zone, Southwest Ethiopia. Methods: This study was conducted in Jimma Zone, Southwest Ethiopia, from September 2012 to December 2013. Mixed study designs, including cross-sectional and prospective follow up, involving both quantitative and qualitative methods were employed. A sample of 3612 pregnant women, who were identified from 73 clusters selected by multistage sampling techniques were included in the study. Community based surveys by using structured interviewer-administered questionnaires were conducted to collect the quantitative data. In-depth interviews and focus group discussions were conducted with purposively selected participants to collect the qualitative data. Descriptive analyses were done by computing summary statistics and proportions. Univariate, bivariate and multivariate analyses were done based on the objectives of the study. Because of the multistage-clustered sampling method, multilevel analyses were done to identify factors affecting the outcomes of interest at different levels. Odds ratios and β-coefficients along with 95%CI were used to show the strengths of associations. Verbal autopsies were also conducted to ascertain the causes of neonatal death. The qualitative data were transcribed in to English and analyzed thematically. Results; From 3612 pregnant women enrolled to the study at the baseline, 3463 live births occurred and included in the final analysis making a response rate of 95.9%. The status of birth preparedness and complication readiness practice was 23.3% (95% CI: 21.8%, 24.9%). Place of residence and access to health centers were cluster level factors having significant association with birth preparedness and complication readiness. Maternal educational status, husband‘s occupation, wealth quintiles, knowledge of key danger signs during labour, attitude towards birth preparedness and complication readiness and antenatal care use were identified as individual level factors affecting birth preparedness and complication readiness. The coverage of skilled care use in this study was 17.5% (95% CI: 16.2%, 18.8%). The most common reasons for not using skilled care were lack of transport (31.1%), home delivery was the usual place (24.0%) and perception that home delivery was more comfortable (23.1%). Place of residence and access to health centers were identified as higher-level factors affecting skilled care use. Maternal educational status, husband‘s occupation, wealth quintiles, gravida, inter-birth interval, knowledge of key danger signs during labour, antenatal care use and birth preparedness and complication readiness plan were identified as lower level determinants of skilled care use. The status of neonatal care practice was 59.5% (95%CI: 57.6%, 61.3%). Place of residence, maternal education, husband‘s occupation, wealth quintiles, birth order and inter-birth interval were identified as factors affecting neonatal care. This study found neonatal mortality rate of 35.5 (95%CI: 28.3, 42.6) per 1000 live births. Birth asphyxia (47.5%), neonatal infections (34.3%) and prematurity (11.1%) were the three leading causes of neonatal mortality. Cluster-level variables were found to have non-significant effect on neonatal mortality. Individual-level variables such as birth order, frequency of antenatal care use, delivery place, gestational age at birth, premature rupture of membrane, complication during labour, twin births, size of neonate at birth and neonatal care practice were identified as determinants of neonatal mortality. Conclusions: The statuses of birth preparedness and complication readiness as well as skilled care use were found to be low in the study area. Though the status of neonatal care practice was relatively better, neonatal mortality was found to be high. The higher-level factors had significant effects on birth preparedness and complication readiness, skilled care use and neonatal care practice, but had non-significant effect on neonatal mortality. Instead, individual level factors related to intra-partum conditions and care as well as neonatal conditions and care had significant effect on neonatal mortality. Birth preparedness and complication readiness had significant effect on skilled care use, but had non-significant effect on neonatal mortality. Neonatal care practice had significant effect on neonatal mortality. The study identified birth asphyxia, neonatal infections and prematurity as major causes of neonatal death. Recommendations: Increasing access to health facilities and means of transportation, strengthening community-based interventions to promote skilled care use, reducing the delays in care seeking for obstetric complications and neonatal care practices are recommended. Besides, designing appropriate context specific behavior change communication strategies both at the facility and at the community levels to improve service use and minimize the existing barriers are needed.
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    Comparison of CBD, Non-CBD, and Former CBD Areas to Assess Effectiveness of Community Based Family Planning Services
    (Addis Abeba Universty, 2000-12) Shimeles Genna; Mesganaw Fantahun
    This is a retrospective cohol1 study designed to assess the effectiveness of Community based Family planning services in Eastern Showa Zone. The study was carried out in 30 PAs selected from five districts, where ten PAs were randomly selected from three areas: Community based distribution (CBO), Former community based distribution (FCBO) and Non-Community based distribution (NCBD) areas. A multistage sampling technique was used to select 310 women in the reproductive age groups( 1 5-49 years)for interview in each of the study areas. A questionnaire survey and focus group discussions were the methods of data collection. Focus group discussion was conducted among women aged 25- 35 years and 45-55 years, as well as among community representatives selected fi'om the study areas. Knowledge about modern contraceptive methods was significantly higher in the CBO communities, propOl1ion of women knowing one method being 89.1 % in CBO area compared to 76.6% in FCBD and 32.2% in NCBD. The most widely known MCM was pill followed by inj ectable hormone. The proportion of women who ever used MCM was significantly higher in CBO area. Ever use rate of of MCM was 57.2% in CBO, 39.2% in FCBD, and 18.3% in NCBD communities; Where as 43.4% ,22.7% , and 7.6% of the respective areas were current users, which was also a significant difference. In all areas over 65% of those who never used MCM expressed intention to use in the future. Although, clients in the CBD area generally claim to be satisfied with the service, they complained of being influenced by service provider. Most respondents approved family planning use. CBD area clients were found to use MCM relatively longer than NCBD area clients. Forty two percent ofCBO, 33.3% of FCBO, and 35.3% ofNCBO area clients used their method at least for one year. Lack of adequate information in non-CBD area and need for more children in CBO area were the major reasons for non-use of family planning methods. Need for (more) children and side-effects were the major reasons mentioned for use di scontinuation in all of the three study areas. Controlling for possible confounders the presence of community based family planning service was found to be the most important ex -planatory variable for increased current use of MCM. Therefore, a quality community based FP service is highly recommended in NCBO areas and further study is necessary to look for feasible mechanisms to sustain the service.
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    Early Discontinuation Rate of Implanon and Its Associated Factors among Women Who Ever Used Implanon in 2012/2013 in Ofla Woreda, Tigray, Northern Ethiopia,2014.
    (Addis Ababa University, 2014-06) Kalayu Birhane; Mesganaw Fantahun
    Background: Contraceptive use plays an important role in reducing fertility; and at times contraceptive prevalence has been used to evaluate the effect of family planning programs. Quality of family planning services is an important determinant of contraceptive use because it is likely to affect contraceptive adoption and, more significantly, contraceptive continuation i.e. poor access to quality Family Planning services, high discontinuation rate and low motivation to use modern FP methods. Objective; the objective of the study was to determine early discontinuation rate of Implanon and to identify its associated factors among women who ever used implanon in 2012/2013 in Ofla woreda, Tigray, North Ethiopia ,2014. Methods: a community based cross sectional study design with structured and pre tested questionnaires was administered for 244 participants from January 20-March 09, 2014. Six data collectors and two supervisors who were trained on the objective of the study and data collection techniques to administer the questionnaire were recruited in the data collection process. All women who ever used implanon in 2012/2013 were included in the study and the data was collected house to house by taking the list of the participants from the family planning registration book of each Health institutions. The data was entered and cleaned in Epi Info by the principal investigator then exported to SPSS version 20 for analysis. Multivariate Logistic regression was used identify factors associated with early discontinuation of implanon. Result: The mean (±SD) ages of the participants were 26.9±6.9 years. More than half of the participants 168(68.9%) were married, and 199(81.6%) were farmer by occupation. The overall early implanon discontinuation rate in this study was 16% with mean duration of implanon use of 6.6±2.8 months. The main reason for early discontinuation of implanon was Health concerns and side effects followed by desire to have more children. Women who have developed side effects during using of implanon, women who didn’t appointed for follow up and women who didn’t satisfied by the service given during the implanon insertion were the predictors of early implanon discontinuation. Conclusions: early implanon discontinuation rate in this study was in a considerable number and the main reason for discontinuation was Health concerns. Pre insertion counseling, close monitoring and follow up of implanon users should be made to increase implanon continuation rate
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    Effect of Community Conversation towards VCT Utilization in Rural SNNPR.
    (Addis Abeba University, 2011-05) Emebet Tekletsadik; Mesganaw Fantahun
    Background information: In contrast to, many initiatives implemented to prevent HIV/AIDS infection; many countries have not so far achieved the planned reduction in HIV/AIDS infection; the main reason mentioned so far being low utilization of VCT for HIV/AIDS. Community Conversation (CC) is a community based strategy meant to enhance the community to utilize VCT for HIV among many other functions. Objective: This study is aimed to determine the disparity in knowledge, attitude and practice towards VCT service utilization of population 15-59 years age, between well and poor community conversation performing rural kebeles of Shebe Dino woreda, SNNPR. Methodology: A cross sectional comparative community based study design was employed to compare the knowledge, attitude and practice towards VCT service among 15-59 years age population between poor and well community conversation performing rural kebeles in Shebe Dino woreda, from August 2010-May 2011. Kebeles were classified as poor or well based on their community conversation performance. A total of 6 kebeles (3 from each CC group) were selected by lottery method after stratifying each CC groups into three strata by their relative distance from the Woreda capital. The number of study participants sampled from each kebele is proportional to the size of study population in the kebele. A total sample of size 462, 231 (50%) from each comparative group were selected and studied. The qualitative data was collected from Focused Group Discussion and analyzed by thematic analysis. A hierarchical logistic regression model was used to determine independent predictors of VCT uptake in blocks of two at 95% CI. Result: The two CC groups were homogeneous in their major socio demographic factors using two sample test of proportion (P>0.05), and hence were comparable. VCT Knowledge didn’t show statistically significant difference between well and poor CC performing kebeles, with a two sample proportion test of difference and 95% CI: 0.05 (-0.04, 0.14). But, attitude and utilization of VCT service was statistically higher in well CC performing kebeles than poor CC performing kebeles (73.0% vs.54.1%, P < 0.001) and (97.8 vs. 93.8, P=0.034) respectively. Age group between 15-24 years, single, trader, knowledgeable about HIV transmissions, and positive attitude to VCT services were independent predictors of VCT service utilization. Conclusion: Proportion of study participants’ with positive attitude towards VCT and practice of VCT service utilization was higher in a well CC group compared to a poor CC kebeles. However the study population in the two CC groups is not different by their knowledge towards VCT service (i.e. CC does have effect on VCT attitude and practice but not on knowledge).VCT service utilization depends on one’s age, occupation, marital status and knowledge of HIV transmission. Therefore, there should be consistent monitoring and evaluation of the CC program, not only by the criteria in use but also in terms of its effect on KAP of the target population towards VCT and or HIV to strengthen CC in all CC kebeles.
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    The Effect of Living Arrangements and Parental Attachment on Sexual Risk Behaviors and Psychosocial Problems of Adolescents in Dessie Preparatory School, Ethiopia
    (Addis Abeba Universty, 2004-04) Solomon Shiferaw; Mesganaw Fantahun
    The family environment is critical in supporting healthy adolescent development. Following the opening of technical and preparatory schools in Ethiopia, it has become necessary for students particularly of the rural areas to move to the nearby towns for the duration of their training. However, whether adolescents who come from rural areas (who might lack consistent adult supervision and exposed to a relatively new environment) are having an elevated sexual-risk taking behavior and more psychosocial problems remain unanswered. In an attempt to respond to questions posed on these differential vulnerabilities of adolescents, a comparative cross-sectional study that examined the effect of living arrangement and parent-teen connectedness on sexual risk behaviors and psychosocial problems of students was conducted in Dessie preparatory school, Ethiopia. A sample of 667 students (512 male and 155 female) completed a pre-tested structured anonymous questionnaire. Qualitative information was obtained from four focus group discussions and sixteen peer-to-peer interviews segregated by gender and residence. We found that living with friends (OR=2.77; 95%CI=1.47, 5.24), alcohol consumption (OR=1.94; 95%CI =1.24, 3.04), lower perceived family connectedness (OR=0.97; 95%CI=0.95, 0.99) and parental monitoring (OR=1.70; 95%CI=1.06, 2.73), older age (OR=4.37; 95%CI=2.11, 9.04), having peer pressure (OR=1.82; 95%CI=1.20, 2.77) and peers who are sexually experienced were associated with increased odds of sexual activity. Having a depressive symptom was associated with female gender (OR=1.96; 95%CI=1.18, 3.23) , lower family connectedness (OR=0.96; 95%CI=0.94, 0.99), lower grade-point average (OR=1.93; 95%CI=1.01, 3.71), and living with friends (OR=3.16; 95%CI=1.66, 5.00), relatives (OR=2.52; 95%CI=1.28, 4.95) or alone (OR=2.15; 95%CI=1.04, 4.46). The study revealed that suicide attempt in the past 12 months was linked to having a history of suicide attempt in the family (OR=2.59; 95%CI=1.09, 6.15) or among friends (OR=4.32; 95%CI=1.88, 9.94), female gender (OR=2.60; 95%CI=1.05, 6.48) and sexual activity (OR=3.00; 95%CI=1.27, 7.11). The overall research finding indicate that living with both biological parents and good parentteen connectedness are related to better psychosocial health and being sexually abstinent. The evidence from this study suggests that parents need to know the continued importance of having good relationship with their adolescents. Youth programs should also address the central role of familial influences (specifically high levels of parental connectedness and monitoring) in protecting boys and girls from unsafe sexual behavior and psychosocial problems. Additional research needs to explore the impact of familial influences on adolescent reproductive and psychosocial health and preferably use longitudinal designs to determine the stability of the observed association over time.
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    Factors Affecting Antenatal Care Attendance and Preferences of Plaoe of Delivery by Pregnant Women in Gulele Distriot, Addis Ababa.
    (Addis Abeba Universty, 1992-03) Mesganaw Fantahun; George Olwit
    A community based cross sectional study was conducted in Gulele district, Addis Ababa to asses the utilization patterns of antenatal care services and the factors affecting antenatal care attendance and preference of place of delivery. A total of 441 pregnant women in the third trimester from 24 out of the 27 kebeles of the district were included in the study to whom pretested questionnaire were administered. The study showed that about 39 % of the third trimester pregnant women had not attended antenatal clinics at all. Only 26% of those attending antenatal care clinics had their first visit during the first trimester. The most important reason for not attending antenatal care clinics was being too busy (49.2%).Out of a total of 15.8 points, the mean knowledge score on MCH for those attending antenatal care clinics was 10.9±2.1 whereas it was 7.42± 2.5 for those not attending antenatal care. In multivariate analysis the risk of non-attendance was higher for those pregnant women whose income was low, (OR 1.77, 95% CI 1.44,2.76), whose husband's or partner's attitude was negative or unknown, (OR 2.63, 95% CI 1.9,3.64), who were first pregnant at the age of 10-18 years (OR 1.85, 95% CI 1.20 , 2. 8 1) and lower for the nulliparae ( OR 0.52 , 95% CI 0.33 , 0.82). Three fourths of the respondents preferred to deliver in health institutions and one fourth preferred to deliver at home. The most frequent reason for preference of place of delivery (40 . 8%) was high quality of service. In multivariate analysis the risk of preference to deliver at home was higher for those who were illiterate (OR 1.5, 95% CI 1.57, 2.00); for those whose husband's or partner's attitude towards antenatal care attendance is negative or unknown, (OR 1.82, 95% CI 1.34,2 . 49) and did not attend antenatal care clinics (OR 2.19, 95% CI 1.69,2.96). It was lower for the nulliparae (OR 0.52, 95%CI O. 3 , 0 . 9) . It is recommended to strengthen health education activities on early attendance of ANC,modern contraceptive methods and age at first pregnancy. Supportive and regular supervision of antenatal care clinics should be considered seriously. Support and training of community health workers should continue. Further studies should be carried out on factors associated with antenatal care attendance in diverse setups and well designed studies should address the influence of antenatal care on pregnancy outcome. In addition, proportion of pregnant women from the total population now used for all practical purposes should be reconsidered for Addis Ababa.
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    The Link Between Contents and Perceived quality of Antenatal Care With low Birth Weight among Term Neonates in Public Health Facilities of Bahir Dar Special Zone, North West Ethiopia.
    (Addis Abeba Universty, 2015) Kindie Mitiku; Mesganaw Fantahun
    Background: Low birth weight is not only an indicator of neonatal mortality and morbidity but also a morbidity risk in later life. Antenatal care is one of the evidence based interventions to decrease the probability of adverse birth outcomes such as low birth weight and preterm births. The effectiveness of antenatal care, however, relies on the quality of care and specific contents provided during each antenatal care visits. But, little information is available whether antenatal care contents and perceived quality are linked with weight at birth. Therefore, this study is aimed to assess the link between contents and perceived quality of antenatal care with low birth weight among term neonates in selected health facilities of Bahir Dar, North west Ethiopia. Methods: Facility based unmatched case control study was conducted among mother-newborn pairs in Bahir Dar special zone selected public health facilities. One referral hospital and four public health centers were selected for this study. The health centers were selected by random sampling technique whereas the referral hospital was selected without undergoing further sampling procedures (as it is the only public hospital in the study area). The sample size was calculated by using EPI info version 7.0 by considering ratio of control to case 2:1, power of 80%, confidence level of 95%, precision level of 5%, odd ratio of 2.014 and percentage of control exposed 21.39. Cases were selected consecutively where as two controls were assigned for each cases. Data was entered by using Epidata version 3.1 and then exported to statistical package for social science version 21 for analysis. Bi variant analysis was done to compare birth weight by each explanatory variable using binomial logistic regression. The adjusted odd ratio was used to determine strength of the association and the corresponding confidence interval was used to decide whether there was a statistical significant between the explanatory and outcome variables. Result: Among the contents of antenatal care, dietary advice AOR 2.29(CI 1.03-5.11) and iron intake of ≥30 days AOR 2.93(CI 1.34-6.42) were significantly associated with low birth weight at term. However, no significant association was observed between antenatal care level of satisfaction and low birth weight at term. Additionally, wealth, household food insecurity, number of ANC<4 and poor nutritional status of the mothers were significantly associated with low birth weight at term. Conclusion and recommendation: In this study setup, the risk of LBW at term was significantly associated with lack of antenatal care contents such as dietary advice and iron intake. It was also associated with other modifiable risk factors such as household food insecurity, wealth and nutritional status. Therefore, public health interventions targeting on antenatal dietary advice and iron intake preferably ≥ 30 days by giving special emphasis for poor and food in secured women during pregnancy is recommended to reduce LBW at term in this study setup.
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    Magnitude of Missed Opportunities on Infants Under one year Routine Immunization Services and Associated Factors in Wolikte Health Center, Gurage Zone, Southern Regional State, Ethiopia, 2015.
    (Addis Abeba Universty, 2015-07) Melese Assefa; Mesganaw Fantahun
    Background: Under five years deaths can be prevented through optimal use of currently existing vaccines. In 2012 nearly one in five infants missed the basic vaccines they need to stay healthy globally, and majority of the children missed in sub Saharan Africa including Ethiopia. Missed opportunities are an obstacle to raise immunization coverage among children and leading high infant morbidity and mortality. Objective: The objective of this study was to determine magnitude and the related factors for missed opportunity of routine immunization of infants under one year age in Wolikite health center Gurage zone, southern regional state, Ethiopia, May 2015 Methodology: The study was health facility based cross sectional design. Exit interview was administered for mothers who had under one infants and who came for any services for their infant at Wolikte health center, Gurage zone from March 27- April 22, 2015 using standard world health organization missed opportunity tool in the context of Ethiopia routine immunization schedule. The sample size was calculated by using single proportion formula with 95% confidence interval and a total of 346 mothers were interviewed. Result: The magnitude of missed opportunity for the study was 49.1% and the major vaccines with high missed opportunity were oral polio vaccine o (37.9), (Bacille Calmette Guerin 35), and measles (31.1) the major reason for immunization for missed vaccines was due to absence of adequate number of children to conduct immunization sessions which was around 81.2% among children who had missed opportunities. Age of children, stock out experience of care takers, knowledge of contact time and purpose of visit to health facility were independently associated factors for children missed opportunity of immunization. Conclusion: The overall magnitude of missed opportunity for the routine immunization is high influencing the success of immunization services. The major vaccines which highly contributed for the prevalence of immunization missed opportunity were measles, and Bacille Calmette Guerin and oral polio vaccine.
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    Measuring Unmet Need for Family Planning among Wives Husbands & Couples.
    (Addis Abeba Universty, 2005-04) Kerimudin Mubarik; Mesganaw Fantahun
    Since husbands & wives differ in fertility desire and intention to use contraception which implies spouses individually & as couple have different level of need regarding contraception. To estimates unmet need level for contraception of couples data from both spouses are required; so community based cross sectional study was conducted between Jan 3-Jan 17, 2005 in six kebeles of Harar city, eastern Ethiopia. After 19 Kebeles of the city was stratified in to three strata based on socio-economic factors, two Kebeles from each of the three strata was selected by simple random sampling. 1/6th of sample size was selected from each of the 6 kebeles by systematic sampling. The study units were married couples with wives age ranges 15-49 year. Four hundred sixty couples were interviewed using pre tested questionnaires. Data were collected from both spouses regarding fertility desire & its timing; wanted-ness and timing of pregnant/lactating women at the time were used to determine level of un-met need among husbands, wives & couples and also to assess factors associated with un-met need. A minimum estimate of unmet need for contraception of couples not practicing contraceptives is produced when both partners have unmet need & a maximum estimate of unmet need for contraception of couples not practicing contraceptives occurs if either spouse having unmet need defines unmet need. Husbands are found to have more children and sooner than wives and wives have more desire to limit and intend to use contraceptives than husbands. Unmet need estimate level for wives’, husbands’ and coples’ (minimum) were found to be 15.3%, 16.5% and 4.7% respectively. All figures are (below expectation) very low in comparison to other study results. For example when compared with 36% unmet level for married women by the DHS Ethiopia survey with the one obtained from this study it is very low (15.3%). This is probably due to the constellation of the following factors. The presence of two hospitals, FGAE clinic & other facility in the city of harar, 86% of all couples in the study have alive children & out of them 58% have at least two children; more than 78% of couples reported usage of a method in the past, only 19% of wives and 10% of husbands are illiterates, mean time to reach the service point was is only 30 minutes, more than 82% of couples approve contraceptive use, 60% of couples have discussed contraceptive issue in the last six months, more than 90% of couples heard and knew about contraceptives, 67% of couples have both T.V and radio; resulting in higher contraceptive prevalence which is 69% for wives and 66% for husbands. Amongst the factors considered to be associated with unmet need like age, education, number of alive children, knowledge & attitude towards contraceptives and so on; only perceived approval of contraceptives use by spouses and discussion about contraceptives between spouses are found to be associated significantly (p=.00) (table8 ,9). This warrants promotion and promotion activity to enhance communication between spouses. Incorporating reproductive health need of male in the over all reproductive health planning and service delivery and to make them male friendly is very important.(3) Endeavour to enhance prevalence of permanent contraceptive methods including vasectomy, which is very low at the moment, for limiters. Studies on family planning should include both women and men to enhance successful family planning service delivery that targets couples.