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First of all, my genuine gratitude goes to my advisor Dr. Alemayehu Mekonnen who dedicated his precious time to give comments and share his valuable knowledge and experiences throughout the study. I would like to forward my deep appreciation to Addis Ababa University College of Health Science School of Public Health for giving me the chance to conduct this study. I want to extend my thanks to CORHA for funding this research project. I am also grateful to supervisors and data collectors for their devotion throughout data collection and taking the responsibility. My appreciation also goes to all my colleagues at Oromia Regional Health Bureau for their encouragement and support during the study, particularly, Mr.Zewede Dinku,Ketema Belda and Dr.Zelalem Habtamu who have helped me in data entry, cleaning and editing of the text for the language clarity. In addition, I would like to extend my gratitude to my family and friends who ever contributed to finalize this research paper. At last but not least my deepest gratitude goes to the community of Girar Jarso district who are involved in giving information for the research work