greatly acknowledge and appreciate Bahir Dar University for the initiative, assigned advisor and funded to prepare this research. I also like to extend my gratefulness to my advisors Mr.Worku Awoke, Assistant professor of Epidemiology), and Alemtsehay Mekonen (MPH/RH) for their technical support. I would like to forward my heartily feeling to Gassera woreda health office for their cooperation by providing the pertinent information. I greatly need to acknowledge all the participants in this study especially respondents and data collectors. Lastly I would like to thanks my wife and my family for their continue support throughout