Skip to main content

Self-medication practices and associated factors among households at Gondar town, Northwest Ethiopia: a cross-sectional study



Self-medication practice is the selection and use of medicines by individuals or a member of the individual’s family without physician’s order to treat self-recognized or self-diagnosed conditions. It is highly prone to inappropriate use and wastage of resources, increase drug resistance pathogens and adverse reactions. Therefore, this study aimed to assess self-medication practices and associated factors among households at Gondar town, Northwest Ethiopia.


This community based cross-sectional study was conducted among households at Gondar town from March to June, 2018. The overall prevalence of self-medication practices among households at Gondar town were 50.2%. The odds of self-medication practices among unmarried participants (AOR = 3.12; 95% CI 2.35, 5.34), influenced by peer (AOR = 3.58; 95% CI 2.89, 7.28), poor perceived quality of health care services (AOR = 4.67; 95% CI 2.56, 7.96) and access to pharmacy (AOR = 2.32; 95% CI 1.65, 6.76) were higher compared with their counterparts. In the contrary, the lesser odd was observed among knowledgeable participants about medications (AOR = 0.27; 95% CI 0.16, 0.39) compared with non-knowledgeable. Therefore, improving perception of participants about quality of services, conducting awareness creation and managing negative effects of peer may reduce self-medication practices.


Self-medication (SM) is the selection and use of medicines by individuals or a member of the individual’s family without physician’s order to treat self-recognized or self-diagnosed conditions [1]. It can help to treat minor ailments that do not require medical consultation and hence reduce the pressure on medical services, particularly in the deprived countries with inadequate health care resources. In a number of developing countries, many drugs are dispensed over the counter without medical direction [2].

Self-medication practices (SMP) is highly prone to inappropriate use and has its own drawbacks resulting wastage of resources, increase drug resistance pathogens and adverse reactions [3, 4]. It can also lead to incorrect self-diagnosis, delays in seeking appropriate care, dangerous drug interactions, risk of dependence, drug abuse, incorrect dosage and choice of medication [5, 6]. A systematic review reports indicated that prevalence of SMP was high globally and varies from 32.5 to 81.5% [7,8,9,10,11] and the average prevalence of SMPs in Ethiopia was also 36.8% [12].

Nowadays, drug resistance is becoming a worldwide problem, mainly in developing countries as a result of the availability and the use of antibiotics without prescription [13,14,15]. Accordingly, new forms of resistant pathogens can spread between continents with ease and this considered as “nightmare bacteria” that “pose a catastrophic threat” to people in every country in the world [16].

In many developing countries, antibiotics and potentially habit-forming medicines are easily available in every pharmacy sells without prescription. This together with poor awareness and lack of a good primary health care system coupled with cost issues cause the general public to buy drugs from private health institutions and shops without prescription [17].

In spite of this, there is limited literatures and no specific measures designed to address the problem in the country. Therefore, this study aimed to assess self-medication practices and associated factors among households at Gondar town, Northwest Ethiopia.

Main text


Study design and settings

A community based cross-sectional study was conducted among households at Gondar town from February to May, 2018. Gondar town is found in the northwest part of Ethiopia and it is 180, and 748 km far from Bahir Dar (capital city of Amhara region) and Addis Ababa, respectively. Based on the 2007 Central Statistical Agency (CSA) report of Ethiopia, the town had a total population of 400,000. From these, 198,120 (men) and 201,880 (women). The town has also 23 kebeles and 48 health institutions; these are: 1 comprehensive referral hospital, 8 health centers, 1 private general hospital, 15 speciality clinics, 15 medium clinics and 8 primary clinics.

Population and sampling procedure

All households in Gondar town were the source population, where as households in the selected kebeles of Gondar town were the study population. The sample size was determined using single population proportion formula with an assumption of the prevalence of SMP in Northwest Ethiopia (27.5%) [18], 95% Confidence Level (CL), 5% margin of error, 5% non-response rate and 2 design effect. The final sample size was 642. After sample size determination, five kebeles has been selected by using lottery method. Then the total sample size, 642, was proportionally allocated among the five selected kebeles based on the size of the households. The head of the household was our study participants. Accordingly, the interval was determined through dividing the total households to the total sample sizes and the first household was selected through lottery method among households within the first range of interval. Finally, systematic sampling technique was used to select participants.

Data collection tools and procedures

Interviewer administered structured questionnaire was used for data collection. The questionnaire was developed from reviewing different literatures [19,20,21,22,23,24]. The questionnaire was first prepared in English, then translated to Amharic and finally back to English by language expertise in order to maintain its consistency. Pre-test was also conducted among 32 households at Bahir Dar town and any ambiguity was modified based on pre-test findings. A total of 6 diploma graduated pharmacy technicians were recruited for data collectors and 3 Bachelor degree graduated pharmacists were recruited for supervisors. A-day training was given for data collectors and supervisors about the basic techniques of the data collection procedures.


Self-medication practice, the outcome variable, was assessed by the selection and use of medicines/drugs by individuals or a member of the individual’s family with out physician’s order to treat self-recognized or self-diagnosed conditions in the past 6 months [25]. Accordingly, knowledge of participants about medications was measured by using eight item questions and each item contains (0 = no and 1 = yes) alternatives, and respondents who scored ≥ 50% of the total knowledge measuring scores were considered as knowledgeable.

Data management and analysis

Data were entered and analyzed using Epi-Info version 7.1 and SPSS version 20, respectively. Descriptive statistics such as frequencies and percentages were presented using tables, graphs, and texts. Variables with p-value < 0.2 during bivariable analysis were fitted to multiple logistic regression analysis. Finally, Adjusted Odds Ratio (AOR) with 95% CI and p-value less than 0.05 were used to determine variables significantly associated with SMPs.


Socio-demographic and economic characteristics

A total of 632 participants were participated with a response rate of 98.4%. About 60.8% of participants were females. 71.4% of respondents aged 30–45 years and the mean age of respondents was 36 ± 11 SD years. More than two-thirds (68.5%) of participants were Orthodox Christians and about 57% of the respondents were married. About 30% of participants had less than ETB 1000 (USD 37.7) monthly household income and attended their secondary school. Nearly one-fifth (18.5%) of the participants were government employee and more than 20% (21.4%) of participants had five or more family members (Table 1).

Table 1 Socio-demographic and economic characteristics of the respondents at Gondar town, Northwest Ethiopia, 2018

Self-medication practices

The prevalence of SMP among households in the past 6 months at Gondar was 50.2%. more than 60% (60.9%) of the household had history of SMPs within their family members in the town, but they didn’t remember the name of the drug. About 13.2% of the participants encounter some drug adverse reactions and more than 40% (43.2%) had checked the expiry date of the drug before they use. Similarly, almost half (49.5%) were concerned that increasing the dose of the drug can be hazardous for health. About 46% of respondents had access to pharmacy and more than half (56%) of participants were influenced by their peer/s (Table 2).

Table 2 Self-medication practices at households of Gondar town, northwest Ethiopia, 2018

Source of information about SMPs

More than one-third (35.3%) of the sources of information for their households about medication practices were pharmacy professionals and previous experience was also the sources of information for around 30% of the participants. On the other hand, one-third (67.8%) of the respondents had bought the drugs for SMPs were private drug stores followed by 11.7% private clinic. About 45.4% participants were knowledgeable about medications, one-fifth (22.2%) of respondents had good perceived quality of governmental health care services and 42.4% perceived the costs of SMs was cheap (Additional file 1: Table S1).

Reasons and common symptoms for SMPs

Participants reported that the reasons for their households SMPs were severity of illnesses (44.8%), emergency cases (35.3%), reducing medical cost (17%), lack of trust by the prescribers (4.1%) and for saving time (5.1%) (Additional file 2: Fig S1).

The common symptoms/illnesses that prompted SMs among participants who had practiced self-medications were headache (63.1%), RTIs (cough, cold/flu) (30.9%), fever (18.9%), GIT infections (diarrhea, vomiting) (38.9%) and dysmenorrhea (7.6%) (Additional file 3: Fig S2).

Factors associated with SMPs

Binary logistic regression model was used for analysis. AOR with 95% CI and p-value less than 0.05 were used to determine variables associated with SMPs. The odds of SMPs was higher among unmarried (AOR = 3.12; 95% CI 2.35, 5.34), influenced by peer pressure (AOR = 3.58; 95% CI 2.89, 7.28), access to pharmacy (AOR = 2.32; 95% CI 1.65, 6.76) and poor perceived quality of governmental health care services (AOR = 4.67; 95% CI 2.56, 7.96) compared with that of their counterparts. On the other hand, lesser odds of SMP was observed among knowledgeable participants about medications (AOR = 0.27; 95% CI 0.16, 0.39) than that of non-knowledgeable (Table 3).

Table 3 Multiple logistic regression analysis for factors associated with SMPs at Gondar town, Northwest Ethiopia, 2018


This study was designed to assess the prevalence of SMPs and associated factors among households at Gondar town, Northwest Ethiopia. In our survey, prevalence of SMPs in the past 6 months was 52.2%. The finding was higher than studies done at University of Gondar (38.5%) [19], Mekelle (43.24%) [20], Meket district (35.9%) [26], Nekemte (36.7%) [27], Northwest Ethiopia (27.5%) [18], Puducherry, India (11.9%) [28], Saudi Arabia (35.4%) [29] and Haman dan province, Iran (35.4%) [30]. However, it was lower than studies done in Harar (57.8%) [31], Addis Ababa (72.8%) [21], Sri Lankan (60.8%) [32], Pune (87.5%) [33], Belgrade, Serbia (79.9%) [34], Oman University (94%) [25], Pokhara, Nepal (59%) [22], Italy (69.2%) [35], Barabanki (69.6%) [36], Delhi, India (92.8%) [37], Turkey (63.4%) [38], private University Malaysia (77.6%) [39], Mbeya, Tanzania (55.7%) [40], Gulbarga Karnataka, India (88.2%) [41], Karachi, Pakistan (76%) [24] and Egypt (62.9%) [42]. This variation may be due to the differences in social determinants of health, beliefs, culture of the population, and variation on recall periods used in each study.

Our finding indicated that the odds of SMPs among unmarried participants were 3.12 times higher than the odds of married participants. This finding was consistent with the studies conducted in Meket district, Ethiopia [27] and Udupi Taluk, southern India [43]. This might be so because unmarried participants could be influenced by peer pressure. The odds SMPs among households who were influenced by peer pressure were 3.58 times higher than that of the respondents who didn’t influence by their peers. This study was in line with other studies done in Meket [27], China [44] and Uganda [45]. The possible explanation might be due to the source of information for peers/friends might be the same. Similarly, they may have similar life experience and can also share their own previous practices between them. This could also work in the case of self-medications.

Our study report also indicated that the odds of SMPs among knowledgeable participants were lesser by 73% compared with their counterparts. This might be due to knowledgeable community members may fear the bad adverse reactions self-medications. Accordingly, the odds of SMPs among participants who had poor perceived quality of health care services in the governmental health care facilities were 4.67 times higher than respondents who had good perceived quality of health care. The possible explanation might be so because participants who had poor perceived quality health care services may decide that the role of physician’s diagnosis is not significant for treating their health problems.

In this study, the odds of SMPs among respondents who had an access to pharmacy were 2.32 times higher compared with the participants who had no access. This finding was supported by studies conducted in Meket, Ethiopia [27], China [44], southern India [43] and Nigeria [46]. The possible justification might be due to the inability of the participants to afford health care fees and lack of time to consult health care professionals. Therefore, improving perception of participants about the quality of health care services, awareness creation and managing peer pressure may reduce self-medication practices.


  • This study was conducted in urban setting which didn’t show the practices of the rural area.

  • The study was assessing only about modern medicines which did not include practices of traditional medications that might be under estimate our findings in the study area.

  • The study might also prone to recall bias as a result of self-reporting of the participants for their last 6 months experiences.



Adjusted Odds Ratio


Confidence Interval


Crude Odds Ratio


Gastro-Intestinal Tract


Respiratory Tract Infections




Self-Medication Practice


World Health Organization


  1. 1.

    Organization WH: The Role of the pharmacist in self-care and self-medication: report of the 4th WHO Consultative Group on the Role of the Pharmacist, The Hague, The Netherlands, 26–28 August 1998. Geneva: World Health Organization; 1998.

  2. 2.

    Sherazi BA, Mahmood KT, Amin F, Zaka M, Riaz M, Javed A. Prevalence and measure of self medication: a review. J Pharm Sci Res. 2012;4(3):1774.

    Google Scholar 

  3. 3.

    Panda A, Pradhan S, Mohapatra G, Mohapatra J. Drug-related problems associated with self-medication and medication guided by prescription: a pharmacy-based survey. Indian J Pharmacol. 2016;48(5):515.

    Article  Google Scholar 

  4. 4.

    Fainzang S. Managing medicinal risks in self-medication. Off J Int Soc Pharmacovig. 2014;37(5):333–42.

    Google Scholar 

  5. 5.

    Ruiz ME. Risks of self-medication practices. Curr Drug Saf. 2010;5(4):315–23.

    Article  PubMed  Google Scholar 

  6. 6.

    Bennadi D. Self-medication: a current challenge. J Basic Clin Pharm. 2014;5(1):19–23.

    Article  Google Scholar 

  7. 7.

    da Silva Pons E, Knauth DR, Vigo Á, Mengue SS. Predisposing factors to the practice of self-medication in Brazil: results from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM). PLoS ONE. 2017;12:12.

    CAS  Article  Google Scholar 

  8. 8.

    Sanghani S, Zaveri H, Patel V. Self medication: prevalence and pattern in urban community. J Pharmacovig Drug Saf. 2008;5:95–8.

    Google Scholar 

  9. 9.

    Phalke V, Phalke D, Durgawale P. Self-medication practices in rural Maharashtra. Indian J Commun Med. 2006;31 (1):34–5.

  10. 10.

    Al Akshar SA, Shamssain M, Metwaly Z. Pharmacists perceptions of community pharmacy practice in UAE: an Overview. IOSR J Pharm. 2014;4(6):47–56.

    Google Scholar 

  11. 11.

    Suleiman AK. Self-medication and the advisory role of pharmacists in Riyadh, Saudi Arabia. Arch Pharm Pract. 2013;4(4):180–6.

    Article  Google Scholar 

  12. 12.

    Ayalew MB. Self-medication practice in Ethiopia: a systematic review. Patient pref Adher. 2017;11:401–13.

    Article  Google Scholar 

  13. 13.

    Pagan JA, Ross S, Yau J, Polsky D. Self-medication and health insurance coverage in Mexico. Health Policy. 2006;75(2):170–7.

    Article  PubMed  Google Scholar 

  14. 14.

    Khan SJ, Amanullah KS, Shah N. Self-medication with antibiotics in urban areas of Peshawar. Gomal J Med Sci. 2011;9(1):1–4.

    Google Scholar 

  15. 15.

    Osemene K, Lamikanra A. A study of the prevalence of self-medication practice among university students in Southwestern Nigeria. Trop J Pharm Res. 2012;11(4):683–9.

    Article  Google Scholar 

  16. 16.

    Centers for Disease Control and Prevention (CDC): antibiotic resistance threats in the United States. 2013. Accessed 24 May 2013.

  17. 17.

    Chang FR, Trivedi K. Economics of self-medication: theory and evidence. Health Econ. 2003;12(9):721–39.

    Article  Google Scholar 

  18. 18.

    Abula T, Worku A. Self-medication in three towns of North West Ethiopia. EJHD. 2017;15:1.

    Google Scholar 

  19. 19.

    Abay S, Amelo W. Assessment of Self-medication practices among medical, pharmacy, health science students in Gondar University, Ethiopia. J Young Pharm. 2010;2(3):306–10.

    CAS  Article  Google Scholar 

  20. 20.

    Gutema GB, Gadisa DA, Kidanemariam ZA, Berhe DF, Berhe AH, Hadera MG, Hailu GS, Abrha NG. Self-medication practices among health sciences students: the case of Mekelle University. J Appl Pharm Sci. 2011;1(10):183.

    Google Scholar 

  21. 21.

    Beyene A, Getachew E, Doboch A, Poulos E, Abdurahman K. Knowledge, attitude and practice of self medication among pharmacy students of rift Valley University, Abichu campus, Addis Ababa, Ethiopia. J Health Med Informat. 2017;8(269):2.

    Google Scholar 

  22. 22.

    Shankar P, Partha P, Shenoy N. Self-medication and non-doctor prescription practices in Pokhara valley, Western Nepal: a questionnaire-based study. BMC Fam Pract. 2002;3(1):17.

    CAS  Article  Google Scholar 

  23. 23.

    Hsiao F-Y, Lee J-A, Huang W-F, Chen S-M, Chen H-Y. Survey of medication knowledge and behaviors among college students in Taiwan. Am J Pharm Educ. 2006;70(2):30.

    Article  Google Scholar 

  24. 24.

    Zafar SN, Syed R, Waqar S, Zubairi AJ, Vaqar T, Shaikh M, Yousaf W, Shahid S, Saleem S. Self-medication amongst university students of Karachi: prevalence, knowledge and attitudes. J Pak Med Assoc. 2008;58(4):214.

    PubMed  Google Scholar 

  25. 25.

    Al Flaiti M, Al Badi K, Hakami WO, Khan SA. Evaluation of self-medication practices in acute diseases among university students in Oman. J Acute Dis. 2014;3(3):249–52.

    Article  Google Scholar 

  26. 26.

    Kassie AD, Bifftu BB, Mekonnen HS. Self-medication practice and associated factors among adult household members in Meket district, Northeast Ethiopia, 2017. BMC Pharmacol Toxicol. 2018;19(1):15.

    Article  Google Scholar 

  27. 27.

    Sado E, Gedif T. Drug utilization at household level in Nekemte Town and surrounding rural areas, western Ethiopia: a cross-sectional study. Open Access Lib J. 2014;1(03):1.

    Google Scholar 

  28. 28.

    Selvaraj K, Kumar SG, Ramalingam A. Prevalence of self-medication practices and its associated factors in Urban Puducherry, India. Persp Clin Res. 2014;5(1):32.

    Article  Google Scholar 

  29. 29.

    Alghanim S. Self-medication practice among patients in a public health care system/Pratique de l’automédication chez les patients bénéficiant d’un système de soins de santé public. East Mediter Health J. 2011;17(5):409–17.

    CAS  Article  Google Scholar 

  30. 30.

    Jalilian F, Mehdi Hazavehei S, Vahidinia AA, Jalilian M, Moghimbeig A. Prevalence and related factors for choosing self-medication among pharmacies visitors based on health belief model in Hamadan Province, west of Iran. J Res Health Sci. 2013;13(1):81–5.

    PubMed  Google Scholar 

  31. 31.

    Mamo S, Ayele Y, Dechasa M. Self-medication practices among community of harar city and its surroundings, Eastern Ethiopia. J Pharm. 2018;2018:1.

    Article  Google Scholar 

  32. 32.

    Fernando A, Bandara L, Bandara H, Pilapitiya S, Silva AD. A descriptive study of self-medication practices among Sri Lankan national level athletes. BMC Res Notes. 2017;10(1):257.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Sajith M, Suresh SM, Roy NT, Pawar D. Self-medication practices among health care professional students in a tertiary care hospital, Pune. Open Public Health J. 2017;10:1.

    Article  Google Scholar 

  34. 34.

    Lukovic JA, Miletic V, Pekmezovic T, Trajkovic G, Ratkovic N, Aleksic D, Grgurevic A. Self-medication practices and risk factors for self-medication among medical students in Belgrade, Serbia. PloS one. 2014;9:12.

    Article  Google Scholar 

  35. 35.

    Garofalo L, Di Giuseppe G, Angelillo IF. Self-medication practices among parents in Italy. Biomed Res Int. 2015;2015:8.

    Article  Google Scholar 

  36. 36.

    Keshari SS, Kesarwani P, Mishra M. Prevalence and pattern of self-medication practices in rural area of Barabanki. Indian J Clin Pract. 2014;25(7):636–9.

    Google Scholar 

  37. 37.

    Kumar V, Mangal A, Yadav G, Raut D, Singh S. Prevalence and pattern of self-medication practices in an urban area of Delhi, India. Med J Dr DY Patil Univ. 2015;8(1):16.

    Article  Google Scholar 

  38. 38.

    Okyay RA, Erdoğan A. Self-medication practices and rational drug use habits among university students: a cross-sectional study from Kahramanmaraş, Turkey. PeerJ. 2017;5:e3990.

    Article  Google Scholar 

  39. 39.

    Ali AN, Kai JTK, Keat CC, Dhanaraj S. Self-medication practices among health care professionals in a Private University, Malaysia. Int Curr Pharm J. 2012;1(10):302–10.

    Article  Google Scholar 

  40. 40.

    Kajeguka DC, Moses E. Self-medication practices and predictors for self-medication with antibiotics and antimalarials among community in Mbeya City, Tanzania. Tanz J Health Res. 2017;19:4.

    Google Scholar 

  41. 41.

    Patil SB, Vardhamane S, Patil B, Santoshkumar J, Binjawadgi AS. Kanaki AR: self-medication practice and perceptions among undergraduate medical students: a cross-sectional study. JCDR. 2014;8(12):HC20.

    PubMed  Google Scholar 

  42. 42.

    Helal R, Abou-ElWafa H. Self-medication in university students from the city of Mansoura, Egypt. J Environ Public Health. 2017;2017:7.

    Article  Google Scholar 

  43. 43.

    Divya M, Bharatesh S, Vasudeva G, Varalakshmi C. Self-Medication Among Adults in Urban Udupi Taluk, Southern India. Int J Med Public Health. 2016;6(3):126–9.

    Article  Google Scholar 

  44. 44.

    Wen Y, Lieber E, Wan D, Hong Y. Group NCHSPT: a qualitative study about self-medication in the community among market vendors in Fuzhou, China. Health Soc Care Community. 2011;19(5):504–13.

    Article  Google Scholar 

  45. 45.

    Ocan M, Bwanga F, Bbosa GS, Bagenda D, Waako P, Ogwal-Okeng J, Obua C. Patterns and predictors of self-medication in northern Uganda. PLoS ONE. 2014;9:3.

    Article  Google Scholar 

  46. 46.

    Abdulraheem I, Adegboye A, Fatiregun A. Self-medication with antibiotics: empirical evidence from a Nigerian rural population. Br J Pharm Res. 2016;11(5):1–3.

    CAS  Article  Google Scholar 

Download references

Authors’ contributions

EJ was involved in the conception, design, analysis, interpretation, report and manuscript writing. AF, AD and GA also involved in the design, analysis, interpretation of the data, and manuscript writing. All authors read and approved the final manuscript.


Authors would like to thanks for Institute of Public Health, College of Medicine and Health sciences, University of Gondar for giving an opportunity to study in this area. In addition, our gratitude goes to Gondar town health office staff members for their co-operation by providing the necessary information. Finally, we would like to thank the study participants and data collectors.

Competing interests

The authors declared that they have no competing interests.

Availability of data and materials

Data is available from the corresponding authors.

Consent of publish

Not applicable.

Ethical approval and consent to participate

Ethical clearance was obtained from the Ethical Review Board of University of Gondar College of Medicine Institute of Public Health. Permission letter was obtained from Gondar town administration and the respective offices. The participants had the right to refuse or discontinue during participation at any time, the right to answer few or all questions was respected. Written informed consent was obtained from the head of the household before data collection and confidentiality and privacy of the respondent was maintained.


This research was sponsored by the principal investigator (self).

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author information



Corresponding author

Correspondence to Ayal Debie.

Additional files

Additional file 1: Table S1.

Sources of information and drugs for SMPs among households at Gondar town, Northwest Ethiopia, 2018.

Additional file 2: Fig. S1.

Reasons for self-medication practices among households at Gondar town, Northwest Ethiopia, 2018 (n = 317).

Additional file 3: Fig. S2.

Common symptoms/illnesses that prompted self-medications among households at Gondar town, Northwest Ethiopia, 2018 (n = 317).

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jember, E., Feleke, A., Debie, A. et al. Self-medication practices and associated factors among households at Gondar town, Northwest Ethiopia: a cross-sectional study. BMC Res Notes 12, 153 (2019).

Download citation


  • Self-medication practices
  • Households
  • Factors
  • Gondar
  • Ethiopia