Professional Documents
Culture Documents
BACGROUND: The first case of HIV in Ethiopia was reported in 1984. Since then,
HIV/AIDS has become a major public health concern in the country, leading the
Government of Ethiopia to declare a public health emergency in 2002. Although the
epidemic is currently stable, HIV/AIDS remains a major development challenge for
Ethiopia. The spread of HIV in any community is in part determined by the knowledge of
attitude towards sexuality of its members and by their actual sexual practices. The aim of
the study was to assess students’ knowledge, attitudes and practices regarding HIV/AIDS
and STDs in Bole preparatory school in Addis Ababa Ethiopia.
OBJECTIVE: To assess Knowledge, Attitude and Preventive Practice towards HIV/AIDS
& sexually transmitted infection among preparatory school students in Addis Ababa city
in Bole preparatory school.
METHODS: A cross sectional study will conduct between February 1 to March 1, 2018
in preparatory high school students. Pre-tested questioner was used to generate the data
and analysis.
1
CHAPTEER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Sexually transmitted infections (STIs) are illnesses that have a significant probability of
transmission from humans to humans by means of human sexual contact, including vaginal
intercourse, oral sex, and anal sex. The term sexually transmitted infections (STIs) has a
broader range of meaning; a person may be infected, and may potentially infect others,
without showing signs and symptoms of disease. Some STIs can also be transmitted via
the use of intravenous (IV) drug needles after its use by an infected person, as well as
through childbirth or breastfeeding. STI is caused by more than 30 different pathogens
including bacteria, virus, protozoa, fungus and ecto-parasites.
Young adulthood is an age at which decisions are taken on whims and unless provided with
appropriate knowledge, their chances of engaging in risky sexual behavior become high.
Many studies have shown that this behavior is influenced by determinants like age, gender,
level and stream of education, socio-economic status, etc. It is interesting to note that poor
knowledge and risky practices related to STIs are a universal phenomenon in the young
adulthood. STI prevalence directly affects the rate of transmission of HIV.
Among other STIs, HIV/AIDS is the major problem disease. HIV/AIDS is a global
challenge that has threatened the very existence of the human race. Acquired Immune
Deficiency Syndrome (AIDS) is caused by a human immunodeficiency virus (HIV) that
weakens the immune system, making the body susceptible to opportunistic diseases that
often lead to death. The first HIV case was recognized in the United States in 1981, and it
2
has spread rapidly throughout the world and also the first case of HIV in Ethiopia was
reported in 1984 and since then it is the major health problem in the country.
Risk behaviors like unprotected sex, multi partnership, no or inconsistence use of condoms
and drug of abuse are extremely determinate to health of adolescents and young adults
putting them at high risk to HIV/AIDS and other Sexual transmitted diseases (STDs).
Girl adolescents are particularly vulnerable to HIV/AIDS and other STDs. Studies
indicated for every 15-19 years old boys there are 5-6 girls of the same age infected with
HIV. This is often exacerbated by the fact that most young women are likely to be having
sex with men older than themselves due to economical like “Sugar daddy” relationship in
many Ethiopian cities. Another serious issue is younger girls lack sexual negotiation
because of fear of physical abuse, rejection and their partner objection.
Other important factors for the spread of HIV and STDs in Ethiopia today are alcohol and
drugs of abuse. The influence of alcohol and experimentation with drug promotes increase
in the incidence of high-risk behaviors in particular sex. Sexual offense such as rape usually
committed under the influence of alcohol or drug.
The spread of HIV in any community is in part determined by the knowledge of attitude
towards sexuality of its members and by their actual sexual practices. Before formulating
public health policies for the prevention of HIV, it is critical to obtain information about
3
the prevalent knowledge, attitude and practice (KAP) regarding HIV/AIDS, other STDs
and sexuality in the target community. Several studies on KAP regarding HIV/AIDS have
been reported from different parts of Ethiopia. However; none of them addressed the
increased risk of HIV infection associated with acquisition of other STDs. In addition,
studies on KAP regarding HIV/AIDS and other STDs in Bole preparatory schools in Addis
Ababa Ethiopia are insufficient and there must be a continuous assessment of KAP
regarding HIV/AIDS and other STDs in a community to observe the impact of different
awareness creation forums. Therefore; the aim of the study was to assess students’
knowledge, attitudes and practices regarding HIV/AIDS and other STDs. We also
investigated the impact of gender and family income of the students on their knowledge,
attitude and practice.
4
CHAPTER 2.
LITRATURE REVIEW
2.1 The HIV/AIDS PREVALENCE AMONG YOUTH
Adolescents and young people represent a growing share of people living with HIV
worldwide. In 2016 alone, 610,000 young people between the ages of 15 to 24 were newly
infected with HIV, of whom 260,000 were adolescents between the ages of 15 and 19. To
compound this, most recent data indicate that only 15 per cent of adolescent girls and 10
per cent of adolescent boys aged 15-19 in sub-Saharan Africa – the region most affected
by HIV – have been tested for HIV in the past 12 months and received the result of the last
test. If current trends continue, hundreds of thousands more will become HIV-positive in
the coming years. Additionally, AIDS-related deaths among adolescents have increased
over the past decade while decreasing among all other age groups, which can be largely
attributed to a generation of children infected with HIV prenatally who are growing into
adolescence (UNICEF, 2017).
Young people’s risk of becoming newly infected with HIV is closely correlated with age
of sexual debut. Abstinence from sexual intercourse and delayed initiation of sexual
behavior are among the central aims of HIV prevention efforts for young people.
Decreasing the number of sexual partners and increasing access to, and utilization of
comprehensive prevention services, including prevention education and increasing access
to condoms are essential for young people who are sexually active (WHO-HIV & youth,
2017)
The HIV/AIDS epidemic has devastating effects on most African youth who often lack
access to sexual health information and services. In particular, unmarried youth have great
difficulty getting sexual health services. At the same time, cultural, social and economic
norms and pressures often put young African women at excess risk for HIV infection
(Akukwe, 2015).
5
Young people are not only at the center of the HIV/AIDS epidemic, they are also the most
vulnerable and the most affected section of the global population (World Health
Organization, 2017).
In studies of nine African countries, among sexually experienced adolescent women and
men aged 15-19 years, between 40 and 73 percent of respondents in seven countries
believed they had little or no risk of contracting HIV/AIDS. There is a prevalent belief, in
most cases, that one is not at risk by having only one partner, owing to awareness of other
risk factors such as sexual history and partners having other sexual partners. (Population
Bureau, 2016).
Women are more vulnerable to contracting HIV/AIDS due to their biological conditions as
the receptive partner. The women biological characteristics consisting of a larger soft body
surface exposed during sexual intercourse permit greater mucosal exposure to seminal
fluids. In addition, the male seminal fluid contains a higher concentration of HIV than
vaginal fluid and it remains in the vaginal canal for a relatively longer time. Tuju (2014)
pointed out that men transmit HIV more efficiently to women than women to men. Other
biological factors include transmission of HIV from mother to child during pregnancy,
birth or after birth through breast feeding.
6
pregnant women, can result in perinatal transmission and serous neonatal infection
(google scholar).
The time adolescence sets in, sexuality becomes the greatest single factor in play through
developmental process of both mind and body. Human and youthful sexuality in particular
involves inevitable and irresistible biological drives that always demand gratification. For
young people the onset of menstrual and sperm development often marks the initiation into
sexual activities, in an attempt to satisfy the newly discovered sexual urges and curiosity
(Mitchell, 2015)
Globally a majority of the youth aged 15-24 have heard of HIV/AIDS, however, evidence
have established that the vast majority of youth do not know how HIV is transmitted or
how to protect themselves (United Nations Children’s Fund, The Joint United Nations
Program on HIV/AIDS and World Health Organization, 2017).
Knowledge on how HIV is transmitted and other STIS is one of the several factors that
enable youth to protect themselves from the virus. Correct knowledge can also reduce
stigma and discrimination against people living with HIV/AIDS. Several studies have
shown that health related knowledge has power to change people’s attitudes and health
care behaviors in different health contexts, including, oral and dental health (Kinirons and
Stewart, 2014). Widespread evidence shows that knowledge about HIV/AIDS and STIs
and reproductive health are key strategies for empowering young people to delay the onset
of sexual activity and to make their sexual behaviors safer (Jackson, 2015).
Jensen and Schnack (2016) argue that the objectives of a program like the HIV and AIDS
education in secondary schools should be able to give direction on the type of knowledge
that would focus on making the learners agents and to enable them participate in the
transfer of that change in the society so as to make more people to embrace that change;
youth should therefore transform the community towards HIV and AIDS control.
Sub-Saharan African youth between the ages of 15 and 24 are particularly vulnerable to
HIV and other sexually transmitted infections (STIs) (Khan and Mishra, 2014),
representing 42 percent of all new infections across the continent (UNICEF, 2016).
7
Right from the beginning, the HIV/AIDS epidemic has been accompanied by an epidemic
of fear, ignorance, and denial, leading to stigmatization of and discrimination against
people living with HIV/AIDS (PLWHA) and their family members (International Center
for Research on Women 2017)
In many African countries, approximately 20% of 15–49-year-olds are infected with HIV.
Among black Africans, high levels of HIV/AIDS misconceptions (e.g. HIV is
manufactured by whites to reduce the black African population; AIDS is caused by
supernatural forces or witchcraft) may be barriers to HIV prevention (African journal of
AIDS research).
In sub-Saharan Africa, surveys continue to indicate that young people between 15-24 years
harbor serious misconceptions about HIV and how it is transmitted (Cohall, et.al. 2014).
Even though it is now common knowledge that the HIV agent cannot be transmitted
through mosquito bites, many people still believe that mosquitoes are a good vehicle for
HIV transmission. In sub Saharan Africa where mosquitoes are endemic, this
misconception is significant because it implies a defeatist attitude that regardless of what
one does, one is subject to HIV infection as a resident of a mosquito infested region. It also
poses a compliance challenge for any educational intervention effort targeted at this group.
(Wodi, 2015).
8
2.6. ATTITUDE RELATING HIV/AIDS AND STDS
Stigma refers to a situation when people living with HIV/AIDS are viewed as shameful
and the disease is perceived to be a result of personal irresponsibility. If not counteracted,
such attitudes fuel prejudice against those living with HIV/AIDS, marginalizing and
excluding individuals. Ultimately such attitudes allow societies to excuse themselves from
the responsibility of caring for and looking after those who are infected. More importantly,
stigma leads to secrecy and denial that hinders people from seeking counseling and testing
for HIV, as well as care and support services.
Stigmatizing attitudes among health care workers can be especially dangerous, given their
potential deterrent effect on utilization of essential health services. A national survey of
health care workers in 2014 found that 15% of physicians believed health workers had the
right to reduce care to people living with HIV. (The Kenya AIDS epidemic update 2016).
Internationally, there has been a recent resurgence of interest in HIV and AIDS-related
stigma and discrimination, triggered at least in part by growing recognition that negative
social responses to the epidemic remain pervasive even in seriously affected communities.
Yet, rarely are existing notions of stigma and discrimination interrogated for their
conceptual adequacy and their usefulness in leading to the design of effective programs
and interventions. Taking as its starting point, the classic formulation of stigma as a
‘significantly discrediting’ attribute, but moving beyond this to conceptualize stigma and
stigmatization as intimately linked to the reproduction of social difference, this paper offers
a new framework by which to understand HIV and AIDS-related stigma and its effects
(science & medicine journal, 2017)
While condoms are the best weapons against HIV infection, studies continue to show
limited use of condoms in sub-Saharan Africa (Eaton.et.al, 2015). These studies implicate
socio-cultural and religious factors in negotiating for safer sex. Knowledge about HIV
transmission and wa7ys to prevent it are less useful if people feel powerless to negotiate
safer sex with their partners. To gauge attitudes towards safer sex, there is need to know if
9
people think a wife is justified in refusing to have sex with her husband when she knows
he has a disease that can be transmitted through sexual contact. There is also need to know
whether a woman in the same circumstances is justified in asking her husband to use a
condom.
10
CHAPTER 3
The main objective of the study is to investigate knowledge, attitude and practice among
adolescent attending Bole preparatory school in Addis Ababa Ethiopia.
11
CHAPTER 4
An Institution based cross sectional quantitative study will conduct from February to June
2018 in Addis Ababa Ethiopia. The study will conduct in Bole preparatory school which
is one of the governmental preparatory school in Addis Ababa city. All students who were
attending grade 11 & 12 in Bole preparatory school will be the source population for this
study.
4.3 POPULATION
Source of population: all Bole preparatory school students attending grade 11 & 12 during
study period.
p= proportional=0.5 or 50%
12
n= Z α/2 P (1-P)/d2= (1.96)2(0.5) (1-0.5)/ (0.05)2=382
Age
Sex
Marital status
Peer pressure
Religion
Ethnicity
Health extension workers
Health professions
Family educational status
Health service accessibility
Accessibility to different Medias like radio, TV...
Teachers
Residences
13
towards HIV/AIDS and Part -D on high risk behavior or practice related to HIV& other
STIs transmission.
Knowledge will be assessed using different questionnaire item which includes knowledge
on STDs, ways of risk reduction for HIV transmission, predisposing risk behavior and
practice to HIV and other STIs, symptoms of STDs other than HIV/AIDS, treatment of
AIDS, prevention methods of HIV and other STIs and the contribution of other STDs
acquisition for the spread of HIV infection.
Attitude will be assessed using different questionnaire items which includes attitude:
towards screening of HIV and other STIs, towards AIDS patients, towards gender equality
as related to sexuality and towards visiting clinics for cases of STDs other than HIV/AIDS.
The questions on high risk behaviors has also different items related to unprotected sex and
needle sharing.
The English questionnaire will translate into simple Amharic (local language) and back
translate into English. Pre- test of questionnaire will be done on twenty students and the
result will be used to improve the phrasing of questions in the questionnaire.
Data will process and analyses using tally sheets and manual scientific calculator. Finally,
the result will present using tables based on finding then discussion, conclusion and
recommendation will be given depending on the result.
Pre-tested questionnaire will be used before the actual data collection done to increase the
quality of data. The questionnaire will be translated to the local language to check its
consistency & we returned to the respondents for our data completeness.
Knowledge: In this research paper, those who will respond correctly 5 or less questions
(<50%) out of knowledge questions will be
rated as having poor knowledge while those who answered correctly
14
6 or more questions (60-100%) was categorized as having good
knowledge.
15
CHAPTER 5
WORK PLAN
The activities to be done and the corresponding time required during the study
is expressed by Gantt chart.
16
CHAPTER 6
BUDGET
The financial plan during the study will be allocated as follows:
1 Photocopy 700
5 Transportation 800
6 Internet 600
8 Others 500
Total 5000
17
REFERENCES
1. Adegbola, O et al 2012, Sexual networking in free town the background
of AIDS epidemics. Health Transition Review.
2. Akwuwe C. (2015): HIV/AIDS in African Children: Major calamity that
Deserve Urgent Global Action Journal on HIV prevention. Education for
Adolescents and Children Vol(IV) NO.11Amornkul PN et al (202013). HIV
prevalence and associated risk factors among individuals aged 13-34 years in
Rural western Kenya. PL.S ONE 4:e6470
3. Cohall, A. et al (2014) Adolescents in the age of AIDS: Myths,
Misconception, and misunderstandings, regrading sexually transmitted
diseases, J Natl med Assoc. 93(2), 64-65
4. Jackson H. (2015) Aids African, continent in Crisis, SAFAIDS, Harare,
Zimbabwe.
5. Kenya National Bureau of Statistics (KNBS) Kenya Demographical and Health
Survey (2013-2015).
6. Kinirons M. J Stewart C (2014). Adolescent Knowledge of common foods and
drinks and the importance of the pattern of consumption: a study in an area of
high dental needs. Community Dent. Health 15(3) 175-178.
7. Likoye, Francis (2013) Knowledge and practice: The implications of Freires,
Concept of critical consciousness for HIV/AIDS awareness, Nairobi:
Unpublished M. Ed Thesis, KU.
8. Mitchelle, J. (205) Adolescence, some critical issues. Toronto and
Montreal. Pinehart and Wiston of Canada Ltd.
9. Microsoft Encarta (2009) Encarta dictionaries 1993-2006
10. National AIDS and STI Control Programme (NASCOP) Kenya AIDS
Indicates Survey 2013: financial report Nairobi Kenya: Nascop; 2015.
11. Tuju R. (2014) AIDS, understanding the challenges, Ace Communication Ltd
Nairobi.
12. Wodi B.E. 2015, International Electronic (Journal of Education pages 5-11).
18
13. World Health Organization (2017), HIV/AIDS Prevention and Control.
Geneva: World Health Organization from:
http://www.searo.who.int/en/Section10/Section18/Section2009.htm
14. Ruikar HA (2013) Knowledge, Attitude and Practices about Sexually
Transmitted Infections- A Study on Undergraduate College Students of
Mumbai. Webmed Central 4: 2-15.
(https://www.webmedcentral.com/article_view/4166.
15. Michael A, Frances C, Patrick F, Helen M, John R (2013) ABC of sexually
transmitted diseases 5th edn: 1-11.
16. http://www.pubmed.gov/STI (https://www.pubmed.gov/STI)
17. Dell DL, Chen H, Ahmad F, Stewart DE (2014) Knowledge about human
papillomavirus among Adolescents 96: 653-665.
(https://www.ncbi.nlm.nih.gov/pubmed/11042295)
18. Workowski K, Berman S (2016) Sexually transmitted diseases treatment guidelines.
55: 1–94. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm)
19. Yitayal S, Agersew A, Amanuel G, Afera G, Andarge K, et al. (2011)
Assessment of knowledge, attitude and risk behaviors towards HIV/AIDS
and other sexual transmitted infection among preparatory students of Gondar
town, north west Ethiopia: 3-5. (https://www.biomedcentral.com/1756-
0500/4/505
20. UNAIDS:Global AIDS epidemic continues to
grow.[http://www.who.int/hiv/mediacentre/news62/en/index.html].
21. AIDS in Ethiopia. Disease prevention and control department, Ministry of
Health, Ethiopia, 4 Oct 2016.
22. United nation international children’s emergency fund(UNICEF, 2017)
19
Universal Medical College,
Research and Publication Office
APPENDIX
20
Annex II: Questionnaire
Part A: Questions on socio demographic characteristics
1. How old are you (in years)?
2. ( ) 15-16yrs ( ) 19-20yrs ( ) 23-24yrs
( ) 17-18yrs ( ) 21-22yrs
a. Male ( ) b. Female ( )
a. grade 11
a. Christian ( )
b. Muslim ( )
a. Yes ( ) b. No ( )
i. Yes ( ) ii. No ( )
21
c) If others (specify) _____________________
22
13. a) To what extent do you feel the following practices transmit HIV/AIDS? (where
4 is Strongly agree, 3 is Agree, 2 is neutral, 1 Disagree and 0 Strongly Disagree)
14. Can a person do anything to protect him/herself from getting HIV/AIDS or STIs?
15. In your own opinion, what is the probability that you may get infected with HIV/AIDS?
16. Most youth who have HIV/AIDS have only themselves to blame
17. Students should be removed from the school if they are HIV positive
23
18. Students with AIDS should be treated with the same respect as other students
19. I am worried about getting STIs from social contact with a fellow student in school
20. People with STIs should tell their sexual partners that they are infected
a. Yes ( ) b. No ( )
23. Did you use a condom the last time you had sex?
a. Yes ( ) b. No ( )
24. In the past year have you: please tick one response.
a. Yes ( ) b. No ( )
26. a) Have you changed your sexual behavior habits because of information gained from
HIV/AIDS awareness campaigns or programs
a. Yes ( ) b. No ( ) c. Somewhat ( )
24
27. Has the topic HIV/AIDS been included in your study program?
29. a) More HIV/AIDS programs and training in schools and institutes are necessary.
a. Yes ( ) b. No ( )
30. What do you think would make the HIV/AIDS awareness programs more
effective for young
people?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
25
በበበበበበ በበበበበ በበበበበበ በበበበበበ በበ በበበ በበበበ በበበበበበበ በበበበ
በበበ በበበበ በበበ በበበበ በበበ በበበ በበበበበ በበ በበበ በበበበበ በበበ በበበበ
በበበ በበበበበበ በበ በበበበበበ በበ በበ በበበበ በበበበበበ በበበበ በበበበ በበበ
በበበበበ በበበ በበበበበ በበበበበበበበ በበበበበ በበበ በበበበ በበ በበበ በበበ
በበበበ በበበ በበበበበበ በበበበ በበበበበበ በበበ በበበ በበበ በበበበ በበበ
በበበበበ በበበ በበበበ በበበበበ በበ በበበበ በበበበበበ በበ
በበበ በበበበ በበ በበበበበ በበበ በበበበበ በበበ በበበበበበ በበበ በበበበበ በበበበበ በበበ
በ በበበበበ በበበበ በበበበ በበበ በበበበ በበበበበበበ በበበበበ በበ በበበበ በበበበ
በበበበበበበበ በበበበ በበበ በበ በበበበበበ በበበበ በበበበበ በበ በበበበበበ በበበበበበ
በበበበበበበበ በበበበበበበበ በበበበበበበበ
በበበ በበበበበበ
በበ በበበበበበ
በበበበበበበ
1 በበበ
()22-24 በበበ
2.በበ
በ. በበበ() በ. በበ()
26
4. በበበበበበ በበበ
በ. 11በ በበበ በ. 12በ በበበ
5. በበበበበ
በ. በበበበበበ በ. በበበበ
በ. በበ(በበበ/በ)-----------
ክክክ ክክክክ ክክ ክክ.ክክ.ክ. ክክክ ክክ ክክክክ ክክ ክክክክክ ክክክክክ ክክክክ
ክክክክ ክክክክክ ክክክክ ክክክክክ ክክክክ ክክክክ
6. በበ በበበ በበ በበበበ በበበበበ በበበበ በበበበ በበበበበ በበበበ በበበ/በ
በ. በበ በ. በበበበበ
7. በበ በበ.በበ.በ. በበበ በበበበ በበበበበ/በ በበበበበ/በ
በ. በበ በ. በበበበበ
በበ በበበ በበበበ በበበበበ/በ በበበበበ/በ በበበ በበ በበበ በበበበበበ በበበበ በበ
በበበ በበበበ በበበበበበ/በ
በበበ በበበ በበበ በበበ በበበበበ በበ
በበበበበበ በበ
በበበበበ
በበበ
በበበበ
በበበ በበበበ
በበበበበበ በበ
በበበበ
በበበበበ
በበበበ በበበ
በበበበበበበ
በበ በበ በበበ/በ………….
8. በበ.በበ.በ በበበ በበበበ በበ በበበበ በበበበበ
በ. በበበበ በ. በበበበበ በ. በበበበበ/በበበበበበበ
9. በበበ በበበ በበበ በበ
በ. በበ በ. በበበበበ በ. በበበበበ/በበበበበበበ
10. በበበ በበበበ በበበ
በ. በበ በ. በበበበ በ. በበበበበ/በበበበበበበ
27
11. በበበበ በበበበበ በበ በበበበ በበበበ በበበበ በበበበበበ
በ. በበ በ. በበበበበ በ. በበበበበ
12. በበበበ በበ በበበበበ በበበበበበ በበበበበ በበበበ በበበበበበ በበበበበበ በበበ/በ
በበበበበ/በ
በ. በበ በ. በበበበበ በ. በበበበበበ
13. በበበበበበ በበበበበ በበበበ በበበ በበበ በበበ በበበበበበበ (4-በበበ
በበበበበበበ 3- በበበበበበበ 2-በበበ በበበበበ 1-በበበበበበበ 0-በበበ
በበበበበበ)
28
17. በበበበ በበበበ በበበበበ በበበበበበ በበ በበበበ በበበበበ
በ. በበበ በበበበበበ በ. በበበበበበ በ. በበበ በበበበ በ. በበበበበበ በ.
በበበ በበበበበ
18. በበበበ በበበበ በበበበበ በበበበ በበበበበ በበ በበበ በበበበ በበበበበ
በ. በበበ በበበበበበ በ. በበበበበበ በ. በበበ በበበበ በ. በበበበበበ በ.
በበበ በበበበበ
19. በበበበበ በበበበበበ በበበበበበ በበበ በበበበ በበበበበ በበበበበበ በበበበበ
በበበበበበ በበበበበ
በ. በበበ በበበበበበ በ. በበበበበበ በ. በበበ በበበበ በ. በበበበበበ በ.
በበበ በበበበበ
20. በበበበ በበበበበ በበበበበበ በበበበበ በበበበ በበ በበበበበ በበ በበበበ በበበበ
በበበበ
በ. በበበ በበበበበበ በ. በበበበበበ በ. በበበ በበበበ በ. በበበበበበ በ.
በበበ በበበበበ
21. በበ በበበ በበበ በበ በበበበ በበበበበበበ
በ. በበበ በበበበበበ በ. በበበበበበ በ. በበበ በበበበ በ. በበበበበበ በ.
በበበ በበበበበ
ክክክ ክክክክ ክክ ክክክ ክክክክክ ክክክክክ ክክክክ
22. በበበበ በበበበበ በበበበበ/በ
በ. በበ በ. በበበበበ
23. በበበበበ በበ በበበ በበበበበ በበበበ በበበበበ በበበ
በ. በበ በ. በበበበበ
24. በበበበ በበበበበ በበበበበ በበበበ በበበበ
በ. በበበ በበበበበ በበበበበ በበበበ በበበበ በበ በበ በበበ
በ. በበበበ በበበ በበበ በበበበ በበ በበበ በበበበበ በበበ
በ. በበበ በበበበ በበበበበ በበበበበበበ/በ
25. በበበበ በበበበ በበበበበ በበበበ
በ. በበ በ. በበበበበ
26. በበ በበበ በበበበ በበበበ በበበ በበ በበበ በበበ በበበ በበበበበ
በ. በበ በ. በበበበበበበ
29
27. በበበበበ በበ በበበበበ በበበበበበ በበበበበ በበበበበ በበበበ በበበበበ በበ
በበበበ በበበበ በበበ በበበበበ/በ
………………………………
………
ስስ ስስስስስ ስስስ ስስስስስስስ
30