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Original Article
Prevalence and factors associated with adjustment problems among first year students in St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
Hadgu Gerensea1, Almaz Seid2, Girma Lemma3, Patricia Malloy4
1School of Nursing, Axum University, Axum, Ethiopia
2Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
3School of education and behavioral studies, Addis Ababa University, Addis Ababa, Ethiopia
4College of Nursing, University of Saskatchewan, Saskatoon Saskatchewan

Article ID: 100011P13HG2017

Address correspondence to:
Almaz Seid
Tikur Anbessa Specialized Hospital
Addis Ababa

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Gerensea H, Seid A, Lemma G, Malloy P. Prevalence and factors associated with adjustment problems among first year students in St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Edorium J Psychol 2017;3:10–17.

Aims: For many new college students attending a university/college for the first time can be a stressful experience. This study focused on assessing the prevalence and factors associated with an adjustment problem among first year students attending St. Paul’s Hospital Millennium Medical College, Addis Ababa Ethiopia.
Methods: A cross-sectional study was conducted with first year students using an adapted and validated, through a pilot study, version of the Students Adaptation to College Questionnaire (SACQ). A total of 108 participants were selected through simple random sampling from a pool of 150 students. Analysis, included descriptive statistics, independent simple t-test, and a one way ANOVA, was completed on the sample (n = 98).
Results: The SACQ tool divides adjustment into four subscales of adjustment, social, personal-emotional, and institutional adjustment. Among the sample of first year students attending Millennium Medical College (n = 98), there was a statistically significant difference between males and females in the subscales of academic adjustment and institutional attachment adjustment. There was no statistical significant difference between males and females for overall adjustment, and subscales of social and personal-emotional adjustment. Conclusion: Adjusting to college classes, associated work load, managing study time, and new living arrangements (dormitory) were the major associated factors for students’ experiencing an adjustment problem. Enhancing the quality of student services, increasing the availability of resources and services for students, strengthening campus counseling center, and increasing positive staff-student interaction will assist in mitigating an adjustment problem. As well, this study needs to be replicated in different geographical locations with different student populations to seek generalizability of the tool.

Keywords: Adjustment problem, First year students, Prevalence


Background of the study

St. Paul’s Millennium Medical School located in Addis Ababa, Ethiopia underwent a dramatic growth from 2007 to 2010. The name is attributed to the establishment of the college in 2000, the new Millennium according to the Ethiopian calendar. Currently, the college offers a medical degree at an under graduate and graduate level. The faculty grew from 3–250 members within this time frame; student enrollment kept in step with the growth. The College has approximately 498 students in the medical doctor program, of which 150 are first year students. The students came from all regions of Ethiopia. Unlike other medical schools in the country, the college gives special attention to female students and the percentage of female students has now reached over 40% [1][2].

The SACQ (Student Adaptation to College Questionnaire) measures the student’s adjustment to college life [3] [4]. The tool is divided into four subscales: academic, social, personal-emotional, and institutional adjustment [3][4]. The personal-emotional adjustment subscale has nine items measuring the students’ adjustment to college through psychological questions. The variables included in this subset relate to emotional well-being (depression for example) that can impact the student’s ability to stay in school. Cultural differences and language barriers have been found to have an impact on adjustment to college life [5][6] [7].

Pilot study

To ensure reliability and validity in this setting, Addis Ababa, a pilot study was conducted. Through simple random sampling, 30 students (male = 17 and female=13) participated with a reflective ratio of male to female for the medical college. The Cronbach alpha coefficient (ra = 0.88) provides an estimate of internal consistency reliability; the SACQ has reliability (0.80–0.89, good) which is relatively comparable to other study [8].

The Cronbach alpha coefficient was applied to the subscales of academic and social adjustment. The subscale academic adjustment score indicated that the test items were consistent with the overall measure (0.92–0.96, respectively). The subscale social adjustment (0.61 to the whole 0.76) indicated that the test items are more fluid and the test items needed to be rephrased, redefined, and provide a local context for the Ethiopian audience. The Spearman-Brown formula calculated the reliability for personal emotional and institutional adjustment is 0.7 and 0.67 respectively.

Validity of the instrument was gained from members from the department of psychology, including faculty and students. vague terms needed to be clarifies; grammar/readability of the tool; more time needed to complete the questionnaire.

Statement of the problem

Adjustment of first year medical students attending St. Paul’s Millennium College.

A review of literature confirms that the experience of attending and adjusting to university is complex and may impinge on a student’s academic success. Social support, parental relationship, scholastic achievement in secondary school, and other variables may provide the student with an easier adjustment period; SACQ subscales social and personal-emotional adjustment. Participating in university orientation activities is associated with better semester averages; SACQ subscale institutional attachment [9][10][11][12].

Unresolved problems such as, higher test anxiety, lower academic self-efficacy, and less effective time management, can lead to mental health issues which can affect academic performance retention and graduation rates [5]. Students facing adjustment issues may be less likely to use effective learning strategies. Other factors facing the first year student include, the rigors of academia, a completely new social network and environment, status and college performance, loneliness, interpersonal conflicts, difficulty in managing time and study skill, financial adjustments making friends poor health, and general adjustment to new situation can influence adjustment to college. Those students living away from home for the first time may have increased adjustment issues [13].

Furthermore, research suggests that male students adapt to the new university environment better than their female counterparts related to an increase in personal responsibility [14][15][16][17]. Different studies found freshman students have higher rates of psychological morbidity compared to other throughout the world, including Ethiopia [18][19].

Summary and implications

The scope of the current study using student adaptation to college questionnaire (SACQ) developed by Baker and Siryk, [3] with the four subscales of to college and factors identified there is a need to enhance student services to reduce the adjustment problems. College life is increasingly harassing and a variety of perplexities were encountered by college students. It is also evident that investigators have used various techniques in an effort to better understand the concerns and problems of college student.


To assess the prevalence and factors associated with adjustment problem among first year students in millennium medical college.

Study design

Cross-sectional study design was employed to address the objective.

Study Area

The study was conducted at St. Paul’s Millennium Medical College.

Study Population

All first year (enrolled 2012 academic year) Millennium medical college students were the study population.

Sample size and sampling techniques

According to Krejcie and Morgan sample size determination formula for 150; 108 samples were taken (confidence = 95% or marginal error = 5%). The researcher determined the actual respondents of the study by using stratified random sampling technique (lottery method) [20].


Dependent variable: adjustment problems

Independent variables

  Socio-demographic characteristics

  • sex, age, geographical distance of the college from their home, student marital status and parental marital condition)

  Utilization of counseling service

  Associated factors of adjustment problems including

  • Being away from home, family, and friends for the first time and homesickness
  • Change in living arrangements or living in dormitory
  • Socializing or making friends
  • Completely new and different social network and environment
  • Managing time and study skill
  • Adjusting to university classes and the accompanying workload
  • Health problems
  • Confused career direction
Data collection instruments

Data were collected using structured self-administered questionnaire having three parts.

  1. Socio-demographic information; containing conditions of parental marital status and students utilization of psychological counseling and academic assistance.
  2. Student adaptation to college questionnaire (SACQ) developed by Baker and Siryk, consists of 67 self-rating responses used to assess the students’ adjustment to college [3].

The items in SACQ are on a Likert scale, specifically a 9-point scale, where 1 represents ‘applies very closely to me’ to 9 representing to ‘does not apply to me at all’. It is divided in to four principal subscale that focus on four aspects or dimensions of adjustment to college academic adjustment (24 items; alpha=0.84) test items measures a student’s success at coping with the various educational demands that are characteristic of the college experience; social adjustment (19 items; alpha =0.84) test items seek to comprehend the relevance to interpersonal-societal demands of college; personal-emotional adjustment (14 items; alpha=0.81) test items are designed to examine how the student is feeling physically and psychologically; and institutional attachment or commitment (8 items; alpha =0.80 ) adjustment focuses on the student’s satisfaction with the college experience; an additional item for overall general adjustment (67 items; alpha =0.91) [21].

  1. The third part was questions to asses potentially associated factors with adjustment problem. These questions were also adopted from Baker and Siryk [3]. The questions were rated on Likert scale for its degree of difficulty (1 slight difficulty, 2 moderate difficulty, 3-great difficulty, and 4 great deal difficulty). Cronbach’s alpha was adequate, with alpha = 0.77.
Data collection procedures

Two data collectors and a supervisor were hired and trained in one day about the assessment tools, the aim of the study, and how to maintain confidentiality of the collected data from respective students. The students completed the questionnaire in class.

Data analysis

The SPSS analyzed the collected data. Descriptive statistics informed the prevalence of adjustment problem and associated factors were summarized and presented by using; percentage and tables. An independent simple T-test was employed to see significance difference in overall adjustment and subscales of adjustment problem between male and female students. One way ANOVA was done to assess whether or not there is a statistically significant difference in overall adjustment scores among respondents demographic characteristics and utilization of counseling service looking at the independent variables.

Ethical consideration

Ethics was gained from Addis Ababa University IRB committee. Confidentiality was maintained through redacting of personal information. No coercion of participants and the participant could withdraw at one point in the study.


Socio-demographic characteristics

From all 108 selected sampled students, 98 (90.7%) respondents completed the questionnaire; the 10 questionnaires were either not completed or not returned.

Fifty-eight percent (n = 57) were male. Common characteristics of all respondents included between the age of 19 and 20 (56.1%); single or non/married (90.8%), households located less than 450 km from Addis Ababa (54.1%); and coming from households where parents were married. Of interest, approximately one-quarter of the respondents were aged 17–18 years (27.6%) and 21-28 years of age accounted for 16.3%; the mean age of the study group was 19.5 years. More than one-third of the study group (36.7%) traveled between 451 and 900 km to attend St. Paul’s Millennium medical College; less than 10% traveled greater than 900 km.

More than three quarters (79.6%) of the study group had not received psychological or counseling services. Twelve students had sought this service once; while eight students had sought counseling or psychological service several times. Similarly, 62 (63.3%) respondents reported never receiving academic assistance and 24 (24.5 %) respondents received academic assistance once. By comparison, only 2 (2%) respondents reported that they had received academic assistance several times after they joined the college (Table 1) (AlmazSeid, 2017).

The prevalence of adjustment problem among the respondents

The majority of the respondents 42 (43%) had moderate adjustment score; while 37 (37.8%) and 19 (19.2%) respondents had low and high adjustment level scores for overall adjustment respectively.

With regards to the subscales of the adjustment problem, majority of the respondents 54 (55.1%) and 42 (42.9%) scored high for personal emotional and institutional adjustment subscale scores respectively. Thirty-six (36.7%) of the respondents scored low for social adjustment scores. From Table 2, it is also indicated that 25 (25.5%) of the respondents scored low for both academic and personal emotional adjustment scores. Similarly, 43 (43.9%) and 41 (41.8%) of the respondents scored moderate level of personal, emotional and academic adjustment score respectively. In contrary, low number of the respondents, 30 (30.6%) and 32 (32.2%) of the participants scored high for personal emotional and academic adjustment scores respectively. Twelve (12.2%) of the respondents scored low level for institutional attachment adjustment scores. Therefore, most of the respondents have undergone with a problem of adjusting to college academically, socially and emotionally (Table 2) (AlmazSeid, 2017).

Adjustment problem of the respondents with respect to their demographic characteristics

Adjustment Problem and Gender

The mean scores showed that there was a difference of male and female respondents score in academic, social, personal emotional and institutional attachment adjustment problem scores including overall adjustment problem scores. Mean score of female respondents was higher than male respondents’ scores in all dimensions of adjustment problem scores including overall adjustment problem score. To generalize the above result to the population the researcher employed independent sample t-test that assumes the dependent variable as continuous to compare only two groups that are randomly selected from a population, was conducted to compare the mean scores of adjustment problem scores for male and female students. After preliminary assumption testing was conducted to check for normality and equality of variance and there is no serious violation. The result showed that there is no statistically significant difference in the mean over all adjustment problem score for male and female students (t (77) = -1.5, p = 0.126).

Whereas with regard to adjustment problem subscales there was a statistically significant difference in the academic adjustment problem scores for male and female students (t (64) = - 3.2, p = 0.003). Similarly, there was also a statistically significant difference in the institutional attachment adjustment problem scores between male and female students (t (41) = - 4.2, p< 0.05). This two findings implies that female students face much difficulty of adjusting academically and institutionally to the college than male students but statistically significant difference was not observed between males and females in social adjustment problem (t (76) = - 0.4, p = 0.57) and personal emotional adjustment problem scores (t (66) = 1.8, p = 0.38).

One way ANOVA was employed to assess whether there is a statistical significant difference in overall adjustment problem score among the students’ marital status, their parental marital condition, the students’ home distance from the college and utilization of psychological/counseling service. The result of one way ANOVA which was employed to see the mean difference in overall adjustment problem score and respondents’ parental marital status (living to get her, divorced, separated in conflict) and their utilization of psychological/counseling services (never, once/just for advice, several times), showed that there is no significant statistical difference of overall adjustment problem score among the above all listed variables. Respondents’ parental marital status df = 2, F (2,76) = 0.46 and p > 0.05 and for the respondents utilization of psychological/counseling services df = 2, F (2,76) = 0.96 and p > 0.05 (Table 3) (AlmazSeid, 2017).

Factors associated with respondents’ adjustment to college

Forty-nine percent respondents reported that university classes and the accompanying workload were the great areas of difficulty in their college followed by change in living arrangements or living in a dormitory (24 (24.5%) respondents). Managing time (study skill) and being away from home, family, and friends for the first time and homesickness were also found to be reported by 24 (24.5%) and 20 (20.4%) of the respondents respectively as a great difficulties for respondents adjustment to their college. Another 44 (44.9%) respondents reported that socializing or making friendships is not an area of difficulty in adjusting to the college. Generally, above 50% of the respondents reported all the above listed factors in the table as factors associated with their adjustment problem (Table 4) (AlmazSeid, 2017).

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Table 1: Sociodemographic characteristics of respondents, MMC April 2013, (n = 98)

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Table 2: Distribution of respondents overall and subscale adjustment level, MMC, April, 2013. (n=98)

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Table 3: Mean standard deviation and t-test values of overall adjustment problem and subscale scores by gender

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Table 4: Levels of difficulties from potentially associated factors as perceived by respondents (n = 98)


A total of 98 first year Millennium Medical College students participated in this study. Majority of the respondents were in the younger age group with mean age of 19.71 years. In this study, the prevalence of low adjustment scores was 37 (37.8%), which was found a little bit higher than the prevalence reported in Malaysia which was 26% [2].

The majority of students in this study reported a moderate adjustment problem 42 (43%) which is slightly lower than that of Malaysia 70% (26) and 19 (19.2%) respondents scored high adjustment for overall adjustment also higher than that of Malaysia student with, 4%[8]. A study conducted at Zambia University also suggested that Zambian students do experience a wide variety of adjustment problems when they transfer from high school to university [17]. A higher prevalence of low adjustment scores in this study compared to that of Malaysia study could be as a result of comparatively conducive living and learning environment and availability and facilities of psychological and academic counseling services in the later study settings.

As for the subscales, academic (26.5%) and social adjustment (36.7%) were high in this study which is comparable to the study in Zambia, academic (26%) and social adjustment problems (19%) [8], and higher when compared to the study from Malaysia, 17%. Whereas institutional adjustment was 13.3% which is a lower report compared to the study finding in Malaysia that is 42.8% [8].

With regards to prevalence of adjustment problem and the types of problems students faced in Ethiopian universities and colleges, this study also confirmed that economic, psychosocial, educational, and health were among the dominant concerns of college students [7][22]. Although there was no quantitative expression, other studies stated that newly enrolled students suffer from either multiple or at least one form of the commonly reported problems more frequently than seniors [7][22]. On the other hand, other studies showed half (50%) of freshman students have social adjustment problems but educational and personal psychological problems are lower than social adjustment [23].

Finding of this study showed that male and female students differ in experiencing adjustment problem at college which is consistent with other study in which in both studies male students were found to be better adjusted compared to the female students [24]. Female students were found to be more affected by adjustment problem especially academic adjustment and institutional attachment adjustment than male which is consistent with the finding at Malaysia, Canada and Jordan University students [2][8][24].

It was indicated that gender is a significant predictor of students’ adjustment in university and male students are found to be better adjusted academically and with the institution compared to the female students. Females have traditionally been thought of as being more social and having a more difficult time adjusting to the college environment and making social connections than their male counterparts and other studies have found high levels of differences in the social adjustment of males and females [19]. This might be from less likely to express their difficulties with their peers or groups compared to male students.

The student background characteristics like distance of the college and socio-demographic characteristics such as marital status, age, parental marital status of the respondents were not significantly related to adjustment scores which were similar to the study conducted on Latino students. In contrary to this study, this result showed a variety of social and cultural factors such as divorce, family dysfunction and instability, might account for some of the increased adjustment problem [9]. This enabled to conclude that the variation in college adjustment scales has less to do with pre-existing student characteristics or socio-demographic characteristics than with the nature of the environments in which these students found themselves.

With regard to associated factors for adjustment problem, 49.9% of the respondents had great difficulty of adjusting to university classes (the accompanying work load) and 24.5% of the respondents had great difficulty in living arrangements (living in dormitory) and managing time (study skill). This finding is comparable to the study done on Malaysia students 48.5% of the respondents took academic related factors for their adjustment problem [8].

Comparatively socializing or making friendships and health problems comprise less percentage of difficulties reported by respondents, 13.3% and 18.4% respectively. Similarly, one study which is done at Jordan freshman university students reported confused career direction and health problems as common sources of adjustment problems [13].

Another study by the same author in Zambia also found out that common associated factors of adjustment problem were; being away from home, family, and friends (20%) and adjusting to college class and the accompanying workload were frequent responses (19%). In a related them, 14% of the participants reported difficulties with time management. Difficulty making friends 12% and roommate issues 12% were the next most commonly reported problems [13].

In general based on this and other research findings, the adjustment difficulties faced by first year students were found to be academic problems, health problems, as well as social and personal problems in consistent to a research conducted in a local public university in Malaysia [25].


The study confirms that substantial number of first year Millennium Medical College students face problems in adjusting themselves at the college with 80.8% prevalence of adjustment problem. Among this 37.8% of the respondents were with high adjustment problem and 43% of the respondents were with moderate adjustment problem. From the subscales; academic and social adjustment problems were found to be main problems. Gender was found to be the predictor of adjustment problem, especially academic and institutional attachment adjustment problems were more prevalent among females. Adjusting to college class and work load, living arrangement (dormitory) and managing time and study skill were the major associated factors for students’ adjustment problem. Based on the findings of this study, several areas of research can be implicated. First, longitudinal studies can be done to clearly identify what determines the level/severity of different forms of adjustment problems on individuals.

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We would like to thank all participants for their willingness in supporting and giving important information.

Author Contributions
Almaz Seid – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hadgu Gerensea – Substantial contribution to conception and design, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Girma Lemma – Substantial contribution to conception and design, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Patricia Malloy – Substantial contribution to conception and design, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
Conflict of interest
Authors declare no conflict of interest.
© 2017 Almaz Seid et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


Hadgu Gerensea is Lecturer and Department Head of Neonatal Nursing at Aksum University College of Health Science and Referral Hospital, Aksum, Ethiopia. He earned undergraduate degree of Nursing from Wolaita Sodo University, College of Health Science and postgraduate degree in Pediatric and Child Health Nursing from Addis Ababa Univerity, Addis Ababa, Ethiopia. He has published more than 15 research papers in national and international academic journals and authored one book. His research interests include under five year malnutrition and clinical trials. E-mail: hadguellen1@gmail.com; hadgugerensea2015@gmail.com

Almaz Seid is Care Giver and Director of in Patient at Tikur Anbessa Specialized Teaching Hospital. She earned undergraduate degree of nursing and postgraduate degree in adult health nursing from Addis Ababa Univerity, Addis Ababa, Ethiopia. She has published more than four research papers in national and international academic journals. Her research interests include compassionate and respectful care. E-mail: almaz15@gmail.com

Sofia Haitami is Assistant Professor, Department of Oral Surgery and Pathology, Faculty of Dentistry of Casablanca, Morocco. E-mail: shaik.ajas@gmail.com

Girma Lemma School of education and behavioral studies, Addis Ababa University, Addis Ababa, Ethiopia.

Patricia MalloyCollege of Nursing, University of Saskatchewan, Saskatoon Saskatchewan.

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