not that significant. the pregnancy related mortality has also dropped over the last three surveys and this could be attributed to the improvement on skilled delivery and family planning. the maternal mortality (if it could be used interchangeably with pregnancy related disease (with all the limitations)) is more than double the sdg target set for maternal mortality reduction (70/100,000 live birth) nowadays children are getting vaccinated better compared to the past two decades. the fact that ethiopia is on the verge of eradicating polio could be a good evidence for that. the percentage of age 12 – 23 months who are fully vaccinated increased by 15% from 24% in 2011 to 39% in 2016. childhood mortality has declined substantially since 2000. however, the change in neonatal mortality is not significant compared to post neonatal and child mortality. reducing child mortality (mdg 3) has been achieved previously and if the effort is maintained the 2030 target of decreasing the under-five mortality to 25 could be met by the end of the target. non-communicable disease proportionate mortality in ethiopia, 2016 due to major life stay change and urbanisation, in the recent two decades in ethiopia there is significant epidemiological change. having the problem of the communicable disease as the major burden, the country is suffering from triple burden of equally significant non-communicable disease burden and emerging injury problems. the global burden of diseases (gbd) 2016 shows that 52% of the mortality and 46% of total disease burden (as measured by disability-adjusted life years) were attributable to ncds and injuries in ethiopia. the 2015/16 national steps survey on ncds and risk factors showed the prevalence of hypertension and diabetes is 15.6% and 3.2% respectively among the adult population. more than 95% of adults have more than one risk factor for ncds among the selected 5 major risk factors identified in the survey, namely current daily smoking, bmi ≥ 25 kg/m2, low consumption of fruits and vegetables, physical inactivity and raised blood pressure. the prevalence of alcohol and khat consumption is very high (41% & 16% respectively), and average daily salt intake of the population is 8.3 g which is much higher than the who recommended intake of less than 5 grams per day. cardiovascular disease the international diabetes federation (idf) estimates diabetes prevalence among adults at 3.39% in ethiopia. a study in addis ababa has reported diabetes prevalence rates of 6.5% and in a recent survey from gondar the prevalence of diabetes mellitus among adults aged 35 years and above was 5.1% for urban and 2.1% for rural dwellers. hypertension is also increasing at frightening rates with prevalence rates of 19 to 30% reported in addis ababa,28% in gondar and 13% in jimma. injury unintentional injury in addis ababa, ethiopia 2006 in ethiopia, injury is significantly increasing partly due to urbanisation & motorisation and mainly due to poor safety measures such as road safety. despite the alarmingly increasing of the public burden, the attention given to the problem is very minimal. unintended injury is the commonest injury accounting for 60% of all injury. road traffic injury is the leading cause of unintentional injury (39% of all injury) followed by fall (16%), machine injury (5.9%), burn (5.3%), animal bite (1.3%) and poising (1%). trauma from interpersonal violence or homicide is the leading cause of intentional injury accounting for 24.4% all injury followed by firearm 5% and self-harm injuries of 2.1%. in ethiopia, the burden of road traffic accident is disproportionally high compared to the rest of the world having road traffic burden and case fatality rate of 946 and 80 per 10000 vehicles respectively. neglected tropical disease neglected tropical diseases are group of chronic parasitic tropical diseases of the bottom billion peoples living under us$2/day. ethiopia is the third following nigeria and democratic congo, having the greatest burden of ntd as public health problem. in ethiopia most of the ntds listed by who are present; having trachoma, podoconiosis and cutaneous leishmaniasis being the highest burden in sub-saharan africa followed by second highest burden of ascariasis, leprosy and visceral leishmaniasis and the third highest burden of hookworm. other infections like schistosomiasis, trichuriasis, rabies and lymphatic filariasis are also common problems in ethiopia. traditional medicine the low availability of health care professionals with modern medical training, together with lack of funds for medical services, leads to the preponderancy of less reliable traditional healers that use home-based therapies to heal common ailments. high rates of unemployment leave many ethiopian citizens unable to support their families. in ethiopia an increasing number of "false healers" using home-based medicines have grown with the rising population. the differences between real and false healers are almost impossible to distinguish. however, only about ten percent of practicing healers are true ethiopian healers. much of the false practice can be attributed to commercialization of medicine and the high demand for healing. both men and women are known to practice medicine from their homes. it is most commonly the men that dispense herbal medicine similar to an out of home pharmacy. ethiopian healers are more commonly known as traditional medical practitioners. before the onset of christian missionaries and medical revolution sciences, traditional medicine was the only form of treatment available. traditional healers extract healing ingredients from wild plants, animals and rare minerals. aids, malaria, tuberculosis and dysentery are the leading causes of disease-related death. largely because of the costs, traditional medicine continues to be the most common form of medicine practiced. many ethiopians are unemployed which makes it difficult to pay for most medicinal treatments. ethiopian medicine is heavily reliant on magical and supernatural beliefs that have little or no relation to the actual disease itself. many physical ailments are believed to be caused by the spiritual realm which is the reason healers are most likely to integrate spiritual and magical healing techniques. traditional medicinal practice is strongly related to the rich cultural beliefs of ethiopia, which explains the emphasis of its use. in ethiopian culture there are two main theories of the cause of disease. the first is attributed to god or other supernatural forces, while the other is attributed to external factors such as unclean drinking water and unsanitary food. most genetic diseases or deaths are viewed as the will of god. miscarriages are thought to be the result of demonic spirits. one medical practice that is commonly practiced irrespective of religion or economic status is female genital mutilation. nearly four out of five ethiopian women are circumcised. there are three levels of circumcision that involve different degrees of cutting the clitoris and vaginal area. many of these practices are done with an unsanitary blade with little or no anesthetics. it can result in heavy bleeding, high pain, and sometimes death. it was not until christian missionaries traveled to ethiopia bringing new religious beliefs and education that modern medicine was infused into ethiopian medicine. today there are three medical schools in ethiopia that began training students in 1965 two of which are linked to addis ababa university. there is only one psychiatric treatment facility in the whole country because ethiopian culture is resistant to psychiatric treatment. although there have been huge leaps and bounds in medical technology there is still a large problem in the distribution of medicine and doctors in ethiopia. tobacco use in ethiopia tobacco use is the major single known risk factor for non-communicable diseases from the four listed main risk factors (diet, physical activity, and harmful use of alcohol). ncds are the leading cause of premature death and disability in ethiopia accounts for about 42% of deaths, of which 27% are premature deaths before 70 years of age. ncds are estimated to account for 39% of all deaths in ethiopia, while 71% in the world. recently, the burden of these diseases is rising rapidly among populations in the low-income countries. the effect of using tobacco, like cardiovascular diseases (heart attack and stroke), cancers, chronic respiratory diseases and lung diseases. the proportional mortality of cardiovascular diseases and stroke is about 16%, 2% of chronic respiratory diseases, 7% cancers, 2% diabetes and 12% other non-communicable diseases from 39% total mortality. although, smoking during the pregnancy period increased risk for complication pregnancy, increased risk for tuberculosis, eye diseases and problem of immune system. the use of tobacco has been complex condition, which influenced by a range of individual, affect social interaction, economic factors, our perceptions and causes for behavioral changes of smokers, including the contamination of weather condition. table 1: tobacco use among place of residence by 2015 place of residence males % current smokers females % current smokers both sexes % current smokers rural7.30.34.3 urban7.60.93.9 tobacco use among different age group by 2015 from the table above, tobacco relatively used in rural 4.3% than urban 3.9% for both sexes current smokers. the percentage of male's current smokers among 45-59 age group 10.4%, 1% female's and both sexes’ current smokers are 6.5% and the use of tobacco among this age group shows increasing when compared to others age group in 2015. the overall tobacco use among adults age (15+) were 4.2% in 2015 and declined to 4% in 2016. smoking prevalence of males were high according to both residences and among all age group when compared to females. ethiopia ratified the who tobacco framework convention on tobacco control (fctc) in 2014 and detailed directives have been developed by ethiopian food medicine and health care administration and control authority. some of the key directives that need to be implemented include: protection from exposure to tobacco smoke; regulation of the contents of tobacco products and tobacco product disclosures; packaging and labeling of tobacco products; prohibition of sales of tobacco products to minors.