The Yilmana Densa and Quarit districts (weredas) are two of the ten districts of the West Gojjam Zone in the Amhara Region, Ethiopia. The two districts are bordering districts selected for the purposes of increasing study area coverage and vegetation cover of the areas. The Yilmana Densa district is bordered by Bahir Dar Zuria (the district that surrounds Bahir Dar, the capital city of the Amhara Region) on the north and Abay River on the east, which separates it from the South Gondar Zone. The major town of this district is Adet (the town which is 42 kilometers far from Bahir Dar). The Quarit district is bordered on the north by Yilmana Densa and on the east by the East Gojjam Zone. The major town is Dabi/Gebez Maryam (Figure 1).

Location of the study Kebeles (smallest administrative units) in the districts of the West Gojjam Zone, Northwest Ethiopia (drawn using Arc GIS ver. 10.5).

The mainland covers in the study areas are settlements surrounded by Eucalyptus trees, cultivated land, grassland, woodland, and shrub/bushland. It also includes evergreens and semievergreens, small trees, and occasionally larger trees. Besides, there are a few scattered trees such as Acacia sp., Cordia africana, and Croton macrostachyus in the farmlands, whereas Eucalyptus camaldulensis is grown around the homestead [9].

According to CSA [10], the Yilmana Densa district has a total population of 214,852, of which 107,010 are males and are 107,842 females, whereas the Quarit district has a total population of 114,771, of which 56,767 are males and 58,004 are females. The majority (98.19%) of the inhabitants of the Yilmana Densa district practiced Ethiopian Orthodox Christianity. Most of the population lives in rural areas, whereas the least number from the population inhabit urban areas. 99.9% of the district's inhabitants are composed of Amhara people, and Amharic is spoken as the first language by 99.96% [11].

The populations of the districts have several livelihoods. The first one is traditional farming using oxen, and rarely, heifers, cows, horses, and mules. Crop production is entirely rain-fed, except in a few Kebeles where small-scale water harvesting practices have been recently introduced by the Office of Agriculture and Rural Development. There is only one rainy season (summer), and it is important for the cultivation of both long- and short-cycle crops [9].

The other alternative sources of livelihood include off-farm and nonfarm activities. Nonfarm activities are practiced because of a shortage of agricultural land. Cultivated land per household is getting smaller and smaller, mainly because of high population pressure. Land and livestock productivity is declining because of natural resource depletion. The newly established houses do not have access to farmland. Thus, the communities are engaged in nonfarm activities such as pottery, metalwork, weaving, carpentry, and basket making even if their numbers are insignificant [12]. Off-farm activities (micro and small enterprises) are the second means of poverty reduction and include animal husbandry, poultry, honey production, and construction [13]. According to [14], livestock is the most valuable resource for the livelihood of the rural people. Especially, cattle are the best source of income [9]. Thus, an average annual income of 12,087,131.00 Birr has been generated from livestock production. The aggregate annual income generated from crop production is estimated at c. 19,725,688 Birr [15].

The main human diseases of the two districts are malaria, tuberculosis, lung diseases, intestinal parasites, diarrheal diseases, gastritis and duodenitis, eye diseases, skin wounds (infections), and epilepsy. The transmission of malaria increases between September and November, which are the major transmission seasons [9]. The seasons are associated with the amount of rainfall and relative humidity. The average monthly rainfall for malaria transmission was recorded to be 86.6-316.3 mm, and that of average monthly relative humidity was 50-78%. The other major disease type is tuberculosis whose consequences are serious and potentially weakens patients and their families. Like brucellosis, it can be transmitted by drinking infected milk [16]. In connection to this, a poor road network and the absence of public transport services are the other major problems that exacerbate the situation of patients that need referral services. There is also a lack of multiple health services such as delivery, injection, essential drugs, and consumable commodities [14].