Academic Achievement and Associated Factors Among Students In Mizan Aman College Of Health Science, Southwest Ethiopia

Background College students’ academic performance plays an important role in producing the best quality graduates who was become great leaders and for the country contributing to the nation’s and social development . From our best knowledge there is information gap that shows students academic achievement and associated factors in study area. Methods Institution based cross sectional study design was employed. 265 students were randomly selected from different departments of college. Interviewer administrated Structured questionnaires adopted from tools used by other studies was used to collect data. Ethical clearance was obtained from Ethical review committee of Mizan Aman College of health science research and publication office. Objective of the study explained to participants and informed consent was obtained before conducting interview. Result: - From a total of 265 sample size, 250 were completed interview and giving 94% response rate. Student’s academic performance which is measured based on whether the students have passed or not the center of competency examination in Mizan Aman collage of health science. Those who passed was found to be 53.3%. In multivariate logistic regression analysis three variables were statistically significant with low student’s academic performance. Those who had habit of reading in library (AOR=3.13, 95% CI: 2.02, 9.27), Attending class regularly (AOR=2.20, 95% CI: 1.28-3.80) and having no history of substance use (AOR=4.14 95% CI 1.65, 22.79) were found to be significantly associated with students academic performance. Conclusion and recommendation According to this study, student’s academic achievement

was low which needs further attention to work on reading habits of students, behavioral changes such as restraining from substance use. Regular class attendance is significant factor to influence students' academic achievement positively or negatively. Therefore, college deans department co-coordinators as well as instructors should focus on students class attendance regularly.

Background
Education was a social process and highly educated individuals can promote a society (1).
In the era of globalization and technological revolutions, education plays a vital role in the development of human capital. Education ensures the acquisition of knowledge and skills that enable individuals to increase their productivity and improve their quality of life (2).
In order to occupy a leading role in world's economy, the education system of a country must produce students who can compete in global job market (3) .The students' academic achievement plays an important role in producing the best quality graduates who was become great leaders and manpower for the country contributing to the nation's economic and social development (4) There are many factors that affect the student's academic performance. These include but not exhaustive: student's motivation and individual characteristics, social, economic, cultural, and community character tics, family background, institutional characteristics, gender and other demographic factors (5). This study fills limited information gap on magnitude of students academic performance and factors affecting students' academic achievement.

Study area and period
The study was conducted in Mizan Aman College of health science, Bench Maji zone, SNNPR from April 15 to May 15, 2018.

Study design
Institution based Cross-sectional study design was used to assess factors affecting academic performance of students at Mizan Aman college of health science.

Source Populations
All Mizan Aman college of health sciences students.

Study population
The study population included all randomly selected competency based exam exposed students in Mizan Aman College of health sciences.

Inclusion criteria
All Mizan Aman college of health sciences randomly selected students who exposed to competency based exam and voluntary to give their consent.

Exclusion criteria
Seriously sick students and non voluntary students to participate in the study were excluded.

Sample size determination
Sample size -Numbers of participants was be determined by using single population proportion formula. Since Proportion of factors affecting academic performance among health science college students was unknown by we took p=50% n = z 2 α/2 (pq)/d 2 .
so p was taken as 50% to get large sample size

Data collection tools and techniques
Structured questionnaires adopted from tools used by other studies (30) had used to assess factors affecting students' academic achievement ,(A) Socio demographic characteristics of students and their parents (B) Teaching learning factors (C), Institution related factors was used.

Independent variable
Socioeconomic characteristics:-Age, Sex, Student marital status, Parental education level, Family income, Student income The instruments was prepared in English language and translated back to Amharic and retranslated back to English to check consistency of the instrument. Moreover, the instruments used in the study were pre-tested on 5% of level 3 students on Aman polytechnic college. The 6 data collectors and 3 supervisors was trained, demonstrated, and practiced the data collection technique to be familiar with the tools. The data was checked by supervisors about their completeness and missed values.

Data analysis
Data was entered using Epi-Data version 3.1 and then exported to SPSS version 21 for analysis purpose. Before analysis, missing values checked and new categories were created as needed. Descriptive statistics (frequencies, percentage) was performed.
Bivariate logistic regression analysis was employed to determine the crude association between dependent variable with each independent variable. Those exposure variables with p-value <0.25 were entered in to multivariable logistic regression analysis.
Multivariable logistic regression analysis was employed to see each independent predictors variables by controlling confounders for the occurrence of postnatal depression; Adjusted odds ratio at 95% CI with p-value<0.05 was used to identify statistically significant association between dependent and independent variables.

Operational definition
Student's academic performance: good academic performance was measured by scoring 18 and above in theory and declared satisfactory in skill examination i.e competent otherwise non-competent.

Ethical considerations
Prior to data collection, ethical clearance was obtained from the research Ethical review board of Mizan Aman College of health science. The benefit and full right not to take part in the study as well right to withdraw during interview was clearly stated. Confidentiality was maintained by using anonymous questionnaire and privacy was assured during interview.
Data collectors asked Amharic version of questionnaires after obtaining informed verbal and written consent from each participant.

Limitations of the study
This study doesn't measure the continuous academic performance of the student since it measures one point of time performance of student.

Independent predictors of academic achievement
Explanatory Variables with p-value less than 0.25 in the bivariate logistic regression was entered into the final multivariate logistic regression. So, habit of using a library (AOR=3.13, 95% CI: 2.02, 9.27), students regular class attendance (AOR=2.20, 95% CI: 1.28-3.80) and having no habit of substance use (AOR=4.14 95% CI 1.65, 22.79) were found to be significantly associated with academic achievement of student s .

Discussion
From 250 sampled students 133(53.3% ) were identified competent in the study. This study result indicates low achievement despite the organization (college) planned to achieve 95% . This can be explained by from all admitted students to academic year in varied baches, only 5% of the expected to fail on competency exam but almost half were unable to be competent ( 47.3%) . Many studies were carried out to explore factors affecting college students' academic performance. Our study tried to show if there is any association of student academic performance in competency examination factors such as attendance in classes, time allocation for studies, parents' level of income, and families educational status. The research is based on student profile developed on the bases of information and data collected through survey from students.
The decreased awareness to use of library, a habit of substance use was a general truth which affects the academic student performance. A systematic review carried out to see students academic performance concluded that student performance depends on different socio-economic, psychological, environmental factors. The findings of studies focused that student performance is affected by different factors such as learning abilities because new paradigm about learning assumes that all students can and should learn at higher levels but it should not be considered as constraint because there are other factors like race, gender, sex that can affect student's performance (6).
A cross sectional study conducted in Pakistan and Saudi Arabia to assess nursing students' academic achievement and associated factors identified that gender of students was a significant factor of academic achievement; but our study showed no difference regarding gender of students and academic achievement ( 7,10). Similarly, study conducted on academic performance on psychology course in Malasia identified that previous academic record, estimate of the mark and satisfaction were identified as determinants of student's academic performance. We also believe that basically students academic background can significant affect recent academic performance ( 8). Study finding showed that senior nursing student( 3 rd year) spent more time on study when compared with their juniors. This had again positive impact on their academic performance, which is in consistent with our study finding; students who spent more time on library had higher academic performance when compared with their counterfits (9,(11)(12)15) .
A study results imply that teachers play a great role in the academic life of the students.
It further implies that the student respondents had a high regard on their teachers' craft in teaching, their mastery of lessons as well as their rapport with their students. Off course, teachers are all over regarding students academic performance, their direction, advice and encouragement can highly influence students' academic performance ( 10).
Our study finding was also supported by a study conducted in Bangladesh which identified that students active class attendance was affecting factors for academic achievement ( 13). We believe that class attending student has strong potential to score higher grade than those who are frequently missing class. So, instructors or teachers are expected to follow their students in each and every day activities based on taking class attendance consistently. An Ethiopian study conducted on Rift Valley University( Private university in Ethiopia ) to examine what factors were affecting students academic performance regardless of department background concluded that both students and teachers or instructors positive opinions strongly associated with students academic performance (14). Encouraging students to invest on reading individually as well as carry out group work which was initiated from instructors can positively influence students' academic performance while students' acceptance to what instructors said to work hardly is also playing great role for academic performance.
The discussion above suggests that academic performance of students is influenced by a combination of factors which includes use of library, class attendance and habit of substance use. Moreover; substance use is identified as reducing students' academic performance when compared with those who never used it in last 12 months (16).

Conclusions
Our study tried to show what factors are affecting students' academic performance. Since Ethiopia is one of the developing country, it requires educated individuals who are not only educated but also qualified on their academic performance, we believe that students should be supported from different direction such as families, schools or college communities, officials all should work in order to protect students from thing that may hinder them from attending classes. This cross sectional study has identified factors such as using library regularly, attending class consistently and using substance as influencing factors for academic achievement. Because of when students newly join to colleges and higher institutions, there are many issues that may force them to behave newly or unusually. So, we conclude based on the study fining habits such as using substances, not attending class as well as not reading in library should be discouraged.

A FOR SCHOOLS, COLLEGES AND UNIVERSITIES
Since students academic performance is the front issue in all the above mentioned institutions, we recommend that student are expected to read regularly in libraries for this reason Libraries should accommodate all necessarily reading materials for their updated status.

B FOR STUDENTS
It has been scientifically proved that those students regularly reading in library scored high level of academic performance; therefore, particularly for those reading hours on per day; students are encouraged to invest reading times in library.
Based on our study finding and other studies finding ; using substance has negative effect on academic achievement; therefore; we strongly recommend that read not by using any substances.
Therefore, due attention should be given for college students to attend class regularly, to improve a habit of using a library. It is also important to create awareness on a habit of using substance since it hinders academic students' performance.
Class attendance is such a powerful means to have remarkable academic achievement.

C FOR INSTRUCTORS OR TEACHERS
Studies have been identified there is always supportive and concerned teachers or instructors upon students academic performance. So, we strongly recommend that instructors should take students class attendance regularly and make sure that whether students are reading regularly or not by using close follow up or assessment tools.

D FOR COMMUNITY
Students' academic achievement issue is not only rendered to schools or colleges but it requires participations from community level. Misbehave of students such as using substance should be also discouraged at community level.

E FOR RESEARCHERS
Further studies should be carried out by using mixed study designs.

Ethical consideration
Mizan Aman health science college research review committee approved this research Consent to publish The Consent to publish not applicable because there no audios and videos in data part. Availability of data and materials The data supporting the finding will be attached to editorial office if necessarily since it is avail in the corresponding author hand.

Competing interests
Authors declare that there is no competing interest.

Funding
No funding is required.

Author's contribution
The authors contributed for this study by originating the study concept, formulating study designing, controlling data quality and analyzing data .  Figure 1 Students academic performance among Mizan Aman collage of health science students 2018.