Study design and area
Institution-based cross-sectional study was conducted in Addis Ababa city, the capital of the Federal Democratic Republic of Ethiopia from March to April 2018. The city has10 sub-cities and 116 Woredas with the total population estimated to be 3,370,778 in 2016 [19]. There are 72 public secondary schools and 103 private schools with 1315 female teachers working in public secondary schools (9–12) [20].