<p>Unmatched case control study design was conducted at Machakel district from August 30 to September 30/ 2022. The sample size was calculated using Epi-info software 211 controls and 106 cases (317 study participants). Simple random sampling technique was used to select the cases using registration books of Machakel woreda health office as a sampling frame. Data were entered to Epi info version 7 and exported to SPSS version 22 for statistical analysis. Binary logistic regression was used to identify explanatory variables. Hosmer-Lemeshow goodness of test was used for model fitness with p-value.</p>