Epidemiology

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Browsing Epidemiology by Author "Addissie, Adamu(Dr.)"

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    Ethiopian Field Epidemiology and Laboratory Training Pro- gram (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-02) Alebachew, Mesafint; Addissie, Adamu(Dr.); Luce, Richard(Dr.)
    Background; epidemic and natural disasters are serious public health emergencies. Particularly,they occurred with little or no warning in the areas where health system is unprepared to deal with the emerging problems. From February 2001 to February 2003 E.C. stay in field epidemiology and training program, in Addis Ababa University and resident attachment in Addis Ababa region and field assignment by FMOH to different region we carried out outbreak investigation, surveillance data analysis, surveillance system evaluation,health profile assessment,accepted abstract for scientific presentation,Public Health need assessment,research proposal and other additional outputs.Epidemiological investigations of two outbreaks conducted during these periods. Descriptive epidemiology and outbreak investigations of acute AWD and HINI conducted. Five years Surveillance data analysis on descriptive epidemiology of disease under surveillance in Addis Ababa Regional Health Bureau was also performed in March 2001E.C.In addition to these morbidity and mortality data was obtained from Federal Ministry of Health, Plan and program department and Addis Ababa city Administration Health Bureau gathered and analyzed. The aim of this data analysis was to provide an insight on the burden of morbidity and mortality disease under surveillance. Surveillance system evaluation was also carried out in selected health facilities, in Kirkose sub-city health office and regional health bureau in 2003E.C. The purpose of this evaluation was to describe how well the communicable disease surveillance system in the region is working to meet its purpose and objectives. Data were gathered through interviewing of concerned bodies using questionnaire coupled with reviewing of existing records and reports and analysed by system attributes like simplicity, timeliness and completeness.The Belg (Sugum) Public Health and Nutrition emergency need assessment was conducted jointly with other partners within selected Woredas in zone Two and Four in Afar region in July 2002E.C. The purpose of the assessment was to identify potential risk for the occurrence of public health emergencies,current preparedness status and response capacity of the region.Existing records and reports were reviewed to obtain data on leading causes of morbidities and mortalities, health human resources, immunization and ITN coverage epidemic prone diseases and current stocks emergency drugs and medical supplies using data collection checklists.Formal interviews was made with Woreda officials and health professionals to obtain in-depth understanding about major health problems,occurrence,distribution,and duration of the disease outbreaks,current preparedness status,and response capacities.Finally research proposal on Prevalence of Salmonellosis among febrile out patients in Addis Ababa by 2003 E.C was prepared and submitted to Addis Ababa University Ethical Review Board and approved. Apart from mentioned above acute watery diarrhoea outbreak response supportive supervision in Addis Ababa 2002 E.C also conducted.
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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELT Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-02) G/libanos, Ghidey; Luce, Richar(Dr.); Addissie, Adamu(Dr.)
    Background A liver disease of unknown etiology which is characterized by epigastric pain, fever, jaundice, nasal bleeding, peripheral edema and abdominal swelling progressing to ascites with high morbidity and mortality reported among humans in six districts of the North-Western Zone of Tigray, Ethiopia since April 2002- 2010. This surveillance data analysis and outbreak/epidemic investigation was thus, aimed at describing the magnitude of unidentified liver disease by person, place and time for recommending possible preventive and control intervention strategies to the disease. Methods Study is conducted in North-Western Zone, Tigray region, Ethiopia. A line list was collected and case register log books of the districts were reviewed. Case definition was set based on the symptoms and signs of the disease to identify cases. Surveillance secondary data of all six districts of the Zone prepared in a line list was reviewed, entered and analyzed in Microsoft Excel. Results A total of 736 cases and 247 deaths were reported from April 2002 to June 2010, with an attack rate of 0.1% and case fatality rate of 33.5%. The median age of cases was 18 years which ranged between 1 and 81 years old. Age group of 5-14 accounted 32.7% (241/736). Sixty percent of total cases and 63% of deaths were males. Out of a total of 124 kebeles in these six districts 39 (31%) reported cases of unidentified liver disease to date. Conclusion and Recommendation Majority of cases affected by the disease were in the age group of 5-14, and with a higher proportion of male cases. Further research has to be employed in the area. Documents on how well cases were managed should be sought at all relevant health facilities to evaluate the the previous management of cases in order to recommend better future case management approaches.
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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-03) Bezabih, Belay; Luce, Richard(Dr.); Addissie, Adamu(Dr.)
    Background: Diarrheal diseases are a global problem, but are especially prevalent in developing countries in conditions of poor environmental sanitation, inadequate water supplies, poverty and limited education. Objective: The study was conducted to investigate the outbreak epidemiologically & provide guidance on interventions to be taken in the control & prevention of the disease. Methods: 58 cases were selected conveniently & interviewed with structured questionnaire. All clinic pharmacy prescriptions from 10/05/2009-16/05/2009 were reviwed & duplicate prescriptions were excluded. Student cafeterias, latrines, water supply, & cooking rooms were observed. Stool & drinking water samples were also collected to verify the etiologic agent. Then data were analyzed using Epinfo version3.3.2 & Microsoft Excel. Results: A total of 538 cases were identified during the outbreak and 482 (89.6%) of them were males. The median & rang of age of cases was 20 & 31 years respectively. The attack rate and case fatality rate was 49% and <1% respectively. 69.0% (40), 22.4 %( 13), & 8.6 %( 5) of the interviewed cases had >6, 4 to 6 & <4 episodes of diarrhea per 24 hrs respectively. Only 22.4 % (13) of the interviewed cases practiced hand washing with soap after latrine while 89.7 % (52) of them made hand washing with soap before any meal. 57.9% (n=58) of cases had also contact history to an individual with similar illness, i.e. either they cared the case or sharing of drinking & eating utensils. Piped water source was used for cooking, cleaning utensils and hand washing. There was no bath room latrine for food handlers who were working in student cafeterias. No pathogen could have been isolated from stool samples which were analyzed in the microbiology laboratory. Conclusions & recommendations: The overall attack rate was high (49%) and based on the case definition and characteristics observed on antibiotic treatment the cause of the outbreak could be shigellosis however the etiology was not confirmed by laboratory. But other agents lik Enterotoxigenic Escherchia coli (ETEC) could not be excluded. Hand washing & other hygienic practices were inconsistent among students & college food handlers & it needs continuous follow up and health education on sanitation issues should be strengthened. Training of health workers on recording and reporting of cases especially during outbreak is necessary. Responsible bodies (like local or regional health bureaus) should also offer training for health workers on epidemic diseases, supervise & monitor the college clinic regularly.
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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-02) Tumato, Million; Addissie, Adamu(Dr.); Luce, Richard(Dr.)
    This body of work which contains various outputs of epidemiological investigatigations onoutbreaks/epidemics and health related emergencies, assessmentand evaluation of surveillance systems,healthprofiles and compilation of various investigation findings and the like wasproduced as Thesis tofulfill partial requirement demanded for MPH degree in School of Public Health (SPH), Addis AbabaUniversity (AAU), Addis Ababa, Ethiopia, February 2011. It contains backgrounds, methods, results and discussions of different research activities undertaken whileaccomplishing very tasks of competency based field attachment which was scheduled to be carried out byresidents upon finishing theoretical part of courses in Field Epidemiology and Labortory Trainingprogram(EFELTP). EFELTP is a program which is firstof its kind in the country and was established on February2 /2009. Ultimate goal of this program is enhancement of dependable progress in public healthdevelopment of the country.Desirable outcomes are expected to be achieved by making unreservedcollaborative efforts through providing trainings to public health workers who were engaged in publichealth services provision activities in their respective regions in attempt of empowering their capacities inthe field and use them as vanguard health cadres in efforts being made to address particularly mostpressing public health problems there by enabling them contribute their level best in this regard. Thisprogram also renders various supports to empower laboratory service capacity to enable the systemprovide quality services to needy communities. It also provides supports to undertake epidemiologicalinvestigations on outbreaks/epidemics and health related emergency events. Moreover it is beingimplemented in geared attempt of strengthening production and communication of evidence based to thosein need to undertake possible intervention activities to address public health problems of the country. It also gives emphasis on supporting demand driven health research activities through provision ofrequired logistics and supplies and creating strong links between health programs,national andinternational health institutions, health research institutions and collaboratingwith local and internationalpartners and make unreserved efforts to meet set objectives of the program.To accomplish very missionof the program it placed utmost emphasis on communicable diseases and health related events prevetionand control ativities undertakings through provision of required supports of different sorts. Adopting thisstrategy of option is very useful to eventually bring about enhancement in health development progress.This approach can be regarded as vital for more than 80% of communicable diseases occurringparticularly in developing countries can be prevented and controlled if proper strategies of option beadopted and implemented as situations warrant. Currently magnitude of emerging and reemergingcommunicable diseases particularly epidemic prone ones show increasing tendency in low incomecountries of the world.. In Ethiopia burden of communicable diseases particularly epidemic prone ones ison increase and as result of which the need to escalate responses to address this cause is unquestionable. This compiled body of work prepared as Thesis can be considered as contribution made to ongoingnational effeorts being made to address issue of pressing public health problems of the country asresidents used to undertake required activities in teams as the program presupposes this approach to beimplemented for best results in this field. Moreover during field attachment period when ever any healthemergency situation occurs residents were made to actively collaborate with health facilities, institutionsand local and international partners (FMOH, AAU, EPHA, WHO, CDC, UNICEF...) to contribute toconcerted efforts and conjoint action being taken to address public health problems. Therefore thisactivities and their outcome contained in the body of work regarded as results of efforts made bymentioned institutions and their officers for intervention activities were undertaken conjointly.Body ofwork of this Thesis incuded: Reports on epidemiological investigations of outbreaks/epidemics/and relatedhealth emergency events, Reports on evaluations of surveillance activities, humanitarian needsassessments and assessment results of health profile of selected zone, woredasand health facilities werealso incorporated. Moreover it contains differentpieces of scientific writing including Abstracts, manuscripts and possiblescientific publication bulletins prepared on different health events which can be used to communicateresearch findingsto all in need to undertake possible intervention measures Having made general summary on What is meant by Body of work for this Thesis in Field Epidemiologyand accomplished very task of describing its overall contents, I here after explain about Epoidemiologicalinvestigations( outbreaks/Epidemics/Related health emergencies, assessments.evaluations of varioussurveillance systems, profiles and the like), what assessment was undertaken where, when and duration ofintervention and methods used to investigate issues/health problems deserved utmost priority. AWD outbreak/epidemic investigation/intervention activities wereundertaken for ten days in Gewane,Burimedaytoand Amibara districts in zone 3, Afar, Ethiopia, June 2009. After onemonth in the sameregion Afar team of Joint mission support to containAWD involvingpartners mentioned above and effortto deal with this problem was made for 02 weeks on July 2009. Since problem of AWD was encounteredalmost in all regions of the country, Multi sectoral involvement in intervention activities undertaken toescalateresponse to contain AWD outbreak. Similarly mentioned multi sectoral team went to DasenechWoreda, S.Omo Zone,SNNPR,December 2010. Methods adopted to investigate outbreaks of AWDincluded: Review of surveillance data, active case search, and Clinical examination of suspected caseswho fulfilled set criteria for case definition, environmental analysisand use of laboratory to investigatestool samples to confirm diagnosis. Based on produced evidence based information immediateintervention activities were implemented to prevent and control the outbreak inattempt of containing it.Because of unreserved efforts made by health service providers, partners and by and large activeinvolvement of communities it was possible to contain outbreaks of AWD in any of the regions affected.It was only in Addis Ababa where(July-December 2009) the epidemic was that of large scale involvingvarious segments of communities and practically all sub-cities where containingof the epidemicdelayedfor 06 months.Even in thiscitythough its magnitude was relatively higher as compared to other regionsthanks to unreserved concerted efforts and conjoint actions of all parties ir waspossible to contain it. Similarly different epidemiological investigations/assessmemts/evaluations were undertaken in differentplaces affecting different populationand for certain period of time.Ultimate goal of undertakingsuchinvestigations was to produce evidence based information and communicate to those inneed to takeappropriate measures to address public health problems particularly most pressing problems of thecountry. Analysis ofsurveillance (IDSR)data(05years)was done in Addis Ababa for06 monthsfromApril toAugust 2009. Outbreak investigation and surveillance activities were undertaken from May-Juneandongoing active surveillance activities with interventions lasted for more than 06 months, up to April 2010.Assessment of magnitude and trends of 10 years (2000-2009) road traffic accidents was undertaken formonthsfromDecember 2009-June 2010. Moreover outbreak investigation of measles and Relapsing feverin Kolfe-keranio sub-city, Addis Ababa was undertaken in February 2010. RelevantInvestigations together with laboratory testingweredone. After laboratory testing diagnosis wasConfirmed and prompt intervention activities were undertaken to contain outbreaks and prevent andcontrol outbreaks from occurring in the future. In additionMeasles surveillance evaluation and Healthprofile assessment activities were done for one month in Sidama zone, SNNPR, December 2010.Assessment of Humanitarian Needs assessment activities were conducted in Southern Nations,Nationalitiesand Peoples region, Ethiopia, July 2010. Proposal on magnitudeand trends of road trafficaccidents in SNNPR and Oromia regions was preparedand submitted to School of PublicHealth (SPH),
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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2011-02) Tafese, Tilahun; Luce, Richard(Dr.); Addissie, Adamu(Dr.)
    The Field Epidemiology and Laboratory Training Program is a competency-based training and service program in applied epidemiology and public health that builds the capacity to strengthen the surveillance and response system in countries where they are implemented. It is co-sponsored by The Federal Ministry of Health, Addis Ababa University School of Public Health, Ethiopian Public Health Association, and U.S. Centers for Disease Control and Prevention. The program is dedicated, through a combination of classroom and on-the-job training and service, to applied field-oriented public health practice. The goal of this program is to improve the health of Ethiopia’s population through a cadre of public health workers who will work on priority issues in the country, strengthening public health capacity and infrastructure and providing essential public health services to country. This compiled body of works has nine main chapters which all of them were done during the residency time of the program. The first eight sections are expected outputs during the residency time; such as outbreak investigation, report of analysis surveillance data, surveillance system evalution, description of a health profile report, writing of finalized scientific manuscript for peer review journals, abstract submit ion in scientific conferences, writing protocol/proposal of epidemiologic research project and a summary of disaster situation visited/risk assessment. In order to accomplish all the above eight outputs of residency and other additional works,different techniques and methods were utilized during an outbreak investigation in the field situation It was not always easy to conduct an investigation or study in well representative and probability sampled population within a limited time period, human and financial resources, So convenient sampling, secondary data and suspected case definitions were applicable for some outbreaks. In surveillance data analysis and system evaluation, it is crystal clear that data or databases at different levels are necessary and we tried our best to write on these two outputs. However, accessing data at national level was very challenging and time consuming because of many procedures and unclear reasons. The overall outputs of the two years field residency in the program are presented in a summarized way as follows; in the outbreak investigations chapter or section two outbreaks were investigated and well documented. These were an acute watery diarrhoea outbreak in Dasenech Woreda, South Omo zone, SNNPR from 11-20/3/2002EC ( November 20-29,2009GC), and Shigellosis Outbreak Investigation at AAU Technology Campus,March April, 2010, Surveillance data analysis on Descriptive Epidemiology of Under-Five Malnutrition in Ethiopia, 2000 And 2005. A measles surveillance system evaluation and a Health profile description report was also done in Sidama zone, SNNPR, 2010. Finalized scientific manuscripts submitted for peer reviewed journals February, 2011. And abstract was also prepared and submitted for scientific conferences accepted for oral presentation in EPHA conference, and APHINET/TEPHINET conference 2010. A report on health nutrition needs assessment (risk assessment) on prioritized districts of Afar regional state was also conducted with other team members from the food security center, WHO, UNCEF and EHNRI. A finalized epidemiologic research project proposal on a title; Assessment of Risk Factors and Trends of Measles Outbreak in Sidama zone, SNNPR, 2010 was also prepared.Under the other additional works/outputs section (chapter) Report on Acute Watery Diarrhea (AWD) outbreak response supportive supervision in Oromia Region, West Harage Zone,1429/12/2001EC and Follow up Visit, Situational Analysis and Need Assessment on the AWD Outbreak Preparedness and Response (April 10 to 27, 2010) was undertaken in Afare Regional State after the occurrence of outbreaks of acute watery diarrhea (AWD) in different districts of the region.