Browsing by Author "Alemayehu Bekele"
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Item Ambulatory Blood Pressure Control Pattern in Hypertensive Patients at Tikur Anbesa Specialized Hospital: A Cross Sectional Study(Addis Abeba University, 2021-05) Alemayehu Mulualem; Abebe Sintayehu; Yadeta Dejuma; Alemayehu BekeleBackground: Hypertension is the most common cardiovascular problem globally with a particularly increasing burden in developing countries like Ethiopia. Ambulatory blood pressure (ABPM) is superior to office blood pressure (OBP) measurement for diagnosing, prognosticating and following treatment efficacy for hypertension. There is no available data on ABPM control pattern in Ethiopians. This study will determine the ABPM control patterns in Ethiopian hypertensive patients on treatment. Material and Methods: This was a cross sectional study in hypertensive patients at Tikur Anbessa Specialized Hospitals outpatient departments carried out during January to May 2021. ABPM values of 244 consecutively sampled patients were analyzed. All patients had their BP monitored over 24 h with a Tonoport V (GE CS V6 71), and the data was interpreted using GE CardiosoftTM ABPM software in accordance with European Society of hypertension guidelines. Ethical clearance was given by Addis Ababa University Institutional Review Board and the study was conducted in compliance to standard ethical guidelines. Results: The study involved 244 adult hypertensive patients; mean age of the patients was 59.4years and, 54% were females. 58.6% of patients had controlled OBP, while only 45.1% had controlled ABPM. The mean OBP was 137 (19)/81 (10) mmHg and mean 24-hr ABP was 137 (16)/81 (10) mmHg; mean daytime BP was 136/79 ± 17/11 mmHg; mean night-time BP, 138/84 ± 16/11 mmHg. Mean ABPM values were not significantly different between men and women. Comparison of ABPM values with OBP revealed high prevalence of the white coat effect (32%) and masked uncontrolled hypertension (46%). Presence of comorbidities particularly diabetes predicted poor ABPM control. Conclusion: More than half of patients had uncontrolled BP as per ABPM criteria and significant discrepancy exists between ABPM and OBP in assessing adequacy of BP control. Guiding management decisions using ABPM can improve BP control rates.Item Assessment of Effectiveness of the Different IEC Interventions in Improving Awareness and Reducing Stigma Related to HIV/AIDS among High School Adolescents in Awassa, Southern Ethiopia.(Addis Abeba Universty, 2007-07) Alemayehu Bekele; Ahmed AliBackground: Stigma and discrimination are common human reactions to disease. HIV/AIDS related stigma and discrimination negatively affect preventive behaviors, HIV test-seeking behavior, and care seeking behavior, quality of care and perception of PLWHA by communities, families, and partners. Objective: The aim of this study was to assess the presence of HIV/AIDS related misconceptions and stigma in adolescents and determine the effectiveness of different IEC interventions in reducing the HIV/AIDS related stigma and to ascertain long-term effects of the IEC interventions. Materials and Methods: Interventional study was employed from January to March 2007 on the adolescents of the four high school students using four different IEC Interventions, namely interpersonal communication, pamphlets, educational video and the combination of the three Interventions. Immediate post intervention and follow up assessments for misconceptions and stigmatizing attitudes were carried out. Result: Misconceptions on HIV transmission/prevention were 0-52.3%. Stigmatizing attitudes ranged from 0-65.2%. Multivariate logistic regression analyses showed Grade, Religion, beliefs in HIV transmission by witchcraft and HIV transmission by feeding on uncooked egg/meat of chicken that swallowed used condom were significantly associated with avoidant behavioral intentions, AOR,2.23(95% CI 1.2-4.1), AOR, 0.43 (95% CI, 0.22-0.82), AOR, 0.22(95%CI, 0.06-0.77), AOR, 3.5,(95%CI, 1.4-8.8) and AOR, 2.1(95% CI, 1.1-3.9) respectively. Regarding beliefs in HIV transmission/prevention, variables like coughing/sneezing, feeding on raw egg of a chicken that swallowed used condom and practicing sex with virgin girls were found to be statistically significantly associated with blaming attitude AOR, 4.8(95% CI, 1.5-15.4), AOR, 2.7(95% CI 1.5-4.9) and AOR,3.8(95% CI, 1.1-13.4) respectively. Residence, fathers’ education, Television ownership, transmission by witchcraft, healthy looking person can have HIV, HIV prevention by having sex with virgin girls and PLWHA had multiple sexual partners were found to be determinants of coercive attitude AOR,0.2(95% CI 0.05-0.80) AOR, 6.4(95% CI, 1.02-40.42), AOR, 5.9(95% CI, 1.0-34.6), AOR, 12.9(95%CI 2.8-58.4), AOR, 6.1 (95% CI, 1.7-22.0), AOR, 22.3(95% CI, 5.1-97.1)and AOR, 2.9(95% CI, 1.02-8.45) respectively. Mothers’ education and HIV transmission by eating with PLWHA were also found to be determinants of the negative sympathetic feelings to PLWHA AOR, 2.1 (95% CI, 1.10-4.14) and AOR, 2.75(95% CI, 1.04-7.30) respectively. IEC interventions were effective in reducing HIV stigma and discrimination. ANOVA (F statistics) revealed that the interventions were effective, ANOVA,17.484 (p-value<0.0001). Conclusion: Misconceptions on the transmission/prevention of HIV and associated stigmatizing and discriminatory attitudes were prevalent among the adolescents. Remarkable reduction in the HIV related misconceptions, stigmatizing and discriminatory attitudes were observed using the combined interventions. Hence, campaigns using combined IEC interventions on HIV/AIDS need to be intensified to dispel some of the prevailing misconceptions and the associated stigma and discrimination among high school adolescents.Item Compiled Body of Work in Field Epidemiology Training.(Addis Abeba Universty, 2015-05) Abdifatah Tahir; Alemayehu BekeleField Epidemiology Training Program (FETP) is a two years in-service training program adapted from the United States Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) program and curriculum. The program is designed to assist the Federal Ministry of Health and Regional Health Bureaus in strengthening health systems preparedness and response against major public health problems, more specifically epidemic prone diseases by creating competent health professionals through basic class room as well as on-the-Job mentorship and training.This compiled body of works has nine main sections which all of them were done during the residency schedule of the program. This include outbreak investigation, surveillance data analysis, evaluation of the surveillance system, health profile report, writing of finalized scientific manuscript for peer review journals, abstracts submitted to scientific conferences, summary of disaster situation visited/risk assessment writing protocol/proposal of epidemiologic research project and other additional works.The document is organized in to nine chapters; Chapter one deals with outbreak investigation. there were two outbreak investigations conducted:; one was measles outbreak investigation conducted in Hamaro woreda of Fik Zone,Ethio-Somali Region, with a follow up case control study. The second outbreak investigation was a case series study conducted in polio disease in the Ethio-Somali Region, Warder Zone of Bookh and Geladin Woreda. Chapter Two explains about Measles case based disease surveillance data review and analysis which was conducted at regional level. The ten year data, from 2004-2013, was analyzed in the Region by place, person and time. Chapter three describes the AFP and measles surveillance system evaluation conducted in Shabeele Zone, Ethio-Somali Region. In this chapter, purpose and objective of surveillance system, progress towards the objective and also attributes of the surveillance system were discussed.Item Compiled Body of Works in Field Epidemiology(Addis Ababa University, 2019-04) Taddie Wondmnew; Hagos Ashenafi; Alemayehu BekeleThe Ethiopia Field Epidemiology Training Program (EFETP) is 8 years competency based master’s program adapted from the United States Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) Program. The School of Public Health/Addis Ababa University, the Federal Ministry of Health of Ethiopia/Ethiopian Public Health Institute (EPHI),and CDC Ethiopia are running the Program jointly former your years. After all the program extended their coverage to other 8 university to increase field epidemiologist for the country. The field work comprises of 75% of the Program which is called residency; learning by working in public health emergency and other health related priority issues. The Program is designed to assist the Ministry of Health in building or strengthening health systems by recruiting promising health workers and building their competencies through on-the-job mentorship and training.Ethiopia adopted the Field Epidemiology Training Program to help improve leadership within Public Health Emergency Management. The Ethiopian Field Epidemiology Training Program (EFETP) provides residents a Master of Public Health Degree in Field Epidemiology after they complete two years of supervised work in applied or Field Epidemiology. This compiled body of works has 10 main sections or chapters accomplished during the residency time of the Program. The first 7 sections are expected outputs during the residency time; comprising of outbreak investigation, surveillance data analysis, evaluation of the surveillance system, health profile description report, writing of finalized scientific manuscript for peer review journals, abstracts submitted to scientific conferences, summary of disaster situation visited/risk assessment and other additional works. The overall outputs of the two years Field Residency Program will be presented in a summarized way; in the outbreak investigations chapter or section, one unmatched case control outbreak investigation of Pertussis in Sayient Woreda, North west part of Ethiopia, January 2019 was documented. Health profile description report was done in Fogera district in March 2018 and Surveillance system evaluation was also done in Fogera and Dera Districts, Amhara Region, in March 2018. One finalized scientific manuscript was prepared for peer reviewed journal. A report on need assessment (risk assessment) on prioritized Districts of Amhara Regional State was also conducted with other XIII team members from food security center, WHO, UNICEF, ADDPS and Other Regional Bureau. Under other additional works/outputs section (last chapter) activities like provision of training for public health emergency management (PHEM) officers working at different levels (regional to health facility level) in the Amhara Regional Health Bureau were also undertaken. Other activities we developed of Rabies and Anthrax case based and line list and weekly Bulletin,update, summary report of Pertussis outbreak, prepared and present Anthrax outbreak investigation report on Workshops.Item Compiled Body of Works in Field Epidemiology(Addis Ababa University, 2019-06) Roman Mengistu; Alemayehu Bekele; Mengistu YelmaThe Ethiopia Field Epidemiology Training Program (EFETP) is an in-service training program in field epidemiology adapted from the United States Centers for Disease Control and Prevention (CDC) and Epidemic Intelligence Service (EIS) program. The goal of the EFETP is to strengthen the Ethiopian Public Health Emergency Management system by: Improving public health event detection and response; creating a robust disease surveillance system; building capacity in field epidemiology and public Health; Enhancing evidence-based decision making for public health practice; and Reducing morbidity and mortality associated with priority diseases. Residents are expected to prepare and submit this body of work which will be assessed and evaluated by examiners to make sure that resident has acquired the expected level of competencies during his/her residency. Therefore, this body of work summarizes the required field residency ‘s outputs accomplished at field base during two years’ residencies. It has Nine chapters namely Outbreak Investigation, Surveillance Data Analysis Report, Evaluation of the Surveillance System, Health Profile Summary Report, Scientific Manuscript for peer review journals, Abstract, Protocol/Proposal of Epidemiologic Research Project, Public Health Emergency Management Weekly Bulletin and a Summary of Disaster Situation Visited/Risk Assessment. Accordingly, the document is organized to nine chapters. The first chapter includes two outbreak investigations and response. One of the investigations was conducted in Gotera refugee Shelter on scabies Outbreak using case control study design and the other Investigation was descriptive study on human exposure to Dog bite in woreda ten of Yeka sub-city Addis Ababa City administration, 2019. The second chapter contains five years (2013 to 2017) Surveillance Data Analysis of Typhoid Fever in Bole sub city, Addis Ababa City administration. Chapter Three describes Measles Surveillance System Evaluation in Bole sub city. Chapter four contains Health Profile Description of woreda nine, Bole sub city, Addis Ababa in 2017. Chapter five and Six contains Loss and damage from flooding in Akaki Kality sub city, Addis Ababa, Ethiopia, 2018 and Scientific manuscripts for peer reviewed journals respectively. In addition, three abstracts (which were developed from the two outbreak investigation and Surveillance Data analysis) are found in Chapter seven. Chapter Eight presents an Epidemiologic research project entitled “Assessment of Report completeness and factor affecting reporting disease under surveillance among private health facilities in Addis Ababa, Ethiopia, 2019. The last chapter (Chapter 9) contains additional out puts (One Epidemic Bulletin, Conference attended, Training received and provided, ……. etc.).Item Compiled Body of Works in Field Epidemiology(Addis Ababa Universty, 2018-06) Mulugeta Asefa; Alemayehu BekeleThis document contains a two years Field Epidemiology Training Program outputs which is equivalent with thesis to be submitted to graduate school of public health for fulfillment of master’s degree in Field Epidemiology. It includes reports of diseases outbreak investigations, public health surveillance data analysis, surveillance system evaluation, narrative summary of disaster situation report, manuscripts, abstracts and research project. The document is organized to nine chapters. Chapter One: contains disease outbreak investigations. I have conducted two outbreak investigations as first Author and one as a collaborator with other field epidemiology residents. One of the investigations was conducted using case control study design. All investigation report contains abstract, introduction, methods, discussions, conclusion, recommendations, acknowledgement and references separately. Chapter Two: contains report of surveillance data analysis which was conducted on Analysis of Measles Surveillance Data in Oromia, 2007-2016: ten year data was used in the analysis. The objective of this study was to assess the Epidemiology of Measles in Oromia Region, Ethiopia: Surveillance Data Analysis from 2007-2016. Chapter Three: addresses surveillance system evaluation entitled “To assess key attributes of Anthrax surveillance system and Performance of the system in line with set objectives and operations of the system to generate evidence based information for the better improvement of the surveillance system” This chapter clearly presents the purpose and objectives of the Anthrax surveillance and its progress towards its objectives. The surveillance attributes: simplicity, flexibility, stability, acceptability, representativeness, timeliness, data quality, sensitivity and predictive positive value were also assessed in the chapter. Chapter Four: Contains assessment of Health Profile Data Description of East Shewa Zone, Lome Woreda, Oromia Regional State. In the chapter health and health related data of Woreda populations were evidently presented which is very imperative for prioritizing problems. Appropriate public health interventions; and is doorway point for operational public health researches. Stake holders of health and health related issues will access evidence based information from this chapter. Chapter Five: Scientific Manuscripts for Peer reviewed Journals. The manuscripts were prepared according to Ethiopian journal of health development author’s guideline. The first manuscript was data analysis of Measles Oromia Region, Ethiopia and the second was Dengue fever Outbreak investigation in Kabridahar, Ethio-Somali Region 2017.Chapter Six: Include Abstracts on Epidemiology of Measles in Oromia, 2007-2016, Outbreak Dengue fever in Kebridehar Town Ethio- Somali region 2017 and investigation of Human Rabies exposure in Dehana woreda, Amhara Region, Ethiopia 2017 sent to international conference. Chapter Seven: Narrative disaster situation report of internally displaced people resided in West and East Hararge zone of Oromia region. The assessment was conducted to identify potential problems which need humanitarian assistance. Based on the report from the assessment humanitarian requirement document was developed and shared with potential partners for response. This chapter presents human health, Wash and nutrition need assessment conducted in IDP found in West and East Hararge zones of Oromia region. Chapter Eight: Epidemiological projects proposal entitled “Challenge associated with malaria parasitological diagnosis in west Hararge zone, Oromia Region, Ethiopia 2018, was developed for epidemiological project to be submitted to Addis Ababa University School of Public Health. Chapter Nine: Malaria research project report. Project proposal was sent to President Malaria Initiative program for mini grant. It was accepted and funded to be conducted. It was conducted among health facilities in West Hararge Zone, Oromia region, Ethiopia 2018.Item Compiled Body of Works in Field Epidemiology(Addis Abeba University, 2019-06) Kidan Wendmu; Alemayehu Bekele; Abdulnasir AbageroThis document contains two years output of field Epidemiology training program that submitted To AAU school of public health for the final accomplishment of master in field Epidemiology.The Ethiopia field epidemiology training program is a two years postgraduate training program. The training is collaborated with Addis Ababa University, school of public health, Ministry of health and Ethiopian public health association.According to the design , the residents expects to spend 75% of their time in the field activities and 25%in class. During the two years residents, the expected output for the partial fulfilment of master’s degree in field epidemiology were ;two diseases outbreak investigation ,public health surveillance analysis , surveillance, system evaluation, district health profile, narrative summery of disaster situation report ,manuscripts ,abstract and additional outputs (EFETP Resident manval,2012.Until know my resident at AAU, school of public health and Tigray regional health bureau PHEM, I have conducted the following output s and activities the detail output that I have accomplished still know are summarized below. Chapter one: Cholera outbreak investigation and suspected measles outbreak investigation1.1 Cholera outbreak investigation in Hadnet district Mekelle special zone July, 2018. From this cholera investigation we use case control study with 50 cases and 100 controls. We identified drinking spring water is risk factor the outbreak, using latrine was preventive factor. 1.2 suspected Measles cases investigation. This was done in Hawelity district Tigray on January 2019.We use decretive study from this study we found 68.7% of the case were vaccinated to measles, 18.2% of the case were not vaccinated and 12.5% of the cases were unknown their vaccination status. Chapter two: Secondary surveillance data analysis 3 years on measles in Tigray region 20152017. Chapter three: Surveillance system evaluation the evaluation was conducted in Kilte Awlaelo district Tigray region Ethiopia,Dec 2019.The woreda surveillance system was assess and the attributors were clarified sensitivity is 50% timelines completeness were greater than 80. Chapter four: health profile District health profile was conducted in Adigrat town Eastern zone of Tigray Ethiopia 2018. In this health profile most of immunization coverage of the woreda was greater than 90 but TT for non-pregnant mothers were less coverage. Chapter five: Manuscript on cases based measles surveillance data analysis this was conducted in Tigray regional health bureau. Chapter six :Cholera outbreak investigation in Hadnet district Mekelle special Zone Tigray region this abstract was prepared for conference. Chapter seven: Narrative summery report on IDP.We assess the IDP site and we observe the condition of the IPD site base on WASH and other health relative conditions. Chapter Eight: Epidemiological research proposal assessment of knowledge on ITN utilization and association factors affecting ITN utilization in raya Azobo district. This will be help identifying knowledge gab in utilization of ITN and association factors affecting the ITN utilization this is will be help in control and prevention of malaria in the district.Item Compiled Body of Works in Field Epidemiology.(Addis Abeba University, 2016-06) Gosaye Beriso; Alemayehu BekeleIntroduction: Measles is highly contagious viral disease and is one of the leading causes of death in children worldwide. In August 2014, Measles like illness affecting the community was detected in Chiro woreda of West Hararge zone, Oromia Region. Woreda health office calls to Oromia Regional Health Bureau for possible assistant to investigate the illness. Therefore, the investigator conducted study to verify the existence of measles outbreak in the woreda and assessed factors contributing to the outbreak. Method: Descriptive study followed by Case-control study design was conducted on January 2015 in Chiro woreda. Initially, Data collection instrument was prepared. During data collection, Cases were identified by Public Health Emergency management Guideline (PHEM) case definition and compared each of them to two controls recruited in the household of the closest neighbors. Finally, A total of 180 samples were interviewed of which 60 were cases; The outbreak was confirmed by laboratory and Bivariate and multivariate analysis were conducted and odds ratio with 95%CI significant statistical association was declared at <0.05 P-value. Result: A total of 173 cases (attack rate 8/10,000) and one death (case fatality rate 58/10,000) were identified .Of the cases 90(33%) were unvaccinated. Being vaccinated and having awareness on the mode of transmission for measles infection were protective factor for developing the disease and statically significant with OR 0.06 (95% CI = 0.03-0.13) and OR 0.04(95%CI= 0.03-0.05) respectively. Conclusion: Low community awareness and low vaccination coverage was prone contributing to the outbreak.Item Compiled body of works in field Epidemiology.(Addis Abeba Universty, 2017-06) Abraham Lere; Alemayehu BekeleBackground: Measles is a highly infectious viral disease that can cause permanent disabilities and death. We investigated measles outbreak to identify the magnitude and factors associated with measles in Cheta woreda, Kefa Zone, SNNPR 2016. Methods: We investigated 50 cases and 100 controls. We used a descriptive study followed by un-matched 1:2 cases to controls were conducted from February to March 2016. We defined a suspected measles case as any person with fever, rash, cough, and coryza or a person suspected of measles by a clinician. Four blood specimens were collected for laboratory confirmation. Data collection instrument was prepared. Multivariate logistic regression analysis was conducted by using Epinfo 7. Result: A total of 136 cases with AR 10.6/1000 and five deaths (CFR 3.6%) were identified. The median age of the cases was 3 years and IQR age was between 2 and 5years. Thirty-five of the cases (70%) and thirty-four (34%) of the controls were not vaccinated. Twenty-nine (58%)cases and 45 (45%) controls were males. The risk factors for contracting measles are - history of contact with suspected or confirmed cases (AOR=18.00 CI 4.31-80.46). Family size peoples living in one house more than five (AOR= 4.00 CI 1.34-11.98), Being vaccinated was protective effect from acquiring measles (AOR= 0.30 CI 0.10-0.78), Knowledge about measles disease is vaccine preventable (AOR= 0.27 CI 0.10-0.73). Conclusion: The most affected age group under five (54%) years followed by 5-14 (32%) years of age. History of contact with suspected or confirmed cases, Un-vaccination, living people more than five members and Lack of knowledge of mother or caretaker were associated risk factors. We recommended supplementary measles vaccination for under 15 children, strengthening of routine immunization defaulter tracing, strengthening of cold chain management and awareness creation in the community.Item Compiled Body of Works in Field Epidemiology.(Addis Ababa University, 2016-05) Tsehay Ayele; Alemayehu Bekele; Million TumatoThe current health service policy of Ethiopia gives emphasis to health promotion and prevention focusing on communicable diseases, nutritional disorders and environmental health problems without neglecting essential curative activities. In order to achieve this government of Ethiopia has outlined major strategies that include human resource development. Ethiopian Field Epidemiology Training Program, adapted from the United States Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) was established in 2009 with the aim of producing skilled public health professionals who provide in-service assistance to advance and prevent public health problems and contribute to evidence-based decision-making. Since its inception the program has played a significant role in investigation of outbreaks of unknown causes, priority disease surveillance activities, strengthening of surveillance system and prevention and control measures of prioritized diseases.From November, 2014 to May, 2016 I have stayed in Field Epidemiology Training Program, School of Public Health-AAU and at South Nations Nationalities Peoples (SNNP) Regional Health Bureau field bases. During my stay I have learnt a lot and carried out many public health activities. I have carried out two outbreak investigations, two surveillance data analysis, one surveillance system evaluation, one district health profile description; two scientific manuscript for peer reviewed journal, three abstracts for scientific conference, one blelg health need assessment and one epidemiological research proposals. In addition I have provided training for district and zonal surveillance focal persons and prepared six weekly epidemiologic bulletins of SNNP regions. We have investigated two Measles outbreaks during field base residency. The investigations were performed by descriptive and analytical epidemiology methods to describe magnitude of the diseases and identify risk factors associated with diseases. Over the period of outbreak in East Badewacho woreda a total of 158 measles cases and 0 deaths were detected. The overall attack rate was 75.7/100,000 and the case fatality rate was 0%. Having contact with a person suspected to have measles, presence of measles case patient in the family and malnutrition were independent risk factors, and not-vaccinated for measles dependent risk factors and for contracting measles infection. We recommend enhanced routine immunization service, strengthened of surveillance and early reporting system and awareness creation to the community on mode of transmission, prevention and health seeking behavior. In Shashogo woreda a total of 44 measles cases with no deaths were identified. The overall attack rate of this outbreak was 3.5/100,000 population with the highest attack rate were Ethiopian Field Epidemiology Training Prograram shayeayele@yahoo.com observed at Shamisa missie kebele with the attack rate of 288/100,000, Pop. 24 (54.5%) measles cases were not received measles vaccine, and 4 (9.1%) measles cases had unknown vaccination history. We recommend, ensuring that the vaccine efficacy is maintained at the kebele level, there should be a refrigerator at the health post. The measles vaccination coverage of the woreda must be improved. We analyzed five years (2011 – 2015) suspected Measles surveillance data in South, Nations, Nationality, Peoples (SNNP) region to know the burden and trends of the disease. In the five years there were 13,270 suspected Measles cases in SNNP Region with a mean annual incidence of 15.2 suspected patients per 100,000 and 66 suspected deaths with case fatality rate of 0.4%. The magnitude of suspected measles in SNNPR region showed an increasing trend during the past five years except in 2015. We recommended the surveillance activities need improvement in early detection of cases, for the completeness of variables and specificity of reporting suspected measles cases especially during outbreaks. We analyzed nine years (2007 – 2015) suspected AFP surveillance data in South, Nations, Nationality, Peoples (SNNP) region to know the burden and trends of the disease. In the nine years there were 2,108 suspected AFP cases in SNNP Region, Out of the total cases, 2074 (98.4%) AFP cases were under 15 years old. The magnitude of suspected AFP in SNNPR region showed the highest attack rate in less than five years age group. We recommended active surveillance of all AFP cases is mandatory to get the Polio eradicated by health facilities, and districts, and improving data recording, and reporting system by health centers, woredas, and zones. We conducted evaluation of surveillance system from March, 15-31, 2016 in Hadiya Zone, SNNP, and Region. The surveillance system of the zone was simple, flexible, useful and acceptable. However, attributes like; data quality, timeliness, and representative require attention for improvement of surveillance process. The system needs to be improved through including timeliness measurement indicators and incorporating all private and NGO health facilities in surveillance reporting units. We have collected and summarized health and other health related events, demographic, socioeconomic, political and cultural aspect of Kedida- Gamela woreda of West Kambata Tambaro Zone from February, 11-18, 2016. The leading cause for both, adult and less than 5 years children outpatient (OPD) and inpatient visit was malaria. Ethiopian Field Epidemiology Training Program shayeayele@yahoo.com. We have also prepared scientific manuscript for peer reviewed journals on measles outbreak investigation and response in East Badewacho woreda , Hadiya zone, SNNP Region ,Surveillance data analysis of suspected measles cases in SNNP, region, from 2011 to 2015, Surveillance data analysis of suspected AFP cases in SNNP, region, from 2007 to 2015, four abstracts were prepared for scientific conference on measles outbreak investigation and response in East Badewacho woreda , Hadiya zone, SNNP Region ,Surveillance data analysis of suspected measles cases in SNNP, region, from 2011 to 2015, Surveillance data analysis of suspected AFP cases in SNNP, region, from 2007 to 2015 . Blelg Season need assessment was conducted in tow zones of South Nations Nationalities People Region (SNNPR), Sidama and Gedeo zones, south Ethiopia, to identify humanitarian needs including Health emergencies like disease outbreaks or wide spread malnutrition, that usually follow after emergency events due to natural or manmade disasters. We identified lack of emergency preparedness, shortage of emergency drugs and therapeutic feedings and medical equipment at both zonal level and many districts of these zones. Epidemiological research project proposal on Assessment of Prevalence and associated risk factors for malaria in Shashogo woreda, Hadiya zone, SNNP region was prepared. A Cross-sectional descriptive study will be used for this study and Multi-stage sampling technique will be used to get study subjects. The total of 766 households will be assessed in this study. The aim of this study could help to get reliable information to determine the effectiveness of the malaria control program and factors associated with the high malaria prevalence in the district. The total estimated budget required for the study is 11,730.USA Dollar. Additionally ten Weekly surveillance bulletin of SNNP region PHEM was also prepared. The bulletin serves to provide feedback on surveillance activities, and summarizes weekly surveillance data and performance of SNNPRHB/PHEM on epidemic prone diseases and other public health emergencies. Health and Nutrition emergency prevention and Response, Command Post ,activities were undertake in Hadiya, Kambata Tambaro zones and Halaba special woreda to coordinate, organize and strengthen the surveillances system of the zone, In South, Nations Nationality Peoples, Region /SNNPR/August- October 2015.Item Compiled Body of Works in Field Epidemiology.(Addis Ababa University, 2017-06) Wadu Marshalo; Wondimu Ayele; Alemayehu BekeleThe Ethiopia Field Epidemiology Training Program (EFETP) started in 2009. The EFETP is an in-service training program in field epidemiology adapted from United States Center for Disease Control and prevention (CDC) Epidemic Intelligence Service (EIS) program. The EFETP has two main components, 25% a classroom learning and 75% practical attachments or field base components, which contribute the award of the Master degree. During my field base attachment, I conducted on outbreak investigations, surveillance data analysis, surveillance system evaluation, district health profile description, participating in disaster situation analysis, writing a project proposal development, abstracts writing for scientific conference, peer review journal writing, public surveillance training and preparing weekly bulletin for regional PHEM. I produced outputs that are compiled in this Body of Work. Outbreak Investigation I-1: Measles Outbreak in Konta special district, Southern Nation Nationalities and Peoples Region, Ethiopia, from February 22 to March 20, 2016. We identified 1068 cases (AR = 926 cases per 100,000 population) and 115 deaths (CFR=10.77%) with 6 IgM+ measles cases. The case-control study revealed persons who were vaccinated for measles before were 68.63% less likely to develop measles disease as compared to non-vaccinated persons (AOR = 0.31; 95% CI = 0.12, 0.83 with p-value = 0.0203). The odds of being a case of measles were 5.53 times more likely among those who were living with cases of measles than those who did not (AOR=5.53; 95% CI = 2.51, 12.13 with p-value 0.000001). Malnourished children had 3.51 times more likely suspected to develop measles (AOR = 3.51, 95% CI = 1.46, 8.44 with the pvalue of 0.0051) as compared to normal children. Outbreak Investigation I-2: We conducted an epidemic of leg swelling of unknown etiology in Mizan prison, Bench Maji Zone, Southern Nations, Nationalities and Peoples Region, Ethiopia, from October 26 to November 19, 2016. We identified 116 suspect cases with leg swelling of unclear etiology. Eight of the suspect cases were examined senior clinicians and 7 met clinical criteria for scurvy. Three cases had non-detectable levels of vitamin C in their blood. Eleven deaths were identified. The attack rate for the prison was 4.2%, and the case fatality rate was 9.5%. Clinical confirmed cases had symptoms of fatigue, myalgias, arthralgia and signs of follicular hyperkeratosis, petechiae, peripheral edema, and/or oral lesions. All clinical confirmed and 16 suspected cases had severe anemia with hemoglobin <8g/dl. Regular consumption of fruits prior to imprisonment,(OR = 0.40,(95% CI;0.23 - 0.69)), and consumption of fruits or vegetables while in prison were protective of disease (OR = 0.122; 95% CI = 0.024-0.628). Prior consumption of alcohol (OR = 2.86,(95%CI: 1.21 – 6.78); use of tobacco (OR = 2.47,(95%CI: 1.33 - 4.61)); and history of a chronic illness (AOR: 4.42,(95%CI: 2.02 – 9.66)) were risk factors for developing leg swelling. Surveillance Data Analysis Report II: Five years (2012 - 2016) Measles surveillance data of SNNPR was analyzed. From 2012 to 2016, the region reported 13,178 (AR=15/100,000 population) both lab confirmed and epidemiological linked Measles cases with 157 deaths (CFR=1.19%). Of them, 3,370 (25.6%) cases reported through case-based reporting and others reported via line list. About 7,841 (59.5%) with AR=267/100,000 under 5 children and 12,389 (94%) with AR=138 per 100,000 under 15 population and above 15 years contributed only 789 (AR=11 per 100,000) measles cases. About 6780 (51.3%) and 6418 (48.7%) of the total cases were males and females respectively. In 2014, about 3046 (88.7%) of the total cases was under five children. Age specific incidence was highest for under five years in 2014, about 137 per 100,000 population. About 5323 (40%) out of total cases were not vaccinated for measles and 2957 (22%) cases had not valid measles vaccination history provided that routine measles vaccination coverage reached 98.2%. In 2015/16, totally 18 confirmed measles outbreaks occurred in six Zones and one special Woreda in the region. One hundred thirty four kebeles affected by these confirmed measles outbreak. Evaluation of Surveillance System III: The public health surveillance system is evaluated to ensure that problem of public health importance are being monitored efficiently and effectively. Therefore, we conducted evaluation of Wolaita zone maternal death (MDSR), Measles and AFP surveillance system from January 24 to February 16, 2017. In 2016, the surveillance system reported 42 maternal deaths, 17-suspected measles and 25 non-polio AFP cases. In 2015/16,there was 24 (0.68%) maternal deaths in Wolaita Soddo University Teaching and Referral Hospital out of 3511 total deliveries and in 2016/17 up to 2nd quarter, there were 12 (0.62%)maternal deaths out of 1938 deliveries. All evaluated units (N=13) have no habit of data analysis. Completeness of recorded data for maternal death, measles and AFP was 83%, 71% and 56% respectively. Timeliness of weekly report was 100% at zonal level while it cannot bedetermine for health facility level. Maternal death surveillance and response system could not Capture both community and health facility deaths. Health Profile Description Report IV: Health profile provides a snapshot of the overall health of the local population. However, in low-income countries like Ethiopia such information especially at district level usually not available. Therefore, a study was conducted to providehealth profile description of Kindo Didaye district of Wolaita zone that will help for healthplanning. The total population of the district in 2016 is estimated as 122,062 based on aprojection of 2007 census with 60726 (49.75%) males and 61336 (50.25%) females. The dependency ratio of the district is estimated about 79%. The employment ratio of the district is estimated as 1.44:1. About 23 (82%) health facilities and 18 (85.7%) kebeles have access toroads of local type. There were a landslide, ice and fire disasters in the district in the past two years ago. The recent landslide disaster affected nine kebeles with 37 deaths, 344 households displaced and more than 275 million birrs estimated property lost. The district has 1 primary hospital, 3 health centers, 24 health posts and 4 private clinics. Malaria and pneumonia were the first top adult and pediatric morbidity and mortality cases respectively. The district has 82%health service coverage, 100% primary school coverage, 100% latrine coverage and 69.64% safe drinking water coverage in 2015. The district sustained 100% coverage for most Expanded Program of Immunization activities. Contraceptive acceptance rate and skill birth attendant was66.12% and 44.3% respectively in 2014/15.Scientific Manuscript for Peer Reviewed Journal V: Reports of new research/study findings are important to fuel innovative assumptions through scientific communication. Scientific journals are an exact means for this communication. Therefore, we prepared a scientific manuscript for peer review journal on a disease entitled "An epidemic of leg swelling ofunknown etiology in Mizan prison, Bench Maji Zone, Southern Ethiopia, 2016.”Abstracts for Scientific Presentation VI: During residency period, two abstracts were prepared for scientific presentation. Of them, “An epidemic of vitamin C deficiency in Mizan prison,Southern Nations, Nationalities and Peoples’ region, Ethiopia, 2016” was submitted to TEPHINET for oral presentation via Ministry of Health, Ethiopia. Narrative Summary of Disaster Situation Visited VII: I was participated two disaster situation visits: Belg Humanitarian, Health and Nutrition Assessment and Rapid Need Assessment following landslide disaster. Rapid Belg assessment was conducted in six woredasof Wolaita and Dawuro zones from June 6 – 23, 2016; four woredas from Wolaita and two woredas from Dawuro. I also conducted Rapid Need Assessment (RNA) and Emergency Prepared and Response Plan (EPRP) following 9th May 2016 Landslide in Kindo Didaye district, SNNPR. Ethiopia. This Landslide affected nine kebeles’ highland areas with impact of 37deaths, 461 households’ and 2882 populations’ displacement, and above 275 million birr estimated property lost.Protocol/Proposal for Epidemiologic Research Project VIII: During residency, I prepared protocol for epidemiologic research project on title “Describing Maternal Death and Exploring Factors Affecting Implementation of Maternal Death Surveillance and Response in Wolaitazone, Ethiopia - 2017.” The purpose of the study is most maternal deaths occurred due to direct obstetric causes, and these can be prevented by providing effective information for action. Ethiopia launched MDSR system, which provides information for action on preventable maternal death, through PHEM structure, but above 80% of maternal death was not reported via this structure in the zone. Therefore, this study was designed to describe maternal death, assess data quality and to explore factors affecting for implementation of MDSR at public health facility level. Other additional outputs IX: There were four additional outputs were done during the period of residency: Investigation of Acute Febrile Illness Outbreak in South Omo zone, SNNPR, Ethiopia, from May 14 – 27, 2016, public health surveillance training on topics of PHEM overview, epidemiology, pathogenesis, clinical features and outbreak management ofAWD/cholrea and scabies outbreak response, Rapid Need Assessment and Response Plan following May 2016 Landslide in Kindo Didaye district and PHEM Weekly Bulletin for epidemiological weeks 40 and 46, 2016 and week 10, 2017.Item Coronary Angiography Findings and outcomes of Percutaneous Coronary Interventions in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia(Addis Abeba University, 2020-12) Semere Akberet; Alemayehu BekeleBackground: Some hospital based studies showed that CAD is a major cause of mortality and morbidity and the incidence of CAD is increasing in middle and low income countries like Ethiopia even though there is no country wide study done. Objective: The purpose of this study is to describe the coronary angiography findings and outcomes of PCI in TASH. Methodology: A retrospective cross sectional study was conducted on coronary angiography findings and outcomes of PCI at TASH using structured questionnaire from January 1/ 2017 to December 1 / 2020. Datas were analyzed and interpreted using SPSS version 26 software. Result: Coronary angiography was done for 149 patients, of which, 124 (83.2%) patients were males and 25 (16.8%) patients were females with the age range of 24 to 88 years. The median age was 52 years with mean ages of 53.2+ 12.46, the most frequent age stratum being 45 to 55 years. ACS was the clinical diagnosis in 68 (45.6 %) of patients, of which 51 patients (34.2% of the total) had STEMI. With catheterization, 108 (72.5%) patients had evidence of CAD, of which, 41 (37.9%) patients had multivessel disease. PCI was done for 60 (40.2%) patients and TIMI III was achieved. The in hospital mortality was 0.67%. In a bivariate analysis, Diabetes was associated with multi-vessel disease (P=0.016), (COR 3.04 ) 95% CI(1.23-7.51). Conclusion: CAD in Ethiopia occurs early in lfe mainly involving LAD and is associated with adverse consequences. PCI has been shown to have low complications and low in hospital mortality making it a safe procedure. Key words: Coronary angiography, PCI, TASH