Browsing by Author "Adamu Addissie"

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    Acceptability and Associated Factors of Provider Initiated HIV Counselling and Testing among OPD Clients with Possible Clinical Sign of HIV Infection in West Arsi Zone, Ethiopia.
    (Addis Abeba University, 2011-05) Tsegaye Tesfaye; Adamu Addissie
    Introduction: HIV counseling and testing is a gateway to prevention, treatment, care and support services and an essential tool in the control of HIV/AIDS epidemic. Currently HIV status has been very low which cannot be achieved only through the traditional VCT alone and another alternative, routine HIV testing and counseling of patients, also called provider initiated HIV Counseling and testing is proposed. Objective: To assess the acceptability and associated factors of provider initiated HIV counseling and testing among OPD clients with possible clinical sign of HIV infection in West Arsi zone, Ethiopia. Methods: Facility based cross sectional study was conducted on outpatient department clients with possible clinical sign of HIV infection in 6 selected health facilities in West Arsi Zone, Ethiopia. The health facilities were selected randomly; study subjects who came to the health facilities were consecutively interviewed. Data collected by a pre-tested, structured interview questionnaire. Regression model was used to assess factors associated with acceptability of provider initiated HIV Counseling and testing. Results: A total of 539 clients were interviewed with a response rate of 92.3%. The majorities (66.4%) were married, major age distribution was range from 25-29 (29.1%) and the main religion was Muslim (66.2%). Knowledge on importance of provider initiated HIV Counseling and testing was low. The willingness and overall acceptability rate was 86.5%, and 83.1% respectively. The major perceived barriers for acceptability were mainly thinking self as not being at risk, followed by fear of stigma and discrimination. On adjusted covariates of acceptability, acceptability of PIHCT was found to be associated with having information on PIHCT service (OR=0.36; CI=0.22-0.60), less and much support for PIHCT (OR=0.30; CI=0.11-0.85 and OR=0.31; CI=0.12-0.77) and tested for HIV before (OR=0.20; CI=0.10-0.41) Conclusion and Recommendations: The acceptability noticed in this study is high. The major perceived barriers for acceptability was thinking self as not being at risk. Having information on PIHCT service, tested for HIV before, and extent of support for PIHCT were found to be important predictors of acceptability of PIHCT. Hence, intensive IEC/BCC and promotional activities through different means should be in place to raise level of awareness, support and routine testing to facilitate its acceptability and reduce major barriers that affect PIHCT service utilization at all level.
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    Assessing Safety and Ethical Issues among Participants in a Herbal Medicine Phase І Clinical Trial: Conducted in Addis Ababa Ethiopia: A Mixed Methods Research
    (Addis Ababa University, 2024-06) Melat Gebremedhin; Adamu Addissie; Solomon M Abay
    Background: Ethics in the conduct of clinical research is mandatory to protect research participants. The goal of phase І clinical trial is to determine the maximum dose of the new medication that may be administered without the risk of serious side effects. Participants in most of phase І clinical trial have no direct benefit in participating in the trial but the amount of money provided for compensation can cause the participants to participate without being concerned to the risks the new drug may bring. Objective: To investigate the safety and ethical issues among healthy volunteers in phases І clinical Study in Addis Ababa, Ethiopia in 2024. Methods: An institutional-based cross-sectional study design mixed with a qualitative description approach was employed. The study was conducted at Armauer Hansen Research Institute; semi-structured interviews were conducted face-to-face. Data was entered into the Kobo toolbox and exported to SPSS version 24; a descriptive analysis was done; and the socio-demographic characteristics of the study participants were described. For qualitative method, twelve interviewees were purposefully selected and interviewed. An open-ended question was developed to facilitate in-depth interviews with respondents. Interviews were audio-recorded with consent. Transcriptions were entered into ATLAS.ti and coded. The data was analyzed using a thematic analysis approach. Result: The major motivation of participants (54.4%) was financial benefit. The majority of the participants (52.6%) had a low monthly income of less than 2000 birr per month, followed by (42.1%) agreed to the need to help in the development of new drugs. When deciding to join a trial, the majority of them (40.4%), strongly agreed with giving consideration to the type of drug under investigation and the level of risk that can be caused. Altruism and medical care provided by the trial site were also the other major decision factors mentioned. Conclusion: The findings of this study indicate that the motivations and enrollment decisions of healthy participants to engage in a phase І clinical trial are diverse, extending beyond financial incentives. By taking these factors into account, researchers can develop more effective approaches to engage and protect the healthy volunteers in the trial.
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    Assessment of Cervical Cancer Services and Cervical Cancer Related Knowledge of Health Service Providers in Public Health Facilities in Addis Ababa.
    (Addis Abeba Universty, 2014-11) Firdawek Getahun; Adamu Addissie
    Background: Human papiloma virus (HPV), which is mostly acquired by sexual intercourse, is a necessary cause of cervical cancer. Every year more than over quarter of a million women die from cervical cancer and because of poor access to screening and treatment services, large majority of these deaths occur in women living in low- and middle-income countries. In Ethiopia, cervical cancer ranks as the most frequent cancer among women and every year nearly three and half thousands women die with cervical cancer.Majorty of the women had poor knowledge about cervical cancer and cervical cancer screening practice. Objective: To assess cervical cancer services and cervical cancer related knowledge of health service providers in public health facilities in Addis Ababa. Method: A facility-based cross sectional study accompanied by observational assessment was conducted from September 2013-September 2014 in public health facilities in Addis Ababa. A pre-tested, structured and semi-structured questionnaire and a checklist were used to collect data. The data was collected from 5 randomly selected health centers and 3 purposively selected hospitals. A total of 309 health service providers were included in the assessment of their knowledge related to cervical cancer. Data was analyzed using SPSS version 21. The chi-square test was used to look for an association between cervical cancer knowledge and socio-demographic variables. Result: Two of the three hospitals included in the study had cervical cancer screening services Visual inspection with acetic acid (VIA), and precancerous treatment cryotherapy and Loop electrosurgical excision procedure (LEEP).One third of the hospital had cervical cancer diagnosis service punch biopsy and cancer treatment. All the hospitals had trained health professionals and basic facilities, materials, and equipments for the available cervical cancer services. Of all the respondents who consider cervical cancer had biological cause, 192 (62.2%) said virus and 79 (25.6 %) said bacteria. Regarding mode of transmission, they said that it could be transmitted through sexual intercourse 274 (88.7%) and blood contact 45(21%). Majority, 289 (93.5. %) of the respondents said cervical cancer was a preventable disease. Out of those who considered cervical cancer preventable by vaccination, only 121(39.2%) identified correctly the recommended age for HPV vaccine. Having multiple sexual partners 257 (83.2%) and post coital bleeding 251(81.2%), were the most mentioned risk factor and clinical manifestation of cervical cancer respectively. Majority of the respondents were aware of the correct time to start screening 291(70.5%) and only small percents 95(25.9%) knew screening intervals. Knowledge about cervical cancer was higher in general practitioner and above (X2 = 20.93, P=0.000) and health officers and degree nurses (X2 = 5.90, P=0.015) than diploma nurses. Female had better knowledge about cervical cancer than male (X2 = 8.4, P=0.003). But overall, 165 (53.4%) of health providers scored below the mean knowledge level score about cervical cancer. All the facilities had internal and external referral slips for communicating of referred patients and also kept their records. Absence of trained man power and necessary facilities were the major reasons for referral. Conclusion and Recommendation: All the hospitals had trained health providers and screening, diagnosis and treatment infrastructures for the available cervical cancer services but the services were not available at one point. Majority of health professionals in service providing facilities knew the biological cause, mode of transmission, risk factors, clinical presentations, screening methods and time to start and prevention methods of cervical cancer. But most did not know HPV vaccine, the recommended age group and the recommended number of doses and over all time taken, screening intervals and the precancerous treatment methods. The government should expand the full cervical cancer services to be available at least in these hospitals (at one point).Training should be considered for health providers who had no previous training to gain more knowledge about this area.
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    Assessment of Factors Associated with Women’s Informed Choice for HIV Testing under Opt-out Approach among Antenatal Attendees in Ghimbi Town, Western Ethiopia.
    (Addis Ababa University, 2013-06) Israel Mitiku; Adamu Addissie
    Introduction: Under routine antenatal HIV testing and counseling or an “opt-out” approach all antenatal attendees are tested for HIV apart from those who actively decline the test. There are concerns that refusal of the test could be difficult for some women given the substantial social status that health providers hold in many societies. However, little is known about pregnant women‟s ability and associated factors to make informed choice for HIV testing under routine antenatal HIV testing in Ethiopia and particularly the selected study area. Objective: To assess women‟s ability to make informed choice about HIV testing and associated factors under opt-out approach among pregnant women attending antenatal care at government health institutions in Ghimbi town. Methodology: Health institution based cross-sectional study was conducted among 252 pregnant women attending antenatal care and known to be tested for HIV at government health facilities in Ghimbi Town from March 15 to May 9, 2013. Pregnant women were interviewed after giving blood for HIV testing but before accepting test result using pretested structured interviewer administered questionnaire. Descriptive statistics and multiple logistic regressions were carried out using SPSS version 17. Qualitative method was used to explore women‟s experience on HIV testing and counseling with focus on consent for HIV testing to clarify the results of quantitative analysis. Results: Only 59.9% of the women described acceptance of HIV testing as their own personal decision and 53.2% felt that they could not able to decline HIV testing. When adjusted for other factors; being asked consent (OR = 12.184, 95% CI: 6.123, 24.243), knowing that antenatal HIV testing is offered for the purpose of PMTCT (OR=3.461, 95% CI: 1.523, 7.864), urban residence (OR=2.442, 95% CI: 1.251, 4.766), and knowing that antenatal HIV testing is optional (OR=2.899, 95% CI: 1.222, 6.876) were associated with the perceived ability do decline HIV testing/make informed choice to decline HIV testing. Conclusion and recommendation: Women are tested in the expense of their right to make informed choice for HIV testing that contradicts with the basic principles of HIV testing. Providing the minimum components of pretest counseling is important to protect the autonomy of women and to ensure fully informed consent for HIV testing and women should be given a chance to decide about the test.
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    Assessment of Knowledge about Cervical Cancer and Barriers Towards Cervical Cancer Screening among HIV Positive Women, in Health Centers of Addis Ababa, Ethiopia
    (Addis Abeba Universty, 2016) Saba Shiferaw; Adamu Addissie
    Background: Cervical cancer is the second most common women cancer with 528,000 new cases each year worldwide. Current estimates indicate that every year 7095 women are diagnosed with cervical cancer and 4732 die from the disease in Ethiopia. The magnitude of precancerous cervical cancer lesions as well as invasive cervical cancer is higher in HIV-infected women than others. Participation in screening for cervical cancer is poor among Ethiopian HIV patients. The awareness women have about the disease can play a vital role in the prevention, early diagnosis and treatment of cervical cancer. Information regarding this area is very scares in HIV patient of Ethiopia, so this study aims to assess women’s knowledge about cervical cancer and barriers to cervical cancer screening among women living with HIV in health centers of Addis Ababa city. Methodology: A facility based cross sectional study design using both quantitative and qualitative method was conducted among 594 HIV positive women with age between 21and 65 years. Univariate and binary logistic regression analysis were performed. Chi square test was used and p-value < 0.05 was considered for multiple regressions. Open code analysis was used to code and categorize qualitative data, and then thematic analysis was employed. Result: Out of 581 women enrolled with mean age 34.9±7.7 years, 41.1% were married, 34.1% had primary school while 57.8% of participants have heard about cervical cancer. Only 21.3% were knowledgeable about cervical cancer and cervical cancer screening, 86.2% were willing to be screened and 10.8%% were already screened for cervical cancer. In multivariate analysis educational status and knowing someone with cervical cancer were associated with knowledge score with p < 0.05. Conclusion and Recommendation: Knowledge regarding cervical cancer is poor among HIV positive women and screening rate was low. The most commonly identified barrier was lack of awareness, so it is needed to scale up health education regarding cervical cancer and screening methods for HIV positive women in Addis Ababa.
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    Assessment of Knowledge and Attitude of Cervical Cancer and Screening among Primary Health Care Workers of West Wollega Zone, Ethiopia,2016.
    (Addis Abeba Universty, 2016-05) Eba Bekela; Adamu Addissie
    Background: Cancer of the uterine cervix is the most common cancers among women worldwide. The global burden of cervical cancer is disproportionately high among the developing countries. Sub-Sahara Africa is the region with the highest incidence of cervical cancer. In Ethiopia many women seek treatment only at a very late stage when their cancer has significantly advanced and facing a higher probability of mortality, though it is a preventable and curable disease if identified at an early stage. Knowledge of cervical cancer helps to have a clear understanding of the need for early detection. Objectives: The aim of this study is to assess knowledge and attitude of cervical cancer and screening among primary health care workers of west Wollega, Ethiopia, 2016. Methods: An institutional based cross-sectional study was conducted from February -June 2016among 417 west wollega primary health service providers. Stratified sampling technique was utilized to stratify study source into Hospitals and health center. Bivariate and multivariate analysis were used. Results: Over all knowledge of cervical cancer was 36% and knowledge of cervical cancer screening were 15% and 44.6%of participants had positive attitude towards cervical cancer. Profession of the respondents was found to be statistically significant towards knowledge of cervical cancer. Majority of the respondent were not heard about cervical cancer screening. Level of knowledge of cervical carcinoma was associated with attitude on screening, those with good knowledge were more positive Conclusion and Recommendation: The study revealed that low level of knowledge on cervical cancer and screening. And also participants had negative attitude. There is a need to design and implement awareness creation program on cervical cancer and screening.
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    Assessment of Magnitude, Barriers and Outcomes Related with HIV Serostatus Disclosure among Art Users, in Addis Ababa Art providing Health Facilities.
    (Addis Abeba Universty, 2009-06) Aklilu Koyira; Adamu Addissie
    Background: Disclosure of HIV Serostatus to sexual partner and other individuals is important in prevention of new HIV infection transmission especially in developing countries and helps to initiate early treatment and in order to obtain appropriate support from sexual partners, family members and the whole community at large. Objective: The aim of the study was to identify the magnitude, barriers and outcomes associated with HIV serostatus disclosure among ART users in Addis Ababa ART providing health facilities to their sexual partners and to significant others. Study Design: Facility based quantitative cross-sectional study was conducted from April-2009 to May- 2009 in Addis Ababa ART providing health facilities using structured questionnaires among ART receiving clients who were married or who were in cohabiting sexual relation with their sexual partners and living together at the time of their initial VCT. Quantitative study was supplemented by qualitative study among ART receiving clients who were involved in PLWHA organizations. Result: In the study 341 study participants who were married in legal way and who were not married in legal way (cohabiting) at the time of their initial VCT were involved in the study. Among them 157(46%) were male study participants and 184(54%) of them were female study participants. Total disclosure rate was 88.3 (89% for males and 87.5% for females). Bivariate and multivariate analysis identified factors associated with disclosure of HIV serostatus to sexual partners includes: Living with sexual partners in legal marital relationship, living with sexual partners within the same household, smooth marital relationship with sexual partner, having sexual partner whose HIV serostatus was positive and discussing with sexual partner about HIV and VCT before HIV diagnosis were identified factors for disclosing HIV serostatus to sexual partners COR 2.737(1.360, 5.430) and AOR 3.572(1.399, 9.122), COR 2.745 (1.336, 5.64), COR 4.608(2.311,9.191) and AOR 5.263(2.360, 11.740) , COR 4.991(2.002, 12.440) and AOR 8.024(2.807, 22.935), COR 5.341(1.820,15.672), COR 6.604(2.224, 19.607) at the 95% CI respectively). Barriers and dalliance for disclosure of HIV serostatus identified were: fear of loss of support from sexual partners (9.4%), not having enough time to discuss with their sexual partner about their HIV serostatus (7.9%) and sexual partner may get anger (6.2%) were some of identified reasons among other identified reasons. Reassurance by disclosed individuals, obtaining support from people, being annoyed by disclosed people; being threatened and beaten by their sexual partners were some of the outcomes associated with disclosing HIV serostatus. Conclusion: Even if the disclosure rate of the study is encourage as it is compared with developing countries still significantly proportion of peoples did not disclose their HIV serostatus immediately and not disclose until know and were found engaged in unprotected sexual activity which could hamper strong effort made to prevent new HIV transmission to sexual partners.
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    Assessment of Noise Induced Hearing Loss and Associated Factors among Workers in Akaki Basic Metal Industry, Addis Ababa, Ethiopia.
    (Addis Abeba Universty, 2015-06) Ashenafi Hailu; Adamu Addissie
    Background: Excessive occupational exposure to noise results in a well-recognized occupational hearing loss and now is taken as a global problem. Worldwide, approximately 600 million workers are exposed and 16% of disabling hearing loss in adults is attributed to occupational noise. However, in developing countries including Ethiopia there is no systematized recording and reporting of noise induced health problems. Objectives: To assess the magnitude and associated factors of noise induced hearing loss among Akaki basic metal Industry workers, between March and April, 2015. Methodology: Institutional based cross-sectional study was conducted in Akaki Basic metal Industry. A total of 244 eligible workers were included in study by using simple random sampling from workers` attendance sheet of respective sections. A pre-tested interviewing questionnaire, Environment noise survey, audiometric test were conducted. Epi-Info version 7 software was used for data entry and cleaning and then data exported to SPSS version 21 software for further analysis. Logistic regression model was used to identify factors associated with outcome variable. Results: Audiometric measurement revealed that the prevalence of noise induced hearing loss in Akaki Basic Metal Industry was 22% (95% CI 17- 27). Previous exposure of noise (AOR = 2.8, 95% CI: 1.032-7.923), service year 11-20 years (AOR = 2.3, 95% CI: 1.078- 6.262) and service years 21-30 years (AOR = 5.2, 95% CI: 2.317- 11.507) when compared with 1-10 years’ service respectively were significantly associated with noise induced hearing loss. But, drinking alcohol (AOR= 1.6, 0.740-3.236) and being hypertensive (AOR = 1.7, CI: 0.800 – 3.776) respectively were not significantly associated with NIHL. The environmental noise level measurement was Mean (SD) of 89 + 13.65 dB A. Conclusion: The prevalence of hearing loss in Akaki basic metal industry shows significant number with association of level of exposure, previously exposure to noise and duration of exposure. This shows as great effort is needed from administrative of the industry to provide appropriate hearing protective devices based on noise level of sections and change the behavior of workers towards using it, monitor noise level according to the country`s standard and installation of acoustics materials with in the industry to protect the health of workers from noise hazard.
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    Assessment of Sexual Behaviors and Factors Influencing Risk Perception on HIV/AIDS among Preparatory Students in Adama Town, East Shoa Zone, Oromia Region, Ethiopia.
    (Addis Abeba Universty, 2011-05) Ketema Gashaw; Adamu Addissie
    Background: Globally an estimated 11.8 million young people aged 15 to 24 are living with HIV/AIDS. Each day, nearly 6,000 young people between the ages of 15 and 24 become infected with HIV. In Ethiopia there are currently 1.2 million PLHIV, with an adult HIV prevalence of 2.4%. Study show that as high as 48.2% of in school youth who were engaged in risky sexual behaviors considered themselves to be at no or low risk of HIV infection. Objective: To assess sexual behaviors and identify factors influencing risk perception towards HIV/AIDS among preparatory students in Adama town. Methods: This cross-sectional survey was conducted from December 27, 2010 to January 12, 2011. Quantitative study was conducted based on self administered questionnaire among 737 in school youths with 97.23% response rate. To support quantitative findings, a qualitative study also was conducted using four focus group discussions. Quantitative data was analyzed using SPSS16 version and qualitative data by thematic analysis. Results: Out of the total respondents 47.1% were males and 52% were grade 11th. About 19.7% of the respondents were sexually experienced. Thirty Six (24.8%) of the sexually experienced respondents reported that they have more than one sexual partners and 7(4.8%) have had sex with commercial sex workers. Among the sexually active respondents 21(22.1%) had never used condom and only 37 (38.9%) use condom consistently. Only 16(2.2%) of Participants perceive they are at risk of HIV infection. In multivariate analysis, being a female by sex (AOR= 0.61(0.39, 0.94), Older youth (20-24) years AOR=3.69(2.09, 6.54), and Khat chewing AOR=3.96(2.34, 6.69) with 95% CI have shown significant association with sexual experience. Conclusions and Recommendation: School youths were beginning sexual intercourse earlier, practicing sex with multiple partners, and with commercial sex workers, and low rate of condom use during their sexual encounter. They have very low personal risk perception towards HIV infection. Therefore programs targeted towards youths should be promoted youths participation and give emphasis on developing their life skills to put knowledge in to practice.
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    Assessment of the Magnitude of Glycemic Control and its Associated Factors Among Patients with Type 2 Diabetes at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2015.
    (Addis Ababa University, 2015-06) Yohannes Tekalegn; Adamu Addissie; Wondimu Ayele
    Background: Diabetes is increasing at an alarming rate throughout the world and about 80% of diabetics‟ lives in low and middle income countries. Glycemic control is the most important predictor of diabetes related complications and death. Identifying factors associated with glycemic control will help health care providers to design programs which improve quality of services provided to diabetic patients. Objectives: The aim of this study was to assess the magnitude and factors associated with glycemic control among type 2 diabetic patients at Tikur Anbessa Specialized hospital, Addis Ababa, Ethiopia. From march to April, 2015. Methods: Facility based cross sectional study was conducted on a sample of 412 type 2 diabetic patients attending diabetic clinic of Tikur Anbessa Specialized Hospital. The study subjects were selected using systematic random sampling technique from March to April, 2015. Quantitative data were collected on demographic, fasting blood sugar, self reported adherence to diabetes self care and diabetic distress scales using structured questionnaires. The data was entered and analyzed on SPSS V20. Descriptive statistics were used to determine magnitude of glycemic control among type 2 diabetes patients. Logistic regression was used to identify factors associated with outcome variables. Result: A total of 412 type 2 diabetic patients were interviewed. Median age of participants was 52 years (IQR= 40-60 years). 51.7% of the respondents were females. Median duration of diabetes is 10 years (IQR: 5-16 years). About 80% had uncontrolled fasting glycemic level. The factors which are significantly associated with poor glycemic control were longer duration of diabetes (AOR: 2.72 95%CI [1.16, 6.32]) and being on insulin therapy (AOR= 3.01 95% CI: 1.5- 5.9). Conclusion: proportion of patients with poor glycemic control is high. Longer duration of the disease and being on drug regimen insulin is was associated with poor glycemic control. Appropriate attention should be given to patient with longer duration of disease and those on insulin therapy
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    Association Between Past Hormonal Contraceptive Use and Preeclampsia among Pregnant Women in Gojjam Zones, Amhara Region, Ethiopia, 2017: Case Control Study
    (Addis Ababa Universty, 2017-10) Abiyot Wolie; Adamu Addissie
    Background: Preeclampsia is a common problem of pregnancy often leading to significant maternal and fetal complications. In Ethiopia the major direct obstetric complications account for 85 percent of maternal deaths. Pregnancy induced hypertensive disorders are one of the common direct causes of maternal deaths in Ethiopia. Those women with a history of preeclampsia have a higher risk of developing preeclampsia in subsequent pregnancies but the effect of commonly used hormonal contraceptives on blood pressure is still not clear. There is no sound study conducted in Ethiopia concerning the specific risk factors, specifically contraceptive use and their effect on preeclampsia. Objective: To assess the association between past hormonal contraceptive use and preeclampsia among pregnant women who came for ANC or admitted in gynecology and obstetrics ward for delivery in the selected hospitals in Amhara Region, Ethiopia from August 2016 to October 2017. Methods: Institution based unmatched case control study design was conducted in Finote Selam, Bure, Debre Markos and Motta hospitals. These hospitals were selected due to their high patient flow among other hospitals in Gojjame Zones. Women who were diagnosed as having preeclampsia considered as cases and women without preeclampsia were controls. Cases and controls were selected consecutively in the ANC clinics, obstetrics and gynecology wards in the selected hospitals. The case to control ratio was 1:2. The total sample size was 330 (110 cases and 220 controls). The data was obtained through reviewing women‟s record, taking some measurements and face to face interview using pretested questionnaire. The data was entered into EPI info and transferred into STATA version 14. Descriptive analysis like frequency, mean and standard deviation were calculated and finally the data was analyzed by logistic regression model using STATA version 14. Result: There was non-significant association between history of past hormonal contraceptive use and preeclampsia except implant. Independent risk factors of preeclampsia were family history of hypertension (COR= 3.04, 95% CI [1.13-8.23]), history of abortion (AOR= 3.17, 95 CI: [1.31-7.70]), change of paternity (AOR= 3.16, 95%CI: [1.47-6.83]) and multiple pregnancies (AOR= 2.68, 95%CI: [1.10-6.58]. On the other hand, using of implant (AOR=0.41, 95%CI: [0.18-0.93]) and fruit during this pregnancy (AOR = 0.36, 95% CI [0.18-0.72]) were found to be preventive factors for preeclampsia. Conclusion: History of past hormonal contraceptive use was non-significantly associated with preeclampsia except implants. History of abortion, change of paternity and multiple pregnancies were risk factors whereas fruit intake and implant use were preventive factors for preeclampsia. Recommendation: Researchers better to do further study on this maternal complication by using large sample size. Health workers better to give attention for pregnant women who have history of abortion and multiple pregnancies. It is better to encourage them to use implant as priority choice of contraception before their pregnancy.
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    Childhood Tuberculosis Epidemiology in Urban Central Ethiopia: Death Predictors, Disease Determinants, and Unfavorable Treatment Outcomes.
    (Addis Ababa University, 2024-06) Abay Burusie Adere; Adamu Addissie; Nicole Salazar-Austin; Fikre Enqueselassie
    Background: Limited evidence exists on the epidemiology of childhood tuberculosis (TB) in Ethiopia. Even though the TB treatment success rate is one of the most important global metrics for assessing the implementation of the End TB Strategy, little is known about the magnitude and determinants of unfavorable TB treatment outcomes that affect TB treatment success rates among children in Ethiopia. Additionally, despite Ethiopia's high national BCG coverage and studies showing the vaccine's effectiveness against TB meningitis (TBM), the disease remains a persistent problem. Objectives: To describe the epidemiology of drug-susceptible TB and identify predictors of TB death, identify determinants of TB disease, assess the magnitude and predictors of unfavorable TB treatment outcomes, and evaluate the effectiveness of BCG vaccine against TBM among children aged 16 and under in Urban Central Ethiopia. Methods and materials: This study was conducted across healthcare facilities in Addis Ababa, Adama, and Bishoftu from September 25 to June 24, 2022. A retrospective cohort design was used to address the following specific objectives: describing TB epidemiology, identifying predictors of death, and assessing the magnitude and determinants of unfavorable treatment outcomes. Additionally, 1:1 matched case-control and 1:4 unmatched case-control designs were used to identify determinants of TB disease and assess BCG vaccine effectiveness against TBM, respectively. Sample sizes were statistically determined. Thirty-two healthcare facilities—26 in Addis Ababa, three in Bishoftu, and three in Adama—were randomly selected. All children treated for TB at these facilities were included in the descriptive epidemiology and predictors of death analyses, as well as in the study on unfavorable treatment outcomes. In the matched case-control study, cases (children with TB) were randomly selected from treated children identified through TB registries. Controls (children never diagnosed with TB) were sequentially chosen from the same facilities. Data on TB cases were collected through TB record reviews and phone interviews with parents or caregivers. Data on controls were obtained through face-to-face interviews with parents or caregivers. Descriptive epidemiology was presented using relative frequency tables and graphs. Statistical analyses included Cox proportional hazards regression(challenged with extended Cox regression) to compute adjusted hazard ratios (a HR) for death predictors, conditional logistic regression for matched adjusted odds ratios (mORadj) of TB disease determinants, log-binomial analysis for risk ratios (aRR) of unfavorable outcomes, and unconditional logistic regression for adjusted odds ratios (aOR) to assess BCG vaccine effectiveness against TBM. This study was approved by the Institutional Review Board of the College of Health Sciences, Addis Ababa University (protocol number: 057/19/SPH). Results: Data from 640 children aged 16 years and under who underwent treatment for TB were analyzed. Among them, 80 (12.5%) were under two years old, and a resurgence occurred starting from around 12 years of age. Most of the enrolled children, 557 (87.0%), had no known household TB contact. Out of 519 children with an identified place of stay, 396 (76.3%) were attending school or daycare before being diagnosed with TB. Thirty-six (5.6%; 95% confidence interval (CI) = 4.0–7.7%) of the 640 children died during the course of TB treatment. Among those who died, nine (25%) were under two years old. Factors such as HIV infection (aHR = 4.2;95% CI = 1.9–9.3), undernourishment (aHR = 4.2; 95% CI = 2.2–10.48), age below 10 years(aHR = 4.1; 95% CI = 1.7–9.7), and relapsed TB (aHR = 3.7; 95% CI = 1.1–13.1) increased the likelihood of death during TB treatment. Children not vaccinated with BCG at birth or within two weeks of birth (mORadj = 2.11; 95%CI = 1.28–3.48), those who lived with a TB-sick family member (mORadj = 4.28; 95% CI =1.95–9.39), those who lived with a smoking family member (mORadj = 3.15; 95% CI = 1.07–9.27), and HIV-infected children (mORadj = 8.71; 95% CI = 1.96–38.66) were more likely to develop TB than their counterparts. A post-estimation analysis indicated that children who were BCG-vaccinated at birth or within two weeks of birth had a lower risk of TB than their unvaccinated counterparts until the age of 15, but there was no difference found between the two groups when they turned 16.Out of 640 children, 42 (6.6%; 95% CI = 4.8–8.8%) had unfavorable TB treatment outcomes, with 31 (73.8%; 95% CI = 58.0–86.1%) occurring after the first two months of treatment initiation. Children under ten years old (aRR = 2.69; 95% CI = 1.56–4.61), those with relapsed TB (aRR = 3.19; 95% CI = 1.79–5.70), undernourished children at TB diagnosis (aRR = 2.68;95% CI = 1.53–4.71), and HIV-infected children (aRR = 2.62; 95% CI = 1.50–4.59) had a higher risk of unfavorable TB treatment outcomes than their counterparts. However, among children who completed the first two months of TB treatment, relapsed TB was not significantly associated (aRR = 2.81; 95% CI = 0.96–8.22) with unfavorable outcomes, while the remaining factors retained significance. No significant association was detected between BCG vaccination and the risk of TBM (aOR = 0.46; 95% CI = 0.11–1.84). Conclusions: Most children contract TB from the community, with morbidity resurging around age 12, possibly due to waning BCG vaccine effectiveness. Despite a pooled global death rate of0.9% in treated childhood TB patients, the death rate in Urban Central Ethiopia is high. Risk factors for death and unfavorable outcomes include being under 10, suggesting redefining the high-risk age category from 5 to 10 years. BCG vaccination is protective of childhood TB but wanes with age. Second-hand smoking increases childhood TB risk, underscoring the need for public health policies to reduce children's exposure to tobacco smoke. HIV remains a significant morbidity and mortality risk factor, raising concerns about the coverage and efficacy of TB preventive treatments. The rate of unfavorable TB treatment outcomes aligns with the WHO's milestone, staying below 10%, but nearly three-quarters of these outcomes occur during the continuation phase, highlighting the need for extended risk-focused follow-up. Under nutrition persisting into the continuation phase of TB treatment predicts unfavorable outcomes, indicating the need for nutritional interventions throughout both the intensive and continuation phases of childhood TB treatment. BCG was not found to significantly protect against TBM compared to other types of TB combined. Recommendations: Expand TB contact tracing in children to include school communities and maintain universal newborn BCG immunization. Consider legislation against smoking in households with children. Include children under 10 as a high-risk group for TB-related death in TB guidelines. Evaluate the coverage and effectiveness of TB preventive therapy intervention in HIV-infected children. Children under 10, those who are HIV positive, and undernourished children should be carefully assessed, treated, monitored, and provided with necessary support, regardless of the phase of TB treatment they are in. This study recommends conducting larger studies to assess the effectiveness of BCG vaccination against TBM compared to other types of TB.
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    Compiled Body of Works in Field Epidemiology
    (Addis Abeba Universty, 2016-05) Mikiyas Mekonnen; Adamu Addissie
    This document contains two years Field Epidemiology Training Program outputs, to be submitted to school of public health for fulfillment of Masters Degree in Field Epidemiology. This Compiled Body of Work has eight chapters and eight annexes. Reports of diseases outbreak investigations, public health surveillance data analysis, surveillance system evaluation, narrative summary of disaster situation report, manuscript and abstracts presented in eight chapters. Chapter One: This chapter contains findings of two outbreak investigations. The first outbreak investigation was conducted on an outbreak of psychogenic disorder in primary school of Sululta district, Oromia Regional State. The objective of the investigation was to verify the outbreak and asses the distribution and risk factors of the outbreak to implement control measures. We used a descriptive analysis of the line list followed by a sex matched case-control study; we identified 183 case of psychogenic disorder (conversion disorder) with female dominance (62%). The outbreak was controlled mainly by giving health education to students, teachers and families of cases. We recommend provision of health education to community of the locality on psychogenic disorders. On a bigger scale, we recommend primary schools in the country to have a school Psychologist to help on overall psychological problems of students including in a possible incidences of mass psychogenic disorders. The second outbreak investigation was on Measles outbreak in Telalake district of Afar. We used a descriptive analysis of the line list followed by a sex matched case-control study; we identified 21 cases of Measles (the first five cases were lab confirmed). Eighty-one percent of the cases were not vaccinated for measles. The outbreak was controlled by providing mass vaccination and health education activities. We recommend strengthening health education and routine and catch up immunization programs activities by the district health office to prevent similar outbreaks. Chapter Two: Presents report of surveillance data analysis conducted on maternal death. We retrospectively analyzed national surveillance report collected from October 2013 to September 2015 to describe the distribution and determinate of maternal death in Ethiopia. The summary of the findings has shown that the overall maternal mortality ratio is 28.9 per 100,000 live birth with big disparity among regions the maximum being at Dire Dawa 94 deaths per 100,00 live birth and the minimum being at Addis Ababa 2.7 deaths per 100,000 live births. The top three causes of maternal deaths found to be hemorrhage followed by sepsis and hypertensive disease of pregnancy. We recommend much focus should be given to the top three common causes of maternal deaths (hemorrhage, sepsis and hypertensive disease of pregnancy) to reduce and improve maternal outcomes. The number of reported maternal mortality is far below the local and international estimates, which needs an evaluation of the overall maternal mortality surveillance system (based on this result, we conducted evaluation of MDSR system in Tigray region which presented in the next chapter).
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    Compiled Body of Works in Field Epidemiology
    (Addis Ababa Universty, 2018-06) Dechasa Nesga; Adamu Addissie
    The 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 Program is designed to assist the Ethiopian 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. Field epidemiology training resembles a traditional medical residency program, because trainees spend an extended period of time practicing and developing their skills in “a hands on” manner. Ethiopia adopted the Field Epidemiology Training Program to help improve leadership within Public Health Emergency Management. The 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. The EFETP program has two main components, each of which contributes to the prize of Master degree; classroom-teaching component consist 25% and practical attachment or field placement component (75%), residents spending 75% of their time in the field, consisting of disease investigations, surveillance data analysis, surveillance evaluations and research on national health problems. Residents have the opportunity for public health practice in the real world. 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. Both of the investigations were conducted using case control study design, one on Relapsing Fever Outbreak in Addis Ketema Sub city,Addis Ababa city administration and the other on Dysentery outbreak in Woreda 9 of Akaki Kality sub city, Addis Ababa City administration. The second chapter contains five years (2012 to 2016) Surveillance Data Analysis of Relapsing Fever in Addis Ketema sub city Addis Ababa City administration. Chapter three contains Measles Surveillance System Evaluation in Addis Ketema Sub city. Chapter four, Five and Six contains Health Profile Description of Woreda Six, Addis Ketema Sub city, Addis Ababa in 2016/2017, Meher health and Nutritional Need assessment conducted in in Afar Regional state, Ethiopia, 2017 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 community LLITNs ownership, knowledge and utilization in Kunaba woreda, Northern Afar, 2018”. The last chapter (Chapter 9) contains additional out puts (One Epidemic Bulletin, Conference attended, Research conducted, abstract summited for scientific presentations).
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    Compiled Body of Works in Field Epidemiology
    (Addis Abeba Universty, 2014-06) Markos Gurmamo; Adamu Addissie
    Background: Malaria is Mosquito vector borne blood parasitic Disease and One of the major Health problems of humankind. Even though intensive control measure like vector control, environmental management through community participation, malaria disease remained public Health concern of our country. Unusual Malaria cases increment was reported from Le-Zembara kebele, Tembaro district, Kembata Tembaro Zone, SNNPR, Ethiopia, in January 2016. We investigated the outbreak to describe the Magnitude of the disease and identify the risk factors associated with the outbreak. Method: Microscopic and RDT laboratory investigation conducted to confirm the disease. Person, place and time describe the disease magnitude. The threshold of the malaria disease in this kebele is compared by using the previous same season case data. We conducted the case control study with randomly selected 44 cases and 88 unmatched community controls. Epi Info 7.1.4 and Microsoft Excel were used to perform data entry and analysis. We also assessed environmental risk factors for the outbreak. Previous years’ malaria data was received to establish threshold level and understand trends of the disease. We conducted case control study randomly selected 44 cases unmatched 88 community controls from the community. Result: A total of 659 confirmed malaria cases (Attack Rate: 106 per 1000) and zero death were reported from January to February 2016 with the peak in February. Slide positivity rate was 77.8 %. Above 4 years age group were more affected by malaria (Age specific attack rate of per population was 121). Using bed net every night was preventive effect for the disease (Odds Ratio: 0.6, 95%CI, and 0.7-1.4). Presence of stagnant water (Odds Ratio: 6.2, 95%CI 1.5-24.8), presence of intermittent rivers in the area is (Odds of 1.6, 95%, 0.7-3.3 were associated with the disease occurrence. Conclusion and Recommendation: Presence of stagnant water bodies near living area , Low utilization of Insecticide treated bed nets in the households and staying more time outside during night time are most associated factors for this malaria disease outbreak .Kebele was not sprayed with IRS (Propecxure chemical) since 12 months. We recommend the draining of stagnant water bodies, Proper Utilization of ITNs, and spray of IRS FOR households.
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    Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-02) Ghidey G/libanos; Richar Luce; Adamu Addissie
    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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    Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-02) Mesafint Alebachew; Adamu Addissie ; Richard Luce
    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 analyzed by system attributes like simplicity, timeliness andcompleteness. 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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    Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2019-04) Melaku Seyoum; Adamu Addissie; Yimer Sied
    This compiled body of works has nine main chapters which all of them were done during the residency time of the program. These nine sections are expected outputs during the residency time; such as outbreak investigation, surveillance data analysis report, surveillance system evaluation, description of a health profile report, Manuscript for peer reviewed journal, abstract for submission in scientific conferences, writing protocol/proposal of epidemiologic research project, a summary of disaster situation report and other additional outputs. Chapter One:-Two outbreak investigations were carried out. The first outbreak was conducted in Hudet Woreda, Dawa zone of Somali region and the second in Addis Ababa. In the first outbreak a total of 358 measles cases with 13 deaths were identified in Hudet woreda and in the second outbreak 260 imported cholera cases with no death were identified in Addis Ababa Bole international airport. Both outbreaks were confirmed at EPHI national reference laboratory. To identify the risk factors case-control study design was conducted for the first outbreak investigations and descriptive for the second outbreak. Recommendation was given for both based on the findings. Chapter Two:-Conducting Surveillance data analysis is the other core competency for field epidemiology training program. We retrospectively analyzed a five year national malaria surveillance data collected from 2013 to 2017 to describe epidemiology of malaria in Ethiopia. Chapter Three:-Gambella regions’ Guinea worm disease surveillance system was evaluated from March 20 to April 5, 2018. Descriptive cross sectional study design was used. The chapter clearly presents the purpose and objectives of Guinea worm disease surveillance; its progress towards its objectives. The surveillance attributes: simplicity, flexibility, acceptability, representativeness, timeliness, data quality, sensitivity, cost, predictive value positive and usefulness of the surveillance system were also assessed and presented in the chapter. Chapter Four:-Health profile is a system of collecting and summarizing health and other health related events, demographic, socio-economic, political and cultural aspect of a particular district. Health and health related data was collected in Soro Barguda Woreda of west Guji Zone during February 25-March 15, 2018.MELAKU SEYOUM, AAU SPH EFETP Compiled Body of Work in Field Epidemiology April 2019. Chapter Five:-Included two manuscripts for peer reviewed journal. The manuscripts were conducted on measles outbreak investigation and cholera outbreak investigation reports. Chapter Six:-Presents abstracts on “Invest igat ion of Measles Outbreak in pastoralists and hard to reach Hudet woreda of Somali region, Ethiopia October 2018” and “Challenges of imported cholera cases among deportees in Ethiopia: From Saudi Arabia prisons March 2019. Both abstracts were developed during this residency period. Chapter Seven:-Narrative summary of disaster situation. Rapid conflict impact and recovery assessment in internally displace population in west Guji and Borena zones was conducted in March 2018. Chapter Eight:-Contain an epidemiological protocol entitled “community based measles immunization coverage survey among children aged 12–23 months in Hudet district of Somali region”. Community based measles immunization coverage was not widely assessed and often there is variation between actual coverage in the community versus administration coverage. The main purpose of this study is to determine community based measles immunization coverages and validate it with administrative coverage figures in the woreda. Cross sectional study design will be used in Hudet woreda from 1 MELAKU SEYOUM, AAU SPH EFETP July to 30th July 2019. Chapter Nine:-Contains other additional outputs like training and weekly epidemiologic bulletin. EFETP frontline workshop1 training was given to woreda and hospital level PHEM officers/focals in Tigray region, November 2018. Training material was comprised of importance of surveillance, Surveillance data collection, Surveillance data analysis and interpretation, surveillance data quality assessment; monitoring and evaluation. In addition to this Weekly epidemiological bulletin was written to SNNPR. FETP frontline trainings given to Oromia and SNNPR, PHEM Integrated supportive supervision, Influenza supportive supervision and the likes were conducted but not included in this report.
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    Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2025-09-20) Atsike Belay; Adamu Addissie; Zeytu Gashaw; Zegeye Hailemariam
    Background: On March 6, 2024, a patient with acute watery diarrhea and vomiting arrived at Dubti General Hospital in Afar Region, Ethiopia, suspecting cholera infection. Stool samples were collected and confirmed with Vibrio cholerae positive. As of April 15, 2024, 410 cholera cases in 2 zones were reported. We described the epidemiology, identified the determinants, and responded to the outbreak accordingly. Method: We conducted a descriptive study followed by an unmatched case-control study, with a 1:2 ratio, conducted from March to April 2024. 410 cases from the line list were used for the descriptive study, and 45 cases and 90 controls for the unmatched case-control study. A structured interviewer administered questionnaire was used for the data collection, with a Simple random sampling method for the sampling. ArcGIS was used to show disease distribution in a Map, and Data were entered into Epi Info software and analyzed using SPSS version 20 software. Logistic regression was used to compute the crude and adjusted odds ratios for the factors associated with cholera infection. Results: The study identified 410 cases (0.93/1000 Attack Rate) with no deaths registered. Of the total cases, 76.6% were severely dehydrated, 87.3% cases used river water sources, and 76% of the cases were in zone 1, The median age was 23 years (interquartile range:18-30 years) with a male-to-female ratio of 4:1, and 64.6% cases were daily laborers. knowledge of cholera infection [AOR=6.06, 95% CI=1.10-33.33], unimproved water sources [AOR=3.28, 95% CI=1.20-8.95], without latrine access [AOR=4.56, 95% CI=1.23-17.00], Contact with suspected cases [AOR=3.28, 95% CI=1.24-8.69], and traveled to active outbreak area [AOR=2.79, 95% CI=1.08-7.22] were the significant determinants of the outbreak. Conclusions: The study highlights that knowledge, unimproved water, and a lack of latrines were the causes of cholera transmission. We recommended that Strengthening WASH services and giving health education are essential to mitigating the outbreak.
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    Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2011-02) Tilahun Tafese; Richard Luce; Adamu Addissie
    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 providingessential 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 evolution, 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/TEPHINETconference 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 HarageZone,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.