Browsing by Author "Bekele, Alemayehu(PhD)"

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    Ethiopia Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2017-06) Marshalo, Wadu; Ayele, Wondimu; Bekele, Alemayehu(PhD)
    The 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. Compeleteness 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 be determine 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 provide health profile description of Kindo Didaye district of Wolaita zone that will help for health planning. The total population of the district in 2016 is estimated as 122,062 based on a projection 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 to roads 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 was 66.12% 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 of unknown 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 woredas of 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 37 deaths, 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 Wolaita zone, 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 of AWD/cholrea and scabies outbreak response, Rapid Need Assesssment 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
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    Ethiopian field Epidemiology Training Program (EFETP) Compiled body of works in field Epidemiology
    (Addis Abeba Universty, 2017-06) Lere, Abraham; Bekele, Alemayehu(PhD)
    Background: 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. Key words: Measles; Immunization; Outbreak; Cheta
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    Ethiopian Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2016-05) Ayele, Tsehay; Bekele, Alemayehu(PhD); Tumato, Million
    The 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 Page xv 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 Prograram shayeayele@yahoo.com Page xvi 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.