Browsing by Author "Tumato, Million"

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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-02) Tumato, Million; Addissie, Adamu(Dr.); Luce, Richard(Dr.)
    This body of work which contains various outputs of epidemiological investigatigations onoutbreaks/epidemics and health related emergencies, assessmentand evaluation of surveillance systems,healthprofiles and compilation of various investigation findings and the like wasproduced as Thesis tofulfill partial requirement demanded for MPH degree in School of Public Health (SPH), Addis AbabaUniversity (AAU), Addis Ababa, Ethiopia, February 2011. It contains backgrounds, methods, results and discussions of different research activities undertaken whileaccomplishing very tasks of competency based field attachment which was scheduled to be carried out byresidents upon finishing theoretical part of courses in Field Epidemiology and Labortory Trainingprogram(EFELTP). EFELTP is a program which is firstof its kind in the country and was established on February2 /2009. Ultimate goal of this program is enhancement of dependable progress in public healthdevelopment of the country.Desirable outcomes are expected to be achieved by making unreservedcollaborative efforts through providing trainings to public health workers who were engaged in publichealth services provision activities in their respective regions in attempt of empowering their capacities inthe field and use them as vanguard health cadres in efforts being made to address particularly mostpressing public health problems there by enabling them contribute their level best in this regard. Thisprogram also renders various supports to empower laboratory service capacity to enable the systemprovide quality services to needy communities. It also provides supports to undertake epidemiologicalinvestigations on outbreaks/epidemics and health related emergency events. Moreover it is beingimplemented in geared attempt of strengthening production and communication of evidence based to thosein need to undertake possible intervention activities to address public health problems of the country. It also gives emphasis on supporting demand driven health research activities through provision ofrequired logistics and supplies and creating strong links between health programs,national andinternational health institutions, health research institutions and collaboratingwith local and internationalpartners and make unreserved efforts to meet set objectives of the program.To accomplish very missionof the program it placed utmost emphasis on communicable diseases and health related events prevetionand control ativities undertakings through provision of required supports of different sorts. Adopting thisstrategy of option is very useful to eventually bring about enhancement in health development progress.This approach can be regarded as vital for more than 80% of communicable diseases occurringparticularly in developing countries can be prevented and controlled if proper strategies of option beadopted and implemented as situations warrant. Currently magnitude of emerging and reemergingcommunicable diseases particularly epidemic prone ones show increasing tendency in low incomecountries of the world.. In Ethiopia burden of communicable diseases particularly epidemic prone ones ison increase and as result of which the need to escalate responses to address this cause is unquestionable. This compiled body of work prepared as Thesis can be considered as contribution made to ongoingnational effeorts being made to address issue of pressing public health problems of the country asresidents used to undertake required activities in teams as the program presupposes this approach to beimplemented for best results in this field. Moreover during field attachment period when ever any healthemergency situation occurs residents were made to actively collaborate with health facilities, institutionsand local and international partners (FMOH, AAU, EPHA, WHO, CDC, UNICEF...) to contribute toconcerted efforts and conjoint action being taken to address public health problems. Therefore thisactivities and their outcome contained in the body of work regarded as results of efforts made bymentioned institutions and their officers for intervention activities were undertaken conjointly.Body ofwork of this Thesis incuded: Reports on epidemiological investigations of outbreaks/epidemics/and relatedhealth emergency events, Reports on evaluations of surveillance activities, humanitarian needsassessments and assessment results of health profile of selected zone, woredasand health facilities werealso incorporated. Moreover it contains differentpieces of scientific writing including Abstracts, manuscripts and possiblescientific publication bulletins prepared on different health events which can be used to communicateresearch findingsto all in need to undertake possible intervention measures Having made general summary on What is meant by Body of work for this Thesis in Field Epidemiologyand accomplished very task of describing its overall contents, I here after explain about Epoidemiologicalinvestigations( outbreaks/Epidemics/Related health emergencies, assessments.evaluations of varioussurveillance systems, profiles and the like), what assessment was undertaken where, when and duration ofintervention and methods used to investigate issues/health problems deserved utmost priority. AWD outbreak/epidemic investigation/intervention activities wereundertaken for ten days in Gewane,Burimedaytoand Amibara districts in zone 3, Afar, Ethiopia, June 2009. After onemonth in the sameregion Afar team of Joint mission support to containAWD involvingpartners mentioned above and effortto deal with this problem was made for 02 weeks on July 2009. Since problem of AWD was encounteredalmost in all regions of the country, Multi sectoral involvement in intervention activities undertaken toescalateresponse to contain AWD outbreak. Similarly mentioned multi sectoral team went to DasenechWoreda, S.Omo Zone,SNNPR,December 2010. Methods adopted to investigate outbreaks of AWDincluded: Review of surveillance data, active case search, and Clinical examination of suspected caseswho fulfilled set criteria for case definition, environmental analysisand use of laboratory to investigatestool samples to confirm diagnosis. Based on produced evidence based information immediateintervention activities were implemented to prevent and control the outbreak inattempt of containing it.Because of unreserved efforts made by health service providers, partners and by and large activeinvolvement of communities it was possible to contain outbreaks of AWD in any of the regions affected.It was only in Addis Ababa where(July-December 2009) the epidemic was that of large scale involvingvarious segments of communities and practically all sub-cities where containingof the epidemicdelayedfor 06 months.Even in thiscitythough its magnitude was relatively higher as compared to other regionsthanks to unreserved concerted efforts and conjoint actions of all parties ir waspossible to contain it. Similarly different epidemiological investigations/assessmemts/evaluations were undertaken in differentplaces affecting different populationand for certain period of time.Ultimate goal of undertakingsuchinvestigations was to produce evidence based information and communicate to those inneed to takeappropriate measures to address public health problems particularly most pressing problems of thecountry. Analysis ofsurveillance (IDSR)data(05years)was done in Addis Ababa for06 monthsfromApril toAugust 2009. Outbreak investigation and surveillance activities were undertaken from May-Juneandongoing active surveillance activities with interventions lasted for more than 06 months, up to April 2010.Assessment of magnitude and trends of 10 years (2000-2009) road traffic accidents was undertaken formonthsfromDecember 2009-June 2010. Moreover outbreak investigation of measles and Relapsing feverin Kolfe-keranio sub-city, Addis Ababa was undertaken in February 2010. RelevantInvestigations together with laboratory testingweredone. After laboratory testing diagnosis wasConfirmed and prompt intervention activities were undertaken to contain outbreaks and prevent andcontrol outbreaks from occurring in the future. In additionMeasles surveillance evaluation and Healthprofile assessment activities were done for one month in Sidama zone, SNNPR, December 2010.Assessment of Humanitarian Needs assessment activities were conducted in Southern Nations,Nationalitiesand Peoples region, Ethiopia, July 2010. Proposal on magnitudeand trends of road trafficaccidents in SNNPR and Oromia regions was preparedand submitted to School of PublicHealth (SPH),
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    Ethiopian Field Epidemiology 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.