Epidemiology

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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELT Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-02) G/libanos, Ghidey; Luce, Richar(Dr.); Addissie, Adamu(Dr.)
    Background A liver disease of unknown etiology which is characterized by epigastric pain, fever, jaundice, nasal bleeding, peripheral edema and abdominal swelling progressing to ascites with high morbidity and mortality reported among humans in six districts of the North-Western Zone of Tigray, Ethiopia since April 2002- 2010. This surveillance data analysis and outbreak/epidemic investigation was thus, aimed at describing the magnitude of unidentified liver disease by person, place and time for recommending possible preventive and control intervention strategies to the disease. Methods Study is conducted in North-Western Zone, Tigray region, Ethiopia. A line list was collected and case register log books of the districts were reviewed. Case definition was set based on the symptoms and signs of the disease to identify cases. Surveillance secondary data of all six districts of the Zone prepared in a line list was reviewed, entered and analyzed in Microsoft Excel. Results A total of 736 cases and 247 deaths were reported from April 2002 to June 2010, with an attack rate of 0.1% and case fatality rate of 33.5%. The median age of cases was 18 years which ranged between 1 and 81 years old. Age group of 5-14 accounted 32.7% (241/736). Sixty percent of total cases and 63% of deaths were males. Out of a total of 124 kebeles in these six districts 39 (31%) reported cases of unidentified liver disease to date. Conclusion and Recommendation Majority of cases affected by the disease were in the age group of 5-14, and with a higher proportion of male cases. Further research has to be employed in the area. Documents on how well cases were managed should be sought at all relevant health facilities to evaluate the the previous management of cases in order to recommend better future case management approaches.
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    Ethiopian Field Epidemiology and Laboratory Training Pro- gram (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-02) Alebachew, Mesafint; Addissie, Adamu(Dr.); Luce, Richard(Dr.)
    Background; epidemic and natural disasters are serious public health emergencies. Particularly,they occurred with little or no warning in the areas where health system is unprepared to deal with the emerging problems. From February 2001 to February 2003 E.C. stay in field epidemiology and training program, in Addis Ababa University and resident attachment in Addis Ababa region and field assignment by FMOH to different region we carried out outbreak investigation, surveillance data analysis, surveillance system evaluation,health profile assessment,accepted abstract for scientific presentation,Public Health need assessment,research proposal and other additional outputs.Epidemiological investigations of two outbreaks conducted during these periods. Descriptive epidemiology and outbreak investigations of acute AWD and HINI conducted. Five years Surveillance data analysis on descriptive epidemiology of disease under surveillance in Addis Ababa Regional Health Bureau was also performed in March 2001E.C.In addition to these morbidity and mortality data was obtained from Federal Ministry of Health, Plan and program department and Addis Ababa city Administration Health Bureau gathered and analyzed. The aim of this data analysis was to provide an insight on the burden of morbidity and mortality disease under surveillance. Surveillance system evaluation was also carried out in selected health facilities, in Kirkose sub-city health office and regional health bureau in 2003E.C. The purpose of this evaluation was to describe how well the communicable disease surveillance system in the region is working to meet its purpose and objectives. Data were gathered through interviewing of concerned bodies using questionnaire coupled with reviewing of existing records and reports and analysed by system attributes like simplicity, timeliness and completeness.The Belg (Sugum) Public Health and Nutrition emergency need assessment was conducted jointly with other partners within selected Woredas in zone Two and Four in Afar region in July 2002E.C. The purpose of the assessment was to identify potential risk for the occurrence of public health emergencies,current preparedness status and response capacity of the region.Existing records and reports were reviewed to obtain data on leading causes of morbidities and mortalities, health human resources, immunization and ITN coverage epidemic prone diseases and current stocks emergency drugs and medical supplies using data collection checklists.Formal interviews was made with Woreda officials and health professionals to obtain in-depth understanding about major health problems,occurrence,distribution,and duration of the disease outbreaks,current preparedness status,and response capacities.Finally research proposal on Prevalence of Salmonellosis among febrile out patients in Addis Ababa by 2003 E.C was prepared and submitted to Addis Ababa University Ethical Review Board and approved. Apart from mentioned above acute watery diarrhoea outbreak response supportive supervision in Addis Ababa 2002 E.C also conducted.
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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-02) Tumato, Million; Addissie, Adamu(Dr.); Luce, Richard(Dr.)
    This body of work which contains various outputs of epidemiological investigatigations onoutbreaks/epidemics and health related emergencies, assessmentand evaluation of surveillance systems,healthprofiles and compilation of various investigation findings and the like wasproduced as Thesis tofulfill partial requirement demanded for MPH degree in School of Public Health (SPH), Addis AbabaUniversity (AAU), Addis Ababa, Ethiopia, February 2011. It contains backgrounds, methods, results and discussions of different research activities undertaken whileaccomplishing very tasks of competency based field attachment which was scheduled to be carried out byresidents upon finishing theoretical part of courses in Field Epidemiology and Labortory Trainingprogram(EFELTP). EFELTP is a program which is firstof its kind in the country and was established on February2 /2009. Ultimate goal of this program is enhancement of dependable progress in public healthdevelopment of the country.Desirable outcomes are expected to be achieved by making unreservedcollaborative efforts through providing trainings to public health workers who were engaged in publichealth services provision activities in their respective regions in attempt of empowering their capacities inthe field and use them as vanguard health cadres in efforts being made to address particularly mostpressing public health problems there by enabling them contribute their level best in this regard. Thisprogram also renders various supports to empower laboratory service capacity to enable the systemprovide quality services to needy communities. It also provides supports to undertake epidemiologicalinvestigations on outbreaks/epidemics and health related emergency events. Moreover it is beingimplemented in geared attempt of strengthening production and communication of evidence based to thosein need to undertake possible intervention activities to address public health problems of the country. It also gives emphasis on supporting demand driven health research activities through provision ofrequired logistics and supplies and creating strong links between health programs,national andinternational health institutions, health research institutions and collaboratingwith local and internationalpartners and make unreserved efforts to meet set objectives of the program.To accomplish very missionof the program it placed utmost emphasis on communicable diseases and health related events prevetionand control ativities undertakings through provision of required supports of different sorts. Adopting thisstrategy of option is very useful to eventually bring about enhancement in health development progress.This approach can be regarded as vital for more than 80% of communicable diseases occurringparticularly in developing countries can be prevented and controlled if proper strategies of option beadopted and implemented as situations warrant. Currently magnitude of emerging and reemergingcommunicable diseases particularly epidemic prone ones show increasing tendency in low incomecountries of the world.. In Ethiopia burden of communicable diseases particularly epidemic prone ones ison increase and as result of which the need to escalate responses to address this cause is unquestionable. This compiled body of work prepared as Thesis can be considered as contribution made to ongoingnational effeorts being made to address issue of pressing public health problems of the country asresidents used to undertake required activities in teams as the program presupposes this approach to beimplemented for best results in this field. Moreover during field attachment period when ever any healthemergency situation occurs residents were made to actively collaborate with health facilities, institutionsand local and international partners (FMOH, AAU, EPHA, WHO, CDC, UNICEF...) to contribute toconcerted efforts and conjoint action being taken to address public health problems. Therefore thisactivities and their outcome contained in the body of work regarded as results of efforts made bymentioned institutions and their officers for intervention activities were undertaken conjointly.Body ofwork of this Thesis incuded: Reports on epidemiological investigations of outbreaks/epidemics/and relatedhealth emergency events, Reports on evaluations of surveillance activities, humanitarian needsassessments and assessment results of health profile of selected zone, woredasand health facilities werealso incorporated. Moreover it contains differentpieces of scientific writing including Abstracts, manuscripts and possiblescientific publication bulletins prepared on different health events which can be used to communicateresearch findingsto all in need to undertake possible intervention measures Having made general summary on What is meant by Body of work for this Thesis in Field Epidemiologyand accomplished very task of describing its overall contents, I here after explain about Epoidemiologicalinvestigations( outbreaks/Epidemics/Related health emergencies, assessments.evaluations of varioussurveillance systems, profiles and the like), what assessment was undertaken where, when and duration ofintervention and methods used to investigate issues/health problems deserved utmost priority. AWD outbreak/epidemic investigation/intervention activities wereundertaken for ten days in Gewane,Burimedaytoand Amibara districts in zone 3, Afar, Ethiopia, June 2009. After onemonth in the sameregion Afar team of Joint mission support to containAWD involvingpartners mentioned above and effortto deal with this problem was made for 02 weeks on July 2009. Since problem of AWD was encounteredalmost in all regions of the country, Multi sectoral involvement in intervention activities undertaken toescalateresponse to contain AWD outbreak. Similarly mentioned multi sectoral team went to DasenechWoreda, S.Omo Zone,SNNPR,December 2010. Methods adopted to investigate outbreaks of AWDincluded: Review of surveillance data, active case search, and Clinical examination of suspected caseswho fulfilled set criteria for case definition, environmental analysisand use of laboratory to investigatestool samples to confirm diagnosis. Based on produced evidence based information immediateintervention activities were implemented to prevent and control the outbreak inattempt of containing it.Because of unreserved efforts made by health service providers, partners and by and large activeinvolvement of communities it was possible to contain outbreaks of AWD in any of the regions affected.It was only in Addis Ababa where(July-December 2009) the epidemic was that of large scale involvingvarious segments of communities and practically all sub-cities where containingof the epidemicdelayedfor 06 months.Even in thiscitythough its magnitude was relatively higher as compared to other regionsthanks to unreserved concerted efforts and conjoint actions of all parties ir waspossible to contain it. Similarly different epidemiological investigations/assessmemts/evaluations were undertaken in differentplaces affecting different populationand for certain period of time.Ultimate goal of undertakingsuchinvestigations was to produce evidence based information and communicate to those inneed to takeappropriate measures to address public health problems particularly most pressing problems of thecountry. Analysis ofsurveillance (IDSR)data(05years)was done in Addis Ababa for06 monthsfromApril toAugust 2009. Outbreak investigation and surveillance activities were undertaken from May-Juneandongoing active surveillance activities with interventions lasted for more than 06 months, up to April 2010.Assessment of magnitude and trends of 10 years (2000-2009) road traffic accidents was undertaken formonthsfromDecember 2009-June 2010. Moreover outbreak investigation of measles and Relapsing feverin Kolfe-keranio sub-city, Addis Ababa was undertaken in February 2010. RelevantInvestigations together with laboratory testingweredone. After laboratory testing diagnosis wasConfirmed and prompt intervention activities were undertaken to contain outbreaks and prevent andcontrol outbreaks from occurring in the future. In additionMeasles surveillance evaluation and Healthprofile assessment activities were done for one month in Sidama zone, SNNPR, December 2010.Assessment of Humanitarian Needs assessment activities were conducted in Southern Nations,Nationalitiesand Peoples region, Ethiopia, July 2010. Proposal on magnitudeand trends of road trafficaccidents in SNNPR and Oromia regions was preparedand submitted to School of PublicHealth (SPH),
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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2011-02) Tafese, Tilahun; Luce, Richard(Dr.); Addissie, Adamu(Dr.)
    The Field Epidemiology and Laboratory Training Program is a competency-based training and service program in applied epidemiology and public health that builds the capacity to strengthen the surveillance and response system in countries where they are implemented. It is co-sponsored by The Federal Ministry of Health, Addis Ababa University School of Public Health, Ethiopian Public Health Association, and U.S. Centers for Disease Control and Prevention. The program is dedicated, through a combination of classroom and on-the-job training and service, to applied field-oriented public health practice. The goal of this program is to improve the health of Ethiopia’s population through a cadre of public health workers who will work on priority issues in the country, strengthening public health capacity and infrastructure and providing essential public health services to country. This compiled body of works has nine main chapters which all of them were done during the residency time of the program. The first eight sections are expected outputs during the residency time; such as outbreak investigation, report of analysis surveillance data, surveillance system evalution, description of a health profile report, writing of finalized scientific manuscript for peer review journals, abstract submit ion in scientific conferences, writing protocol/proposal of epidemiologic research project and a summary of disaster situation visited/risk assessment. In order to accomplish all the above eight outputs of residency and other additional works,different techniques and methods were utilized during an outbreak investigation in the field situation It was not always easy to conduct an investigation or study in well representative and probability sampled population within a limited time period, human and financial resources, So convenient sampling, secondary data and suspected case definitions were applicable for some outbreaks. In surveillance data analysis and system evaluation, it is crystal clear that data or databases at different levels are necessary and we tried our best to write on these two outputs. However, accessing data at national level was very challenging and time consuming because of many procedures and unclear reasons. The overall outputs of the two years field residency in the program are presented in a summarized way as follows; in the outbreak investigations chapter or section two outbreaks were investigated and well documented. These were an acute watery diarrhoea outbreak in Dasenech Woreda, South Omo zone, SNNPR from 11-20/3/2002EC ( November 20-29,2009GC), and Shigellosis Outbreak Investigation at AAU Technology Campus,March April, 2010, Surveillance data analysis on Descriptive Epidemiology of Under-Five Malnutrition in Ethiopia, 2000 And 2005. A measles surveillance system evaluation and a Health profile description report was also done in Sidama zone, SNNPR, 2010. Finalized scientific manuscripts submitted for peer reviewed journals February, 2011. And abstract was also prepared and submitted for scientific conferences accepted for oral presentation in EPHA conference, and APHINET/TEPHINET conference 2010. A report on health nutrition needs assessment (risk assessment) on prioritized districts of Afar regional state was also conducted with other team members from the food security center, WHO, UNCEF and EHNRI. A finalized epidemiologic research project proposal on a title; Assessment of Risk Factors and Trends of Measles Outbreak in Sidama zone, SNNPR, 2010 was also prepared.Under the other additional works/outputs section (chapter) Report on Acute Watery Diarrhea (AWD) outbreak response supportive supervision in Oromia Region, West Harage Zone,1429/12/2001EC and Follow up Visit, Situational Analysis and Need Assessment on the AWD Outbreak Preparedness and Response (April 10 to 27, 2010) was undertaken in Afare Regional State after the occurrence of outbreaks of acute watery diarrhea (AWD) in different districts of the region.
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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2011-03) Bezabih, Belay; Luce, Richard(Dr.); Addissie, Adamu(Dr.)
    Background: Diarrheal diseases are a global problem, but are especially prevalent in developing countries in conditions of poor environmental sanitation, inadequate water supplies, poverty and limited education. Objective: The study was conducted to investigate the outbreak epidemiologically & provide guidance on interventions to be taken in the control & prevention of the disease. Methods: 58 cases were selected conveniently & interviewed with structured questionnaire. All clinic pharmacy prescriptions from 10/05/2009-16/05/2009 were reviwed & duplicate prescriptions were excluded. Student cafeterias, latrines, water supply, & cooking rooms were observed. Stool & drinking water samples were also collected to verify the etiologic agent. Then data were analyzed using Epinfo version3.3.2 & Microsoft Excel. Results: A total of 538 cases were identified during the outbreak and 482 (89.6%) of them were males. The median & rang of age of cases was 20 & 31 years respectively. The attack rate and case fatality rate was 49% and <1% respectively. 69.0% (40), 22.4 %( 13), & 8.6 %( 5) of the interviewed cases had >6, 4 to 6 & <4 episodes of diarrhea per 24 hrs respectively. Only 22.4 % (13) of the interviewed cases practiced hand washing with soap after latrine while 89.7 % (52) of them made hand washing with soap before any meal. 57.9% (n=58) of cases had also contact history to an individual with similar illness, i.e. either they cared the case or sharing of drinking & eating utensils. Piped water source was used for cooking, cleaning utensils and hand washing. There was no bath room latrine for food handlers who were working in student cafeterias. No pathogen could have been isolated from stool samples which were analyzed in the microbiology laboratory. Conclusions & recommendations: The overall attack rate was high (49%) and based on the case definition and characteristics observed on antibiotic treatment the cause of the outbreak could be shigellosis however the etiology was not confirmed by laboratory. But other agents lik Enterotoxigenic Escherchia coli (ETEC) could not be excluded. Hand washing & other hygienic practices were inconsistent among students & college food handlers & it needs continuous follow up and health education on sanitation issues should be strengthened. Training of health workers on recording and reporting of cases especially during outbreak is necessary. Responsible bodies (like local or regional health bureaus) should also offer training for health workers on epidemic diseases, supervise & monitor the college clinic regularly.
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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2011-04) Kidu, Beyene; Luce, Richard(Dr.); Adissie, Adamu(Dr.)
    Three outbreak investigations were conducted in Oromia region: acute bloody diarrhea outbreak in Alagie Agricultural College (May 2009), acute watery diarrhea outbreak in Shashemene districts (June 2009) and pandemic influenza A (H1N1) 2009 in Illu ababora zone (Nov2010).The outbreak investigation made in Alagie Agricultural College and IlluAbaBora zone were exclusively descriptive type. In both cases the purpose of the investigation was to confirm the etiology of the outbreak and providing assistance in the prevention and control of the outbreak.The outbreak investigation carried out in Shashemene districts was case control study. Apart from confirming the etiology this investigation was aimed at identifying the possible risk factors associated with outbreak. National acute respiratory infections surveillance data analysis was also performed in March 2009. In this case, two years i.e. from 2006 to 2007 morbidity and mortality data was obtained from Federal Ministry of Health, Plan and program department. The aim of this data analysis was to provide an overview of the burden of acute respiratory infections in under five children in Ethiopia. A surveillance system evaluation was carried out in selected health facilities, district health offices and the regional health buraeu, Tigray region in Dec 2010. 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. Concurrently, a health profile assessment of 2002 Ethiopian fiscal year of Enderta district was carried out.
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    Assessment of the Association between HIV/AIDS and Multi-Drug Resistance Tuberculosis: A Systemic Review with Meta-analysis.
    (Addis Ababa University, 2012-06) Moges, Asmamaw; Hailemariam, Damen(Prof.)
    Back ground: Human immunodeficiency virus, multi-drug resistant tuberculosis and extensive drug resistant tuberculosis are emerging as major challenges facing tuberculosis control programs worldwide (especially in Asia and Africa). The challenge is not only from a public health point of view but also in the context of global economy, especially in the absence of treatment for multi-drug resistant tuberculosis at national-level programs in developing countries. The association between multi-drug resistant tuberculosis and Human Immunodeficiency Virus infection has not yet been fully investigated and the results of the studies so far conducted were not consistent. Objective: The aim of this study was to summarize the evidence on the association between multi-drug resistant tuberculosis and HIV infection through a systematic review of existing literature. Methods: Literature based systemic review of observational studies was conducted. Original studies providing Mycobacterium tuberculosis resistance data stratified by Human Immunodeficiency Virus status were identified using data bases such as MEDLINE/PUBMED, Google Scholar and HINARI. The descriptions of original studies were made using frequency and forest plot. Publication bias was assessed using Funnel plot graphically and Egger weighted and Begg rank regression tests statistically. Heterogeneity across studies was checked using Cochrane Q test statistic and I. Pool risk estimates of multi-drug resistance tuberculosis and sub-grouping analysis were computed to analyze associations with Human Immunodeficiency Virus status. Results: Random effects meta-analysis of all the 24 observational studies showed that Human Immunodeficiency Virus infection was associated with an increased risk of multi-drug resistant tuberculosis (summery odds ratio 1.24; 95%, 1.04 – 1.43). Subgroup analyses showed that effect estimates were higher for primary multi-drug resistance tuberculosis and in population based studies. Conclusions: Human Immunodeficiency Virus infection is positively and significantly associated with an increased risk of multi-drug resistant tuberculosis regardless of study base and multi-drug resistant tuberculosis type. There should be strong collaboration between HumanImmunodeficiency Virus and tuberculosis control programs.
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    Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2012-06) Adamu, Zekarias; Aragaw, Mer’Awi(Dr.)
    Backgrounds: In 2011, Ethiopia faced measles outbreak from different regions of the country. Bahir Dar Zuria woreda, Amhara Region is one of affected woreda by measles outbreak. Bahir Dar Zuria woreda health office reported the Chenta outbreak to Regional Health Bureau, Public Health Emergency management department by telephone on April 9, 2011. The report initiated outbreak investigation to identify the etiology, assess risk factors and propose appropriate intervention. Methods: Descriptive study was conducted in Chenta kebele, Bahir Dar zuria, Amhara Regional state, from April 20 to June 7, 2011. Data were collected by using measles outbreak reporting line list and unstructured questionnaire. Those cases that develop fever, rash and either cough or Coryza or Conjunctivitis were searched from clinic registration and house to house. Descriptive analysis done by entering and recoding collected data using Epi-info version3.5.1 and Microsoft office Excel 2007. Results: A total of 46 cases with 2 deaths (Case fatality rate CFR=4.35%) were identified in Chenta Kebele. The age range was 1 to 38 year with median age of 11.5 year; and age distribution of cases were 11(23.9%), 17(37%) and 18(39.1%) cases at age groups of 1 to 4, 5 to14 and 15 to 38 years old respectively. Of 46 cases 24(52.2%) were Females. The vaccination status of cases were 24(52.2%) not vaccinated, 17(37%) received 1 dose and 5(10.9%) received 2 doses of measles vaccine. The first index case of Chenta has travel history to Dehina Mariam which reported measles outbreak prior to Chenta. Conclusion and Recommendation: .In this kebele, legible children are found not vaccinated. Travel history to measles affected area and accumulation of susceptible children in the kebele may have facilitated the outbreak. And hence, strengthening routine and supplemental immunization activities and early control of localized outbreak elsewhere will prevent future outbreaks and expansion of outbreaks.
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    Assessment of Prevalence and Associated factors with Female Genital Cutting among Young Adult Female Students in Jigjiga District, Somali Region, Ethiopia
    (Addis Ababa University, 2013-05) G/mariam, Kidanu; Assefa, Demeke(MD, MA)
    Introduction: Female Genital Cutting (FGC) is a harmful traditional practice detrimental to the sexual and reproductive health of girls/women which is a common practice in most developing countries of the world. It is a very common practice in Ethiopia, particularly in Somali region; it is commonly being practiced since generations and it seems to be almost universal in the region. Following this ,the study was aimed to assess the prevalence and factors associated with female genital cutting. Objective: To assess prevalence and associated factors with FGC in Jigjiga district. Methods: School based cross-sectional mixed method combining both quantitative and qualitative research method was conducted among 679 randomly selected young adult female students from high school and college in Jigjiga district from Feb-mar2012. For the quantitative study, a multistage sampling technique was employed to select study subjects and a pretested structured questionnaire was used to collect data. The qualitative data were collected using FGDs and four FGD discussions were conducted using non directive open ended questions. Epi Info version3.5.3 was used for data entry and SPSS versions17 for data analysis. Open Code was used to analyze the qualitative data. Results: This study revealed that the prevalence of FGC among the respondents and their youngest sister were 82.6% and 81.1% respectively. The dominant form of cutting was Type I, 265(49.3%) in the study area. Majority of girls, 575 (88.3%) and 407(62.7%) had good knowledge towards the bad effect of FGC and had positive attitude towards FGC discontinuation respectively. Religion(AOR=3.7;95%CI:1.1-12), residence (AOR=4;95%CI=2.4-6.8), respondents‟ educational level (AOR=0.5; 95%CI:0.3-0.8), maternal education (AOR=2.4;95%CI:1.3-4.3), attitude (AOR=0.5;95%CI:0.3-0.9)and religious requirement (AOR=1.7 95%CI=1.07-2.8) were the most significant predictors of FGC. The possible reasons for FGC practice were to keep virginity, to improve social acceptance, to have better marriage prospects, religious approval, and to have hygiene. Conclusion and recommendation: Despite girl‟s knowledge and attitude towards the bad effect of FGC, the prevalence of FGC was still high. The direct and indirect effect of FGC on violation human rights of girls/women may seriously affect the effort made towards realization of empowering women and gender equity. There should be a concerted effort among women, men, religious leader and other concerned bodies in understanding and clarification of the wrong attachment between the practice and religion through behavioural change communication and advocacy at all levels.
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    Magnitude and Trends of Road Traffic Accident and Associated Factors: from Akaki to Adama, July 2007-June 2012, Oromia, Ethiopia
    (Addis Abeba University, 2013-06) Asefa, Fekede; Assefa, Demeke(Dr.); Worku, Alemayehu(Dr.)
    Background: Road traffic accident is now becoming a public health problem in the world and resulting in human tragedy. Globally, about 1.2 million people are killed in road traffic accident every year and 20 to 50 million more are injured and/or disabled. These injuries account for 2.1% of global mortality. Low- and middle-income countries account for about 85% of the deaths and 90% of the DALYs lost annually due to road traffic accident. Without appropriate action, by 2020,road traffic injuries are predicted to be the third leading contributor to the global burden of disease. Despite having low road network density and vehicle ownership, Ethiopia has a relatively high accident records. Road accidents are concentrated in few of the regions in the country. The capital City of Addis Ababa and Oromia Region account for 58 per cent of all fatal accidents and two thirds of all injuries Objective: To assess magnitude, trends and associated factors of road traffic accident from Akaki to Adama. Method: Retrospective study was conducted from police reports between July 2007 and June 2012 retrieved from the 8 police stations in the study area. Result: A total of 2335 accidents have been registered in the study area from July 2007 to June 2012. Of those 389 (16.7%) resulted in death (fatal accident), 316 (13.5%) resulted in severe injuries, 290 (12.4%) resulted in slight injuries. The rest 1316 (56.4%) accidents resulted in property damage. During the study period, 1745 individuals were affected as a result of the accident. Of those 515 (29.5%) victims died, while 549 (31.5%) sustained severe injury and the rest slight injury. The major reason for the accidents were over speeding accounting for 836(36.1%) followed by careless driving 573 (24.8%) and failure to give priority 507 (21.9%) for other vehicles and pedestrians. Being Female driver, accident occurring at mid night, accident caused by over speeding, failure to give priority and vehicles having technical problem are strong determinants of fatality. Conclusions and recommendations Trend of road traffic accident was steadily increased in magnitude from July 2007-June 2012 in the study area which calls for urgent interventions. Enforcing drivers to obey traffic rules and strong enforcement of speed limit appear to be the most critical parts of interventions.
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    Trends and Magnitude of Women’s Overweight and/or Obesity and its Socio-demographic Correlates among Urban Ethiopian Women, Urban Ethiopia; Evidence from EDHS, 2000 to 2011
    (Addis Abeba University, 2013-06) Abreha, Solomon; Shiferaw, Solomon(MD, MPH)
    Background: Overweight and obesity are among the risks factors of various chronic diseases. In developing countries undergoing nutritional transition, overweight and/or obesity is becoming more prevalent among women. Though less attention is given to the problem of overweight and/or obesity in Ethiopia, its prevalence is on a rise among urban Ethiopian women (15% in 2011). Hence, documenting the magnitude of overweight and/or obesity and identifying its socio-demographic correlates will help to understand the scope of overweight and/or obesity among urban women. Objective: To examine trends and magnitude of overweight and/or obesity and to identify its socio-demographic correlates among urban Ethiopian women aged 15-49, between 2000 and 2011. Methodology: Cross sectional data from the three Ethiopian Demographic Health Surveys was used for this study. A total of 7,312 non pregnant urban women were included in this study. The main outcome of interest was overweight and/or obesity and the independent variables were age, wealth index, parity, occupation, region of residence, educational and marital status. Complex sample descriptive, bivariate and multivariate logistic regression was used to analyze the data. Results: The prevalence of overweight and/or obesity among urban women was 10.7% in 2000,14.0% in 2005 and 14.9% in 2011. The overall prevalence increased by 4% from 2000 to 2011 though it was not statistically significant: [from 10.7% with 95% CI; (9.8, 12.8) in 2000 to 14.9% with 95% CI; (12.4, 17.6) in 2011]. Particularly, the prevalence significantly increased over time among women who were older, 40-49 years: [from 15.6% with 95% CI; (11.6, 20.5), in 2000 to 32.2% with 95% CI; (25.4, 39.8), in 2011, x 2=25.7 and p < 0.001]. It was also significantly increased among those who were residents of the three Metropolis (Addis Ababa, Dire Dawa and Harari): [from 15.9% with 95% CI; (13.3, 17.7) in 2000 to 20.3% with 95% CI; (18.2, 22.50), in 2011, x2=5.3 and p < 0.05]. Being older, 40-49 years, [OR=4.5 (95% CI; (2.2, 9.0)], attainment of secondary education or above, [OR= 2.5 (95% CI; (1.4, 4.7)] and living in the three metropolis [OR=5.8 (95% CI; (3.2,10.4)] were significantly and positively associated with the condition of overweight and/or obesity in 2000. Being older, 40-49 years, [OR=5.1 (95% CI; (2.3, 11.7)], resident of the three Metropolis,[OR=3.8 (95% CI; (1.4, 8.2)], in the richest quintile, [OR=2.2 (95% CI; (1.2, 4.1)], attainment of secondary education or above, [OR=2.2 (95% CI; (1.2, 4.3)] and being currently married[OR=2.5 (95% CI; (1.2, 5.3)], were found to be significantly and positively associated with being overweight and/or obese while women engaged in manual work were less likely to be overweight and/or obese, [OR=0,4 (95% CI; (0.2, 0.8)] in 2005.The odds of be being overweight and /or obese was significantly higher among women were older, 40-49 years [OR=9.8 (95% CI; (5.1, 13.8)] , resident of the three Metropolis [OR=2.2 with 95% CI; (1.2, 4.2)], in the richest quintile, [OR= 1.8 (95% CI; (1.1, 2.5)], currently married[OR=2.0 (95% CI; (1.2, 3.1)] and among those with secondary education or above [OR=2.0;with 95% CI; (1.3, 3.1)]. Conclusions and Recommendations: the findings of this study have provided information on the prevalence and socio-demographic correlates of overweight and/or obesity among urban Ethiopian women. The findings also showed that the problem of overweight and/or obesity is on a rise among urban Ethiopia women. Hence, there is a need for policies and public health interventions which promote healthy lifestyle (consumption healthy diet and doing regular physical activity) to address the problem of overweight and/or obesity. These policies and interventions need to be age sensitive and need to target more urbanized cities and towns. However, the scope of such interventions can be broaden based on evidences from future researches.
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    Survival to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program in Southern Ethiopia.
    (Addis Abeba University, 2013-06) Merid, Melkamu; Deyessa, Negussie(MD, MPH, PHD)
    Background: Community-based management of severe acute malnutrition has been widely rolled out and integrated to the existing health care system in Ethiopia. But there is a dearth of information concerning the survival to recovery of severely acutely malnourished children after rolling out of the program to a health post level in the country. Objectives: To examine survival to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program in Southern Ethiopia. Method and materials: Institution based retrospective cohort study was conducted using a data available from Jan. 2011 to Jan. 2013 in twelve randomly selected health posts. A two population proportion formula was used to calculate a sample size of 374. Descriptive analysis was done using percentages for categorical data and mean/median for continuous variables. Chi-square was used to measure associations between categorical variables. The Mann-Whitney U test for the independent two samples test was used to compare the medians for non-normally distributed continuous variables. The outcome variable was time to recovery. The life table analysis and the Kaplan-Meier product limit were used to estimate the survival characteristics of the study subjects. And the log rank test was used to compare the survival curves. The Cox proportional-hazard regression model was used determine predictors of time to recovery. Result: A total of 348 patient cards were reviewed. The median time to recovery was 35 days and 49 days for children with kwashiorkor and marasmus respectively. It was significantly different (Log Rank=46.93, df=1 P<0.001). There was a 1.2% decrease in the likelihood of recovery for one month increase in age (AHR=0.988, (0.977, 0.999)). Children with marasmus were also 48% less likely to recover (AHR=0.517, 95% CI (0.386, 0.691)). Children who had a weight gain of >=3.21gm/Kg/d were 2.43 times (AHR=2.434, (1.828, 3.241)) more likely to recover. For a MUAC gain (mm/day) of one unit increase there was a 2.33 times (AHR=2.326, (1.373, 3.942)) increase in the likelihood of recovery. Conclusion: Being marasmic, age, weight and MUAC gain were identified as a predictor of recovery. Hence it needs special attention on counseling the care taker about the appropriate way of feeding the therapeutic diet to the sick child to improve weight and MUAC gain with due emphasis given to marasmic children.
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    Ethiopia Field Epidemiology Training Program (EFETP)Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2018-06) Abichu, Getachew; Enquselassie, Fikre(PhD,Prof.); Abuna, Fufa(PhD)
    Ethiopian Field Epidemiology Training Program (EFETP) is a two years in-service training program adapted from the United States Centers for Disease Control and Prevention (CDC). The program is designed to assist the Federal Ministry of Health (FMOH) and Federal ministry Livestock and Fisheries (MOLF) as one health approach to track epidemic and zoonotic diseases which confront the public health. This program strengthen early detection of disease outbreaks forming a bridge among human and animal health profession to control public health importance diseases. This compiled body of work composed of mainly seven main section which performed during residence I and II. Main section includes: outbreak investigations, surveillance data analysis,surveillance system evaluation, health profile assessment, scientific manuscript, project proposal and one research conducted on zoonotic disease.This document is organized in eight chapters:Chapter One: Disease outbreak investigation which contain two outbreaks: one with outbreak investigation of Measles in Mieso district, West Hararge zone, Oromia region and the second one was Anthrax outbreak investigation and confirmation in Farta and Smada districts, South Gondor, Amhara regional state. Chapter two: Surveillance data analysis on Malaria in Sebeta district of six year data to capture the outbreak trend from 2012-2017 Chapter three: Public Health profile assessment in one of the special zone of Oromia region which showed tremendous demographic dynamicity in related to different health and health related facilities in 2018. Chapter four: public disease surveillance system evaluation in Malaria an existing surveillance which is one of the weekly reportable prioritize disease. Chapter Five: epi project proposal on Brucellosis one of zoonotic disease having economically and public importance disease. Chapter six: Written Manuscript on the detection and confirmation of Anthrax outbreak investigation Chapter seven: Serological and molecular detection of brucellosis from camel, cattle goat and sheep from Eastern part of Ethiopia, which explain current prevalence of the disease from livestock mainly in pastoral communities. Chapter Eight: Abstract for scientific presentation, contains two abstracts of measles outbreak in Mieso district West Hararge zone, Oromia regional state, and Animal and Human Anthrax in Farta and Smada districts of south Gondor, Amhara regional state.
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    Burnout and professional satisfaction among primary healthcare providers in Southern Ethiopia
    (Addis Abeba University, 2018-10) Selamu, Medhin(PhD); Fekadu, Abebawdu (MD, PhD); Prof.Thornicroft, Graham(MD, PhD); Hanlon, Charlotte(MD, PhD)
    Background: Wellbeing of healthcare workers (HCWs) is important for the effective functioning of health systems; it impacts the health service quality and patient outcome.HCWs are at an increased risk of stress and burnout both the nature of their work and their context of their work, but this has been little investigated in low income countries. The aim of this study was to: (1) explore the conceptualisations of wellbeing, stress and burnout, (2) assess the level of burnout and, professional satisfaction and (3) evaluate the short-term outcome of burnout and associated factors in the context of mental health service provision among HCWs providing healthcare in a rural districts in Southern Ethiopia. The study has followed a mixed methods approach divided into three overlapping studies. Study one (conceptualisation of burnout) Methods: was a qualitative study conducted in the Silti zone. A total of 52 frontline primary HCWs participated in either the in-depth interviews (n=18) or Focus Group Discussions(FGDs) (4 groups, total n=34). Data were analysed using thematic analysis. Results: Most participants conceptualised wellbeing as absence of stress rather than as a positive state. Many threats to wellbeing were identified. For facility-based workers, the main threats to wellbeing were inadequate supplies leading to fears of acquiring infection and concerns about performance evaluation. For community -based health workers, the main threat was role ambiguity. Workload and economic inefficiency were concerns for both groups. Burnout and its symptoms were recognised and projected by most as a problem of other healthcare workers. Derogatory and stigmatising terms, such as, “chronics”, were used to refer to those who had served for many years and who appeared to have become drained of all compassion. Most participants viewed burnout as inevitable if they continued to work in their current workplace without career progression. Structural and environmental aspects of work emerged as potential targets to improve wellbeing, combined with tackling stigmatising attitudes towards mental health problems. An unmet need for intervention for healthcare workers who develop burnout or emotional difficulties was identified. Study two (level of burnout) Methods: was a sequential, mixed quantitative and qualitative methods study of HCWs working in all 66 rural primary healthcare facilities (n=145) of the Sodo district, South Ethiopia, where a new integrated mental health service was being implemented. First a quantitative cross-sectional survey was conducted. The Maslach Burnout Inventory (MBI) was the primary measure of burnout, comprising three domains: emotional exhaustion, cynicism and reduced feeling of personal accomplishment. Cynicism was excluded from most analysis because of poor internal consistency of the domain. A set of instruments measuring professional satisfaction and psychosocial stress were also included. All instruments were self-administered. To assist understandings of the quantitative findings, four FGDs were conducted with 17 community and 16 facility-based HCWs. Results: A total of 145 HCWs who had worked for a median of 5.0 (25 th and 75 percentiles or interquartile range (IQR) 0.4, 12) years participated in the study. Most participants were female (62.1%; n=90) and working in healthcare facilities (65.5%; n=86); a third were community-based health extension workers. The median score (IQR) on the MBI was 3 (0, 8) for emotional exhaustion, and 34 (24, 40) for reduced personal accomplishment. High depression symptom scores (adjusted Odds Ratio (aOR) 1.19, 95% CI 1.05, 1.34), poor social support (aOR 1.45, 95% CI 1.12, 1.86), and experiencing two or more stressful life events(aOR 1.41, 95% CI 1.12, 1.95) were associated with higher emotional exhaustion. Only about half (50.8%) reported a high level of job satisfaction. FGD participants spoke of high levels of burnout and job-related stress, which the participants believed was under-reported in the quantitative study due to the overwhelming expectations to be strong and exemplary in the eyes of the community. Study three (short-term outcome of burnout) Methods: was a longitudinal follow up of the study two participants (145 primary HCWs working in the Sodo district). Burnout was assessed at baseline (when the new service was being introduced), as part of the initial cross-sectional survey, and after six months. Multivariate logistic regression and generalised estimating equations (GEE) were used to assess the association between burnout and relevant work-related and psychosocial factors. Results were considered statistically significant whenever p-value was less than 0.05. Results: A total of 136 (93.8%) of PHC workers were re-interviewed after six months. There was a non-significant reduction in the burnout level between the two time points. In GEE regression models, high depression symptom scores (adjusted mean difference (aMD) 0.56,95% CI 0.29, 0.83 p<0.01), experiencing two or more stressful life events (aMD 1.37, 95% CI 0.06, 2.14 p<0.01) , being a community health extension worker (aMD 5.80, 95% CI 3.21,8.38 p<0.01) and perceived job insecurity (aMD 0.73, 95% CI 0.08, 1.38 p=0.03) were significantly associated with higher levels of emotional exhaustion. Conclusion: Ethiopian primary healthcare workers, particularly community health workers,face job-related stress and experience symptoms of burnout, which may contribute to the dissatisfaction of both patients and HCWs. However, the overall prevalence of burnout was lower than expected. There was also little change in severity score in the short-term. At least in the short-term, there is no apparent negative impact on burnout of adding mental healthcare into the care portfolio of PHC workers. Recommendation: Longer term and larger scale studies are required to substantiate these findings and understand the issue in depth. Future qualitative studies need to be done to understand the expression and impact of burnout in this setting and how barriers to detection may be overcome. Contextually relevant interventions also need to be developed and tested, giving priority to community health workers. Preventive works such as routine screening of HCWs for job related stress might help to prevent burnout. Improving awareness about mental health and self -care may have impact on preventing burnout.
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    Survival of Stroke Patients According to Hypertension Status in Northern Ethiopia
    (Addis Ababa University, 2019) Gufue,Zenawi Hagos; Gizaw,Naod Firdu (MD, MPH, Ass. Prof.); Ayele,Wondimu (MSC, PhD candidate); Yifru,Yared Mamushet(MD, MSC, Ass. Prof.)
    Background: Globally, stroke appears as a major cause of preventable death and disability. In Ethiopia, the intra-hospital mortality of stroke is significant and there is scarcity of epidemiologic data whether there is a difference in the overall survival time between hypertensive and non-hypertensive adult stroke patients admitted in specialized hospitals. Objectives: To determine the survival of stroke patients according to their hypertension status admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia from March 1, 2012 to February 28, 2019. Methods: A facility-based retrospective cohort study conducted among all cohorts of confirmed first-ever stroke patients admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Kaplan-Meier survival analysis applied to estimate the survival probability of hypertensive and non-hypertensive first ever stroke patients. Cox proportional hazards regression model used to determine the adjusted hazard ratio of death for each main baseline predictor variable, with 95% CI and P-value <0.05 was used to declare statistical significance. The assumptions of Cox proportional hazards regression model assessed by the global test, Schoenfeld residuals. Results: There were 503 (323 were hypertensive, 180 Non-hypertensive) confirmed first, ever stroke patients, the overall median age of the patients was 65 years, IQR (53-75) years. Seventy-five (14.91%) of them were dead, with median survival time of 48 days and 428 (85.09%) of them were censored. At any particular point in time the hazard of death among hypertensive patients was two times higher than non-hypertensive patients but this was not found to be a statistically significant (adjusted HR=2.13: 95% CI 0.66-6.81). Glasgow coma scale 3-8 at admission (adjusted HR=10.12; 95% CI 2.58-40.68), presence of stroke complications (adjusted HR=7.23; 95% CI 1.86-28.26) and borderline high total cholesterol level (adjusted HR=3.57; 95% CI 1.15-11.1), were the only independent predictors of intra- hospital patient mortality. Conclusion and recommendations: There was a non-significant difference in the overall survival time between hypertensive and non-hypertensive first-ever stroke patients. Early identification and treatment of stroke complications, co-morbidities along with strict follow up of comatose patients may improve intrahospital survival of stroke patients and we recommend community based studies using large sample size.
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    Ethiopia Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2019-04) Wondmnew, Taddie; Ashenafi, Hagos(Prof.); Bekele, Alemayehu(Dr.)
    The Ethiopia Field Epidemiology Training Program (EFETP) is 8 years competency based master’s program adapted from the United States Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) Program. The School of Public Health/Addis Ababa University, the Federal Ministry of Health of Ethiopia/Ethiopian Public Health Institute (EPHI),and CDC Ethiopia are running the Program jointly former your years. After all the program extended their coverage to other 8 university to increase field epidemiologist for the country. The field work comprises of 75% of the Program which is called residency; learning by working in public health emergency and other health related priority issues. The Program is designed to assist the Ministry of Health in building or strengthening health systems by recruiting promising health workers and building their competencies through on-the-job mentorship and training.Ethiopia adopted the Field Epidemiology Training Program to help improve leadership within Public Health Emergency Management. The Ethiopian Field Epidemiology Training Program (EFETP) provides residents a Master of Public Health Degree in Field Epidemiology after they complete two years of supervised work in applied or Field Epidemiology. This compiled body of works has 10 main sections or chapters accomplished during the residency time of the Program. The first 7 sections are expected outputs during the residency time; comprising of outbreak investigation, surveillance data analysis, evaluation of the surveillance system, health profile description report, writing of finalized scientific manuscript for peer review journals, abstracts submitted to scientific conferences, summary of disaster situation visited/risk assessment and other additional works. The overall outputs of the two years Field Residency Program will be presented in a summarized way; in the outbreak investigations chapter or section, one unmatched case control outbreak investigation of Pertussis in Sayient Woreda, North west part of Ethiopia, January 2019 was documented. Health profile description report was done in Fogera district in March 2018 and Surveillance system evaluation was also done in Fogera and Dera Districts, Amhara Region, in March 2018. One finalized scientific manuscript was prepared for peer reviewed journal. A report on need assessment (risk assessment) on prioritized Districts of Amhara Regional State was also conducted with other XIII team members from food security center, WHO, UNICEF, ADDPS and Other Regional Bureau. Under other additional works/outputs section (last chapter) activities like provision of training for public health emergency management (PHEM) officers working at different levels (regional to health facility level) in the Amhara Regional Health Bureau were also undertaken. Other activities we developed of Rabies and Anthrax case based and line list and weekly Bulletin,update, summary report of Pertussis outbreak, prepared and present Anthrax outbreak investigation report on Workshops.
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    Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2019-04) Tesfaye, Neamin; Belachew, Ayele(MD, MPH); Ayele, Wondimu( Ph.D. fellow); Assamaw, Negga(Ph.D. fellow)
    This document contains two years Field Epidemiology Training Program outputs, to be submitted to the school of public health for the fulfilment of the master’s degree in Field Epidemiology. This Compiled Body of Work has nine 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 as well epidemiological project proposal with that additional output is incorporated within the nine chapters
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    Ethiopia Field Epidemiologyand laboratory Training Program (EFETP)Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2019-04) Seyoum, Melaku; Addissie, Adamu(Phd, Ass.Prof.); Sied, Yimer(BSc, MHP)
    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 “communit y 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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    Ethiopian Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2019-05) Shitu, Dessalew; Girmay, Abiy(Dr.); Regassa, Fikru(Dr.)
    This document contains all outputs which are accomplished in residency periods in field epidemiology training program. This body of works is compiled as per the format provided by the program and submitted to graduate school of public health for partial fulfillment of Master Degree in Field Epidemiology. The document is organized by eight chapters consisting of expected outputs produced through the two years of residency periods. Chapter one contains two outbreak investigation reports. The two studies conducted on Rotavirus and suspected anthrax outbreaks using case-control study design. Chapter two contains report of surveillance data analysis which was conducted on five years aggregated meningococcal meningitis data reported through weekly bases in Southern Nations,Nationalities and Peoples (SNNP) region. Surveillance system evaluation report is included in chapter three which was conducted on meningococcal meningitis surveillance system as proxy indicator in Kolfe Keranio Sub-city, Addis Ababa. Chapter four contain health profile assessment of Ginir woreda in Bale zone, Oromia region. Chapter five contains scientific manuscript of Rotavirus outbreak for peer reviewed journals. In chapter six, two abstracts are presented on Rotavirus outbreak investigation and meningococcal meningitis surveillance data analysis. The other expected output is disaster situation narrative summary report which was conducted on IDPs in Bale zone and it was described on chapter seven. Lastly, epidemiologic research proposal ent it led ‘Mapping the risk of anthrax outbreaks both in humans and animals in Waghimra and South Gondar zones of Amhara regional state’ are presented on chapter eight.
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    Ethiopian Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
    (Addis Ababa University, 2019-05) G/Mariam, Tadesse; Worku, Alemayehu(Prof.); Firdu, Naod(Dr.)
    The Ethiopian Field Epidemiology Training Program is a two year post graduate training program. The training is provided in collaboration with Addis Ababa University, School of Public Health, Ministry of Health and Ethiopian Public Health Association. The program designed to work 75% of the time in service and 25% theory, it is learning by doing. For the partial fulfillment of master‘s in public health in field epidemiology, this summary compiled two year residency outputs; surveillance data analysis, surveillance system evaluation, health profile, outbreak investigation, manuscript and disaster report. The document is organized in eight chapters; chapter one deals about outbreak investigation. During the residency period it has been conducted two outbreak investigation; one was measles outbreak investigation which was conducted in South Sudan refugee camp in Gambella region. On this investigation we conducted a case control study. The second outbreak investigation was a case study on food poison conducted in Kubri Kebele Lare woreda Gambella region. Chapter two explains about manuscript on measles outbreak investigation. Chapter three explains about surveillance data analysis which was conducted Gambella region on Malaria disease. The analysis was made from the year 2015-2017 and it address the burden of rubella disease in the country by place, person and time. Similarly chapter four is about malaria surveillance system evaluation conducted in Gog wereda Gambella region. In this chapter purpose and objective of surveillance system, progress towards the objective and also attributes of the surveillance system was discussed. Chapter five is about health profile of Itang special wereda Gambella region. In this chapter health and health related data of the woreda presented. Chapter six presents narrative summary of disaster situation which was conducted in Nuer Zone Gambella region; as part of early warning and vulnerability assessment. It was done together with partners working on health and nutrition. The assessment was conducted to identify potential problems which need humanitarian assistance in the Maher season. Chapter seven presents Project proposal on knowledge, attitude and practice of notifiable disease surveillance and reporting. The proposal intended to do descriptive cross-sectional study in Nuer Zone Gambella regional state. Finally, chapter eight presents Public Health Emergency Lare woreda yearly bulletin prepared.