Epidemiology

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    Alcohol Use Disorder, Help-seeking Behavior and the Impact of a Brief Alcohol Intervention in Sodo District,Gurage Zone, South-central Ethiopia.
    (Addis Abeba University, 2021-06) Zewdu, Selamawit(Phd); Teferra, Solomon(MD, PHD); Hanlon, Charlotte(MD,PhD)
    Background: Alcohol use disorder (AUD) is disabling yet neglected and frequently left untreated in low- and middle-income countries (LMICs). To increase the treatment rate, AUD services need to be integrated into primary health care (PHC) units as people with the disorder often make contact with PHC due to physical health consequences of AUD. Objectives: 1) To determine the magnitude of AUD and associated disability, co-morbid depression, suicide, internalized stigma and help seeking behavior in Sodo district, Gurage Zone,South-Central Ethiopia. 2) To assess the impact of a brief intervention delivered at PHC on alcohol use after 12 months. 3) To explore the perspectives and experiences of people with AUD, caregivers and service providers about the brief intervention delivered at PHC in Sodo district. Methods: The study was nested within the PRogrammme for Improving Mental health carE(PRIME). Mixed quantitative and qualitative methods were used: 1) Using a cross-sectional house-to-house community survey of 1500 adults (aged 18 years and above) living in Sodo district. The prevalence of AUD help seeking behavior, barriers to care, disability, co-morbid depression, internalized stigma and suicidality were determined. AUD was assessed using a culturally adapted version of the Alcohol Use Disorders Identification Test (AUDIT), A Poisson working model with robust variance was used to determine prevalence ratios. 2) A pilot beforeand-after study was carried out among 49 people attending PHC facilities who had probable alcohol use disorder. Participants received an evidence-based single session brief intervention for AUD which was delivered by trained PHC workers. Follow-up assessment was conducted at 3 and 12 months. This included evaluation of AUD severity, functioning using World health organization disability assessment schedule (WHODAS 2) Score), consequences of drinking using Short Inventory of Problems revised version 2 (SIP-2R) and depression using the patient health questionnaire (PHQ-9). A mixed-effect linear model was used to assess the impact of the intervention at 3 and 12 months. 3) A nested qualitative study was conducted to explore perceptions and experience of service users, caregivers and service providers on the acceptability, impact and implementation of the intervention. Twenty-six in-depth interviews were conducted with 14 people with alcohol use disorder, four caregivers and eight health professionals who were providing the intervention. Framework analysis was used for analysis. Results: The prevalence of alcohol use disorder was 13.9% (25.8% in men and 2.4% in women).Alcohol used disorder was more prevalent among men (adjusted prevalence ratio (aPR) 7.7, 95% confidence interval (CI): 4.4, 13.1; farmers aPR 3.9, 95% CI: 1.0, 14.8), traders (aPR 6.0, 95% CI: 1.5, 23.9) and daily laborers (aPR 6.3, 95% CI: 1.5, 26.1) compared to housewives. A oneyear increase in age was associated with a 1% increase in the prevalence of AUD (aPR 1.01,95% CI: 1.00, 1.02). As the number of stressful events, depressive symptom score and disability score increase by one, the prevalence of AUD increased by 27% (aPR 1.2, 95% CI: (1.1, 1.3), 3.0 % (aPR 1.03, CI: 1.01, 1.03) and 2.0% (aPR 1.02, 95% CI: 1.01, 1.04), respectively. Having suicidal thoughts was also associated with AUD (aPR = 1.5; 95%CI: 1.1, 2.1). Of participants with an AUDIT score ≥16 (indicating harmful drinking), only 13% (n=6) sought help for alcohol problems, and 70.0% reported high internalized stigma. Major barriers to seeking help were: wanting to handle the problem on their own, believing that it would get better by itself, being unsure about where to go, not bothered by the problem, financial barriers, including being concerned about the cost of professional help, concerned about what people might think, and access. Forty-nine people with AUD received the brief intervention, and 92 % completed the assessments. Following the brief intervention, there was a statistically significant reduction in AUD severity, consequences of drinking and depressive symptoms. The adjusted mean difference (AMD) in AUDIT score at 3-months was -2.66 (95% CI -5.21, -0.11) and at 12 months was -4.15 (95% CI -6.76, -1.54). For SIP-2R score, AMD for AUDIT score was -2.52 (95% CI -4.86, -0.18) at 3-months and -3.00 (95% CI -5.87, -0.14) at 12-months. For PHQ-9 score AMD was -2.06 (95% CI -3.35, -0.77) at 3-months and -2.03 (95% CI -3.35, -0.72) at 12months. Although positive effects of the intervention on functioning were not seen in the quantitative analysis, the qualitative study strongly supported the impact of the intervention on improving functioning. People with AUD and caregivers reported improved work capacity,increasing earnings, less money wasted and, consequently, being able to better provide for their family. The brief alcohol intervention was accepted by most service users. Service providers reported low acceptability of their advice by participants, participants’ lack of openness to talk about alcohol, and shortage of space as barriers for implementation. Primary health care workers recommended further training, raising awareness of the community about alcohol use disorder, and working with the community and health extension workers. They also requested a stronger administrative support system for improving management of alcohol use disorder. Conclusions: Although alcohol use disorder was a common problem in the study setting, the unmet need for treatment was substantial. A pilot integration of a single session brief intervention in PHC had a positive impact on the severity of AUD, consequences of drinking,and depressive symptoms over a period of 12 months. The intervention was also feasible,acceptable and perceived to bring benefits. However, there is a need to address such issues as low community awareness about AUD, stigma, inadequate skills of PHC workers and engagement of the community in order to increase help-seeking behavior, and enhance acceptability and the impact of intervention in PHC settings. With more frequent supervision,non-specialized workers at the PHC level have the potential to contribute to the reduction of the burden of AUD through early screening, brief intervention, and referring people with severe AUD for specialist treatment.
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    Assessment of health related quality of life and its determinants among type II diabetes mellitus patients in selected public hospitals of Addis Ababa, Ethiopia.
    (Addis Abeba University, 2020-11) Esubalew, Habtamu; Belachew, Ayele (MD, MPH); Sied, Yimer(MPH, PHD Can.); Tarekegn, Getahun ( Dr.)
    Background: People with diabetes have an increased risk of developing a number of serious lifethreatening health problems which lower quality of life. Poor quality of life is believed to negatively influence self care, which brings to declined glycemic control, increased dangers for complication, and intensification of diabetes overwhelming in both the short run and the long run. In Ethiopia, which is among the top four nations with the highest adult diabetic populations in subSaharan Africa, there are just a few studies directed on health related quality of life in type II DM patients. Objective: The aim of the study was to assess health-related quality of life and its determinant among type II diabetes mellitus patients, in selected public hospitals of Addis Ababa, 2020. Methods: Institution-based cross sectional study was conducted among systematically sampled 309 type II diabetes mellitus patients attending diabetes follow up clinic of three randomly selected public hospitals in Addis Ababa from May-18 to June-17, 2020 using short form-36 questionnaires to determine the health-related quality of life. The data was collected through face-to-face interview from selected public hospitals. We used descriptive statistics to present the data. Simple and multiple linear regressions were done to identify associated factors with health-related quality of life. P-value <0.05 was considered as independently associated factor for health-related quality of life. Ethical clearance was obtained from School of Public Health ethical review committee. Result: The mean age was 52.28(12.9). Around 59 % were female and 68 % were married. Around 30.1% of patients developed one or more diabetic-related complications and 57.9% have comorbidities.The mean for the domains of Short-form-36 ranges from 52.91(24.33) for role limitation due to physical problem to 72.7(15.13) for mental health. The mean and standard deviation for physical and mental component summary were 40.15 (7.27) and 48.11 (8.87) respectively. Multiple linear regressions indicated age, married, attended college and above,overweight, obesity, longer durations of diabetes mellitus, treatment modality, diabetic-related complications and co-morbidities as independent factors for one or more domains of SF-36 and the two summary measures of health-related quality of life. Conclusion: Age, married, attended college and above, obesity, overweight, longer duration of DM, used insulin alone or combined medication, diabetic-related complications and co-morbidities were factors associated with health-related quality of life.
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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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    Assessment of quality of life among adult gastrointestinal cancer patients in Tikur Anbessa specialized hospital, Ethiopia.
    (Addis Abeba University, 2020-06) Gebregiorgis, Helen Gebrelibanos; Taye, Girma(Ph.D., Ass.Prof.)
    Background- Non-communicable diseases are now accountable for the majority of global deaths and cancer is anticipated to rank as the leading cause of death and one of the threats to escalating life expectancy in every country of the world in the 21st century. Cancer is recognized to reduce the quality of life, thus has a negative impact not only on physiological symptoms but also on the psychological functioning of the individual. The objective of the study was to assess the quality of life among adult Gastro-Intestinal Cancer patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2019. Method- Institution based cross-sectional study was done in Tikur Anbessa specialized hospital from February to April 2019 on adult Gastrointestinal (GI) cancer patients. All consecutive GI cancer patients were included, a total of 250 participants. The validated Amharic version questioner of the European organization for research and treatment of cancer core 30 and diseasespecific questioner for each of GI cancers was used.The dependent variable Global health status (QOL)was dichotomized with a cutoff point above and below 50 for interpretation. Association between each variable with QOL was examined using binary logistic regression. Variables with pvalueof<0.2on bi-variate were candidate for multivariable logistic regression analysis. Result-A total of 250 study participants were in the study period, among them 159 were colorectal cancer,40 esophageal cancer, 39 gastric cancer, and 12 hepatocellular cancer. The response rate was 95.7%. The mean ±SD score of QOL of CRC, esophageal cancer, gastric cancer and HCC was 52.8±21.02,37.2±17.29,47.4±20.9 and 30.5±18.57 respectively. Sex (AOR=6.3 95%CI=1.8322.12),occupational status (AOR=0.06 95%CI=0.01-0.3), clinical-stage (AOR=4.98 95%CI=1.51-16.4), physical functioning (AOR=1.04 95% CI=1.01-1.06), social functioning(AOR=1.02 95%CI=1.01-1.06), financial difficulty (AOR=0.975 95%CI=0.959-0.99), stoma presence (AOR=7.98 95%CI=1.51-16.45), blood and mucus in stool (AOR=0.93 95%CI=0.900.96)had an association with QOL for CRC patients. Conclusion and recommendation-Quality of life of Gastrointestinal cancer patients were very poor. The focus should have to be given for their respective symptom scales by responsible stakeholders.
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    Assessment of Routine Health Information System (RHIS) Data Quality and Factors Affecting it, Addis Ababa City Administration, Ethiopia,2020
    (Addis Abeba University, 2020-10) Haftu, Binyam; Taye, Girma(Ph.D., Ass.Prof.); Ayele, Wondimu (Ph.D. fellow Ass.Prof.)
    Background: Effective and efficient health care services need evidence-based decisions and these decisions should rely on information from high-quality data. However, despite a lot of efforts, routine health data is still claimed to be not at the required level of quality for decision-makers. Previous studies have primely relay on organization-related factors little emphasis was given for perception and knowledge of service providers' gaps. Therefore, this study aims to evaluate the quality of data generated from routine health information systems and factors contributing to data quality from diverse aspects. Objective: To assess the quality of data from routine health information systems and factors contributing to data quality collected in health centers of Addis Ababa City administration, Ethiopia. Method: A cross-sectional study was conducted on 568 health professionals from 33 health centers selected randomly using a two-stage sampling method. A qualitative study was conducted using 12 key informants. The World Health Organization data quality report card framework and PRISM tools are used to assess the quality of routine health data and factors affecting it. Descriptive statistics, correlation,ANOVA, and non-parametric tests were done using SPSS version 23. Qualitative data analysis was done using ATLAS ti version 7.5 using a thematic analysis approach. Result: Timeliness of report, data accuracy, registration completeness, and report completeness level of the selected facilities was 40.39%, 76.67%, 96%, and 93.93%, respectively. The overall regional data quality level was 76.22%. Health professional perception on evidence-based decision making, the emphasis given to data quality, feedback, and health professionals motivation towards routine health care data have shown a strong association with data quality,(r (31) =.78, p<.001), (r (31) =.72, p<.001),(r(31)=.75,p<.001, (r(31) =.71,p<.001),respectively. Lack of adequate health information system task competence and Knowledge, non-functional PMT, lack of supervision, and technical factors were alsocommonly reported reasons for poor data quality Conclusion: This review has documented data quality of routine health information systems from health centers under Addis Ababa city. Overall data quality was found to be below the national expectation level.The study emphasized strengthen the existing performance monitoring team and building a motivated and skillful health workforce has a crucial role in improving the quality of routine health care data.
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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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    Assessment of the Long Term Unmet Supportive Care Needs of Stroke Survivors and associated factors in Tikur Anbessa specialized hospital and Saint Pauls’ hospital millennium medical college.
    (Addis Abeba University, 2020-06) Tamrat, Edna Gebremichael; Gizaw, Muluken(MPH, PhD can.); Getachew, Sefonias (MPH, PhD can.); Mamushet, Yared(MD)
    Background Stroke is a global public health problem with a magnitude of 13.7 million new stroke cases and 25.7 million stroke survivors. Even though the exact burden of Stroke in Ethiopia remains undocumented, it has been estimated that stroke deaths in Ethiopia reached 6.23% of total deaths in 2017. Identifying the unmet needs of stroke survivors is essential to design interventions that can potentially hasten their recovery process and improve their quality of life. Hence, the aim of this study is to determine the Long Term Unmet Supportive Care Needs of Stroke Survivors in Tikur Anbessa specialized hospital and Saint Pauls’ hospital millennium medical college. Method Institution-based quantitative cross-sectional study was conducted on Stroke Survivors who came to the neurology outpatient department for a follow up in Tikur Anbessa Specialized Hospital and Saint Paul's Hospital Millennium Medical College. A total of 422 participants were included in the study. Data was entered on EPI info and analyzed using SPSS version 25. The dependent variable long term unmet need was dichotomized as no need and unmet need. Binary and multivariable logistic regression were done to examine the predictors against the outcome of interest. Result Among the 422 participants which were included in the study 57.6% were male. The median age of participants was 54.5 years with IQR (42.75-62.25) years. Three hundred sixty (85.3%)of the respondents had Ischemic stroke. Seeking information about stroke and how to avoid another recurrence (98.6%), concerns about public transport utilization (80.6%) and needing advice about improving diet (79.4%) were the most frequently reported unmet needs. Long term unmet supportive care needs of stroke survivors were significantly associated with lower educational status (AOR= 6.5; 95% CI 2.1,20.5), time since last stroke attack (AOR=2.0; 95% CI 1.1, 3.5, being hypertensive AOR= 5.3; 95% CI 3.1, 9.1), having heart diseases (AOR=2.6; 95%CI 1.4,4.9) and physiotherapy utilization (AOR= 3.4; 95% CI of 1.839,6.369). Conclusion The results from this study suggest significant unmet needs and gaps in clinical and rehabilitation care in long-term stroke patients. High levels of unmet needs were reported by people who had their last stroke attack within 6-12 months, with low educational level and have comorbidities. The development of services to meet long-term needs among stroke survivors is warranted.
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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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    Cervical cancer screening Uptake, acceptability and associated factors among women of age 30-49 years old in Gondar North west Ethiopia.
    (Addis Abeba University, 2019-10) Destaw, Alemnew; Gizaw, Muluken(PHD Can.); Ayele, Wondimu( PhD can.)
    Background: Although cervical cancer is preventable, screening coverage in Ethiopia is too low.Socio demographic, individual related, health facility and accessibility factors were identified barriers of cervical cancer screening. However study on cervical cancer screening uptake and acceptability has not well documented in Ethiopia. Objective: To assess cervical cancer screening uptake, acceptability and associated factors with“see and treat approach” among women of age 30-49 years old in Gondar town public health facilities North West Ethiopia from December to June 2019 E.C Method: A facility based cross sectional study was conducted from December to May 2019 G.C at public health institutions in Gondar town Northwest Ethiopia. Women who visited public health facilities were advised for VIA. Uptake of screening was recorded at each screening sites. Exit interview was conducted to determine acceptability after the screening procedure. The total sample size for the study was 493.Consecutive sampling method was applied to select study participants. Crude and adjusted OR was calculated to determine statistical association. P value<0.2 was used to select and transfer variables in to multivariable logistic regression to determine predictors of cervical cancer screening uptake. Result: Out of 464 women advised for screening, only 76(16.4%) were screened and out of 76 screened women 44(57.9%) accepted VIA test. Educational status(P=0.003),Knowledge status (AOR=8.4,95%CI(3.33,21.21),Perceived susceptibility (AOR=6.5,95%CI(2.72,15.51), Perceived barrier (AOR=6.4,95%CI(2.30,17.80), Cues to action (AOR=4.6,95%CI(1.86,11.32), Perceived self-efficacy (AOR=5,95%CI(2.14,11.73) and Ever been recommended for screening by health worker (AOR= 2.7,95%CI(1.15,6.51) were significantly associated with the screening uptake. Conclusion: The actual VIA cervical cancer screening uptake for the offer was measured to be very low among women in Gondar public health facilities despite more than half of screened women accepted the VIA test which uses “see and treat “approach. There is a need to increase awareness regarding VIA cervical cancer screening for those women eligible for screening at health facilities and to the community so as to increase VIA screening uptake and acceptability.
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    Compiled Body of Works in Field Epidemiology and Laboratory Training Program (EFELTP)
    (Addis Abeba University, 2021-05) Negash, Gebrekristos; Hailemariam, Zegeye ((MPH, DVM, MTVM)
    Background: Measles is a highly infectious virus transmitted through contact with fluids from an infected person's respiratory secretions. Measles causes high morbidity and mortality particularly in developing countries. An average of 10-15 measles cases per year were reported in western and north western zone of Tigray region during the previous 4 years. We investigated an occurrence of extended measles transmission in a remote area to confirm the existence of outbreak, identify the etiologic agent and provide guidance on prevention and control measures. Methods: A descriptive study was conducted and case definition for measles was applied, a suspected measles case was defined as any person with fever and maculopapular rash, and cough,conjunctivitis, or coyrza or a patient diagnosed with measles by a clinician. From January 28- 31,2011 attempts were made to identify all cases by collecting a line list of cases from health facilities in the affected zones and data was analyzed by MS-Excel. Blood specimens from 5 suspected cases were collected in December 2010. Result: From October 2010 to January, 2011 a total of 408 clinically suspected cases and 16 deaths were reported. The case fatality rate was 4%. The median age of suspected cases was 18.3 years (range 3 months-36 years) and 228 (56%) cases were ≥ 15 years of age. Three quarters(75%) of cases were male. The majority of cases, 352 (88%), were unvaccinated or had unknown vaccination status. The attack rate of 10/10,000 was highest in the western zone where 379 (93%) cases were reported. In the North western zone there were 29 (7.1%) cases with an attack rate of 2/10,000. Of the 5 blood specimens collected for testing 3 (60%) were positive for measles specific IgM. Conclusion and recommendation: A laboratory confirmed outbreak of measles occurred over a period of 5 months in primarily affecting those ≥15 years of age. The older age of those affected in this outbreak combined with low levels of measles immunization suggests that both routine and supplementary immunization activities need strengthening Immunization campaigns may need to include older ages groups to improve herd immunity.
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    Compiled body of work in Field Epidemiology
    (Addis Abeba University, 2019-06) Diriba, Dereje; Enkusselassie, Fikre(Prof.); Gizaw, Muluken
    Despite many intervention activities undertaking preventable communicable diseases are remain a public health problem globally. The Ethiopian government policy is more emphasis on prevention measures of communicable and non-communicable diseases. Also many strategies and programs were set to enhance disease prevention activities. Ethiopian Field Epidemiology Training Program that adapted from the United States Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) is one of the programs focusing on capacity building public health practitioners. The training enables trainers to conduct disease surveillance and implement prevention and control measures of prioritized diseases. I stayed from November 2017 to June 2019 in Addis Ababa university school of public health field Epidemiology training program and at Addis Ababa City administration Health Bureau field Base. During my stay, I carried out two outbreak investigations, surveillance data analysis, surveillance system evaluation, district health profile description, submission of one abstracts, one scientific manuscript for peer reviewed journals, one narrative summary of disaster management, and one epidemiological research proposal during my stay. We investigated two outbreaks (Measles and Relapsing fever) during field base residency. There was measles outbreak in Jeldu Woreda of west Shoa zone, Oromia region that we had investigated in February 2019. During this outbreak, a total of 179 measles cases and 2 deaths were reported from January 2019 to March 2019. Low measles vaccination, poor ventilation, malnutrition and weak community’s awareness were attributed for measles in the Woreda. We recommend, strengthen routine and supplemental immunization programs, good cold chain management system and increase community awareness on measles prevention and control measures. Descriptive and analytical epidemiology methods were used to describe magnitude of the diseases and identify risk factors associated with diseases. In addition a total of 33 and 14 confirmed RF cases were reported from Woreda three of Bole sub City, Addis Ababa City administration health bureau in 2018. We identified that mass sleeping ,no changing cloth at night , no taking bath at least once every two week ,no washing cloth at least once every two week and having contact history with ill LBRF person for RF outbreak in the Woreda. We recommend to organize meeting session with representative of all sectors including the sub City administrators to discuss the way how to minimize mass sleeping houses and solutions for homeless people. Addis Ababa University, College of Health Sciences, School of Public Health, 2019 AAU/SPH Dereje .D EFETP/2019 Increase awareness through continuous health information for street’s or homeless people. Homeless people must wash cloths and take bath at least once every week. Homeless people must change their cloth at night and stack holder help cloth and close supportive supervision by sub City health office. I conducted typhoid fever surveillance data analysis at Addis ketema sub city health office, the analysis was indicate low water and sanitation coverage and I conducted surveillance system evaluation at Addis ketema sub city health office , surveillance of selected diseases ( measles ) was assessed. The system was satisfactory at sub City level; whereas not satisfactory at 1, 4, 5 Woredas. Poor data management, infrequent supportive supervision, absence of well-organized feedback, poor utilization of manuals and guidelines were contributed for unsatisfactory of the system at the Woreda level. Health profile description was carried in Woreda nine of Addis ketema sub City , Addis Ababa health Bureau from Janua ry 22-March 23/2018. Low community awareness and low coverage of latrine and Poor waste management in the Woreda. I prepared scientific manuscript for peer reviewed journals on typhoid fever data analysis in Addis ketema sub City health office ,Addis Ababa ,Ethiopia ,2013-2017. One abstracts were done for scientific conference submission; Measles outbreak Investigation and Intervention in Jeldu Woreda of west shoa zone ,oromia ,ethiopia, 2019. Narrative disaster management was conducted in selected Woredas of (Hudet, Moyale and Mubarek) in Dawa zone in Ethio Somali region during 2018 to identify humanitarian needs following emergency occurrence. Malnutrition is anticipated to be a major public health concern in Dawa zone. We identified shortage of drugs and medical equipment at both zonal level and all Woreda of these zones. Epidemiological research project proposal on assessment of latrine utilization and factors associated with latrine utilization in Woreda nine of Addis ketema sub City, Addis Ababa, Ethiopia, 2019 was prepared. Descriptive cross-sectional study will be used for this study in Woreda nine. A total of population Woreda nine 35,636, HH 7424 and 422 sample households with latrine will be included in the study. The overall activities of study will be expected to finish in three month (June -September), 2019. The total estimated budget required for the study is 73,321.5 ETH Birr. I prepared weekly bulletin on PHEM report of Addis ketema sub City health office for WHO Epidemiologic week 9 of 2018. The health facilities report completeness for that week was 98% and above the expected national level (80%). Dysentery cases and epidemic typhus cases were kept increasing during week 9 of 2018
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    Compiled Body of Work in Field Epidemiology
    (Addis Abeba University, 2019-06) Amene, Kefyalew; Girmay, Abiy(Phd); Wondmagegnehu, Abigiya( PhD. fellow); Bancha, Misgana (MPH)
    This document contains a two years field epidemiology training program outputs to be submitted to Addis Ababa University, School of Public Health, Department of Preventive Medicine for partial fulfillment of master's degree in Field Epidemiology. This document is organized by classifying in to seven chapters. These seven chapters are outbreak investigation one, outbreak investigation two, surveillance data analysis, surveillance system evaluation, narrative summary of disaster situation visited, health profile description projectand epi-project thesis proposal. Chapter one contains report of first outbreak investigation. The outbreak was rubella outbreak at General Tadesse Biru Primary School, Addis Ababa, Ethiopia 2018. Unmatched case-control study was conducted to investigate the outbreak in which I was leading the investigation. Chapter two is about outbreak investigation two. This outbreak was suspected chickenpox outbreak, which was occurred in Aleltu Soldier Training Center, North Shewa Zone of Oromia region. Unmatched case-control study was conducted to investigate this suspected outbreak and I was the leading this investigation. Chapter three is about analysis of five years (2013-2017) malnutrition surveillance data of Addis Ababa City Administration. A retrospective record review data analysis was conducted. Cases and deaths were described epidemiologically and trend of cases was also seen. Incidence rate of malnutrition and trend of cases through time was determined. Chapter four addresses MDSR surveillance system evaluation in Addis Ababa City Administration, Ethiopia, 2018. It describes the status of the system in the city administration towards meeting its establishment objectives. System attributes including simplicity, flexibility,usefulness, stability, acceptability, representativeness, timeliness, data quality, sensitivity, cost and predictive value positive were described in regard to MDSR system. Chapter five presents a narrative summary of disaster situation visited. The disaster situation was about Internally Displaced Populations (IDPs), which was happened in Kochere and Yirga chefe woredas found in Gedeo zone of SNNP region, Ethiopia due to Ethnic based border conflict between SNNP and Oromia regions. Chapter six contains health profile description of woreda 05 of Nefas silk sub-city, Addis Ababa, Ethiopia 2018. Health and health related information were presented, which can be used for evidence based planning and effective utilization of limited resources. These data can be used to identify risk factors and prioritize public health problems to take appropriate interventions. The last chapter (chapter seven) contains the epi-project proposal. The epi-project proposal was developed to assess predisposing factors of undernutrition in Addis Ababa city administration 2019. Unmatched case-control study will be conducted to identify the predisposing risk factors of undernutrition in the city administration.
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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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    Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2021-01) Mulugeta, Achamyeleh; Worku, Alemayehu(Prof.); Abagero, Abdulnasir; Awraris, Daniel
    The Ethiopia Field Epidemiology and Training program (EFETP) is a two years in-service training program in field epidemiology adapted from the United States Centers for Disease Control and Prevention (CDC). 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. The program has two main components: a classroom-teaching component (25%) and practical attachment or field placement component (75%). Completion of the above mentioned two components of the residency culminates in a final output of works, which is equivalent to a thesis for the graduate school of public health for partial fulfillment of a master degree in Field Epidemiology. These out puts of work have eight chapters, which includes report of outbreak investigations,surveillance data analysis, evaluation of a surveillance system, description of a health profile, scientific manuscripts for a peer review journal, abstracts for scientific presentation, proposal for epidemiological research project and another additional output report. To complete these outputs of work different methods were used. In chapter one two outbreaks were investigated one is Epidemiological description of unknown skin lesion outbreak in Jimma town, Ethiopia December 2019 and the other is Dengue Fever Outbreak Investigation in Millie Woreda, Zone one, Afar Region, Ethiopia, January 2020. In chapter two, three and four. Influenza Surveillance Data Analysis: Magnitude and distribution of Severe Acute Respiratory Illness (SARI) at Yekatit 12 Hospital Medical College 2009-2019, Addis Ababa, Evaluation of National Laboratory based Antimicrobial Resistance Surveillance System and Health Profile Description of Bahirdar Zuria Woreda, Amhara Regional State, Ethiopia 2019 included respectively. In chapter five and six one Manuscript titled with Hospital based epidemiology of influenza in Ethiopia: Descriptive analysis of Severe Acute Respiratory Illness (SARI) 2009-2019, Addis Ababa, Ethiopia: and three abstracts is done respectively. In chapter seven research work on Performance of Laboratory Professionals working on Malaria Microscopy at public and privet Health facilities of malaria elimination districts North Shewa Zone Amhara Region, and finally, in chapter eight additional output report on Rapid Assessment report on Malaria epidemic affected Woredas of Tigray region January 2020 included.
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    Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2021-01) Bekele, Daniel; Deressa, Wakgari (Prof.); Abagero, Abdulnasir (MPH, PhD fellow)
    Introduction: Cholera is a diarrheal infection caused by gram -negative bacteria Vibrio cholerae,either type O1 or O139. Globally in 2019, there were 923,037 cases and 1911 deaths of choler with case fatality rate of 0.2 and in Africa 55,087 of cases and 872 deaths with (CFR of 1.6). Since the beginning of 2017 and as of 7 May, Ethiopia has reported 32,689 acute watery diarrhea cases and 776 deaths with CFR 2.4%. Cholera could affect both Males and Females and remains a challenge to countries where access to safe drinking water and adequate sanitation cannot be guaranteed. Cholera is usually transmitted through fecal contamination of water or food. We conducted cholera outbreak investigation, characterized cases by time, place, and persons and described the morbidity and mortality due cholera outbreak in West Arsi zone, Oromia region,Ethiopia, 2019. Methods: Descriptive study was carried out among 167 cholera patients’ line list from September 29 to November 30, 2019. We defined cases, selected study participants and conducted descriptive analysis. We analyzed data using Microsoft excel 2010, calculated and described frequency, percentage, mean and median, attack rate (AR) and cases fatality (CFR). Results: A total of 164 cases and 3 deaths with CFR 1.8% were identified from the line list. Female were 94 (56.3%) and the median age for case was 12 years with range of (1.0-85.0). Highest proportions of cases 58 (34.7%) were within 5-14 age group and list affected 24 (14.4%) >44 age groups. Age specific case fatality rate was highest in > 44 years. Highest cases were reported from Shashamane 112(67%) district. The outbreak started from 15 th August and lasted over 18 December, 2019. Of the total cases 122 (73%) were severely dehydrated. Conclusion: Cholera outbreak with relatively increased overall attack and case fatality rate was conformed. Females affected more than males and the highest proportion of affected age group was above fifteen years of age. We recommend prevention of future outbreak and implementation of response measures to reduce morbidity and mortality and prospecting future strategies to prevent cholera outbreak in the zone.
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    Depression, Post Traumatic Stress Disorder and Alcohol Misuse among Eritrean Refugees living in a camp in Ethiopia: Risk and Protective factors
    (Addis Abeba University, 2019-06) Getnet, Berhanie(PhD); Alem, Atalay(PhD,Prof.)
    Background By the year 2020, depression is projected to be the second leading cause of disability and the fourth leading contributor to the global burden of disease. Depression and post traumatic stress disorder (PTSD) are among the commonest mental health problems in refugee communities. Studies have shown that exposure to traumatic events refugees encountered in the pre-migration, during exile and post-migration periods are associated with symptoms of PTSD and depression in refugee populations. There were inconclusive findings from previous studies that have looked into the differential predictive significance of trauma related factors,particularly that of exposure to in pre-migration and post-migration traumatic experiences with symptoms of PTSD and depression among refugees. More importantly, there is no a rebust study that investigated the significance of association between trauma related and socio-demographic factors as predictors of psychological symptoms in Eritrean refugees living in Ethiopia. Despite the fact that there are several studies on detection of depression in the community using different measures, valid depression measure adapted in Eritrean culture for Eritrean community in humanitarian settings does not exist. In this regard, the latent factor structure (symptom presentation) for most measures of depression in many low income countries, particularly in almost all African countries, is not well understood Although there is abundant literature and theoretical basis on the co-morbidity of PTSD and depression in people affected by trauma, the extent of symptom co-variance and overlap between the two frequently reported forms of psychological symptoms by refugees (PTSD and depression) is not well known particularly in our study population.Mental health research is also increasingly focusing on the importance of investigating resilience in dealing with risk factors for mental health problems, such as personal coping styles and sense of coherence in people who are vulnerable for mental health problems in humanitarian crisis. Although extensive studies on the topic of resilience and sense of coherence were carried out among Eritreans in humanitarian settings, empirical adaptation studies on resilience measures and their validity were not given due attention. There is no quantitative evidence to confirm the psychometric properties of resilience measures in Eritrean refugees living in Ethiopia to date. There is also increasing concern on the co-morbidity of alcohol misuse with other mental health problems in refugee population in the context of humanitarian settings (refugee camps). Indeed, the current study tried to investigate the relationship between theory driven risk and protective factors with mental health concerns of refugees (depression, PTSD and alcohol misuse) in Eritrean refugees living in Mai Aini refugee camp. Objectives: The objectives of this study are to: (a) identify which socio- demographic and trauma related factors are associated with PTSD and depression; (b) explore the direct,mediating and moderating effects of traumatic events on PTSD and depression; (c)determine the psychometric properties of measures employed in the study; (d) determine the structural relationship between exposure to cumulative trauma and poor mental health(indicated by co morbid symptoms of depression, PTSD and alcohol misuse). Methods: Cross-sectional study was conducted. In the survey, 562 adults were randomly selected from Eritrean refugees living in Mai Aini camp, Ethiopia. Center for Epidemilogic Studies Depression (CES-D) scale, Post-Migration Living Difficulties checklist, Primary Care PTSD screener (PC-PTSD), Oslo Social Support Scale (OSS-3), Sense of Coherence Scale (SoC-13), Coping Style scale and Fast Alcohol Screening Test (FAST) were administered concurrently.Data were analyzed using multiple linear regression modeling, path analysis and multivariable logistic regression model. In order to estimate the structural relationship between exposure to trauma, risk and protective factors (as mediating factors), and co morbid mental health outcomes (indicated by PTSD, depression and alcohol misuse), Structural Equation Modeling (SEM) was employed.SEM was also employed to identify the percentage of variance explaining common latent factors by the three outcomes of mental health concerns in refugees (PTSD, depression and alcohol misuse). It was also used to estimate symptom co-variance between symptoms of PTSD and depression. In order to test the factor structure of measures used in the present study, Confirmatory Factor Analysis (CFA) was carried out. Results PTSD and depression symptoms did not vary across major demographic variables with respect to gender, age and marital status. Exposure to pre-migration trauma was associated significantly both with increased symptoms of PTSD (β =0.11, p<0.05) and depression (β =0.29, p<0.001) after adjusting for demographic factors, sense of coherence and social support. Exposure to post-migration trauma was associated with increased symptoms of depression (β =0.21, p<0.001), but not with PTSD symptoms. There was 85% co-variance between latent factors of depression and PTSD, which shows the likelihood of symptom overlap between the two constructs. Pre-migration living difficulties were directly associated with symptoms of PTSD (β=0.09, p<0.05), and indirectly associated with PTSD through paths of duration of stay in camp, sense of coherence, post-migration living difficulties, task-oriented coping style and depression (standardized indirect coefficient=0.26, p< 0.01). Depression was directly associated with pre-migration (β=0.35, p <0.001) and post-migration (β=0.23, p < 0.05) living difficulties. Post-migration living difficulties were indirectly associated with PTSD through paths of sense of coherence, task-oriented coping style and depression (standardized indirect coefficient=0.13, p<0.01). Social support moderated the effect of post-migration living difficulties on depression (β = -0.106, P<0.05). Emotion-oriented coping style moderated the effect of pre-migration threat for abuse on PTSD (β = -0.18, p<0.001) and depression (β = 0.12,p<0.01).It also moderated threat for life on PTSD(β=-0.13,p<0.001).With respect to the measure of depression, first-order two factors with second-order single factor model of CES-D (correlated error terms) yielded the best fit to the data [CFI= 0.975;RMSEA=0.040 (90%CI=0.032, 0.047)]. The 16 items defining depressive affect were internally consistent (Cronbach‟s alpha = 0.932) and internal consistency of the four items defining Positive Affect was medium (Cronbach‟s alpha = 0.703). CES-D has acceptable convergent validity with pre-migration living difficulties checklist (r= 0.545, p<0.001), postmigration living difficulties checklist (r= 0.47, p<0.001), PC-PTSD (r= 0.538, p<0.001) and FAST (r=0.197, p<0.001). It has acceptable divergent validity with SoC-13 (r= -0.597,p<0.001) and OSS-3 (r= -0.319, p<0.001). Key findings regarding the validity of the measure for sense of coherence (SoC-13)demonstrated that the one factor model of SoC-13 with twelve items best fitted the present data (CFA=0.982, RMSEA=0.035), with good internal consistency (Cronbach‟s Alpha=0.75). The negative association between SoC-13 and PC-PTSD (r= -0.433, p<0.001), CES-D(r= -0.597, p<0.001), pre-migration and post-migration living difficulties checklist subscales((r=-0.265,p<0.001andr=-0.249,p<0.001respectively),and FAST (r=-0.105,p<0.001)provided sufficient evidence for its divergent validity. SoC-13 has positive association with Oslo Social Support scale (OSS-3) (r= 0.363 p< 0.001) and task oriented coping style sub-scale(r=0.089, p<0.001), demonstrating acceptable convergent validity of this measure. Multivariable logistic regression analysis indicated that exposure to pre-migration living difficulties (Adj. OR = 1.09 [95%, CI =1.03, 1.08] p˂ 0.001) and use of emotion-orientecoping (Adj. OR=1.63 [95% CI=1.15, 2.32], p˂ 0.01) were positively associated withrefugees‟ alcohol misuse. Bi-variate analysis of perarson‟s correlation also indicate that refugees‟ alcohol misuse is positively associated with depression (r=0.197, p˂0.01).Iaddition, in the multivariable logistic model, being a female (Adj. OR = 0.30[95%, CI= 0.170.55], p< 0.001) is associated with decreased odds of alcohol misuse compared to maleParticipants aged 25-34 (Adj. OR = 0.40 [95%, CI =0.20, 0.80], p< 0.05) and those withiage group of 45-54 (Adj. OR =0.14 [95% CI=0.02, 0.78], p< 0.05) were less likely exposedfor alcohol misuse compared to the younger refugees aged 18-24. Increased frequency oprayer was negatively associated with probable alcohol misuse (Adj. OR = 0.51 [95%, CI0.37, 0.70], p< 0.001). Furthermore, findings from the SEM analysis demonstrated thalcohol misuse has significantly loaded onto the second-order common factor (β =0.21,p<0.001) with symptoms of PTSD and depression; which means 21% of variance for thsecond-order common factor (co-morbid problem) is accounted for by alcohol misuse in structural model which demonstrated close acceptance of fit to the current data (χ /df =2.508,CFI=0.868; TLI=0.855, RMSEA= 0.052(90%:0.055 0.066). Conclusions Fostering sense of coherence, social support, task-oriented and emotion-oriented coping styles and preventing post-migration abuses, especially for female refugees, need to be given particular consideration when planning an intervention. The current finding regarding significant positive correlates of alcohol misuse (such as pre-migration trauma, depression,emotion-oriented coping, and younger age) and significant negative correlates (such as beingfemale in gender, sense of coherence and frequency of prayer) provide useful information specific to intervention of alcohol misuse in Eritrean refugees. Inferences from co-variances of latent factors indicate that there is a strong co-morbidity between the two mental health concerns in Eritrean refugees (PTSD and depression). The evidence regarding modest comorbidity between alcohol misuse and psychological symptoms strongly suggests the importance of considering alcohol misuse as an integral part of intervention in the mental health care endeavors for Eritrean refugees. The findings regarding‟ refugees‟ longer duration of stay in the camp for mediating the effect of exposure to pre-migration traumatic experiences on PTSD informs the need for their acceleration of repatriation,resettlement or integration with the host society.
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    Determinants of survival among breast cancer patients in hawassa,Southern Ethiopia: a retrospective study,2019.
    (Addis Abeba University, 2019-09) Shita, Abel; Worku, Alemayehu (Prof., PhD); Getachew, Sefonias (PhD Fellow)
    Background: Breast cancer (BC) is the second most common of all cancers and the commonest in women contributing 12% of all new cancer cases and 25% of all cancers in women. It is the most prevalent cancer in Ethiopia. Even if the estimation of BC survival is beneficial to improve the current breast cancer care & treatment, studies are lacking in Ethiopia. Objectives: To identify determinants of survival and to estimate cumulative survival probabilities of patient’s with BC that are diagnosed from 2013-2018 in Hawassa University Comprehensive Specialized Hospital and Yanet Hospital. Methods: A health facility-based retrospective study of 302 patients was conducted. The median survival was estimated by Kaplan- Meier. Log Rank test was used to compare survival among groups. Cox proportional hazards model was used to identify determinants. Results were repaired as hazard ratio (HR) along with the corresponding 95% CI. Sensitivity analysis was done with the assumption of lost to follow-ups (LTF) might die 3 months after last hospital visit. Results: Majorities (83.4%) were presented at an advanced stage. The study participants had followed for a total of 4685.62 person-months. Their median survival is 50.61 months (IQR=18.38-50.80) declined to 30.57 months in worst case analysis (WCA), the outcome of 57 patients were unknown (majorities, 96% being advanced stage) and 67 patients were died. The overall survival (OS) of patients at two years is 69.3% (61.30, 76.03) and it declines to 51.3 % in WCA. Rural residence (AHR=2.71, 95% CI: 1.44, 5.09), travel time > 7 hours(AHR=3.42, 95% CI: 1.05, 11.10), duration of symptom 7-23 months (AHR=2.63, 95% CI:1.22, 5.64), > 23 months (AHR=2.37, 95% CI: 1.00, 5.59), advanced stage (AHR=3.01, 95% CI: 1.05, 8.59) and not taking chemotherapy (AHR=6.69, 95% CI: 2.20, 20.30) were independent predictors of death. Through WCA, rural residence, advanced stage of BC, not having breast surgery, poor adherence to chemotherapy were independent predictors of death. Conclusion: The 2 years OS is low in Hawassa (69.3% and declines to 51.3% in WCA). Rural residence, advanced stage and poor adherence to chemotherapy were independent determinants of death. Increasing early diagnosis of BC and access to cancer treatment is mandatory.
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    Effect preeclampsia/Eclampsia on incidence rate of small for gestational age among pregnanat women in mekelle general Hospital and ayder comprehensive specialized hospital, Tigray, Northern Ethiopia.
    (Addis Abeba University, 2019-10) Tekelaye, Embaba; Taye, Girma(Ph.D., Ass.Prof.); Seid, Yimer(MPH)
    Background: In low and middle-income countries including Ethiopia, small for gestational age is a serious health problem, due to an increase in fetal and neonatal mortality and morbidity. In Ethiopia and particularly in Tigray there is a paucity of information on incidence rate and predictors of small for gestational age among pregnant women.Therefore the aim of this study is to determine the effect of preeclampsia on the incidence of small for gestational age among pregnant women in Mekelle General Hospital and Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia, 2019. Methods: A retrospective cohort study was employed to compare the small for gestational age between the exposed; preeclampsia (n=239) and non exposed; normotensive (n=476) women who were antenatal care follow-up in Mekelle General Hospital and Ayder Comprehensive Specialized Hospital from January 01, 2014 to March 31,2019. Systematic sampling was used to select the study participants. A pre-tested structured data abstraction checklist was used to extract data. Collected data were entered and cleaned using Epi Data version 3.1 and exported to STATA version 14 for analysis. The incidence rate was calculated dividing all small for gestational age cases in the cohort for the person-weeks of follow-up. The data analysis was performed by Cox proportional hazard model. Results: The incidence rate of small for gestational age was higher among preeclampsia than normotensive women (94.5 versus 24.9 per 1000 person weeks, Z=9.42, p<0.000001).The hazard of small for gestational age was four times higher in preeclampsia women than normotensive pregnant women, (AHR=3.92, 95% CI 2.55-6.01), history of low birth weight (AHR=0.41, 95%CI 0.17-0.94), poor gestational weight gain (AHR=1.89, 95% CI 1.15-3.1) were significant predictors. Conclusion and recommendation: There is a significant difference between preeclampsia and normotensive pregnant women in terms of the incidence rate of small for gestational age. Preeclampsia, a history of low birth weight and weight gain had significant predictors for small for gestational age. It is needed to strengthen the screening of preeclampsia for optimal fetal growth, and counseling on nutrients for adequate gestational weight gain. Further study will be also important to confirm the predictors at the community level.
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    Effects of maternal near miss on neonatal Mortality in Bale Zone Southeast Ethiopia: prospective cohort study
    (Addis Abeba University, 2019-10) Adem, Ahmednur; Deyessa, Negussie (PHD); Yilma, Mengistu (MSC)
    Background: Maternal near-miss is a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy. It has very close effect on maternal and neonatal heath. Hence the study assess effect of maternal near miss on neonatal mortality. Methods: Prospective cohort study was done on 354 pregnant women who came for delivery service to selected hospitals in Bale Zone. The hospitals were selected purposely based on average number of delivery and neonatal mortality they have in the last six month. Then all mothers with near miss were included until the required sample size is obtained. Two non near miss mothers were selected using lottery. Frequency distribution was done for selected important variable. Survival curve for both groups and Cox regression to look for effect of maternal near miss on neonatal mortality was done. Ethical clearance from Addis Ababa University School of Public Health and verbal informed consent from study participant were obtained. Results: Out of the 384 sampled pregnant complete responses were obtained from 354 respondents yielding a response rate of 92.2%. . Of all 55 (15.5%) of them have previous history of abortion and 44 (12.4%) and 22(6.2%) have history of past delivery of still birth. From the total live birth there were 17 (48 per 1000 live birth) neonatal death at the end of the study. As monthly income increase by one Ethiopian birr the risk of neonatal mortality decrease by 0.002 [(AHR 0.998, 95% CI (0.996, 0.999)]; 6.48 times for non cephalic presentation than for cephalic presentation [(AHR 6.48,95% CI 1.84-22.73)]. As APGAR score increase by one score risk of neonatal mortality decrease by 0.2 [(AHR 0.746, 95% CI (0.620, 0.898)], 8.40 times for mother with severe morbidity than for mother with no maternal near miss after controlling for the effect of other variables (AHR 8.40, 95% CI (1.638, 43.118). Conclusion: Neonatal mortality was higher among near miss mothers. But it was not only the result of maternal complication. It has share from other factors. Therefore most of the factors were modifiable if efforts were done to improve socioeconomic status of community.
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    Ethiopia Field Epidemiology and Laboratory Training Program (EFELTP) Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2019-06) Shimels, Kalkidan; Adisie, Adamu(Dr.); Abunna, Fufa(Dr.)
    This document contains a two year output of Field Epidemiology Training Program that has to be submitted to Addis Ababa University, graduate school of public health for the finaaccomplishment of master degree in Field Epidemiology. The majority of the program (75%)contains field works that known as residency. This document includes the two year outputs including diseases outbreak investigations, public health surveillance data analysis, surveillance system evaluation, health profile description report, narrative summary of disaster situation report, scientific manuscript and abstracts. During my residency I have tried to work my best in both office works as well as field works. The two years activities are summarized and presented by one document in eight chapters. The first chapter consists of two outbreak investigations which aresuspected scabies outbreak investigation which is conducted in Humbo district of Welayta zone SNNPR from 10November to 20November, 2018 and malaria outbreak investigation conducted in Areka town administration in Welayta zone, SNNPR from May 11 to 20, 2019. The second chapter is five years (2013-2017) human and animal anthrax data analysis report in SNNPRS. Surveillance system Evaluation which is found in the 3rd chapter was conducted in Hawella Tulla sub city of Hawassa city administration from March 05 – March 11/2019.The fourth Chapter contains Health profile description report which is conducted in Wensho District of Sidama zone SNNPR from February 5 up to February 15, 2018. One manuscript was prepared for peer reviewed journals and two abstracts were prepared. Meher Season Emergency Health and Nutrition needs assessment was conducted in GURAGIE and SILTE zones SNNPREthiopia, in December 2018 together with other relevant sectors and partners.The final output was protocol/proposal for epidemiologic research project with a title of assessment of knowledge, attitude and practices towards scabies prevention and control strategies- Humbo district, Welayta zone SNNPR region, EthiopiaApril, 2019. In addition, I was participated in weekly Emergency health and nutrition response activities and in all PHEM activities of the region as the program expectation.