Epidemiology

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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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    Incidence and Predictors of Chronic Kidney Disease Among Diabetespatients in two Hospitals in Wolaita Sodo Town , Southern Ethiopia: Aretrospective Follow-up Study
    (Addis Ababa University, 2023-06-21) Amanuel Arota; Wakgari Deressa(PhD, Prof.)
    Chronic kidney disease is type of progressive kidney disease that mainly attributed to diabetes. Ethiopia is one of the developing countries with high incidence of chronic kidney disease among diabetes mellitus patients. However, little is known related to the incidence and predictors of chronic kidney disease among diabetes mellitus patients in Ethiopia. Objective: The main objective of this study was to determine incidence and predictors of chronic kidney diseases among diabetes mellitus patients in Wolaita Sodo Town, Southern Ethiopia. Methods: A health facility based retrospective follow-up study was conducted among 495 diabetes mellitus patients in Wolaita Sodo Town during March to May 2023. Simple random sampling technique was used to select individuals. A pre-tested structured data extraction toolwas used to collect data from patient’s chart using open data kit (ODK). Data were exported to STATA V17 software and cleaned for analysis. The mean and median were used to describe continuous variable. The Kaplan Meir curve along with log rank test was used to estimate and compare survival time. The cox hazard proportional hazard model with p value <0.05 was used to declare significance of association. Assumption was checked using Schoenfeld residual test. Result: The cumulative incidence of chronic kidney among diabetes mellitus patients and the incidence density is 14.9% (95CI%12-18.03) and 2 cases per 100 person years respectively. The median survival time wa 130 months (IQR128, 133). History of cardiovascular disease [adjusted hazard ratio (AHR) =2.12, 95%CI 1.16, 3.87], diabetic retinopathy [AHR= 1.86 95%CI 1.03–3.36], and acute kidney injury [AHR= 2.49, 95%CI 1.37, 4.54] was associated with higher risk of chronic kidney diseases. However, high density lipoprotein cholesterol ≥ 40 mg/dl was associated with lower risk of chronic kidney disease [AHR= 0.537, 95%CI 0.303, 0.0.95]. Conclusion: Incidence of chronic kidney disease among diabetes has become significant public health problem. Diabetes patients having baseline low level high density lipoprotein, developed diabetic retinopathy, had history cardiovascular disease, patients developed acute kidney injury were at high risk to the incidence of chronic kidney disease compared to their counter parts. Thus appropriate health interventions should be implemented to prevent and control the disease.
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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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    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 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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    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 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, 2011-03) 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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    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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    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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    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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    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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    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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    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 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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    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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    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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    Ethiopia Field Epidemiology Training Program (EFETP)Compiled Body of Works in Field Epidemiology
    (Addis Abeba University, 2021-03) Wedajo, Emebet Alemu; Dr.Girmay, Abiy (PhD); Abagaro, Abdunnasir(MPH, PhD Fellow)
    In our country. the principal health techniques has prevention of disease so to perform this public Health emergency Management has the core and has been giving specific interest to the manipulate of epidemic inclined diseases, of worldwide subject and ailments on eradication and elimination programs, through surveillance activities. The function of public Health practitioners include ensuring high quality health promotion, disease prevention and manage activities, conducting surveillance on rising public health threats and offering pertinent information to policy makers and public health officials. From October, 2019 to end of Jan, 2021 I have stayed in Field Epidemiology Training Program, School of Public HealthAAU and at both EPHI and Oromia Regional Health Bureau field base. We carried out two outbreak investigations, one surveillance data analysis, one assessment of surveillance system, and one woredas Health profile description, four abstracts for scientific conference, one Disaster assessment, one lookup notion and education as outputs. Chapter One: We performed epidemiological investigations of two outbreaks. We used descriptive and Case Control Study in the course of investigations. We identified several factors that contributed to malaria outbreak in Shebe Sonbo district and observed that Low coverage Indoor Residual Spray and presence of stagnant water have been attributed for the outbreak. We recommended acceptable environmental management through optimized community participation. We also confirmed measles outbreak in Fitche Prison. Being unvaccinated and overcrowded Living circumstance for measles infection had been observed to be risk elements for developing the disease. We recommended use of standard prison and Health policy and for any health campaign measles immunization focused on prison community, and additionally health training on capacity of transmissions, treatment and prevention of measles infection has to be enhanced. Chapter Two: We did Measles surveillance data analysis of six years (2014-2019) of Bale zone to describe by person, Place and time. Less than 5 years was the most affected age group observed through 5-14 years. Enhancing improved events and campaign measles immunization targeting much less than 15 years of age would prevent future risk. Chapter Three: We performed Malaria assessment of surveillance system in East Showa Zone from June 15-30, 2019. The average surveillance system of the area mainly at lower stage used to be weak. Regular monitoring of program unique supportive supervision and continuous feedback system be strengthened for greater enhancement of the completeness and timeliness and/or surveillance system as a whole. .Chapter Four: We did health profile, health and health associated data, of Lomé Woredas from January 1-18, 2018, health and health related data the major causes of adult morbidity in woredas were acute upper respiratory tract infection acute febrile disease and Diarrhea While in under-five years, non-bloody Diarrhea, acute febrile disease and upper respiratory tract infection were the three leading causes of morbidity. Chapter Five: We did scientific manuscript for peer reviewed journals on Measles outbreak in Fitche Prison, North Showa Zone. Chapter Six: We organized four abstracts for submission to scientific convention in the course of residency time. These are:  Outbreak of malaria-Shebe Sonbo Jimma Zone Oromia Region, Ethiopia, 2020  Measles Outbreak-Fitche Prison, North Showa Zone, Oromia Region, Ethiopia, 2019.  Six years (2014-2019) measles surveillance information analysis Bale Zone, Oromia Region, Ethiopia, 2019.  Health Profile in Lome Woredas , East Showa Zone , Oromia Region ,2018 Chapter Seven: We conducted Natural Disaster (Flooding) assessment (Narrative summary of disaster situation) in Oromia Region to identify humanitarian needs in Flood affected areas from July 22 to August 19, 2020 in Fentale Woredas and Methehara Town of East Showa Zones. Malaria outbreak was happed flood hap pine in zones. Malaria are the most predicted risk in the zones. Food was a major problem after Flood occur for the first thee day. Chapter Eight: We prepared one proposal for research project. The objective of this study is to assess magnitude of childhood measles vaccination status among Child aged12-23 month and determinant factors in Ginner District. We designed cross-sectional community and facility the sample measurement will be calculated using: n= (Z α/2)2 P (1 − P) d2 Chapter Nine: We did In COVID19 diseases Surveillance case Team and we also did weekly PHEM bulletin of Oromia Region from March 2019 to October 2020.
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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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    Ethiopian Field Epidemiology and Laboratory Program: Compiled Body of Work in Field Epidemiology
    (Addis Abeba University, 2020-10) Gete, Dilnesaw Teshome; Belachew, Ayele(Dr.); Gizaw, Muluken; Hailemariam, Zegeye(Dr.)
    This compiled body of work consists a two year Field Epidemiology Training Program Outputs, which were done during the residency time. All these outputs are expected in the residency time which is submitted to graduate school of public health for partial fulfilment of master degree in Field Epidemiology. These are; diseases outbreak investigation, public health surveillance data analysis, surveillance system evaluation, Health profile description, manuscript, abstracts, and protocol/ proposal for epidemiologic research project and additional work like weekly bulletin. The document is organized in eight chapters. Chapter One: - The first chapter contains two outbreak investigation. The first was malaria outbreakm investigation conducted in Elu Gelan woreda of west shoa zone Oromia, Ethiopia from 24/2019 – 16/2020 WHO week in which 2099 malaria cases and no deaths were identified and the second was measles outbreak investigation occurred in Caliya woreda of west shoa zone Oromia, Ethiopia from 50 -1/2019 WHO weeks in which 16 cases and 2 deaths were identified. The second outbreak was confirmed at EPHI national reference laboratory. For both outbreaks. Case control study design was conducted to identify associated the risk factor. Recommendation was given for outbreaks based on the findings. Chapter Two: - this chapter contains meningococcal meningitis surveillance data analysis which is one of the core competency for field epidemiology training program and conducted in southern nation and nationalities and peoples region from 2012-2018. Seven years meningococcal meningitis data was analyzed retrospectively to describe epidemiology of the disease. Chapter Three: - malaria surveillance system evaluation conducted in Elu Gelan woreda west shoa zone,Oromia, Ethiopia in 2019 is presented in this chapter. The purpose and objective of malaria disease surveillance was clearly presented and we used descriptive cross sectional study design. It also addressed Public health emergency management surveillance system attributes like simplicity, flexibility,acceptability, representativeness, sensitivity and positive predictive value, timeliness and quality. Chapter Four: - contains health profile description conducted in Bona Zuria of Sidama zone, SNNPR, Ethiopia in 2019. Health and health related data of the woreda were presented in this chapter. Chapter Five: - Included scientific manuscript for peer reviewed journal on malaria outbreak investigation conducted in Elu Gelan woreda. Chapter Six: - Three abstracts were presented in this chapter. These are Abstracts of malaria outbreak investigation conducted in Elu Gelan woreda, meningitis surveillance data analysis conducted in SNNPR,and malaria surveillance system evaluation conducted in Elu Gelan woreda. Chapter Seven:- contains protocol/ proposal for epidemiologic research project namely assessment of long lasting insecticide net utilization and associated risk factors in under five children in Elu Gelan woreda of West shoa zone, Oromia, which is developed as one of the outputs. Assessment was not widely done in the district on the utilization of long lasting ITN especially for under five children. So the main purpose of this study is to assess ITN utilization and associated risk factors