Ethiopian Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology

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Addis Ababa University


The Ethiopia Field Epidemiology Training Program (EFETP) started in 2009. The EFETP is an in-service training program in field epidemiology adapted from United States Center for Disease Control and prevention (CDC) Epidemic Intelligence Service (EIS) program. The EFETP has two main components, each of which contributes the award of the Master degree (a class-room teaching component and practical attachment or field placement component. During the field placement component I was engaged on outbreak investigations, surveillance data analysis, surveillance system evaluation, district health profile development, while participating in disaster situation analysis, writing a project proposal development, abstracts writing for scientific conference, peer review journal writing, oral presentation in scientific conference, and giving refreshment training for Zone and Woreda level PHEM officers. I produced outputs that are compiled in this Body of Work. Outbreak investigationI-1: Meningococcal meningitis was reported in Hawassa city from 22 January to 17 February 2013. In this out break we identified 87 cases and 4 deaths (attack rate: 26.1/ 100,000, case fatality rate: 4.6). The age adjusted attack rate was highest among persons aged 15-29 years (ASAR 37.5/100,000). We isolated Serogroup, A, C, and W135, and gram negative diplococcus, from 8 CSF specimens. The dominant sero group was Nm. type A which was 4(50%) of confirmed cases. In the case control study we identified that; out of 27 cases and 54 controls having a history of recent past ten days acute respiratory infection was significantly associated with contracting meningococcal meningitis {AOR = 4.7, 95% CI(1.5-14.9)}. Living in a room with a family size of four and above was significantly associated with the disease (AOR) =4.5, 95% confidence interval (1.005-20.6). Outbreak investigationI-2: Measles outbreak was occurred in Sodo Town capital of Wolayita Zone. In this outbreak 53 measles cases and 5 deaths were identified. The age specific attack rate was highest among infants (893/ 100000) with CFR= 9.4%.We selected 25 cases and 50 controls for risk identification and identified that households with a family size of > 6 persons were significantly associated with the disease {AOR=4.2, 95% CI (1.2, 14.4)}. Individuals with no history of vaccination for measles showed significant association with the disease {AOR=3.7, 95% confidence interval (1.03, 13.36)}. Yeshitila Mogessie EFETP cohort IV Resident / 2014 Page xiv Surveillance Data Analysis Report II-1: Six years (2007-2012) SNNPR Meningococcal Meningitis surveillance data was analyzed. During this period a total of 1605 meningococcal meningitis cases were detected by surveillance system. The CFR was 1.2 %( 19/1605). The mean annual incidence was 1.6 per 100,000 populations. Cases were reported from 18(95%) of surveillance data reporting Zones and Special Woredas. The number of cases reported in2012 increased by 3.5 times the 2007 cases. Surveillance data analysis reportII-2: Southern Nation Nationalities and Peoples Region yellow fever surveillance data from December 2012 to March 2014 was analyzed. During this period a total of 165 cases and 62 deaths were reported. The epidemic was confirmed on 15 May 2013. A total of 38 specimens were collected for laboratory confirmation. From 38 specimens 9 were positive and 23 negative for yellow fever. The rest 6 samples result not known. From reported cases 97(58.8%) were males. Total case fatality was 37.6% and the sex specific case fatality rate was 47(48.5%) for males and 15 (22.1%) for females. The Age specific attack rate was highest in persons aged 15-44(44.37/100,000). Evaluation of surveillance system III: The public health surveillance system is evaluated to ensure that problem of public health importance are being monitored efficiently and effectively. So we evaluated measles and malnutrition surveillance system attributes and core functions of surveillance system in Dawro zone. In 2013 the surveillance system detected 1423 SAM cases and 13 measles cases but we identified gaps for indicators in well functioning public health surveillance system. In general there was electronic data base at health facility and Woreda level. Even the available database at Zone level was aggregate of health facility reports. Data was not analyzed and there was no documented feedback that given through the surveillance system. Health profile description report IV: Health profile provides a snapshot of the overall health of the local population. However in low income countries like Ethiopia such information especially at district level usually not available. So a study was conducted to provide health profile description of Konta special Woreda which will help for health planning. Konta special Woreda is one of the fourth special Woredas in SNNPR with a population of 108,909. The Woreda have 4 HC and 40HP with 44 administrative kebeles. Top ten leading morbidity in the outpatient department was malaria. There are 29(65.9%) malaria prone kebeles. The 2011/2012 ITNs Yeshitila Mogessie EFETP cohort IV Resident / 2014 Page xv coverage was 100% and IRS 34%. Majority of the notifiable diseases burden was increased in the last two years. Measles and PV3 vaccination coverage was 93%and 87% respectively and health workers density per 1000 population was 1.31. Scientific manuscript journal V: Scientific journals prepared to communicate findings or present new ideas that help improve the health, safety and well being of the population. As a result a peer review journal was prepared on a disease entitled "Meningococcal Meningitis Outbreak in Hawassa City, South Nations, Nationalities and Peoples Region Ethiopia, 2013". Abstracts for scientific Presentation VI: Two abstracts were prepared and submitted for scientific conference. From the two abstracts "Meningococcal Meningitis Outbreak in Hawassa City, South Nations, Nationalities and Peoples Region Ethiopia, 2013" accepted at 5th AFENET conference for Oral presentation and presented. The second Abstract was "Measles Outbreak Investigation--Sodo Town, Southern Ethiopia October/2013 which was submitted to ASTMH. Disaster situation visited VII: I was participated in Meher Assessment from November 25 to December 09/2013 at Gureghe, Hadiya and Silite Zones and 8 selected Woredas. And I also participated in health and nutrition disaster assessment and response in Dasenech Woreda, South Omo Zone. Proposal development for epidemiologic research VIII: In the residency time one Project proposal was prepared with a title "Assessment of Seroprevalence of Measles Specific Antibody (IgG) among children 12-59 month children in Hawassa City, 2014". The purpose of the study was measles is vaccine preventable disease which has routine EPI program .In addition to the routine vaccination there were several SIAs but SNNPR including Hawassa City experienced large epidemic in 2013/14. Measles outbreaks are known to be associated with low coverage of measles immunization (low prevalence of IgG antibody against measles. So this study was designed to assess the prevalence of Measles specific antibody IgG and the vaccination coverage that indicates the immunization coverage which will help to improve the EPI program. Other additional outputs IX: In the residency time additional outputs done were Measles outbreak investigation in Dawro Zone, participating in Health and nutrition disaster in Dasenech Woreda, South Omo Zone; producing weekly epidemiological bulletin for SNNPR PHEM; and providing refreshment training for Zonal and Woreda level PHRM officers on deferent topics.



The Ethiopia Field Epidemiology Training Program (EFETP)