Ayele, WondimuBekele, Alemayehu(PhD)Marshalo, Wadu2018-07-252023-11-052018-07-252023-11-052017-06http://etd.aau.edu.et/handle/123456789/9980The 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, 25% a classroom learning and 75% practical attachments or field base components, which contribute the award of the Master degree. During my field base attachment, I conducted on outbreak investigations, surveillance data analysis, surveillance system evaluation, district health profile description, participating in disaster situation analysis, writing a project proposal development, abstracts writing for scientific conference, peer review journal writing, public surveillance training and preparing weekly bulletin for regional PHEM. I produced outputs that are compiled in this Body of Work. Outbreak Investigation I-1: Measles Outbreak in Konta special district, Southern Nation Nationalities and Peoples Region, Ethiopia, from February 22 to March 20, 2016. We identified 1068 cases (AR = 926 cases per 100,000 population) and 115 deaths (CFR=10.77%) with 6 IgM+ measles cases. The case-control study revealed persons who were vaccinated for measles before were 68.63% less likely to develop measles disease as compared to non-vaccinated persons (AOR = 0.31; 95% CI = 0.12, 0.83 with p-value = 0.0203). The odds of being a case of measles were 5.53 times more likely among those who were living with cases of measles than those who did not (AOR=5.53; 95% CI = 2.51, 12.13 with p-value 0.000001). Malnourished children had 3.51 times more likely suspected to develop measles (AOR = 3.51, 95% CI = 1.46, 8.44 with the pvalue of 0.0051) as compared to normal children. Outbreak Investigation I-2: We conducted an epidemic of leg swelling of unknown etiology in Mizan prison, Bench Maji Zone, Southern Nations, Nationalities and Peoples Region, Ethiopia, from October 26 to November 19, 2016. We identified 116 suspect cases with leg swelling of unclear etiology. Eight of the suspect cases were examined senior clinicians and 7 met clinical criteria for scurvy. Three cases had non-detectable levels of vitamin C in their blood. Eleven deaths were identified. The attack rate for the prison was 4.2%, and the case fatality rate was 9.5%. Clinical confirmed cases had symptoms of fatigue, myalgias, arthralgia and signs of follicular hyperkeratosis, petechiae, peripheral edema, and/or oral lesions. All clinical confirmed and 16 suspected cases had severe anemia with hemoglobin <8g/dl. Regular consumption of fruits prior to imprisonment,(OR = 0.40,(95% CI;0.23 - 0.69)), and consumption of fruits or vegetables while in prison were protective of disease (OR = 0.122; 95% CI = 0.024-0.628). Prior consumption of alcohol (OR = 2.86,(95%CI: 1.21 – 6.78); use of tobacco (OR = 2.47,(95%CI: 1.33 - 4.61)); and history of a chronic illness (AOR: 4.42,(95%CI: 2.02 – 9.66)) were risk factors for developing leg swelling. Surveillance Data Analysis Report II: Five years (2012 - 2016) Measles surveillance data of SNNPR was analyzed. From 2012 to 2016, the region reported 13,178 (AR=15/100,000 population) both lab confirmed and epidemiological linked Measles cases with 157 deaths (CFR=1.19%). Of them, 3,370 (25.6%) cases reported through case-based reporting and others reported via line list. About 7,841 (59.5%) with AR=267/100,000 under 5 children and 12,389 (94%) with AR=138 per 100,000 under 15 population and above 15 years contributed only 789 (AR=11 per 100,000) measles cases. About 6780 (51.3%) and 6418 (48.7%) of the total cases were males and females respectively. In 2014, about 3046 (88.7%) of the total cases was under five children. Age specific incidence was highest for under five years in 2014, about 137 per 100,000 population. About 5323 (40%) out of total cases were not vaccinated for measles and 2957 (22%) cases had not valid measles vaccination history provided that routine measles vaccination coverage reached 98.2%. In 2015/16, totally 18 confirmed measles outbreaks occurred in six Zones and one special Woreda in the region. One hundred thirty four kebeles affected by these confirmed measles outbreak. 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. Therefore, we conducted evaluation of Wolaita zone maternal death (MDSR), Measles and AFP surveillance system from January 24 to February 16, 2017. In 2016, the surveillance system reported 42 maternal deaths, 17-suspected measles and 25 non-polio AFP cases. In 2015/16, there was 24 (0.68%) maternal deaths in Wolaita Soddo University Teaching and Referral Hospital out of 3511 total deliveries and in 2016/17 up to 2nd quarter, there were 12 (0.62%) maternal deaths out of 1938 deliveries. All evaluated units (N=13) have no habit of data analysis. Compeleteness of recorded data for maternal death, measles and AFP was 83%, 71% and 56% respectively. timeliness of weekly report was 100% at zonal level while it cannot be determine for health facility level. Maternal death surveillance and response system could not capture both community and health facility deaths. 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. Therefore, a study was conducted to provide health profile description of Kindo Didaye district of Wolaita zone that will help for health planning. The total population of the district in 2016 is estimated as 122,062 based on a projection of 2007 census with 60726 (49.75%) males and 61336 (50.25%) females. The dependency ratio of the district is estimated about 79%. The employment ratio of the district is estimated as 1.44:1. About 23 (82%) health facilities and 18 (85.7%) kebeles have access to roads of local type. There were a landslide, ice and fire disasters in the district in the past two years ago. The recent landslide disaster affected nine kebeles with 37 deaths, 344 households displaced and more than 275 million birrs estimated property lost. The district has 1 primary hospital, 3 health centers, 24 health posts and 4 private clinics. Malaria and pneumonia were the first top adult and pediatric morbidity and mortality cases respectively. The district has 82% health service coverage, 100% primary school coverage, 100% latrine coverage and 69.64% safe drinking water coverage in 2015. The district sustained 100% coverage for most Expanded Program of Immunization activities. Contraceptive acceptance rate and skill birth attendant was 66.12% and 44.3% respectively in 2014/15. Scientific Manuscript for Peer Reviewed Journal V: Reports of new research/study findings are important to fuel innovative assumptions through scientific communication. Scientific journals are an exact means for this communication. Therefore, we prepared a scientific manuscript for peer review journal on a disease entitled "An epidemic of leg swelling of unknown etiology in Mizan prison, Bench Maji Zone, Southern Ethiopia, 2016.” Abstracts for Scientific Presentation VI: During residency period, two abstracts were prepared for scientific presentation. Of them, “An epidemic of vitamin C deficiency in Mizan prison, Southern Nations, Nationalities and Peoples’ region, Ethiopia, 2016” was submitted to TEPHINET for oral presentation via Ministry of Health, Ethiopia. Narrative Summary of Disaster Situation Visited VII: I was participated two disaster situation visits: Belg Humanitarian, Health and Nutrition Assessment and Rapid Need Assessment following landslide disaster. Rapid Belg assessment was conducted in six woredas of Wolaita and Dawuro zones from June 6 – 23, 2016; four woredas from Wolaita and two woredas from Dawuro. I also conducted Rapid Need Assessment (RNA) and Emergency Prepared and Response Plan (EPRP) following 9th May 2016 Landslide in Kindo Didaye district, SNNPR. Ethiopia. This Landslide affected nine kebeles’ highland areas with impact of 37 deaths, 461 households’ and 2882 populations’ displacement, and above 275 million birr estimated property lost. Protocol/Proposal for Epidemiologic Research Project VIII: During residency, I prepared protocol for epidemiologic research project on title “Describing Maternal Death and Exploring Factors Affecting Implementation of Maternal Death Surveillance and Response in Wolaita zone, Ethiopia - 2017.” The purpose of the study is most maternal deaths occurred due to direct obstetric causes, and these can be prevented by providing effective information for action. Ethiopia launched MDSR system, which provides information for action on preventable maternal death, through PHEM structure, but above 80% of maternal death was not reported via this structure in the zone. Therefore, this study was designed to describe maternal death, assess data quality and to explore factors affecting for implementation of MDSR at public health facility level. Other additional outputs IX: There were four additional outputs were done during the period of residency: Investigation of Acute Febrile Illness Outbreak in South Omo zone, SNNPR, Ethiopia, from May 14 – 27, 2016, public health surveillance training on topics of PHEM overview, epidemiology, pathogenesis, clinical features and outbreak management of AWD/cholrea and scabies outbreak response, Rapid Need Assesssment and Response Plan following May 2016 Landslide in Kindo Didaye district and PHEM Weekly Bulletin for epidemiological weeks 40 and 46, 2016 and week 10, 2017enThe Ethiopia Field Epidemiology Training Program (EFETP)Thesis