Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP)

Kombolcha, Dereje Mamo (2015) Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP). Masters thesis, Addis Ababa University.

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Abstract

Field Epidemiology and Laboratory Training Program (FELTP) 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 Ethiopian Field Epidemiology and laboratory training program (EFELTP) started in 2009 G.C. The EFETP grants a Master of Public Health degree (MPH) in Field Epidemiology after residents complete two years of supervised work in applied epidemiology or field epidemiology. The EFETP has two main components, each of which contributes for the award of the Master’s degree (a class-room teaching component, 25% of the whole course, and practical attachment or field placement component 75%. I am one of the Cohort five EFELTP residents from Southern Nations Nationalities and Peoples Region (SNNPR) field base. During the field placement component, I was engaged on outbreak investigation, surveillance data analysis, surveillance system evaluation, district health profile development, Participated in disaster situation analysis, project proposal development, abstract writing for scientific conference, Peer review journal writing, oral presentation in scientific conference, giving refreshment training for Zone and Woreda level PHEM officers, and I produced outputs that compiled in this Body of Work. Outbreak investigation: Measles outbreak was occurred in Gedeb Woreda, Gedeo Zone from December 2013 to January 2014. In this out break we identified 108 cases and 0 deaths. The highest age specific attack rate was observed among children under five years of age (ASAR 185/100,000). We selected 41 cases and 82 controls for risk identification and identified that being vaccinated is showed significant negative association with contracting measles disease (OR = 0.04; 95% CI, 0.016-0.114). Outbreak of unknown disease was reported from Konso woreda, Segen Zone, SNNPR on February 27, 2015. A total of 77 cases and 6 deaths (CFR: 7.8%) from 24 different kebeles with sign and symptoms of acute diseases were registered. Six possible causes of disease were hypothesized; Botulism, Diphtheria, Anthrax, brucellosis, Meningitis and poisoning, and outbreak investigation was conducted taking all hypothesized diseases in consideration. The most affected age group was 15-59 years (ASAR: 47/100,000) followed by 5-14 years (ASAR: 33/100,000). On risk identification, 96% of the cases have consistent clinical and epidemiological suggestive evidences to Diphtheria. However, the laboratory investigation does not supported this all the interventions implemented against Diphtheria were found effective in controlling the outbreak. Surveillance Data Analysis Report: Five years (2009-2013) SNNPR Measles surveillance data was analyzed. During this period a total of 54,221 measles cases were detected by surveillance system. Both male and female sex was equally affected (50.8%, 49.3%). The most affected age group is under 5 years (ASAR: 10.1/1000) and 5-14years (5.0/1000) followed by above 15 years (0.8/1000). Among all cases 48.8% were never vaccinated while 32.2% were vaccinated with one dose and 6.8% were vaccinated with two doses. The proportion of birth cohort to susceptible population during 2004, 2008 and 2013 was 1:1.03, 1:0.74 and 1:1.67 respectively. Evaluation of surveillance system; we evaluated malaria surveillance system attributes and core functions of surveillance system in Gambella Region. In consecutive five years malaria cases was the leading cause of morbidity but we identified gaps in malaria surveillance system coordination between government and private health system, documentation, data analysis and use for intervention. Zonal health departments are not active on surveillance and other PHEM activities. Only woreda and regional health bureau is communicating actively by passing zonal department. Data was not analyzed and there was no proper documentation, no feedback for respective units, no monitoring system for malaria, and there is weak utilization of surveillance data for malaria prevention and control. Health profile description report; 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 Wonago Woreda, Gedeo Zone, SNNPR. Wonago Woreda is one of the six Woredas in Gedeo Zone with total population of 179,239. There are 6HCs and 20 HPs in the woreda in 20 administrative kebeles. Among the top ten causes of morbidity, malaria is a leading cause of morbidity in outpatient department. Measles and penta 3 vaccination coverage of the woreda by the year 2013 was 94.2% and 87.6 % respectively. Scientific manuscript journal: Scientific journals are prepared in order to communicate research findings and new ideas that help improve the health, safety and well-being of the community. So that, we prepared a peer review journal on a disease entitled "Measles surveillance data analysis of Southern Nations, Nationalities and Peoples Region Ethiopia, 2009-2013". Abstracts for scientific Presentation: Two abstracts were prepared on the title “Measles surveillance data analysis of SNNPR, Ethiopia, 2009-2013” and “Outbreak of Unknown disease in Segen Zone, SNNPR, Ethiopia, 2015”. Disaster situation visited: I was participated in “Belg” assessment of health and nutrition needs during the first two weeks of July 2014 at Gedeo and Sidama Zones. In both zones; measles, malaria and malnutrition were among the identified potential risks of morbidity in subsequent months of the assessment. Proposal Development for Epidemiologic Research: one project proposal was prepared with a title "Assessment of malaria surveillance and control interventions in Gambella Regional state, Ethiopia, 2015”. The objective of the study was to assess malaria control interventions and magnitude of malaria in Gambella Regional State. Gambella regional state is one of the regional states in the country and known with its high burden of malaria, all the year. During the last several years’ malaria remain the leading cause of morbidity in all age groups and one of the leading causes of mortality in children under 5 years of age in the region. Low land altitude ranging from 300meter to 2,000meter above sea level, weak surveillance system, low LLITNs coverage (23.9%) (5), large number of immigrants from South Sudan who probably has no/weak immunity, rivers and irrigation of large farms found in the region and movement of the people from high land areas of the country to the region largely contributes for malaria. In this case, epidemiological assessment of malaria surveillance and control interventions at community level in this region is necessary to measure the status of malaria surveillance, prevention and control efforts, and to identify the gaps and intervene accordingly.

Item Type:	Thesis (Masters)
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RA Public aspects of medicine > RA1001 Forensic Medicine. Medical jurisprudence. Legal medicine
Divisions:	Africana
Depositing User:	Vincent Mpoza
Date Deposited:	10 Jul 2018 13:22
Last Modified:	10 Jul 2018 13:22
URI:	http://thesisbank.jhia.ac.ke/id/eprint/6916

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