Ethiopia Field Epidemiology Training Program (EFETP) Compiled Body of Work in Field Epidemiology

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Abstract

e Ethiopia Field Epidemiology Training Program is a two years' service program in field epidemiology adapted from United States Center for Disease Control and Prevention (CDC) epidemic intelligence service (EIS) program. The program is designed to assist the ministry of health in building or strengthen health system by recruiting and promising health workers and building their competence through on the job mentorship and training. The program has two main components a class room - teaching component (25%) and practical attachment or field placement component (75%). June 17, 2016, the Gela'lo District Health Office announced to the Afar Regional Health Bureau Public Health Emergency Management (PHEM) department. There were 79 suspected measles cases and 1 deaths occurred in two kebelle (Debel and kodie) of the district. The region deployed a team of investigators on February 26, 2016, to undertake possible investigations and intervention measures. The team provided rapid response and control during the outbreaks. We interviewed 30 cases; a 1.25% case fatality rate from 27th February, 2016 to 15th March 2016. Seventy three of the patients (93.3%) were from Kodie kebele (attack rate of 15.2 per 1000 population) and seven of the patients (8.75%) were from Debel Kebele (attak rate 0.18 per 1000 population). Ethiopia is one of the six countries that contribute to about 50% of the maternal deaths Worldwide. The others being India, Nigeria, Pakistan, Afghanistan and the Democratic Republic of Congo (Lancet, April 2010). We conducted retrospective cross-sectional study of maternal death audit in Tigray region to describe the data in term of time, place, and person and the causes of maternal deaths were described by percent. XIV The number of maternal deaths in three years was 286. In 2013 G.C, 45.5% of deaths were occurred and 72.64% were direct obstetrics. The timing of deaths relation to pregnancy in postpartum was 212(76.89%). Most of the deaths were due to hemorrhage followed by sepsis which were 171(50.94%) and 24(8.49%) respectively. From all maternal deaths, 72(25.09%) were from central zone, 78(27.53%) were from North West zone and 58(20.21%) were from Southern zone, 36(12.53%) were Eastern zone, 31(10.8%) were from western zone, 11(3.83%) were from Mekelle special zone. Thus, the number of deaths were high in north western zone; followed by western zone even though Central zone signify 25.5% of deaths occurred. Because, the population of central zone were much higher compared to them and the deaths were lower in eastern zone compared to all five zones. Because, measuring maternal mortality is difficult and complex, reliable estimates of the dimensions of the problem are not generally available and assessing progress towards the goal of reducing maternal mortality is difficult. In particular, it tells us nothing about the faces behind the numbers, the individual stories of suffering and distress and the real underlying reasons why particular women died. We conducted MDSR Evaluation to evaluate the performance of the existing surveillance system of maternal deaths of the North Western Zone, Tigray region, April, 2016. In 16(80) % of health facilities there were national manuals for MDSR. But in 4(10%) of the health facilities which had not national manual for MDSR which were health posts in rural area. Only the regional health bureau used a computerized system to monitor district completeness and timeliness reporting, but there was no cross checking how many health facilities reported at the ground level. There was shortage of reporting format in the last six months in all visited health facilities and health offices except one health center. In one of the district offices they use their own hand written paper to receive reports. Overall completeness of reporting of the visited sites was 83.3%, completeness of reporting was high in Atsegede Tsimbila district (98.9%) followed by Medebay zana (69%). XV Timeliness of reporting from health post to health center then to district of maternal death is difficult to evaluate because date of receipt was not recorded in all health facilities. Finally, we concluded that supportive supervision on quarterly basis is a good trend in Tigray region but specific surveillance system evaluation and feedback is not practiced at regular basis. Laboratory participation in surveillance is very limited and quality assurance system is not practiced in health facilities by the regional health research laboratory. Data utilization is very low at the lower level of the reporting unit. No refunding mechanism for personal telephone expenditures. Reporting entities are almost governmental health facilities, only limited number of private health sectors have participated in reporting of the diseases under surveillance. We conducted Health profile Description report to assess health and health related issues about health status of the Aysata District, Afar Region, in April, 2015. Different instruments like checklists and structured questionnaire were used as tools for data collection from various governmental organizations such as district health office, health facilities, education sector, finance office, agriculture sector, district water resource office, district electric power authority and district political administration office. The district has two health centers and nine health posts; with ratio of 1: 30,295 health center to population ratio and 1: 6,732 health post to population ratio. Health center coverage was above 100 % and health post 98.8%; with the ratio of 1:39,525, 1:3,040 and 1:3,953 health officer, nurse, HEW to population respectively. No X-ray technicians and environmental health experts were found in the district. From the total district health professional (manpower) females account 38.7%. About 350 community health agents were working XVI in the district on health promotion and disease prevention activities. The overall health worker to population ratio was 1.02. No diagnostic laboratories were available in the district. The overall health worker ratio per 1000 population was 1.02. This result is far less than the standard set by the World Health Organization of 2.3 per 1000 population. Malaria was the top causes of morbidity in 2015, 68.6%, outbreak was occurred in 2015; lack of ITNs coverage and problem of environmental sanitation may contributed to its existence. Females experience higher incidence of HIV/AIDS; 3/10000 population which is 1.8 times higher than males. This may be attributed to the biological vulnerable nature of females and//or more of those were engaged as commercial sex workers. But, there was encouraging screening program which diagnosed significant amount of peoples in its system. The overall 0.54% prevalence of HIV in Aysata district is less than the EDHS 2011 finding (1.5%). Participatory humanitarian needs assessments help to understand the actual emergency situations at the grassroots level. The Government of Ethiopia has been conducting two Disaster Risk Management and Food Security Sector led by multi-agency emergency needs assessments following the Meher/Karma and Belg/Sugum rainy seasons every year in selected hotspot woredas nationwide. Health/nutrition emergency needs assessment was anticipated to identify, analyze and evaluate public health risk factors resulted from the outcomes of 2015 Sugum season in Afar Regional State based on six hotspot woredas, (two woredas from zone four and four woredas from Zone two). It is known to be affected with recurrent drought. Moreover, access to food and nutrition, water supply and sanitation, financial income, and health services is very low. The major health risks in the region are Malaria, Diarrhea, pneumonia & other AURTI2.