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

Abstract

Executive summary From November 2015- February 2018, I went to Saint Paul’s Hospital Millennium Medical College to have Master of Public Health in field Epidemiology degree. My field base was in Bole Sub City Health office in Addis Ababa. During my stay, I did one outbreak investigation, one surveillance data analysis, one surveillance system evaluation, one Wereda health profile description, submission of three abstracts, coordinated one vaccination campaign and one research. We investigated Acute Watery Diarrhea outbreak in Bole sub city. I did four years surveillance data analysis on hypertension in Bole sub city. I evaluated Bole sub city health office’s surveillance system. I described the health profile of one of the Weredas of Bole sub city. I submitted three abstracts for different conferences. I coordinated measles vaccination campaign and prepared a report. I did my thesis on Meta analysis of prevalence and risk factors of hypertension in East Africa. We did Acute Watery Diarrhea outbreak investigation in Bole sub city. We conducted descriptive cross-sectional study and unmatched case-control study with 55cases and 110controls in Bole sub-city. We identified cases from Amoraw Cholera Treatment Center and controls from the community. Male patients accounted 65% of 717patients. The most affected age group was 25-44 accounting 73.8% of 717 patients. The sub-city’s attack rate was 198/100,000 populations. The response rate for the case control study was 97%. Factors associated with AWD were eating raw meat with Adjusted Odds Ratio (AOR) of 39.6 (95% Confidence Interval [CI], 6.31-248.18); eating cold leftover food with AOR of 9.17(95% CI, 1.58-53.31); boiling drinking water 0.03 (95% CI, 0.001-0.39); and treatment of water with water guard 0.07 (95%CI, 0.01-0.82). The AWD outbreak has caused many people illness and missing days out of work. The risk factors of the cholera outbreak were eating raw meat and cold leftover food and the preventive factors were using boiled water and water guards for drinking water. We recommend educating the community on raw meat and cold leftover food consumption during the outbreak periods and utilization of water treatments like water guards and boiling would help in prevention and control of cholera outbreaks. I conducted measles surveillance system evaluation in Bole sub-city from 2013-2016. A descriptive cross sectional study design was used. Two-hundred-forty-seven patients of measles were reported in Bole sub-city from 2013- 2016. Epidemic preparedness plan and supervision was carried out in some Weredas and the sub-city. No written feedback and budget specifically allocated to carryout surveillance activities from sub-city to health facility levels. The completeness of the Bole sub-city surveillance report the last 12months was 89.5% while the timeliness was 72.2%. To improve the feedback mechanism, budget allocation, the timeliness surveillance activities and presence of epidemic preparedness plan and meet the standards of CDC guideline, stakeholders at all level must work together. I did health profile of Bole sub city Wereda 9 administration from April 25-May 9, 2016. One Hospital, 1 Health Center and 9 clinics were available in the Wereda. To estimate the health coverage of the Wereda, data from Wereda 9 Goro Health Center was used from 2005-2007E.C. Except BCG vaccine all the vaccination coverage were above 100%. Acute Upper Respiratory Tract Infection was the leading cause of morbidity among all age groups & both sexes. Measles outbreak occurred in 2006E.C and there were 52 cases and 2 deaths. Twelve tracer drugs were available within three years but 10 were absent one time or another. Most of the health coverage indicators of Wereda 9 Goro Health Center were above 100% which shows underestimation of the catchment population. Data on safe drinking water and toilet services of the Wereda were not available. Data handling and quality control mechanisms should be improved in the Wereda and in the Health Center. I prepared three abstracts for scientific conference submission. The abstracts were; Four years hypertension trend analysis in Bole sub city, 2013-2015, Measles surveillance system evaluation of Bole sub city administration, 2013-2017 and Factors associated with acute watery diarrhea outbreak in 2016 at Bole sub city, Addis Ababa, Ethiopia. I investigated two building collapses in Bole sub city Wereda 10 that collapsed on April 27, 2016 and Feb 14, 2017. The probable causes of the collapses were use of sub standard materials and design modification. The problems could have been detected if there was a continuous follow up from the regulatory body. The total estimated loss due to the collapse was 8 million Birr. No one was injured or died. To prevent future similar incidences, the land authorities at different level should have strict follow up of buildings under construction. I coordinated measles Supplemental Immunization Activity from March 3-12, 2017. The target population of the campaign were children aged 9-179 months in Bole sub city in 2017. Children from 9- 15 years of resided in Bole sub city vaccinated for measles during the measles campaign were 115,522. The post campaign Rapid Convenient Survey showed an overall sub city coverage of 95.3%. I conducted a study on meta analysis of the prevalence and risk factors of hypertension in studies conducted in East Africa, 2011-2016. Data was extracted from quantitative facility or community based cross-sectional studies. PubMed, Medline, HINARI and Google scholar search engines were used. Non published literatures were included in the study to minimize publication bias. Data was extracted using Microsoft excel and analyzed using medcal and Review Manager 5.3. A total of 2,567 studies from PubMed, Medline, HINARI, Google Scholar search engines and from other records were searched and screened. We included 14 studies in this study. The pooled prevalence of hypertension in East Africa using DerSimonian Laird random effect was 25.37 % (17.67-33.76%). The prevalence among women was 26.7% (95%CI, 17.63-36.89%) and men was 24.87% (95%CI, 17.87-32.61%). The identified risk factors of hypertension with statistically significant pooled Odds Ratio were being obese/overweight 3.39 (95%CI, 2.17-5.29), excess alcohol consumption 1.27 (95%CI, 1.01-1.61), having family history of hypertension 1.94 (95%CI, 1.41-2.64), high waist circumference 2.99 (95%CI, 2.34-3.84) and having physical activity 0.62 (95%CI, 0.44-0.88).