Volume 9 Number 2 August 1995
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The role of Ethiopian Public Health AssociationAlthough it is difficult to obtain accurate information about epidemic prone diseases, available .reports have indicated that these diseases are causing high morbidity and mortality . EPHA, recognizing the devastating effect of these diseases in the population, has immense responsibility in assisting the national health system to modifying the effects of these diseases. During the activity of the working group, we have identified problem areas which need to be addressed by EPHA if sustainable effort is to be made in the prevention and control of epidemic prone diseases. We have come to recognize that one of the biggest problems in our public health system is the lack of surveillance mechanism that should help public health professionals to monitor epidemic prone diseases. In our opinion the lack of an efficient surveillance system has left policy makers in health with no basis for developing and implementing policies for controlling the spread of epidemic prone diseases. It is known that a well designed and well implemented surveillance program can provide the means to detect epidemics early, document their geographical and demographic spread, estimate the magnitude of the outbreak and initiate timely action. We have enumerated a list of identified problems at local, zonal and regional levels that affect the management, prevention and control of epidemic prone diseases. 1. Lack of simple reporting systems at the levels of the region, zone, district and community. 2. Under-reporting of epidemic prone diseases by health institutions. Notifiable diseases are not listed and reported on a regular basis. 3. Delay in reporting, as a result of which effective and timely action cannot be carried out. 4. Poor collection and documentation of data on the type and number of outbreaks, number of people affected, number of deaths and so on. 5. Lack of knowledge of health personnel in regard to reporting requirements. This includes unawareness of responsibility to report, unawareness of which diseases to report, how, when and to whom to report. 6. There is no epidemic intelligence unit at regional, zonal and local levels. Thus, supervision and coordination of activities is missing. 7. An efficient surveillance system does not exist at all levels including at the level of the community . 8. There is a gap between information received and action. Surveillance data are not linked with public health programmes. 9. A vailable data on epidemic diseases if they exist, are not disseminated to health institutions and other public agencies. 10. There is lack of training of health professionals at different levels of the health system in epidemic disease recognition and management. 11. Lack of inadequate public health laboratory facilities to support disease recognition and management. l2.. Absence of a guideline that could assist health professionals in epidemic investigation and control or unawareness of health professionals about the existence of such a guideline. EPHA recognizing these and other problems which affect the recognition, prevention and control of epidemic prone diseases can assist the national, regional and local health system in the following areas: 1. In the development of a national policy for the management of epidemic prone diseases. 2. In strengthening the health information system at the community, local, zonal, regional and national levels, including in the identification of key information to be collected. 3. In the development of mechanisms for monitoring epidemic prone diseases. This includes the establishment of a system of identifying epidemic risk and possible risk factors by considering the epidemiological history and ecological and social characteristics of the specific areas. 4. In assisting in the development of essential indicators for predicting potential epidemic prone diseases. 5. In formulating national policies and in the establishment of coordinating mechanism to ensure that development activities do not create or enhance epidemics. 6. In the training of health professionals in epidemic investigation, control and prevention- a prerequisite for achieving sustainable disease control. 7. In the development of a simple operating surveillance system at every level of the national health system. This should allow information received to be used for prompt public health action. 8. Assist in the establishment of public health laboratories at regional levels to support disease surveillance. 9. In the formulation of laws and regulation in the reporting, investigation and control of epidemic prone diseases. 10. In carrying out relevant epidemiological studies and operational health system to support the recognition, management and control of epidemic prone diseases. Thus, EPHA has an active role to play in creating awareness among policy makers, health professionals and the media that due attention be given to the control of epidemic prone diseases. We hope this working document will provide the basis for further discussion. AcknowledgmentsWe are very grateful to Dr. Befekadu Tefaredegne, of the Epidemiology department Dr. Workeneh Feleke, Head of the AIDS Control Team, Members of Statistics and Health Research Team, in the Ministry of Health, Dr. Elias Senbeto, Family Healtl Coordinator of Region 3 Health Bureau and concerned officials of North Gondar Zona: Health Department for their valuable Support in supplying the necessary materials. References1. Joshua L, Robert E, Stanley C. Emerging infections, Committee on Emerging Microbia: Threats Health, Division of Internationa: Health, National Academy Press, Washington C.C., 1992 2. WHO, GPA raises infection estimates. Global AIDS Action, 1993;3-16 3. WHO. Malaria control strategy .WHO Technical Report Series No 837,1993;1-10 4. WHO Guidelines for the control of epidemics due to Shigella dysenteriae. WHO/CDD/SER/1988;12 5. KIoos H, Zein A. The Ecology of Health and Disease in Ethiopia., Westview Press, 1992;507-511,191-203,213-223,285-295,319- 353,389-407 6. Belay B, Fekadu B, John M, Lulu A, Nebreed F and Dereje K. Description of meningitis epidemic in Haikoch and Butajira District, The Ethiop. J. Hlth. Dev.1991;8:7-16 7. Hunter's Tropical Stickland, Gnt. ed. W .B. , Saunders Co. Philadelphia, 1984;211-213. 8. Ministry of Health Guidelines on surveillance and epidemic control (in Amharic) Department of Epidemiology .Addis Ababa. August, 1993. 9. Fontaine RE, Najar And E, Prince JS. The 1958 malaria epidemic in Ethiopia. AM J Trop Med and Hyg 1961;10:795-803. 10. Cruickshnk R, Standard KL, Russel HBL. Medicine in the Tropics: Epidemiology and community Health in warm climate countries. Churchill Livingston, Edinburgh, 1976. 11. Ahmed Zein Z and KIoos H. The Ecology of Health and Disease in Ethiopia. Ministry of Health. Addis Ababa, 1988. 12. Ministry of Health. National Guidelines for the prevention and control of cerebrospinal Meningitis outbreaks in Ethiopia, MOH, WHO, Pan African EPR centre, 1991. 13. Ministry of Health. Comprehensive Health Service Directory ( selective information 1981 EC (1988/89 GC.). Addis Ababa, 1991. 14. Ministry of Health. Control of Diarrhoeal Diseases. 1989. (unpublished data) 15. LindtJorn B. Severe Measles in the Gardulla area of southwest Ethiopia. I Trop Pediatr 1986;32:234-9. 16. Alemu W, Woldeab M, Palme B. Missed opportunities for immunization in Ethiopia. Ethiop I Health Dev 1989;3: 115-24. 17. AlemuW, WoldeabM, Meche H. Factors influencing non-attendance in the immunization of children in three selected regions in Ethiopia, July 1988. Eth Med I 1991 ;29:49- 55. 18. Tsega E, Krawczynski K, Hansen BJ, et al. Outbreak of acute hepatitis E virus infection among military personnel in Northern Ethiopia. I Med ViroI1991;34:232-6. 19. Gebresellassi L et al. Serological studies of Louse-borne and flea borne Typhus in Addis Ababa. Eth Med J 1990;28:77-90 20. Knodakovich L, Zewdie D. AIDS. In: Kloos H and Ahmed z. (eds), the Ecology of Health and Disease in Ethiopia. Westview Press, 1993:319-37. 21. Tsega E et al. Serological survey of human immunodeficiency virus infection in Ethiopia. Ethiop. Med. I. 1988;26:179-184. 22. AIDS Update: AIDS Cases Surveillance in Ethiopia. Epidemiology and AIDS Control Department, MOH. July 31, 1994. 23. Mehret M et al. Prevalence of HIV infection among various socio-economic groups of females practising MPSC in Addis Ababa. Ethiop J Health Dev 1990;4(2):171-6. 24. Larson CP et al. Risk behaviours for HIV infection: their occurrences and determinant. in Jimma Town, North-western Ethiopia. Eth Med J 1991;29:127-36. 25. Kefenie H et al. Prevalence of HIV-1 antibodies in patients with sexually transmitted diseases. Eth Med ] 1991;29:63-9. fc 26. Kebede Yet al. HIV-1 infection in an 3 Ethiopian prison. Am ] Publ Health 1991; 1 81:625-7. 27. Gebre S. Sexual behaviours and knowledge of AIDS & other STD's: a survey senior high school students. Eth ] Health Dev 1990;4(2): 123-32. 28. Tesfu L et al. Knowledge, attitude and behaviour on HIV / AIDS among pupils of rural high school in Gorgora, Gondar , Ethiopia. 1991/92 Final Year Medical Students' Research Works-Abstracts. Department of Community Health (DCH), Gondar College of Medical Sciences (GCMS), May 1993, Gondar. 29. Shabbir I and Larson CP. Urban to rural routes of HIV infection spread in Ethiopia. ] . Trop. Med. Hyg. (under review for publication) 30. Shabbir I et al. Knowledge, attitude and practice on high risk factors for HIV / AIDS in a rural community of North Western Ethiopia. Eth Med ] (under review for publication) 31. Imran A et al. Male reaction to high risk heterosexual contacts appeal to use condoms. 1991/92 Final Year Medical Students Research Works -Abstracts. DCH, GCMS, May 1993, pp 13-14. 32. Kidane G, Berekt A. Condom use among students of Gondar College of Medical Sciences.(sent to the Ethiop ] -Health Dev for publication) . 33. Fantahun M, Chala F. KAP on HIV / AIDS among out of school youth and female commercial sex workers in Bahir Dar .1994 (unpublished report). 34. Eshete H. Knowledge and feeling of some people about condom use in relation to HIV/AIDS in Addis Ababa. (A brief report). Ethiop] Health Dev 1991;5(2):81-2. 35. DAC/MPH. Priority areas in the prevention and control of HIV /STD . Guidelines to the Regional Health Bureaux, May 1993, Addis Ababa, Ethiopia. 36. DAC/MOH. The National AIDS Control Program of Ethiopia. Second Medium Term Plan, 1992-1996,. and work plan and budget for 1992-96. 37. Annual Report of Region 3 Health Bureau 1993/94. Bahir Oar, 1994. Notice board Training OpportunitiesLocal The Department of Community Health in the Faculty of Medicine of Addis Ababa University wants 1nterested individuals to be aware of the Master of Public Health Degree Program which will welcome a new class of students in September 1995. The program includes basic postgraduate courses in Management, Epidemiology, Biostatistics, Maternal and Child Health, Health Education, Environmental Health and Nutrition. Another vital part of the curriculum is the Community Health Residency in a Woreda Health Department or its equivalent. The candidate's individual interests and career plans can be pursued in an area of concentration and thesis research. The applied research project is carried out during the second year, usually in the location of the Community Health Residency. The program continues for 22 months from September 1995 until July 1997. Application forms are available at the Registrar's Office in the Sidist Kilo Campus of the University. All documents must be submitted to the Registrar's Office between March and May 1995. Equally important is obtain ing letters of support from institutions which plan to utilize the new knowledge and skills acquired by the trainee. Most candidates are sponsored by the Ministry of Health. The Department encourages other institutions to do likewise. Prospective candidates must have at least a baccalaureate degree, previous training in health or related professions, and at least two years' experience in health or related services. Other academic requirements are as specified in , the application form of the School of Graduate Studies of the University. If you have inquiries, please forward them to Dr.Derege Kebede, Head, Dept. of Community Health, Faculty of Medicine, P .O.Box 1176, Addis Ababa. Fax: 251-1-51-77-01 International International Research Fellowship Award -The applicants must be in the first ten years of their career. -They must have experience in research and must have publications. -They must identify a sponsor in the U.S. in their field of research. The fellowship is granted for two years and covers round trip travel, a stipend and an institutional allowance for the awardee's research expense.
Managing Successful Training Programs, Dakar, Senegal 23 October-17 November, 1995 For more Information Contact: Management Training, Management Sciences for Health, 165 Allandale Road, Boston, Massachusetts 02130- 3400, USA. |